Charles Gaba's blog

Week 3 via CMS:

Week 3, Nov 11-17, 2018

In week three of the 2019 Open Enrollment, 748,244 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

Last spring, both New Jersey and Maryland were among the states which were the most pro-active about passing lesiglation to cancel out Donald Trump's attempts to deliberately sabotage the Affordable Care Act. Both states passed laws cracking down on non-ACA compliant short-term and association health plans (NJ actually already didn't allow short-term plans before the ACA anyway), both states established robust reinsurance programs, and both states tried to pass bills reinstating the ACA's Individual Mandate Penalty which Congressional Republicans repealed last winter in different ways.

New Jersey was successful: They kept their mandate penalty restoration bill pretty much identical to the version repealed at the federal level and plan on using the revenue from it to help pay for the reinsurance program. The combined impact of all of their anti-sabotage efforts led to roughly a $1,500 annual premium savings for every unsubsidized individual market enrollee in the state.

(sigh) Just nine hours ago I posted the following about Kentucky's Medicaid expansion work requirement waiver:

A waiver was approved for Kentucky last spring, but has been (temporarily?) invalidated by court order.

I guess it's a good thing I included the "temporarily" caveat, because just moments ago...

.@CMSGov just re-approved Kentucky’s #Medicaid waiver. https://t.co/2Q16AKQoLS

— Dustin Pugel (@Dpugel) November 21, 2018

Sure enough, here it is:

With all the attention being paid to the midterm elections causing ACA Medicaid expansion to be passed in Utah, Nebraska and Idaho (while also now being at risk in Alaska and Montana), I've kind of lost track of the situation in Virginia, where it was expanded last May to over 400,000 Virginians.

Thankfully, Esther F. linked me to this article from the Virginia Mercury, which brings me up to speed on the actual implementation of the VA expansion program:

Less than two weeks after Virginia opened registration for its expanded Medicaid program, officials say they’ve already drawn thousands more applicants than initially anticipated.

The state had expected the new program to enroll 300,000 over the next year and a half. They now expect that number to reach 375,000. The new estimates won’t alter the total expansion population, which the state has said will be about 400,000.

Over at the Washington Post, Catherine Rampell has an article which confirms EVERYTHING that I and other healthcare wonks have been warning about for months (or years) regarding the real-world impact of imposing work requirements for Medicaid expansion recipients:

...For many low-income families, the Arkansas experiment has already proved disastrous. More than 12,000 have been purged from the state Medicaid rolls since September — and not necessarily because they’re actually failing to work 80 hours a month, as the state requires.

...McGonigal, like most non-disabled, nonelderly Medicaid recipients, had a job. Full time, too, at a chicken plant.

...More important, McGonigal’s prescription medication — funded by the state’s Medicaid expansion, since his job didn’t come with health insurance — kept his symptoms in check.

OK, this is a bit embarrassing. I've made a point of calling attention to the widely varying Open Enrollment deadlines from state to state, and I also made sure to write up a blog post regarding Covered California, which started their 2019 Open Enrollment period a full two weeks earlier than everyone else, on November 15th.

However, I completely forgot that New York State of Health does things sort of the opposite way: While new enrollees could start signing up for 2019 coverage as early as November 1st, existing enrollees had to wait two weeks into Open Enrollment to actively renew or change their policies:

Press Release: NY State of Health Annual Renewal Begins Today!
Nov 16, 2018

2018 Qualified Health Plan Enrollees Can Renew Their Coverage for 2019 Now

We're over 1/3 of the way through the 2019 Open Enrollment Period in most states, so I figured this would be a good time to check in and see where things stand.

For the most part things are pretty close to where I estimated they'd be--HealthCare.Gov is running about 13% behind last year as of the same point, but Colorado is running 13% ahead; Minnesota and Washington State are both around 5-6% ahead; and Connecticut is running dead even. I still don't have any data from California, which holds around 13% of all ACA enrollees nationally, nor do I have data from any of the other 7 state-based exchanges (DC, ID, MD, MA, NY, RI or VT).

Connect for Health Colorado® Reports Increase in 2019 Medical Plan Selections

DENVER — More than 25,000 Coloradans selected health coverage through Connect for Health Colorado® between Nov. 1 and Nov. 15, a number 13 percent ahead of the pace one year ago, according to new data released today.

“This number of initial sign-ups is the strongest start to an Open Enrollment Period we have seen,” said Connect for Health Colorado® CEO Kevin Patterson. “By acting early, these Coloradans will ensure their health coverage is in place Jan. 1, 2019, protecting their health and their family finances.”

The two-week period saw 25,614 medical plan selections. The total was 22,650 medical plan selections for the comparable period in 2017. Twelve percent of the plan selections are by customers who are new to Connect for Health Colorado and 88 percent are renewing customers.

The midterms are over, and the Democrats won back the U.S. House, so the ACA is (mostly) safe at last, right?

Well...maybe. In addition to the ongoing regulatory sabotage by the Trump Administration to undermine, weaken and generally piss all over the law as much as possible, there's also still a little thing called Texas vs. Azar, aka the #TexasFoldEm federal lawsuit. Oral arguments were held way back in early September, and right-wing Judge O'Connor claimed that he'd rule on a preliminary injunction "quickly" afterwards.

Well, today is November 18th, and there's been nary a peep from Judge O'Connor. Does 75 days later count as "quickly"? In judiciary time, I suppose it might.

via Christine Stewart of CT News Junkie (11/15/18):

Access Health Enrollment Off To Steady Start

HARTFORD, CT — The number of customers purchasing plans through Connecticut’s insurance exchange is around what it was last year in the first two weeks of open enrollment.

Since Nov. 1, 12,777 customers have shopped and purchased a plan for 2019, according to Access Health CT officials. That means about 85,000 enrollees have yet to renew into a 2019 policy.

...Traffic on the website is trending about 18 percent higher than it was at this time last year, according to Access Health CT’s Director of Technical Operations and Analytics Robert Blundo.

...An estimated 60 percent of customers are picking plans that are different from their plan in 2018 and that’s compared to only 18 percent who were changing their plans last year. It also means there are a higher percentage of customers using brokers to help them make a decision about the health plan that’s right for them.

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