Don't worry, I'm not gonna rehash the whole thing, but some of you may recall that way back in January (a lifetime ago, this morning), I caused a bit of a brouhaha (or a "bro-ha-ha") when I noted that Bernie Sanders' Single Payer Healthcare Plan (aka "Medicare for All"), while sounding awesome in theory, was not only absurdly lacking in detail even for a general campaign outline, but that there were simply too many logistical problems for it to go into effect within such a short timeframe (which I assumed would be perhaps the same 5-year timeline as the ACA, since Sen. Sanders didn't specify any sort of timeline himself).
The response from Bernie's supporters was, to put it mildly, negative.
While I knew that a national single payer system was a non-starter, I thought that perhaps it might be feasible to get one through at the state level (assuming the funding mechanism could be adequately resolved, which was the Achilles' heel of Vermont's failed attempt a few years earlier).
Margot Sanger-Katz of the New York Times and Sarah Kliff of Vox.com each take a crack at what the Republican Party and their leader and official face for the next generation, Donald Trump, repealing the Affordable Care Act would actually look like in practice.
The kind of partial repeal possible through the reconciliation process could lead to greater instability than total repeal. That means that it could lead to more people losing health insurance than the estimated 20 million who have gained it under the law. The health law was designed with a number of interdependent provisions devised to keep insurance affordable. By removing only some of them, a partial repeal could disrupt insurance arrangements not just for people newly insured under the law, but also for those who had purchased their own insurance before the law.
UPDATE: This comment (from a cross-post over at dKos) is exactly what I'm talking about:
Yeah, I don’t know what to do. I filled out the first part of the application last week. I guess I’ll finish the process. But what’s the point if it’s going to be repealed “Day One”?
I made a commitment to keep this site up and running through next spring, and I intend on keeping this commitment. Beyond that, I have no idea what my plans for the site are.
After yesterday's atrocity, however...I'm honestly dreading the thought of what most of my charts, graphs, spreadsheets and blog entries are going to look like.
You see those impressive-looking odometer-style numbers at the top of the home page? Yeah, forget about those. They're meaningless now.
A lot of people will still sign up, but I'm guessing many who were planning on doing so once they were certain the ACA would still be around next year are now going to take a pass. And that's simply the beginning.
Beyond that...it's 4:30am. I'm exhausted, my stomach hurts and my hands are shaking.
It's important to keep in mind that applications submitted are not the same as healthcare policies selected. A submitted application simply means you've created an account and filled out all of your personal data, household data, financial data and so forth; actually shopping around and selecting a plan is the next major step.
Having said that, how does this year compare with last? Well, as I noted the other day, the 150,000 applications submitted on Nov. 1st this year was higher than last year (HHS didn't provide a Day One total but did list it as 250K for the first two days).
I don't write about Idaho much, which is a bit surprising when you think about it because it's kind of a unique state when it comes to the ACA exchanges. Most states never set up their own exchange platform. A dozen or so set them up and are still using them. Two states (Massachusetts and Maryland) scrapped their original, failed platforms and completely overhauled them. Three states started out with their own platform but gave up when they failed, moving home to the mothership (HealthCare.Gov). One state, New Mexico, was supposed to move off of HC.gov after the first couple of years, but changed their mind and is still hosted by the federal platform. Oh, and there's also Kentucky, which is scheduled to scrap their perfectly-functioning tech platform for absolutely no good reason other than the petty whim of their new Governor, Matt Bevin.
Last year, MNsure, Minnesota's technically (and actuarially) troubled ACA exchange enrolled "several hundred" people in Qualified Health Plans (QHPs) in the first day, and exactly 6,864 people in the first 17 days...which breaks out to an average of 404 per day for the first couple of weeks.
With improvements at the call center and on the website, MNsure has enrolled a record number of Minnesotans in coverage, O’Toole said.
“We’ve helped more Minnesotans than we have in any two day period in our history,” she said. “We’ve now enrolled more than 10,000 Minnesotans. That’s a benchmark that we didn’t hit until after Thanksgiving last year.”
Last week, ahead of the launch of the 2017 Open Enrollment Period, I took a look at what's new over at HealthCare.Gov this year. For the most part I was pretty impressed; they've made it more mobile-friendly, added refinements and changed the plan filtering interface so that it's consistent across both desktop, laptop and mobile devices.
The actual enrollment process itself also appears to be running smooth as silk; here's a comment from just this morning:
However, there are still a few user interface glitches which need to be addressed, at least on the "Window Shopping" tool. Here's two of them (three, really, although two are the same problem for different functions):
Modern Healthcare has an OE4 Launch roundup of sorts; most of the data is stuff I've already written about, and there isn't much in the way of hard enrollment data, but in general it sounds like things are off to a pretty promising start. First they note the 150,000 submitted applications on Tuesday which I wrote about earlier today; after that:
Open enrollment so far “has been going really well,” said Ambar Calvillo, national director of field and partner engagement at Enroll America, a D.C.-based not-for-profit group that helps people sign up for coverage. Calvillo said the group, which works with enrollment assistors across the nation, hasn't seen any major obstacles. Before open enrollment, exchange shoppers scheduled more than 5,400 appointments for in-person enrollment assistance through Enroll America's Get Covered Connector tool, up 80% over last year.
...State-run exchanges in California, Colorado, Idaho and Massachusetts reported no problems on the first day of enrollment.