One of the most popular provisions of the Affordable Care Act's Three-Legged Stool's "Blue Leg" is the prohibition of caps on annual or lifetime benefits. When you consider that a baby born prematurely or a cancer patient undergoing chemotherapy can eat up several million dollars worth of care within a few months, this makes perfect sense. Even a moderately wealthy family can be brought down by high medical costs, and a middle class family can be financially wiped out. If you're lower income, don't even get me started.
After approving Medicaid work requirements, Trump’s HHS aims for lifetime coverage limits
After allowing states to impose work requirements for Medicaid enrollees, the Trump administration is now pondering lifetime limits on adults’ access to coverage.
Senate Democrats, led by Sen. Patty Murray, are pushing to increase the Affordable Care Act's subsidies as part of a stabilization bill being renegotiated with Sen. Lamar Alexander. This would mean increasing the amount of financial assistance people receive, as well as making it available to more people.
...“We’re interested in both expanding access to subsidies and increasing their value. You’ve got two different sets of populations that will be impacted in different ways depending on how cost sharing” is structured, a Democratic aide told me.
Welp. In the end, enough Democrats joined Republicans in both the U.S. Senate and House to pass a massive spending bill in the dead of night. Donald Trump signed it into law early this morning.
Needless to say, I'm not happy at all about a major missing piece of the bill: The DREAM act, which would protect around 690,000 young adults who were brought to the United States as children, was not part of the bill. The Dems in the Senate were able to lock in a formal immigration debate which will presumably be focused in large part on DACA and the Dreamers, but there was no such guaranteed baked in on the House side by Speaker Paul Ryan. Personally, I'm pretty disappointed with the 73 Dems who folded on the issue, but the fight isn't over yet.
According to the CMS/ASPE 2016 Final Enrollment Report, during the 2016 Open Enrollment Period, Louisiana enrolled 214,148 people in exchange-based Qualified Health Plans.
Most states dropped a bit year over year in 2017 in large part due to the Trump administration cutting off outreach/marketing during the critical final week, but Louisiana saw the worst year over year drop. Why? Well, the most obvious reason was pretty simple: The state expanded Medicaid halfway through the year.
Last year, in my "If I Ran the Zoo" piece, I stuck my neck out and noted that the single biggest problem with the Individual Mandate isn't that it exists, but that it's not strong enough (conservative healthcare writer Michael Bertaut, who I disagree with on most issues but respect on this topic, also argues that the mandate has never been enforced strongly enough either). Here's what I said at the time:
The reality is that as much as everyone complains about the $695 or 2.5% income individual mandate penalty for NOT having qualifying healthcare coverage, the penalty should really be increased. There, I said it. The problem is that if the penalty is significantly less than the amount that the premiums would be, some people will still decide to eat the tax instead of signing up.
UPDATE: (sigh) OK, it looks like the final number for the District of Columbia was slightly too low; I've received official notice from the DC exchange that it was actually 22,584, 115 enrollments higher than the NASHP report pegged it at. The Graph and spreadsheet below have both been updated...
OK, here it is...
This morning Covered California issued their final 2018 ACA Open Enrollment numbers. I was a bit disappointed to discover that instead of beating out last year slightly, they ended up coming about 2.3% short year over year...but there's a very good reason for that: Like Maryland, California not only utilized the full "Silver Switcharoo" strategy with individual market premiums, they actively encouraged current UNSUBSIDIZED on-exchange Silver enrollees to switch to off-exchange Silver plans instead.
Note: This is more of a placeholder for the moment; it'll be updated as soon as the numbers are available.
At around 10:30am this morning, Covered California will be announcing their final, official 2018 ACA Open Enrollment Period numbers, along with other various demographic info.
Keep in mind that California is second only to Florida in terms of ACA exchange enrollees, with around 13% of the national total each year, so this is a big deal.
Last year Covered CA's 1/31 total hit 1,556,676 (or just under 15,000 enrollees higher). In 2016 they had their all-time high of 1,575,340, so they'd have to have tacked on about 34,000 more over the final 10 days of Open Enrollment this year in order to beat their record.
Last month, Covered California issued an extensive analysis of the individual market landscape for 2019 and concluded that the recent actions taken by Donald Trump and Congressional Republicans (especially, of course, the repeal of the individual mandate) will collectively cause rates to spike by up to 30% even without taking into account the normal medical inflation one would normally expect every year anyway. I didn't see a whole lot of reporting on this report other than my post and Michael Hiltzik's story on it at the L.A. Times, but I might've missed others.
Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.
So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.
The type of demographic data available varies greatly from state to state, but a major data point available from all six of them also happens to be one of the more interesting points, especially this year, given the " CSR Silver Loading" gambit available in most states this year.
Maryland was originally one of 3 state-based exchanges which stuck to the "official" half-length, December 15th Open Enrollment Period deadline this time around. However, with just 2 days to go before the original deadline, the MD Health Connection announced that they had decided to bump out their deadline by an extra week after all, through December 22nd.
