UPDATE: After thinking about it all day, I've decided to remove the "scrotum" nickname from the headline. I reserve the right to keep it in the body of this and future posts, however.
After being lambasted by pundits, reporters and politicians across the political spectrum for pushing an ACA replacement bill which would effectively raise insurance premiums on older enrollees up to eight times higher than they would be otherwise (eating up over 50% of their annual income in some cases)...
I've spent the past two months painstakingly crunching the numbers in an attempt to project just how many people would likely lose their healthcare coverage if the ACA were to be: a) fully repealed; b) with immediate effect; and c) without any substantive replacement policy put into its place.
My conclusion, after much analysis, double-checking and updating, is that the grand total would be roughly 24 million people: Around 8.2 million current exchange enrollees, nearly 15 million via Medicaid (expansion or otherwise), and the 750,000+ people enrolled in BHP programs in Minnesota and New York.
When I was 18 years old, my father died of a brain tumor.
A few weeks after the funeral, I left for college at Michigan State University. Freshmen were required to room blind, so I had no idea who my roommate would be. When I met him, a tall blonde guy named Brian, I was still wearing the Kriah ribbon--a small torn piece of black cloth.
We shook hands, introduced ourselves, and then Brian asked me what the torn ribbon was for. I explained that my father had recently passed away, and that Jewish custom was for mourners to wear torn black cloth as part of the mourning process.
His response?
"Oh, I'm sorry to hear that he's burning in hell right now."
I should note that this was less than 5 minutes after we had met. I was assigned to live in the same room as this guy for the next 9 months.
For 2017, the weighted, average, unsubsidized (that's critical!) premium rate increase for ACA-compliant individual market healthcare policies was roughly 25% nationally.
There were plenty of reasons for this, including normal inflation/healthcare costs; the discontinuation of two of the three stabilization programs (Reinsurance and Risk Corridors, although the RC program had already been sabotaged a year earlier anyway); correction for under pricing by many carriers in the first couple of years of the ACA exchanges; and, of course, the fact that the ACA exchange risk pool continues to be worse than hoped for in numerous states/counties.
Of course, for the roughly 10 million exchange enrollees who are receiving tax credits, this didn't really impact them much at all:
On average, ACA marketplace consumers receiving tax credits are literally paying exactly the same this year as last year -- $106 per month. pic.twitter.com/WzqA6DsWRN
You may have noticed that I haven't been posting as many blog entries the past week or two. This has been partly due to our 5-day power outage, of course, as well as various other personal odds & ends. The main reason, however, is that I've been driving around the metro Detroit area giving a PowerPoint presentation about the ACA and Trumpcare to various groups. Last night was my 4th or 5th presentation, and while it was kind of sloppy and scattershot the first few times, I'm streamlining and modifying for each new event.
Even so, I'm cramming a lot of information into an hour or so, and several people at each event have asked if I could upload the slideshow to the website for easy download.
Of course, it's impossible to prove that the Trump executive-order/ad-kill combo was the cause of the numbers petering out at the end of the enrollment period...but I have some pretty strong evidence that it did.
How? Well, remember, the 12 state-based exchanges, which cover around 1/4 of all Qualified Health Plan (QHP) selections nationally, were not hurt by the ads being killed. The executive order might have had some impact, but the actual HC.gov ads being yanked shouldn't have hurt them much since these exchanges have their own, separate branding, marketing budgets and outreach programs.
I therefore decided to compare how the 39 HC.gov states performed relative to the 12 state exchanges...the results are pretty telling.
...UPDATE 3/16/17: I've updated the tables and chart below with the final, official 2017 Open Enrollment Period numbers from CMS.
As I noted earlier today, CMS has released the official 2017 Open Enrollment Period report, along with a whole mess of State, County and Zip Code-level breakouts and related demographic information, including APTC/CSR recipients, Metal Levels, Income Levels and so on.
On the one hand, this will take some time, so please bear with me. It took nearly 2 months to compile this data for all 50 states; it might take another week or so to update them with the latest numbers. Also note that it may only be the 39 states on the federal exchange which get updated, unless some of the state-based exchanges release their own updated reports.
On the other hand, it's important to note that for most counties/congressional districts, the numbers are likely to be fairly close to where they already are. For example, I've already completed Michigan; here's a before/after comparison:
In addition, unless I'm mistaken, most of the actual staff...the career employees at CMS/HHS, many of who've been there through more than one administration, will likely remain, and will do their jobs to the best of their ability, including trying to compile and publish data as accurately as possible.
Yesterday the CBO pretty much torpedoed the Trumpcare bill. Everyone from across the political spectrum now seems to agree that it's a complete disaster, with the exception of Paul Ryan and Tom Price (hell, even an internal Trump White House analysis apparently concluded that even more people would lose coverage than the CBO did...26 million vs. the CBO's 24 million).
However, there's one part of the AHCA which should be kept: The $100 billion that they currently have allocated to throw at the states to stabilize the individual market. As the CBO noted:
