Back in 2013-2014 when I started this project, the most frustrating data to track down was OFF-exchange individual market healthcare policy enrollments. I tried my best to do so, painstakingly verifying around 560,000 across a handful of states, but with the knowledge that there were at least a few million more out there.
While this may sound obvious now, at the time, there were a lot of people who should've damned well known better, like Avik Roy, who actively tried to claim that the off-exchange individual market was nominal at best, documented in this jaw-dropping Tweet from him:
@UriManor@charles_gabaOff-exchange enrollments don’t affect exchange risk pool; usually previously insured. Not a big number either way.
Welcome, fellow Wonks! It's a great honor to be asked to host Health Wonk Review, especially the week of the 6th Anniversary of the Affordable Care Act!
Since this is the first time I've hosted HWR, I'll keep things pretty straightforward:
David Harlow of HealthBlawg addresses the question of "Narrow Networks in California?", pointing out that "Managing cost and quality requires use of narrow networks. A proposal up for consideration in California is deemed “novel” by some. Opponents seem afflicted by the Lake Wobegone Effect."
Now, I'm no fan of Gov. Kasich, but credit where due: Like my own otherwise-destructive governor here in Michigan, Rick Snyder, Gov. Kasich knew a good deal when he saw it and pushed through the ACA's Medicaid expansion program in the Buckeye State, resulting in somewhere between 590,000 - 650,000 additional low-income Ohioans receiving heatlhcare coverage, many for the first time.
I'm aware that aside from my mini-obsession with the Ohio Town Hall incident, my posts have been a bit light the past few weeks, and I've missed out on some important ACA stuff this month.
Part of this is catching up with my day job (which I'm massively backed up on); part is general burnout, and part is due to an unrelated side project that I'm working on (more on that soon).
Anyway, aside from hosting HWR this week, I'm also putting together my final OE3 ASPE/State Breakdown analysis, along with some "ACA at 6" stuff. Look for it over the next few days.
A few days ago, I noted that several Ted Cruz supporters had filled out and submitted the contact form on this site, oblivious to the fact that it has nothing to do with Cruz's campaign.
This morning I received yet another one of these:
I watched your talk this morning on FOX News concering the latest bombing. I take offense to your turning this event into a political issue with your comments on Trump. Whether or not I I am a Trump supporter is of no consequence. I will vote for the GOP candidate that shows the most civil campaign and does no degrade another, but talks more about their policies and ambitions.
Aside from the insanity of suggesting that Donald Trump has run a "civil campaign" which "doesn't degrade others", I'm still flabbergasted that these people are incapable of digesting the voluminous evidence that they're at the wrong website. For once, I decided to address the issue head on by writing this individual back:
Dear XXXXXXX,
I realize that you likely misspelled Sen. Cruz’s name when entering the domain name to visit my website.
There's growing evidence that most of the dramatic gain in the number of Americans with health care coverage is due to President Barack Obama's law, and not the gradual recovery of the nation's economy.
That could pose a political risk for Republicans running against "Obamacare" in the GOP primaries as they shift to the general election later this year.
...Under "Obamacare," the share of Americans without health insurance has dropped to a historic low of about 9 percent, with room to go even lower. But even as the economy has expanded, major government surveys point to a lackluster rebound for employer-based coverage.
Last October, I posted a piece in which I blasted the Heritage Foundation for posting a widely-disseminated article in which they claimed that only 3% of the net increase in 2014 insurance coverage was "due to" private ACA healthcare policies, with the remaining 97% being found via expansion of Medicaid via the ACA.
It's a long, wonky piece, but Heritage's claims fell into two main areas:
First, they, like so many other right-wing organizations, constantly operate under the presumption that Medicaid "doesn't count" for some reason or another.
Apparently people enrolled in Medicaid aren't human beings deserving of healthcare coverage, and can therefore simply be subtracted from the "real people" total. This is the same type of logic which, to this day, has Republicans stating that "Barack Obama only won because so many black people voted for him"...which, even if true, is utterly irrelevant: "So many" black people did vote for him, and their votes count just as much as anyone else's. You could just as easily argue that most other presidents "only won" because so many white people voted for them, and it would have exactly the same relevance to the fact that they were still, you know, elected president.
More to the point, though, the other main claim was this:
Yes, the Heritage Foundation says, the private individual market did increase by about 4.8 million people, however...
Over 4.5 million people who had been covered by employer-sponsored insurance lost or moved off of their plans at the same time, meaning that...
...the net increase in private policy coverage only went up about 260,000 people, which, in their view, means that...
only about 3% of the 9.25 million net increase in covered individuals in 2014 was via private policies, with the remaining 97% being via Medicaid expansion.
I countered by pointing out a whole mess of other reliable sources which collectively concluded that the "4.5 million ESI reduction" was likely way off base for a variety of reasons, including cherry-picking multiple sources, misinterpreting datasets and so forth.
Samaritan Ministries is an organization of devout Christians who eschew traditional health insurance to pool their money and cover each other’s catastrophic medical bills. It’s one of the very last mutual aid societies in the U.S., in which a community of individuals with shared beliefs band together to form a voluntary social-safety net. A century ago, an estimated one-third of American men belonged to mutual aid societies, but most faded away with the expansion of the welfare state.
Three years ago, I travelled to Samaritan’s headquarters in Peoria, Illinois to learn more about this remarkable organization.
In the story that came out of that trip, I predicted that Obamacare would lead to the demise of Samaritan and two similar organizations in the U.S. This model, I thought, wouldn’t be able to compete with the heavily subsidized plans soon to become available on the new health-care exchanges.
Thanks to Richard Simpkins for bringing this to my attention.
A week or so ago, Akash Chougule, Director of Policy at Americans for Prosperity (you know, the Tea Party political outfit funded by the Koch Brothers), posted an Op-Ed piece at Forbes tearing apart Ohio Governor John Kasich's decision to expand Medicaid via the Affordable Care Act. From a Republican POV, of course, Kasich agreeing to accept ACA Medicaid expansion is blasphemous. The piece was posted just ahead of the Ohio Republican Presidential primary, so naturally it was intended to hurt his chances of winning his home state (it didn't work, of course; Kasich did indeed win Ohio, keeping his campaign alive awhile longer, if just barely).
Anyway, here's the part which made both Simpkins and myself scratch our heads:
Ohio Governor John Kasich has spent no small amount of time on the presidential campaign trail discussing his decision to expand Medicaid to 650,000 able-bodied adults under Obamacare. But policymakers in non-expansion states should take a closer look at what’s actually unfolded in Ohio before considering going down the same path.
SORRY ABOUT THE DELAY!! I posted Part One on March 11th and planned on posting Part Two last weekend, but the week kind of got away from me...
In Part One of my analysis of the final, official OE3 ASPE report, I looked at the grand total nationally, the final state-based exchange numbers, revisited the BHP/pre-purged QHP factor, and also took a quick peek at some other odds & ends. Here's my long-overdue look at the rest of the report:
Re-Enrollments:
In 2015, appx. 6.1 million people ended up renewing their policies nationally (4.5 million via HC.gov, 1.6 million via the SBMs) out of 6.3 million still enrolled through the end of the year. That's a 97% renewal/re-enrollment rate, which is pretty good.
In 2016, appx. 7.8 million people renewed their policies nationally (5.6 million via HC.gov, 2.2 million via the SBMs) out of 8.8 million still enrolled through the end of the year. That's down to an 89% renewal/re-enrollment rate...still not terrible, but concerning.
Bear in mind that I was expecting assumed 9.0 million to renew...but I was also expecting about 9.7 million to still be enrolled (ie, I expected a 93% renewal rate out of a higher total). HHS, meanwhile, had a mid-range of 8.1 million renewing out of an expected 9.1 million (89%). The actual numbers were lower on both sides, which isn't a good sign.
