Charles Gaba's blog

Thanks to Zachary Tracer for the heads up.

The other day I wrote a general overview of the ACA "Risk Corridor" debacle.

The short version is that there were 3 funding programs put in place under the Affordable Care Act designed specifically to help smooth the waters and keep insurance carriers afloat for the first few years until they got past the bumpy transition period. One of these was called the "Risk Corridor" program. Basically, the carriers who lose their shirts the first 3 years were supposed to have at least a portion of their losses covered to tide them over; call it "training wheels" for the insurance industry. The funding was supposed to come partially from the other insurance companies which did better than expected...but any shortfall was supposed to be covered by the federal government, with the caveat that any surplus paid to the government stayed there as a type of profit.

In my most recent Maryland exchange update, I noted that after months of ACA exchange enrollments increasing during the off-season (if slowly), net policy cancellations finally started to outweight off-season additions starting in August:

As of Aug. 13th, 606,226 Marylanders have enrolled in quality, affordable health coverage for 2015 through Maryland’s state-based insurance marketplace.

That includes 123,673 people enrolled in private Qualified Health Plans (QHP) and 482,553 people enrolled in Medicaid through the marketplace since open enrollment for the year began on Nov. 15, 2014. Nearly 94 percent of all Marylanders who have enrolled through Maryland Health Connection for coverage this year received financial assistance.

Today, the exchange tweeted out a quickie update ahead of the 2016 Open Enrollment period:

A couple of days ago I noted that Covered California is adding a very good feature this year: They're opening up 2016 enrollment nearly 3 weeks early...for those who are already currently enrolled. Starting this monday, Oct. 12, current enrollees will be able to renew or switch to a different CoveredCA plan, 19 days ahead of he official Nov. 1st Open Enrollment launch.

Today I discovered that at least one other state-based exchange (Kynect, in Kentucky) is doing this as well...sort of:

I clicked through and saw this listed under the Frequently Asked Questions:

1. How do I enroll in kynect?
Simply visit kynect.ky.gov or talk to your insurance agent. If your insurance plan is up for renewal, you may be eligible to enroll through kynect today. You can also call Customer Service at 1-855-4kynect (459-6328).

A couple of weeks ago I wrote about a "new" Scary Headline® story from the AP about cybersecurity at the federal ACA exchange, HealthCare.Gov.

My entry was about how the AP utterly misrepresentated the actual security situation a year ago, then compounded their mistake (I'll be gracious and assume it was done out of ignorance, not malice) a year later in their follow-up story. As for the actual HC.gov security situation, the short version was:

Just a couple of quick social media notes:

  • Those who follow me on Twitter know that I almost always include 3 hashtags with every Tweet: #ACASignups, #ACA and #Obamacare. During the 2016 Open Enrollment Period, I'll be changing the #Obamacare tag to simply #OE3, not out of any disrespect towards the President but simply because of the character limit.
  • Twitter followers also know that my personal feed (@charles_gaba) also includes all sorts of non-ACA-related stuff. If you want to keep up with my ACA-specific stuff but don't care for my unrelated political rantings, just follow the official @ACASignups Twitter account instead!
  • Finally, don't forget you can also follow updates on Facebook!

That is all.

I planned on posting about this earlier today, but had to deal with a crisis for one of my Day Job clients (yes, I still have one believe it or not).

Early this afternoon, Covered California, the largest state-based ACA exchange in the country, held a conference call accompanied with a lengthy press release and a very nice slideshow full of pie charts and data points, giving a comprehensive overview of where things stand in the Golden State.

With 47 states plus DC under my belt, at this point I'd say I have a pretty good feel for the overall national premium rate increase scene; it still looks like around 12-14% nationally on average, ranging from a low of under a 1% average hike in Maine and Indiana to a high of 40% or so in Alaska and Minnesota.

However, I admit it would be nice, as a point of personal pride, if I could squeeze in the last three states: Nebraska, Pennsylvania and Wisconsin. Fortunately, Louise Norris has brought to my attention the fact that the Nebraska Dept. of Insurance has issued the final approved rate changes for the individual market:

I've said before that there are a few areas of the ACA which I simply don't consider myself knowledgable enough about to try and explain to others in depth. One of these is the so-called "Cadillac Tax" on high-end employer sponsored insurance policies. The other (well 3 others, really) are the "3R" programs which were set up to try and smooth out the transition period for insurance carriers for the first few years. The "3 R's" are "Risk Adjustment", "Reinsurrance" and "Risk Corridors".

Since I don't know much about them, here's a quick explainer from the Commonwealth Fund. A summary version is below:

Risk adjustment is a process that deters insurance plans from trying to attract healthy enrollees (“cherry picking”), and protects companies that may—by chance or because of their particular benefits—attract sicker than average customers (“adverse risk selection”). Though the Affordable Care Act bans carriers from turning people down or charging them more based on their health, the incentive to attract healthier enrollees remains because healthier customers increase profits by reducing companies’ payouts.

This is really more for budget wonks than healthcare wonks, but still kind of interesting: The Congressional Budget Office just issued their September 2015 Monthly Budget Review report. Since the fiscal year runs from October through September each year, this means that they're basically closing the books on 2015 from a budgetary POV:

The federal government ran a budget deficit of $435 billion fiscal year 2015, the Congressional Budget Office estimates—$48 billion less than the shortfall recorded in fiscal year 2014, and the smallest deficit recorded since 2007. Relative to the size of the economy, that deficit—at an estimated 2.4 percent of gross domestic product (GDP)—was slightly below the average experienced over the past 50 years, and 2015 was the sixth consecutive year in which the deficit declined as a percentage of GDP since peaking at 9.8 percent in 2009. By CBO’s estimate, revenues were about 8 percent higher and outlays were about 5 percent higher in 2015 than they were in the previous fiscal year. CBO’s deficit estimate is based on data from the Daily Treasury Statements; the Treasury Department will report the actual deficit for fiscal year 2015 later this month.

This is a pretty minor 2015 exchange enrollment update, and one of the last ones I'll be doing before the 2016 Open Enrollment period kicks off, but I should squeeze it in:

From October 1, 2013 to September 23, 2015, 166,789 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:

  •  24,663 people enrolled in a private qualified health plan,
  •  120,739 people have been determined eligible for Medicaid, and
  •  21,387 people enrolled through the DC Health Link small business marketplace (includes Congressional enrollment)

As always, the DC exchange insists on giving cumulative totals since 10/1/13 instead of the 2015-only numbers, which isn't particularly useful. However, by comparing it against their earlier update, I can figure out the difference since then:

From October 1, 2013 to June 7, 2015, 125,478 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:

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