This morning I noted several new developments in the ongoing King v. Burwell saga (formerly Halbig v. Burwell...and yes, I know that's technically a separate case, but cut me some slack here). However, I forgot a couple more:
Here's a list of people who--to the best of my knowledge--have now been proven not to ever have the slightest inkling, hint, suggestion or thought that federal tax subsidies weren't supposed to go to states which didn't establish their own ACA exchanges at any point throughout the many-year process of the law being crafted, drafted, printed, read, debated, argued about, voted on or signed into law:
Now, technically speaking, that exact number isn't precisely what it was as of January 16, because it includes 1 extra day for 13 of the state exchanges and 2 extra days for California. I have no clue why they did it that way, but whatever. Really, though, enrollment dropped off dramatically for a few days after the 15th, because that was the February-start deadline in 46 states +DC (including California), so I don't imagine more than 10-15,000 of this came in on the 17th or 18th.
Since the day I started this project (before it, really), I've been asking for the HHS Dept. to simply release the enrollment data in as much detail as possible on a frequent basis...and by frequent, I didn't mean "monthly"; that's far too long given the 24-hour, 24-second news and political cycle. For 7 months, the HHS Dept. ignored this plea, followed by another 6 months of not just ignoring it but actually going backwards on enrollment data (ie, cutting off even the monthly reports during the off-season). Fortunately, since November, they've done a total 180, issuing not only "weekly snapshot" reports giving the overall HC.gov enrollment numbers, but more recently breaking these down by all 37 states on a weekly basis. This is awesome!
Remember all last summer and into the fall when I kept pointing out to anyone who would listen that just because the official Open Enrollment period had ended back on March 30th (or April 15th, depending on your POV), there were still a good 9,000+ people per day enrolling via the ACA exchanges due to major life changes?
Of course, those people being added were also being cancelled out to some degree by people dropping their policies (or being dropped whether they liked it or not due to non-payment or immigration/residency issues). From what I could tell, the additions seemed to be outnumbering the subtractions for most of the summer, up until around August, at which point the trend reversed. However, it was difficult to know this for certain until the CMS head unexpectedly mentioned that 7.3 million people were still enrolled as of mid-August (going up!), followed by a drop to 7.1 million as of mid-October (going down!).
Here in Michigan, the official estimates of how many residents are eligible for ACA Medicaid expansion ranged from around 477K to 500K, and over the past month or so, the weekly reports from the official MI Dept. of Community Health "Healthy Michigan" website has pegged the current enrollment total at between 490K - 510K. This led me to assume, naturally, that the program has been essentially tapped out, with close to 100% of those eligible already having signed up within the first 10 months.
Yesterday, however, they posted the weekly update again, and guess what?
Healthy Michigan Plan Enrollment Statistics
Beneficiaries with Healthy Michigan Plan Coverage: 533,110
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)
*Statistics as of January 26, 2015
*Updated every Monday at 3 p.m.
Wow. 533,000 people. So, what's going on here? Well, possibilities include:
Indiana has been given the green light to expand its Healthy Indiana Plan, which would offer insurance to an additional 350,000 Indiana residents who currently lack insurance.
The state will begin taking applications immediately for its so-called HIP 2.0 plan, for which coverage begins Feb. 1, Gov. Mike Pence announced Tuesday morning at a packed speech at St. Vincent Health.
So, what makes this different from standard Medicaid expansion?
Indiana is the only state to apply private market measures, such as requiring participants to make monthly contributions to help cover the benefit.
Anyone who falls below 138 percent of the federal poverty level will now be eligible to enroll in what the state is terming the Healthy Indiana Plan Plus. The plan includes dental and vision benefits, as well comprehensive prescription drug benefits.
Participants in this plan will be expected to make contributions of between $3 and $25 per month, or about 2 percent of the annual income for the year.
In recent weeks, I've turned into quite the Debbie Downer regarding the outcome of the King v. Burwell federal ACA tax credit case, set to be argued this March with a decision expected to be announced sometime in June. This is a far cry from 6 months ago, when I first proposed my apparently naive "Denny's Grand Slam" workaround (has it really been that long?).
Anyway, today brings three important takes on the case from The New Republic's Brian Beutler, the Washington Post's Greg Sargent and Scholars Strategy Network's Prof. Theda Skocpol which have bolstered my spirits somewhat. First up, Beutler:
NOTE: The source of this guest post by Esther Ferington is a wee bit out of date by now, but it's still an interesting topic and she's done her research, so I figured it should still be posted; I apologize to her for the delayed publication:
Unraveling the "Pediatric Age" Proposal
by Esther Ferington
When HHS rolled out its proposals tied to Open Enrollment for 2016, many of the usual topics made the list (re-enrollment guidelines, start and stop dates for open enrollment, and so on). One that seemed a lot less familiar was "pediatric age":
Pediatric Age. We propose that pediatric benefits be provided until the end of the plan year in which the enrollee turns 19.
So... that was unexpected. And since we're in new territory here, it raises a few questions:
(sigh) I might as well get this out of the way now.
I've been promising for some time to write a post explaining the difference between the CBO's "13 Million QHPs" projection, the HHS Dept's "9.1 million" projection and my own "12.5 Million" projection. I've alluded to this here and there, but a lot of people are still confused, so it behooves me to dedicate a full post to the topic (which I can then add to the menu for quick access).
I was planning on waiting another week or so before writing this, but with the CBO issuing their latest 10-year Budget Outlook, which quietly reduces their "13 million" figure down to 12 million, it seems like now is the time. I'm already anticipating people thinking that this means that my own projection is now higher than the CBO's...which it isn't.
In a nutshell, here's what the different numbers mean:
