This Just In...Maryland has announced their official final QHP selection tally for 2015 Open Enrollment (including the 2-week "wait in line" extension period):
289,131 Marylanders enrolled through Maryland Health Connection from Nov. 15, 2014 to Feb. 28, 2015. That includes 122,778 people enrolled in private Qualified Health Plans (QHPs) and 166,353 enrolled in Medicaid. Due to high demand during the final weekend of open enrollment, Maryland Health Benefit Exchange allowed people who started an application at MarylandHealthConnection.gov or contacted the Consumer Support Center by Feb. 15 to complete the process by Feb. 28.
Now that the King v. Burwell Supreme Court oral arguments are out of the way (with radio silence expected until they announce the decision sometime in June) , the next Big Development to keep an eye on ACA-wise is...Tax Season! There will be plenty of stories about how many people have to pay back some/all of their 2014 tax credits, how many will receive additional tax credits...and, most germane to this site, how many additional people enroll via the exchanges to avoid having to pay (most) of the higher tax penalty next year for not being covered in 2015 during the Tax Filing Season Special Enrollment Period (SEP), or #ACATaxTime as I prefer to call it.
If the Supreme Court does rule in favor of the government, then all of this will be moot (until the next BS, frivolous legal challenge to the law, of course). Healthcare.Gov will presumably be full-steam ahead, the tax credits will flow to all 50 states (+DC), and all will be (relatively) well. In fact, I wouldn't be at all surprised to see some of the smaller states such as Rhode Island, Vermont and Hawaii scrap their own exchanges and move to HC.gov the way Nevada and Oregon did (although in the case of RI, VT & HI, it would be more about funding issues than technical problems).
However, I've laid out a number of potential workaround/solutions in the event that the SCOTUS does rule for the plaintiffs...the massive catch being that all of them would require some amount of cooperation on the part of a) Conservatives on the Supreme Court; b) Republicans in Congress and/or c) Republicans in the 34 states in question.
(title corrected...everyone knows it was "licks", not "bites"...d'oh!!)
Last night I got embroiled in a Twitter discussion with Ken Kelly and Seth Trueger about the various categories of policies available (on exchange, off exchange, grandfathered, etc). I got to thinking about it; believe it or not, there are over a dozen that I've tried to track over the past year and a half:
1. ACA Exchange-Based Qualified Health Plans (QHPs) Current Paid Enrollment: Around 10.3 Million
2. OFF-Exchange (direct) Qualified Health Plans (no tax credits) Current Paid Enrollment: Around 8.1 Million (including #3 below)
3. Off-Exchange ACA-Compliant (but not QHPs)...believe it or not, there are policies available directly via the insurance companies which are compliant with ACA requirements, but which aren't defined as "QHPs" (that is, they still couldn't be sold on the exchanges even if the insurance company wanted them to be).
The following is an actual email exchange from last spring between someone working at a private, for-profit insurance company and myself. I've blocked all personally identifiable information as a courtesy, even though I probably shouldn't have. I had completely forgotten about this incident until the Huffington Post's Jeffrey Young tweeted something which reminded me of it.
Hello Charles,
I work for an insurance organization in (city, state) and have been following your information as it relates to enrollment. I have been tracking competitor information manually as our state insurance department has not, up to this point, provided any enrollment information.
We are extremely interested in enrollment numbers for (competitor) and (competitor) in the state of (state). Here is a link to some more enrollment numbers for (competitor) - (link), however, they are old because we currently got some information that they are now up to (number) total enrollment members. Please, if you do report these numbers, I wish to keep my identity confidential.
When you're deep in the weeds on this stuff, you tend to take things for granted. Case in point: I kind of figured that it was obvious that everyone who purchases private insurance coverage in the 34 Federal Exchange states will be utterly screwed in the event of the plaintiffs in King v. Burwell winning (assuming, of course, that the GOP Congress doesn't show a lick of decency for once and none of those states slap together an exchange-in-a-box, that is).
Apparently I was mistaken about this, so to review:
Under King premiums for subsidized enrollees would ↑ 256%. As the risk pool deteriorates, premiums for all in the individual market also ↑.
UPDATED w/explanation (although this really isn't a serious analysis, just trying to make a larger point:
The conventional thinking now seems to be that Roberts and Kennedy are likely to side with the 4 liberal/Dem-appointed Justices to rule against the plaintiffs, 6 to 3.
This translates to roughly, say, a 75% chance of the federal exchange subsidies continuing, 25% chance of them being cut off:
A couple of weeks back, CoveredCA reported that they had renewed 944,000 2014 QHP enrollees, and added another 474,000 new enrollees for 2015, for a grand total of around 1,418,000 private policy enrollees (payments pending, of course). Like every other state, CA tacked on an "overtime" period for people who were waiting "in line" by the 2/15 deadline but hadn't completed the process. I was assuming this might push their grand total up to perhaps 1.5 million or so.
Today, CoveredCA released their final official numbers, and they're...underwhelming:
Obamacare: @CoveredCA says newly enrolled 2015 was 495K, total enrollment including renewals is 1.41M #ACA
Some people were disappointed (and others no doubt relieved) that after flapping my gums about it for the past 9 months, I didn't have anything to say about the actual King v. Burwell oral arguments yesterday. As I noted, I'm neither an attorney nor a SCOTUS or Constitutional scholar. I really don't know much about the actual mechanics of Supreme Court procedures--heck, until yesterday evening, I didn't even realize that the 2-3 hours of lawyers and Justices chit-chatting was the whole ball of wax:
@onceupona@nicholas_bagley Stupid question: Was today IT? that is, was the whole #King thing a 1-day deal, followed by 3 mo of waiting?
The Silver Lining: Medical Tax Breaks Can Offset Health Care Costs
Everyone needs medical services at some point in their lives. Yet, annual expenses rise every year: health care costs increased 22% from 2010 to 2013 alone. Now that health insurance has become mandatory, many fear that their health expenses will increase even more. Luckily, Americans may be able to offset some of their health care costs by by deducting applicable medical expenses.
