Back in early July, I made a simple proposition which could conceivably mitigate the otherwise severe damage to the Affordable Care Act (as well as to the lives of millions of Americans, the entire healthcare industry and, indirectly, the entire U.S. economy) in the event that the Supreme Court ultimately rules for the plaintiffs in the federal Halbig/King cases.
I called it the "Denny's Grand Slam" solution (alternately the "$360 Solution" or the "GoDaddy Solution"...take your pick), which basically involved states which are currently having enrollments run through the federal exchange set up a bare-bones "exchange" of their own by essentially filing some simple paperwork, registering a domain name for $9.95 with a basic splashpage and then repointing the whole damned thing right back to Healthcare.Gov for the actual enrollment process.
The Healthcare Twittersphere is all abuzz today with the surprising news that the Supreme Court has agreed to take up the King vs. Burwell case regarding Affordable Care Act tax credits for people who enroll thorugh the federal exchange (Healthcare.Gov). (The King case is sort of the kid brother to the Halbig vs. Burwell case, but they're essentially about the same issue).
All sorts of people on both sides of the issue who are much smarter than I about the legal aspects of this case are furiously posting their take on what's likely to happen after the SCOTUS issues their ruling, which I understand wouldn't happen until sometime next summer (they've agreed to take up the case, but I don't think they start hearing arguments for a few months, and then they bop it around for awhile before issuing their final ruling).
Of course, even if the SCOTUS does rule for the plaintiffs in the end, it's very likely that they'll include a note that basically tells Congress "You know, there's an easy way to fix this; just go over section 1401 with a dab of liquid paper and revise the sentence to read "...enrolled in through an Exchange established by the State or the Federal Government" or whatever.
That would be a completely reasonable solution...if there was a snowball's chance in Hell that Congress would do so. Obviously the GOP would never let it go through (assuming that they hold the House and/or take over the Senate), so the clusterf*ck would ensue.
However, depending on what "established by" and "facilitates" are defined as (see section 1311 as referred to in the passage above), it seems to me that there's a different, equally simple (if utterly stupid) possible resolution which would cost no more than $358.20!
Yesterday, in my Big Exclusive Post® about the number of people currently enrolled in exchange QHPs appearing to have dropped down to a bit below 7 million, I noted that based on the 15 states for which I have current enrollment data from September or October (plus 1, Oklahoma, from August), it looks like the national total is right around 7 million on the nose at the moment. However, if you throw Florida into the mix, it drops noticeably, making it look more like 6.8 million.
I also noted that there are two problems with the Florida data: First, that it's had significantly more dropoff (22.5%) from the official April figure than any of the other states listed (with the exception of Nevada, which has had its own technical headaches to the point that it's dropping its exchange entirely).
Even more problematic is that this 22.5% "drop" was supposedly only as of June 30th (it comes from Florida's 2015 policy rate request filing report from the insurance companies operating on the federal exchange).
This makes Florida an incredible outlier; take another look at the chart:
I still stand by this, but an extensive discussion with Jed Graham of Investors Business Daily made me realize that presenting it this way can lead to confusion, because I'm essentially mixing together two different estimated numbers (% paid & attrition rate), each of which may vary widely from state to state, instead of simply comparing the number of people currently enrolled against the 8.02 million who had enrolled (whether paid up yet or not) as of April 19th.
Amazing. Even with things ramping up for #OE2 (Open Enrollment Period 2), and even with the midterm elections overwhelming everything for the past few weeks, Minnesota continues to quietly plod along, racking up the ACA enrollments along the way:
Latest Enrollment Numbers
November 4, 2014
Health Coverage Type Cumulative Enrollments
Medical Assistance 233,194
MinnesotaCare 80,111
Qualified Health Plan (QHP) 55,813
TOTAL 369,118
OK, that was unexpected. After a solid month without any updates, last week CoverOregon, being dismantled even as we speak as the state makes the move to HC.gov for #OE2 (Open Enrollment Period 2) suddenly issued a new update. I figured it was their last hurrah before going silent, but it seems they've decided to put out one (or possibly 2?) more updates before going to the Great Beyond:
November 3, 2014
Update: Private coverage and Oregon Health Plan enrollment through Cover Oregon
Medical enrollments through Cover Oregon: 420,450 Total private medical insurance enrollments through Cover Oregon: 105,661
Oregon Health Plan enrollments through Cover Oregon: 314,789
Dental enrollments
Total private dental insurance enrollments through CoverOregon 1: 20,893
Net enrollments
Net private medical: 77,288
Net private dental: 13,782
Compared to last week, that's another 606 total QHPs added, plus an additional 3,788 added to the Medicaid tally.
I'll have much more to say about the impact of yesterday's disastrous election on the ACA and healthcare coverage in general tomorrow, but for the moment let me just note something about the GOTV effort here in Michigan, which was focused on getting about 900,000 Democrats who showed up in 2008 & 2012 but not in 2010. Here's how that worked out:
Schauer actually did receive over 190,000 more votes than Virg Bernero did 4 years ago (about 15% higher), and Snyder's vote tally was down about 270,000 from 2010 (about 14% lower)...but it wasn't nearly enough. Schauer still lost by about 130,000 votes.
I'm kicking myself for not writing up a full post on this issue, since it's the issue which most directly connects today's election to ACASignups-specific issues, but thankfully, Sam Stein and Jeffrey Young have done a fantastic job anyway. The key takeaway is this:
There are two threads of conventional wisdom heading into Tuesday's midterm election. The first is that the election doesn't much matter. Regardless which party controls the Senate, President Barack Obama will still occupy the White House, which means gridlock will remain, if not escalate. The second is that, when it comes to Obamacare, the status quo will remain in place for at least the next two years. Senate Republicans may push for repeal votes. But Obama will veto them. Smaller reforms may pass. But the law will mostly remain intact.
