Over at Forbes, virulently anti-ACA critics Josh Archambault and Jonathan Ingram have written a detailed analysis of What Went Wrong with Iowa's implementation of the Affordable Care Act's Medicaid expansion provision. While their tone is understandably hostile, from what I know of the situation, it seems to check out for the most part (granted, the only part of this piece I knew much about until now was the CoOportunity failure portion of it).
First, it's important to understand that Arkansas is not the only state which has been using a "private option" solution for their ACA Medicaid expansion program; Iowa opted for this as well. For some reason, Arkansas is the only state ever mentioned when this comes up, probably because they were the first ones to do so, I believe:
Iowa’s expansion was loosely modeled afterArkansas’ Obamacare expansion. Under Iowa’s “Marketplace Choice” waiver, able-bodied adults above the poverty line would receive Medicaid benefits through Obamacare exchange plans.
I've spent tons of time the past few months obsessing over the average percentageincrease in monthly premiums for ACA-compliant individual market policy enrollees, and as I wrap up this project, I've concluded that, assuming EVERYONE sticks with their current policies and doesn't bother shopping around, the overall national average increase will likely end up being between 11-15%.
However, aside from a few hypothetical examples, I haven't even touched on what this means in terms of the actual dollar amounts.
This is no small thing. "Percentage" changes can be very misleading, if you don't know what the actual dollar figure is in the first place. Consider this:
When patients need simple health care, they can get impatient about having to wait.
That’s prompted more health care systems to stress convenience.
This month, North Memorial Health Care will open two easy-access clinics in new Hy-Vee grocery stores in New Hope and Oakdale, hoping that shoppers might add treatment for warts, fever and other ailments to their grocery lists.
The resurgence of retail health clinics by hospital operators comes as they also pump money into online programs that let patients tap into care through computers and smartphones without leaving home.
This one is a heck of an eye-opener, considering the ongoing technical problems Vermont has had with their exchange website...
As always, once you're into the off-season, the total number of QHP selections is more of a symbolic milestone than anything, since the effectuated number is more significant...but it's the selections which cancel out attrition (whether voluntary, in the case of people not paying their premiums or moving on to other coverage; or involuntary, in the case of the several hundred thousand people kicked off of their policies due to legal residency verification issues).
I honestly thought that was the end of his story, but back in late August out of curiosity, I did check in on his GoFundMe page and found a link to a rather interesting, if belated correction over at the Charlotte Observer (the newspaper which posted his story in the first place):
For months now, regular readers know I've spent countless hours crunching the numbers in an attempt to figure out the national, weighted average rate increases for individual health insurance market premiums. I've dug into the numbers for just about every state, filling in hard data where I can and making educated guestimates where I couldn't.
For instance, If I found a state where I was able to get a hard weighted average of, say, a 15% increase for 50% of their market, but didn't know what increase the other 50% had been approved for other than it being "less than 10%", I've been assuming around 7% for the missing half, giving a total weighted average of (0.15 x 0.5) + (0.07 x 0.5) = 0.075 + 0.035 = 0.11 = 11.0%.
A couple of weeks ago, my post on Indiana's average 2016 rate increases on the individual market would likely be very close to flat, based on partial enrollment data (i.e., they provided the rate data for every insurance company, but enrollment data for only one of them). The one company they provided enrollment information for, Physicians Health Plan, also happens to have the highest average rate hike, 13.5%.
However, I noted that since a) Physicians only holds around 4% of Indiana's market, and b) several of the other companies were approved for rate decreases (up to -19% for Mdwise Marketplace), it's entirely possible that the state could be looking at an overall rate decrease, or a very low increase at worst. I decided to split the difference and go with a flat zero percent change until further notice.
A Twitter discussion with Andrew Sprung, along with my own prior grumbling about this issue, led me to actually compile the following list of just what "Medicaid" is actually called in each state.
Our discussion was specifically about some seemingly odd data he found in the U.S. Census Bureau's official healthcare coverage report released the other day; he was perplexed as to how come poor people seemed to increase their rate of private healthcare coverage while less-poor people increased their publicly-funded coverage, which seems rather backwards. In any event, one of the reasons noted by myself and "HotWxTakes" is that it's likely that a large number of those responding to the survey may have simply gotten confused as to whether their own coverage falls into the "private" or "public" category...most notably, confusion over "Medicaid". As I noted, "Medicaid" is operated at the state level, not federal, and is run under different names in different states, making some amount of confusion understandable.
As a progressive Democrat, I was thrilled when I heard Donald Trump was entering the Presidential race as a Republican, for obvious reasons.
I've been as guilty as anyone of treating Donald Trump like an entertainer, a joke.
For months, I've described Trump as being "Zaphod Beeblebrox with a mean streak". More recently I revised this to "Part Zaphod Beeblebrox, part Andrew Dice Clay".
I'm cheating a bit here; CT Mirror reporter extraordinaire Arielle Levin Becker has posted the key points from the AccessHealthCT monthly board meeting via Twitter:
Now, this is very interesting to me. Yes, the 2/22/15 QHP selection totally was around 110K, but compare 96,621 as of (I assume) mid-September against the HHS Dept's Q1 and Q2 reports:
