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:

This Just In...

Gov. Pence gets federal OK for Medicaid alternative

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:

What are "pediatric benefits"?

(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:

For the past few months, the estimates of the reduction in the uninsured people in the U.S. has ranged from as low as 8-9 million to as high as 10-11 million, depending on the survey source (Gallup, Urban Institute, the Census Bureau, etc), when it was done (a lot has changed over just the past few months), whether it includes children under 18 or not, whether it includes undocumented immigrants or not and so on.

However, the official number which has been tossed around by both the White House as well as the mainstream media has pretty much settled on an even 10 million of late. It's been used in various press releases and as a talking point in Sunday morning talk shows, and President Obama even used the 10 million figure in the State of the Union.

Last Friday's weekly report for the MA Health Connector had the official QHP selection tally up to 108,051 as of January 22nd. Since then, there have been another 4,751 QHP determinations, of which around 2,100 or more should have actually selected a policy.

Note the huge gap between last Friday (3,440) and the following two days (1,311 combined). This is partly due to the weekend drop-off, but is mostly because Friday was the enrollment deadline for February coverage. Anyone enrolling on Saturday or Sunday won't have their policy start until March 1st anyway, thus the massive drop-off.

Anyway, this should mean that Massachusett's QHP total is now up to at least 110K, while Medicaid (MassHealth) enrollment are now above 200K, at 206,063.

Meanwhile, the MA exchange has also announced that due to the massive blizzard/snowstorm rolling into the area later on today, they're extending the payment deadline for people who enrolled by the 1/23 deadline out to this Friday, January 30th:

Presented without any comment on my own part, because really, WTF else is there to say here?

Alan Grayson, 2009:

 If you get sick, America, the Republican health care plan is this: "Die quickly." That’s right. The Republicans want you to die quickly if you get sick."

AEI scholar Michael Strain, 2015:

End Obamacare, and people could die. That’s okay.

...Consider this question: Should society have as its goal that the government prevents all deaths from any health-related ailment other than natural causes associated with ripe old age? The notion is absurd — to both conservatives and liberals. There are limits to the proper amount of scarce resources, funded by taxpayers, that Washington should redirect toward health care.

As Laura Clawson succinctly puts it:

I debated whether to put the "Off Topic" header in the title since this isn't about the ACA or healthcare, but this is most definitely not off topic.

Trust me, just watch this; it's about 9 minutes long. I actually cheered out loud several times.

After the one-two punches of both Rhode Island and Vermont moving in exactly the wrong direction (at least before the King v. Burwell SCOTUS decision is announced this summer), my jaw nearly dropped when I read this story out of Texas, of all states:

LEGISLATURE: Bills would create Texas' own health benefit exchange

AUSTIN -- On Wednesday, State Rep. Chris Turner (HD 101-Grand Prairie) filed two bills, HB 818 and HB 817, both creating a state health benefit exchange.