via Clarisse Loughrey of The Independent:

Early concept art has revealed a very different look for Toy Story's dynamic duo, Woody and Buzz Lightyear.

Pixar's first feature started life as a full-length take on their short Tin Story, which saw a mechanical drummer attempting to navigate his way through a baby's playroom. The drummer was soon ditched for a more glamorously conceived "space toy" named Lunar Larry, later renamed Buzz Lightyear in honour of famed astronaut Edwin "Buzz" Aldrin.

The original concept pitched its drummer against an antagonistic ventriloquist's dummy, who gradually evolved into a pull-string cowboy doll named Woody, inspired by Western actor Woody Strode.

Yes, Woody was originally the bad guy; though his character didn't prove popular with his voice actor Tom Hanks, who reportedly shouted "This guy is a jerk!" while recording lines for the story reel.

In U.S. politics, the Hyde Amendment is a legislative provision barring the use of federal funds to pay for abortion except to save the life of the woman, or if the pregnancy arises from incest or rape. Legislation, including the Hyde Amendment, generally restricts the use of funds allocated for the Department of Health and Human Services and consequently has significant effects involving Medicaid recipients. Medicaid currently serves approximately 6.5 million women in the United States, including 1 in 5 women of reproductive age (women aged 15–44).

Federal dollars can't be used to pay for abortion outside of the above restrictions, but Medicaid is funded via hybrid federal/state funding, so there are 15 states where Medicaid does pay for abortion using the state's portion of the funding.

Yesterday I posted an entry which gained some attention in which I noted that yes, Bernie Sanders' specific single payer bill (aka "Medicare for All", S.1804) would in fact eliminate "nearly all" private healthcare insurance...and in fact, that's one of the primary selling points of the legislation in the first place. I wasn't arguing for or against the bill, mind you, I was just asking supporters to stop misleading people about this point.

Note: I'm going to use "Bernie-MFA" going forward instead of just "MFA" because the term "Medicare for All" has been turned into some sort of catch-all rallying cry for universal coverage even though there are major differences between some of the bills and proposals on the table, and on this subject it's important to be clear about which bill I'm talking about.

I'm rather late to the game on this issue, but it looks like the story is already making major headlines elsewhere so I don't feel too bad; via Robert Pear of the NY Times:

In Utah and Idaho, G.O.P. Looks to Curb Medicaid Expansions That Voters Approved

The voters of Utah and Idaho, two deeply Republican states, defied the will of their political leaders in November and voted to expand Medicaid under the Affordable Care Act. Now those leaders are striking back, moving to roll back the expansions — with encouragement, they say, from the Trump administration.

Utah’s ballot measure, approved with support from 53 percent of voters, would expand Medicaid to cover people with incomes up to 138 percent of the poverty level — up to about $16,750 a year for an individual — and pay the state’s share with a small increase of the sales tax. Under the ballot initiative, 150,000 people are expected to gain coverage, starting April 1.

As the 2020 Presidential race starts to heat up, one of if not the biggest issue which will be on the minds of every Democratic candidate and primary voter will be about the Next Big Thing in U.S. Healthcare policy.

By the time January 20, 2021 rolls around, the Affordable Care Act will be just shy of 11 years old...assuming, that is, that it manages to survive the insanely idiotic #TexasFoldEm lawsuit (as an aside, it looks like the 5th Circuit of Appeals will likely take up the case this July).

The ACA has done a fantastic job of expanding healthcare coverage to over 20 million more people, lowering or eliminating costs for millions of them, and completely changing the zeitgeist about what's acceptable (no longer acceptable: denying coverage to or discrimininating against those with pre-existing conditions). Unfortunately, while it was a major step forward, it was still only a step, and between its intrinsic limitations, original flaws and major incidents of sabotage both passive (refusal to expand Medicaid in many states) and active (the Risk Corridor Massacre, CSR cut-off, mandate repeal, etc), the Democratic base is hungry for a truly universal healthcare coverage system.

And so, the $64,000 question for every 2020 Democratic candidate is whether or not they support "Medicare for All"...and, as a subsection of that, do they insist on "Medicare for All" as the only way forward.

This just in via NY-based Politico healthcare reporter Dan Goldberg...

@charles_gaba final tally from NY: QHP 271,873; EP 790,152; 22% enrollees were new and 78% re-enrolled for a QHP. Number were 12%, 88% for EP

— Dan Goldberg (@DanCGoldberg) February 4, 2019

This is 6,664 QHP selections higher than the 1/29 tally, or slightly more than the 5,000 I expected NY to tack on for the final two days of Open Enrollment. New York wrapped things up with an impressive 7.4% increase in QHP enrollees over last year and a 6.9% increase in Essential Plan (BHP) enrollment.

UPDATE: Here's the official press release with a few more details:

The Minnesota ACA exchange, MNsure, wrapped up their 2019 Open Enrollment Period on January 13th, and recently released three big reports chock full of wonky healthcare data nerd goodness. I'm mostly going to just repost some of the key graphs/charts, but make sure to read the full reports for all the details:

The annual report is mostly full of inside baseball administrative info, but the first two reports have lots of stuff of interest to the average reader of this site:

First up, their January board meeting slideshow:

Things have been happening so quickly of late that I'm getting farther and farther behind on some important healthcare policy developments, particularly at the state level. There are two extremely important Public Option announcements which could be game changers if they make it through the legislative process.

Since I don't have time to do full write-ups on either one right now, I'll just present these summaries:

My friend and colleague Colin Baillio, policy director of Health Action New Mexico, has been working on this for a long time, and it looks like this project has finally entered the legislative stage:

LUJÁN APPLAUDS INTRODUCTION OF MEDICAID BUY-IN LEGISLATION IN NEW MEXICO

This Just In from DC Health Link...

DC Health Link Extends 2019 Open Enrollment Deadline to Wednesday, Feb. 6

Washington, DC­­ – DC residents will have an additional six days to sign up for 2019 health insurance coverage through DC Health Link.  The new deadline to sign up is 11:59pm on Wednesday, February 6.  Individuals who sign up by that deadline will have coverage beginning March 1, 2019.

DC Health Link customer service representatives will be available today at (855) 532-5465 from 8:00am to 8:00pm and on Monday, February 4th through Wednesday, February 6th to work with individuals seeking to enroll in health insurance coverage effective March 1. In-person assistance will also be available at enrollment centers throughout the District to assist residents with the enrollment process through February 6th.

The 2019 ACA Open Enrollment Period has finally officially ended nationally. HOWEVER...

  • GEORGIA residents in 69 counties (around 1.37 million people) who were impacted by last fall's hurricanes have until February 20th to enroll by calling HC.gov directly at 800-318-2596.
    • Counties Eligible: Appling, Atkinson, Bacon, Baker, Ben Hill, Berrien, Bleckley, Brooks, Bulloch, Burke, Calhoun, Candler, Chattahoochee, Clay, Coffee, Colquitt, Cook, Crawford, Crisp, Decatur, Dodge, Dooly, Dougherty, Early, Echols, Emanuel, Evans, Glascock, Grady, Hancock, Houston, Irwin, Jeff Davis, Jefferson, Jenkins, Johnson, Jones, Laurens, Lee, Macon, Marion, Miller, Mitchell, Montgomery, Peach, Pulaski, Putnam, Quitman, Randolph, Schley, Screven, Seminole, Stewart, Sumter, Tattnall, Telfair, Terrell, Thomas, Tift, Tooms, Treutlen, Turner, Twiggs, Washington, Webster, Wheeler, Wilcox, Wilkinson, Worth

As I noted a few weeks ago, I haven't written a whole lot about the idiotic (but terrifyingly so) TexasFoldEm lawsuit in awhile. Part of this is because I was out of the country over the holidays; part is because there hasn't been a whole lot of movement on the case since right-wing federal Judge Reed O'Connor ruled that the ACA was unconstitutional using a legal argument so thin it hula hoops with a Cheerio.

Anyway, when I last checked in, a coalition of Attorneys General from 16 states (plus the District of Columbia) had formally filed to appeal Judge O'Connor's ruling, and the U.S. House of Representatives had also formally voted to intervene on behalf of defending the ACA from the lawsuit, which was filed last year by a coalition of 18 Republican Attorneys General, plus two Republican Governors.

I debated whether or not to upload another update now instead of waiting for DC & NY to wrap things up, but figured what the hell.

I still expect the final national QHP selection tally to increase by around 35,000 more when the dust settles, including perhaps 1,000 more from DC, 5K - 10K more from New York and around 28,000 from Vermont (which hasn't reported anything so far this Open Enrollment Period). If so, the official total should end up around 11.47 million nationally, with the 12 State-Based exchanges coming in around 1.6% higher than last year (an all-time high for them collectively) vs. the 39 states on the federal exchange, which dropped another 3.8% this year. Nationally, the official total should end up around 280,000 enrollees short of last year.

Last night, in response to CMS Administrator Seema Verma taking shots at both Covered California (for blaming their drop in new enrollment on the federal mandate being repealed) and New Jersey (for seeing a 7.1% exchange enrollment drop in spite of reinstating the mandate), I wrote a long analysis which noted that:

  • Verma may have a valid point, but...
  • There's not nearly enough data available to know one way or the other (especially the missing off-exchange data for this year), and...
  • Even if she turns out to be correct about NJ's total enrollment drop, NJ reinstating the mandate still resulted in a substantial premium drop for well over 100,000 residents.

Today, I was able to fill in some of that missing data...although some of it is still frustratingly absent.

So, a couple of hours ago, CMS Administrator Seema Verma tweeted out the following:

.@coveredca blames subpar enrollment on no federal mandate penalty, but NJ kept penalty and saw much, much bigger drop. Forcing Americans to buy insurance they can’t afford isn’t the answer.

— Administrator Seema Verma (@SeemaCMS) January 31, 2019

Last fall, I reported that thanks to the one-two punch of a) reinstating the ACA's individual mandate penalty at the state level and b) using the revenue generated from the mandate penalty to help fund a robust reinsurance program, the state of New Jersey had successfully lowered average unsubsidized premiums for 2019 individual market policies by a net swing of nearly 22 percentage points.

With Covered California releasing their final, official 2019 Open Enrollment Period data, and the latest updates from New York (which still has 2 days to go) and Massachusetts (which wrapped up last week), I now nearly all 2019 OEP data on hand.

I say nearly all because there are still three numbers missing:

  • Vermont has yet to release any 2019 enrollment data. This is the 3rd year in a row that they've been radio silent. Assuming they're close to last year (28,763 QHP selections), they should add around 28,000 to the national total.
  • New York still has 2 days left for people to #GetCovered. I'm going to assume they'll tack on perhaps 5,000 more people today and tomorrow.
  • The District of Columbia hasn't posted any updates since December 11th, which means not only do they still have 2 days for people to sign up, they're actually missing a whopping 51 days worth of enrollment data. Again, assuming they wrap up close to last year, that should mean another 1,400 or so from DC.

Between the three, I'd expect another ~34,000 QHP selections to be tacked onto the totals below.

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