For years now, I (and many other healthcare wonks) have been arguing that one of the most important fixes/improvements that the ACA needs regardless of the Next Big Thing® is to #KillTheCliff...that is, to eliminate the infamous "subsidy cliff" which hits those who earn just over the 400% Federal Poverty Level income cap for Advance Premium Tax Credit (APTC) assistance.

Once again: Under the ACA, if you earn between 100-400% FPL (between $12,140 and $48,560 for a single person), you're eligible for APTC assistance on a sliding scale. The formula is based on the premium for the Silver "benchmark" plan available in your area, which averages around $611/month in 2019.

Here's how the formula works under the current ACA wording:

*(Yes, that's sarcasm...it's been anything BUT "just like that" in Maine...)

Openly racist and mini-Trump GOP Maine Governor Paul LePage spent the better part of the past eight years blocking the expansion of Medicaid under the Affordable Care Act. First, he vetoed the Medicaid expansion bills passed by the state legislature a whopping seven times. Then, when Maine voters finally had enough and successfully passed a statewide ballot initiative to force the issue, LePage spent another full year continuing to fight against actually implementing the expansion provision via legal challenges and flat-out violation of court orders.

This happened while I was out of town, but it's welcome news nonetheless...

Governor Northam Announces Medicaid Expansion Hits Milestone with More Than 200,000 Enrolled
Virginians can apply at any time of the year

RICHMOND—Governor Ralph Northam announced Friday that more than 200,000 Virginia adults are now enrolled and will have health coverage starting January 1. The achievement marks a major milestone in the Medicaid expansion initiative approved last summer.

“This bipartisan initiative has empowered men and women across the Commonwealth to take an active role in improving their health,” said Governor Northam. “The historic response from our citizens demonstrates the need for access to health coverage that will benefit our families, our communities and Virginia’s economy. I encourage uninsured individuals to learn more about this new health coverage opportunity and to apply today.”

OK, with the FINAL HC.gov Report having been released, I can now fill in even more blanks in the 2019 Open Enrollment Period: A grand total of 11.24 million 11.3 million QHP selections nationally so far. That includes 8.41 million on the federal exchange, plus another 2.82 million 2.9 million on the 12 state-based exchanges.

If the counting were to stop right here, the total would be 3.9% 3.8% lower than last year nationally, which would actually be pretty good all things considered.

HOWEVER, it isn't over yet. Deadlines in several state-based exchanges haven't expired yet. New York and DC are open for business until January 31st, and many people in Alaska, Georgia and Florida still have time to enroll due to last fall's earthquake and hurricanes.

Here's what it looks like as of right now:

New York State of Health just became the 6th State-Based Exchange (SBE) to officially surpass last year's final Open Enrollment Period total:

Press Release: NY State of Health Announces Qualified Health Plan Enrollment Tops January 31, 2018 Level
Jan 4, 2019

• Still Time to Enroll
• Consumer Demand for Affordable Coverage is High

ALBANY, N.Y. (January 4, 2019) - NY State of Health, New York’s official health plan Marketplace, today announced that as of January 1, 2019 more than 254,000 New Yorkers have enrolled in a Qualified Health Plan (QHP). With less than one month to go in the 2019 Open Enrollment Period, the number of QHP enrollees has already exceeded QHP enrollment at the end of the 2018 Open Enrollment Period.

Minnesota's ACA exchange, MNsure, last reported having enrolled over 113,000 people in Qualified Health Plans (QHPs) as of the first December 15th deadline, putting them just 3,300 enrollees behind last year's final total of 116,358 QHPs.

However, MN is one of the states sticking with an extended deadline this year, which means their 2019 Open Enrollment Period is still going on through January 13th...and they just reported having broken last year's total with 11 days remaining for Minnesotans to #GetCovered:

There is Still Time to Get Covered—MNsure's Open Enrollment Period Ends January 13
January 3, 2019

So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet. 2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!

• In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st

• In the District of Columbia and New York, open enrollment runs through Jan. 31st for coverage starting March 1st

ALSO...

For four years now, I've been meticulously tracking and analyzing the annual premium rate change filings on the individual market (and usually the small group market) for pretty much every insurance carrier in every state, then consolidating all of that data into tables which break out the weighted average premium increases (or decreases, in some cases) on a state-by-state and national basis. Each year I've been proven to be pretty damned accurate:

It's been pretty obvious for the past two years that the states which fully control their own ACA exchanges (including their own marketing and outreach budgets and their own exchange website platform) seem to be outperforming the states hosted by the federal exchange, HealthCare.Gov, in terms of open enrollment numbers year after year.

However, this can be a bit tricky to compare because some of the states have shifted back and forth...four states which ran their own platform for the first one to three years (Hawaii, Kentucky, Nevada and Oregon) moved home to the mothership in later years, while one state (Idaho) did the reverse--they stuck with HC.gov for 2014 but then broke off onto their own platform after that.

Yeesh...when it rains, it pours! Right on top of updated and/or final 2019 Open Enrollment numbers 41 states (Idaho, Rhode Island and the 39 states hosted by HealthCare.Gov) comes yet another updated tally from Massachusetts:

As of today:

• 274,317 enrollments for January
• 2,997 enrollments for February or March
• 3,763 plans selected (1st premium not paid but not due yet)
• 281,077 total

Retention rate is 91 percent, up 2.6 percent from last year.

The total is only 252 higher than their last update as of December 17th, but that's not surprising considering that we had both Christmas and New Year's in between. Again, MA has managed to improve their enrollment number every year for 5 years straight, an impressive feat indeed!

Again, Massachusetts' total from last year was 267,260 QHP selections, which means they're now 5.2% ahead of last year's final number...with 3 weeks left to go!