UPDATE 5/4/18: On the one-year anniversary of the House Republicans passing their ACA repeal bill, I figured it'd be a good time to once again promote my 17-minute explainer video about why the ACA was necessary, how it's supposed to work, why some parts of it are very much in need of fixing/improvement and an overview of every one of the half-dozen different repeal bills that the GOP tried to push through last year.

Over 2,500 people have watched my 17-minute 3-Legged Stool explainer video to date, and many have given it high praise (especially considering the utter lack of production value). However, there've been a few complaints about a couple of patches which are a bit slow or where the slides accompanying the audio are a bit confusing, so I've added some additional slides and reworked a few others to make it more clear. I've also noted the most significant update: That in the end, yes, the GOP did indeed repeal the Individual Mandate.

(Note: In my original tweet on this, I misstated the number of Dreamers as 800K; turns out it's a bit under 700K, apologies for my mistake)

In this corner: Over 690,000 young people who were brought the the United States as children who are now facing deportation if the Deferred Action for Childhood Arrivals (DACA) program isn't codified into law by Congress no later than March 5th (although it's actually not that simple--850 are losing their DACA protection every week already).

In the other corner: Around 9 million children enrolled for part or all of the year in the Children's Health Insurance Program (CHIP) who are on the verge of being kicked off the program if it isn't funded by Congress in the immediate future. It's officially funded through the end of March, but again, it's more complicated than that--21 states will still run out of CHIP funding as soon as the end of February, and some could lose funding as early as January 19th, the same date as the federal budget appropriation deadline.

Both of these should be no-brainers. CHIP has long had strong bipartisan support, and the CBO has concluded that funding it for five years would only cost a pittance (by federal budget standards), while funding it for ten years would actually save the federal government $6 billion.

With the big news this week about CMS giving work requirements the green light and Kentucky immediately jumping all over it, I decided to look up a few data points from some expansion states which don't include a work requirement for the heck of it:

MICHIGAN:

• As of January 8th, 2018, Michigan had 669,362 adults enrolled in the "Healthy Michigan" program (aka, ACA Medicaid expansion), or over 6.7% of the total population.
• Men make up slightly more enrollees than women (51% to 49%)
• Enrollees are spread fairly evenly by age brackets (19-24, 25-34, 35-44, 45-54 and 55-64)
• Around 80% of MI expansion enrollees earn less than 100% of the federal poverty line; the other 20% earn between 100-138% FPL.

LOUISIANA:

• As of January 8th, 2018, Louisiana had 457,178 adults enrolled in Medicaid expansion (nearly 9.8% of the population)
• Women make up 62% of enrollees

As of December 4, 2017...

Ten days ago the Washington Health Benefit Exchange reported having enrolled around 231,500 people in 2018 policies after having purged a few thousand who were auto-renewed but then cancelled. This still left them over 6,000 enrollees ahead of last year's final total of 225,600.

Today, with one day left for people to sign up before the January 15th deadline, the Seattle Times reports that WA's tally is up to 234,000:

Washington state is on pace to increase the number of people with health insurance despite efforts by the Republican Congress and the Trump administration to gut the laws known as Obamacare that expanded insurance coverage across the nation.

*UPDATE: Some have accused me of hyperbole in the headline because a) it's a "state-approved health or financial literacy" course, not a "can you read" test and b) because it would only be required if they're unable to meet the requirements in other ways. I guess I can see their point, but it strikes me as splitting hairs:

First, "literacy course" was their wording, not mine (I guess there's a distinction between "completeing a course" and "passing a test"?).

Second, there doesn't appear to be any real description of the "courses" in question--how long it is, what the criteria for measuring "completion" is, who would be conducting the course, whether you'd have to attend classes in person (vs doing so online?), how many sessions there'd be and so forth. Here's the description as laid out in the waiver request itself:

h/t to Mike Bertaut for the head's up on this:

Landmark lawsuit: ACA employer mandate case costs Dave & Buster’s $7.4M

...After trying — and failing — to get a high-profile lawsuit dismissed, Dave & Buster’s agreed to pay $7.425 million to settle the suit, which accused the restaurant and entertainment chain of illegally cutting staffers’ hours to prevent them from receiving healthcare benefits.

...As HR Morning covered previously, the ERISA lawsuit was the first case in which an employer was accused of intentionally interfering with employees’ hours to avoid the ACA’s employer mandate.

The lawsuit hinged on a very specific section of ERISA — the employees sued under ERISA Section 510.

Granted, ERISA was written primarily to apply to retirement plans. But Section 510 can be applied to a number of benefit plans as well — including healthcare coverage.

Section 510 says (the critical parts are in bold):

Whenever I write or talk about the 3-Legged Stool of the ACA and the actual flaws in the law (as opposed to the ones deliberately created by the GOP), I usually focus on two "gaps" in the legs: The APTC subsidies getting cut off at 400% FPL and being too stingy below that level, and the individual mandate not being large enough (and not being properly enforced). As it happens, part of the first problem has already been unintentionally "solved" thanks to Trump's ham-handed CSR reimbursement cut-off (which ended up increasing APTC tax credits for those below the 400% cut-off), while the second problem has just been made a whole lot worse thanks ot the GOP repealing the mandate altogether.

However, in focusing on the legs of the stool, I often forget to mention another important issue: The width of the seat itself. That is, how wide the network of doctors and hospitals which accept the policy is. The Affordable Care Act does give some guidelines/regulations about how wide ACA-compliant policy networks have to be, like so:

Of all the state-based exchanges, the one in DC has gone the longest without a formal enrollment update; the last one only included data through December 5th, a whopping 5 weeks ago. Fortunately, the DC board of directors held their monthly meeting last night and produced the following update.

As shown, the tally as of 1/8/18 is 21,352 QHP selections, slightly below last year's 21,437 as of the same date. Since DC (along with California and New York) are sticking with the full 3-month Open Enrollment Period, it should provide a good apples-to-apples comparison (and the fact that very few DC enrollees have CSR assistance also means there's a nominal CSR loading impact, either).

The final, official DC ACA exchange tally last year was 21,248, so technically speaking they've already surpassed that figure...but again, it was 21,437 as of 1/8/17, which means there were at least a few hundred people who were dropped off at the tail end due to cancelling or non-payment of their first premium.

Last week the Congressional Budget Office reported that funding the CHIP program for 5 years, which they had previously estimated would increase the federal deficit by about $8 billion over the next decade, would instead only increase it by about 1/10th as much: Roughly $800 million, a rounding error when it comes to the federal budget. The reason for this isn't that funding CHIP had suddenly become less expensive, it was instead, ironically, because due to the GOP repealing the ACA's individual mandate starting in 2019, NOT funding CHIP has suddenly become more expensive.

OK, first of all, here's the actual press release from CMS about it:

CMS announces new policy guidance for states to test community engagement for able-bodied adults
Will support states helping Medicaid beneficiaries improve well-being and achieve self-sufficiency

CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries. The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities – including skills training, education, job search, volunteering or caregiving – would be a condition for Medicaid eligibility for able-bodied, working-age adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.

In other words, work requirements for Medicaid expansion enrollees are now officially on the table.