It's finally here, and just in the nick of time for the U.S. Senate's big vote on whether to scrap the Individual Mandate or not.

In around 15 minutes, I guarantee that you’ll understand how the ACA’s 3-legged stool works and why the Individual Mandate, while being about as popular as a root canal, still serves an important function. Don’t forget the popcorn!

(Oh, and if you'd like to help support my work, please feel free to do so via either my Patreon or GoFundMe accounts, thanks!)

A week or so ago, Connect for Health Colorado reported that they'd enrolled 22,650 people in ACA exchange plans as of November 14th, up a full third over last year by the same date. Today they've posted their third week numbers, and while things have started to slow down, they're still running 25% ahead of last year.

Given the whole Silver Load/Silver Switcharoo craziness, I was mildly surprised to see that the ratio between Bronze, Silver and Gold have barely changed year over year, and in fact Silver has inched upward by a few points...until I remembered that Colorado is among the few states which went with the "broad load" model, spreading the additional CSR cost across all metal levels both on and off the exchange. This makes the similar metal level spread more understandable, but it also makes the 25% enrollment increase even more surprising, since subsidized enrollees will pay pretty much the same (no more or less) than this year, but unsubsidized enrollees are seeing their rates shoot up no matter where they go. As you can see below, the average premiums for unsubsidized enrollees ("NFA" = "Non-Financial Assistance) is 36.6% higher this year than last.

Not an official update, but I just saw this from KXRA's Voice of Alexandria:

(St. Paul, MN) -- More than 100-thousand Minnesota residents have enrolled in the state's MNSure health insurance purchasing exchange. And about 50-thousand families are expected to get average tax credits of 72-hundred dollars to help pay for their coverage. Credits are higher in southeast and southwest areas. MNSure C-E-O Allison O'Toole says they can make the difference between "unhealthy and healthy" for thousands of people -- and yet, she says too many residents are not taking advantage. The open enrollment for MNSure runs through January 14th -- and O'Toole says that for at least a couple years, the tax credits will remain in place regardless of what happens to Obamacare in Congress.

That's the enitre article...it's dated yesterday (11/24), so I'm assuming the 100K figure was as of Thursday evening (Thanksgiving, Nov. 23rd).

 

(h/t to former CCIIO Director Gary Cohen for the reminder)

You've probably never heard of the Center for Consumer Information & Insurance Oversight (CCIIO)...

The Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight (CCIIO), part of the Department of Health & Human Services (DHHS), provides national leadership in setting and enforcing standards for health insurance that promote fair and reasonable practices to ensure that affordable, quality health coverage is available to all Americans. The center also provides consumers with comprehensive information on coverage options currently available so they may make informed choices on the best health insurance for their family.

...but among other things, they're the folks who actually implement the ACA, including, among other things, HealthCare.Gov (I'm not sure if it's the same team that operates HC.gov or not...probably a lot of overlap between the two?).

Consumer Information and Insurance Oversight

Ensuring the Affordable Care Act Serves the American People

As I keep noting, early enrollment numbers can be extremely misleading, especially given the half-length Open Enrollment Period this year. Yes, enrollments via the federal exchange are up around 38% year over year so far, as well as being up 40% in Massachusetts, 3% (including auto-renewals) in Maryland, 33% in Colorado and so forth...but the shorter period could simply mean that more enrollments are being "front-loaded" this year. It's still all about how big the 12/15 surge is, along with how many NEW enrollees are added.

On the one hand, I nailed the Week Three HC.gov number almost perfectly (I projected 2.3 million, the actual number is 2,277,079). Yay, me! Only off by 1%! On the other hand, I seriously underestimated the first two weeks, so I'm not patting myself on the back too much. It's an insane year with too many unknowns for me to do much more than throw darts at the board. Still, I'll take credit where I can.

In addition, CMS has also started breaking the numbers out by state, which helps analysts look for trends and cause/effect relationships, so let's jump in!

First, the main numbers:

I used to track the monthly Medicaid/CHIP enrollment reports issued by CMS, watching as the numbers rose dramatically thanks to ACA Medicaid expansion.

I pretty much stopped doing that about a year ago, however, since the expansion numbers have mostly petered out. ACA Medicaid expansion actually has continued to climb a bit more since January, and is likely somewhere around 16 million people as of now, but it's also been partly cancelled out by a slight drop in standard Medicaid enrollment as the economy has continued to improve in general. In short, there's little reason to keep writing the same update every month.

 

(h/t to nmbrmnstr via Twitter for the heads up)

As part of their Godawful "tax reform" bill, Congressional Republicans have decided to toss repealing of the ACA's individual mandate penalty into the mix, partly because they've always hated it but mainly because doing so would allegedly save the federal government $338 billion over the next decade...which in theory would be enough to keep the total increase in the federal deficit bythe tax bill below the $1.5 TRILLION mark (yes, you read that correctly: $1.5 TRILLION, with a "T").

It's my understanding that if they can't keep it below that threshold, the bill won't go through for some obscure Senate rule reason or another (although apparently White House budget director Mick Mulvaney also stated that they really don't give a crap whether the mandate is repealed or not as long as the larger bill gets passed, so perhaps I'm mistaken about this? Need clarification on this point...)

Press release from the Massachusetts Health Connector...

BOSTON – November 20, 2017 – With a stable system and user process complemented by a proactive outreach and education effort, the Massachusetts Health Connector has seen members and new applicants more active in the first two weeks of Open Enrollment compared to last year.

Through Nov. 15, plans selected and enrollments are more than 40 percent higher than last year at the same time, new program determinations for Health Connector are up nearly 70 percent, and plans selected and enrollments by new members are up more than 15 percent.

“It is encouraging to see people hearing our message to shop for new coverage, and taking early advantage of Open Enrollment and finding the plan that best fits their needs for the new year,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We hope all of our current members take time to review their coverage for next year, and people who don’t currently have health insurance sign up so they have the health and financial security that comes with having coverage next year.”

Not much of an update, but good to see a hard number officially posted at AccessHealthCT (I assume they'll be updating this regularly from the looks of it):

 

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