Sorry, that's really the only headline which came to mind when I read this story:

Ryan wants to end Obamacare cost protections for sick consumers

U.S. House of Representatives Speaker Paul Ryan called on Wednesday for an end to Obamacare's financial protections for people with serious medical conditions, saying these consumers should be placed in state high-risk pools.

In election-year remarks that could shed light on an expected Republican healthcare alternative, Ryan said existing federal policy that prevents insurers from charging sick people higher rates for health coverage has raised costs for healthy consumers while undermining choice and competition.

The rule, a cornerstone of President Barack Obama's Affordable Care Act, has been praised by patient advocates for providing access to medical care for people who previously could not afford private health insurance. The Affordable Care Act also bars insurers from excluding coverage for pre-existing conditions.

Maryland's ACA exchange saw a dramatic 35% year over year enrollment increase during the 2016 Open Enrollment Period, totalling 162,177 QHP selections.

I was just informed by the MD Health Benefit Exchange that as of April, their effectuated individual enrollments are down to 139,379 people. That's a drop of just over 14%. This is completely in line with my numbers for 8 other states.

Last fall, Aetna reported a total of 1.1 million members in the individual market as of the 3rd quarter, including both ON and OFF exchange enrollees. That was broken out as 815,000 exchange-based (74%) and 280,000 off-exchange (26%).

Just moments ago, Bob Herman reported:

$AET finished Q1 with 1.2 million individual members. (Not sure of #ACA exchange vs off exchange breakout.)

— Bob Herman (@MHbherman) April 28, 2016

Herman just reported that the actual number of exchange-based enrollees is 911,000, a drop of 4.1% year over year.

Noteworthy: Aetna's exchange-based indy enrollments have inched up to 76% of their total indy market.

Here's what the Big Boys are looking like so far:

A few months ago I noted that while UnitedHealthcare and some other carriers may be losing money hand over fist on the ACA exchanges, at least some of them are making a profit, breaking even or at least cutting their losses down to a reasonable level.

In the past few days, this has become increasingly clear, as Centene's news from yesterday shows.

As Kevin Drum at Mother Jones notes (quoting Richard Mayhew of Balloon Juice):

As a simple reminder, competitive markets should see some companies make money and some companies that offer more expensive and less attractive products lose money. I would be extremely worried if everyone was making money after three years, just like I would be extremely worried that everyone was losing money after three years of increasingly better data.

Over the past week or two I've been compiling the currently effectuated exchange enrollments for as many states as possible (the official Q1 ASPE effectuation report likely won't be available until early June). So far I have the data from either February, March or April for 7 states: CO, CT, MA, MN, NH, OK and WA.

Today I can add Idaho to the list, and unlike some of the other states, Your Health Idaho's number appears to not only be cut & dry, but very good news indeed:

Hello Mr. Gaba,

Your Health Idaho’s effectuated enrollments for March stand at 95,522. Numbers for April are preliminary at this point.

That compares to 101,073 QHP selections as of the end of the 2016 Open Enrollment Period, which means that as of 3/31/16, Idaho had only lost 5.5% of their total enrollments, which is fantastic considering the 13-17% drop on average from the other states so far.

With all the gloom & doom over UnitedHealthcare pulling out of over 2 dozen states next year due to large losses on ACA exchange policies, one might wonder whether anyone is actually making money on the exchanges.

Well, today, Centene appears to have answered that question:

Centene (a Medicaid insurer) is achieving profit margins on its #ACA exchange plans "at the higher end of our targeted range."

— Bob Herman (@MHbherman) April 26, 2016

Last fall, Centene's quarterly report stated that they had around 155,600 ACA exchange enrollees nationally, or just 1.7% of the total, so this might not seem that significant.

HOWEVER, I just checked their Q1 2016 10-Q report, and there's an eye-opener on page 24:

The UnitedHealthcare Dropout Odometer grew by two more states today, as both Kentucky and Iowa were scratched off the "2017 Exchange Participation" list.

However, there's some positive news for Iowa, at least; as noted by Cynthia Cox and reported on by Tony Leys of the Des Moines Register, Wellmark is joining the Iowa exchange next year:

Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies.

Wellmark Blue Cross & Blue Shield has not participated in the Affordable Care Act’s online health insurance marketplace, which launched in the fall of 2013. The main effect of the company’s decision was that moderate-income Iowans could not choose Wellmark insurance if they wanted to purchase policies that qualified for new federal subsidies to help pay premiums.

A couple of weeks ago I noted that New Hampshire may be the only state on the federal exchange which actively tracks their effectuated exchange enrollment on a monthly basis.

At the time, I noted that unlike most states, their effectuated numbers seem to have increased from February to March (January doesn't really apply since Open Enrollment was still ongoing at the time):

• January 2016 Exchange-Based QHP Enrollment: 49,937 (+33,604 PAP enrollees)
• February 2016 Exchange-Based QHP Enrollment: 53,109 (+38,735 PAP enrollees)
• March 2016 Exchange-Based QHP Enrollment: 55,212 (+43,732 PAP enrollees)

Well, thanks to Louise Norris for the heads up: NH's April numbers are out, and there's something odd:

According to the Kaiser Family Foundation, California averaged around 7.8 million Medicaid/CHIP enrollees prior to the ACA; this number has since shot up about 58%, to 12.3 million people.

One of the chief arguments in favor of the ACA has always been that uninsured people tend to not get treated for ailments/injuries at all (for obvious reasons), and then end up going to the emergency room when that gangrenous foot leaves them no choice. Not only does this end up costing much more to treat, the hospital is also stuck footing the bill (no pun intended) since the uninsured also tend not to have any money to pay out of pocket either (if they did, the odds are that they'd have some form of insurance, after all).

Sometimes you just need the headlines to tell the story:

• 09/25/15: NEW YORK: Health Republic 4th ACA Co-Op to close down

• 11/01/15: NEW YORK: Good grief. Health Republic CO-OP enrollees won't even be covered thru the end of 2015.

• 11/03/15: NEW YORK: Up to 166K people facing literal disaster in 12 days due to bureaucratic f*ckups.

• 11/07/15: NEW YORK: Latest Health Republic Co-Op developments not exactly confidence-building