Ah. OK. Well, this time it's different, because this time, the Republican-controlled Senate has signed onto repealing the ACA as well, which means that it'll actually make it as far as President Obama's desk for once, requiring him to...pull out a pen and veto it.
...as Majority Leader Kevin McCarthy puts it, that’s the goal: “With this bill, we will force President Obama to show the American people where he stands.”
One of the many standard Republican talking points when it comes to healthcare is this old chestnut:
"Let insurance carriers sell their products across state lines!!"
I've never quite understood why this was supposed to be such a panacea, but I guess it's supposed to have something to do with "removing burdensome government regulations!" and "allowing the Invisibile Hand of the Free Market" to work it's wonders, bla bla bla. The idea is that the carriers have, until now, staked out their turf and aren't allowed to compete with each other outside of their home states; presumably, if they were allowed to do so, prices would drop accordingly due to competitive pricing, etc etc.
Long-time readers may have noticed that unlike private QHP enrollment, I've sort of given up on trying to track Medicaid expansion numbers at the state-level on the Medicaid Spreadsheet this year. Quite frankly, there's simply too much missing data and way too much "churn" in Medicaid for me to keep track of it at that granular level. Instead, I've just been looking at the Medicaid numbers from the national level, guided by CMS's monthly reports...but I've proven to be pretty accurate with my proejctions on those trends so far, so I'm not too concerned about it.
Starting Friday, low-income Montanans covered by Montana’s expanded Medicaid program can start using their coverage – and 20,000 people have already signed up.
Connect for Health Colorado® and Colorado Medicaid Report Enrollment Gains of More Than 169,000
January 5, 2016
DENVER — Between Nov.1 and Dec. 31, more than 169,000 Coloradans enrolled in health coverage for 2016, either in private health insurance purchased through the state health insurance Marketplace or in Medicaid, or Child Health Plan Plus (CHP+), according to new data released today by Connect for Health Colorado® and the Colorado Department of Health Care Policy and Financing.
“We are very happy with the enrollment growth during the first two months of this open enrollment period,” said Connect for Health Colorado® CEO Kevin Patterson. “But I want to urge everyone who does not have health insurance provided through their employer to act now to provide financial security for their families and to avoid a penalty of nearly $695 or more. The final deadline for 2016 coverage –Jan. 31 – is fast approaching.”
Rhode Island, which already had one of the later deadlines in the first place, just bumped it out even later...all the way out through December 29th. However, having such a small population, Rhode Island's latest update still doesn't move the needle that much:
INDIVIDUAL AND FAMILY ENROLLMENT As of January 2, 2016:
34,627 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.
Nearly all of these individuals are current HSRI enrollees that have been autorenewed into a 2016 plan.
4,462 of the 34,627 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.
27,124 of the 34,627 individuals are enrolled in 2016 coverage through HSRI, and have paid their first month’s premium.
A new study further undercuts a major claim by critics of the Affordable Care Act, who contended that the law would encourage companies to slash full-time workers' hours and shift them into part-time work in order to avoid having to offer them health insurance.
The study "found little evidence that the ACA had caused increases in part-time employment as of 2015," according to a summary of its findings published in the journal Health Affairs on Tuesday.
In 2014 and 2015, the Washington State ACA exchange was one of a handful of exchanges which also handled the billing for QHP enrollees...and in their case, ran into a lot of technical problems in doing so. This year, they've given up on trying to handle the payments themselves, offloading them to the actual insurance carriers as most other states do. I have no idea how much impact this change has had as opposed to improved outreach, the individual mandate penalty increase and so on, but whatever the reasons, WA's numbers are dramatically improved this year:
The Washington Health Benefit Exchange today announced that nearly 174,000 residents have signed up for or renewed their health coverage as 2016 open enrollment enters its final month. The deadline to select a Qualified Health Plan through wahealthplanfinder.org is Jan. 31 for coverage effective March 1. Customers who select a plan by Jan. 23 will have their coverage start Feb. 1.
I've been getting a little worried about the Minnesota exchange of late. Their first two years were pretty rough, and their most recent update prior to today had them at only 26.5K QHPs as of 12/13. Of course, that didn't include the critical final few days before the January enrollment deadline...nor did it include the extended deadline for Minnesota, which was pushed all the way out to 12/28.
Abby Goodnough had an interesting story in the NY Times yesterday about the fact that for some people, simply paying the Affordable Care Act's "Shared Responsibility" tax (otherwise known as the Individual Mandate penalty) may actually be more affordable than actually signing up for an ACA-compliant healthcare policy.
I've written about this before, of course. It is absolutely true that for some people (the Kaiser Family Foundation estimates roughly 7.1 million people), their mandate tax (whether a flat $695/person or 2.5% of their household income, whichever is greater) is indeed less than the annual premiums for the lowest-cost policy available in their area (even after taking federal tax credits (APTC) into account). By KFF's estimates, the mandate tax would cost more than the least-expensive policy for only around 3.9 million currently-uninsured Americans (although the actual number of uninsured who could potentially enroll in exchange policies, whether with APTC or at full price, seems to be closer to 15 million according to the very same KFF study from which they stated the 11 million figure...I'm not sure what accounts for the 4 million difference, but that's actually besides the point here).
Now, as I noted in my own analysis of the potential impact of the mandate tax on "Young Invincibles", I noted that given a choice between paying $X for nothing and $X + (some variable amount) for a ACA-compliant healthcare policy, my guess is that most people are likely to still go ahead and sign up as long as the cost is less than perhaps twice as much, even if the plan itself seems somewhat skimpy.
In other words, if the choice is between a $700 penalty for bupkis and, say, $1,000 for a Bronze plan (43% more), most people will probably go ahead and spring the extra $300...but they if the least-expensive plan is more than twice the penalty (say, $1,500) they're much more likely to say "screw that!" and just pay the tax. Again, I'm not basing this on any hard analysis, it's just my gut instinct; I could be wrong about this.
Three portions of the total are eligible to enroll in private policies through the ACA exchanges: "Tax Credit Eligible", "Ineligible for Financial Assistance due to ESI Offer" and "Ineligible for Financial Assistance due to Income" (22%, 15% and 12% respectively). It's important to remember that "Ineligible for Financial Assistance" means that they can enroll through the ACA exchanges, they just have to pay full price if they do so. Many of these folks will simply enroll off-exchange, directly through the insurance carriers, but there's nothing preventing them from going through the exchange instead.
