OK, this one may seem a bit petty, but I'm recovering from a nasty flu at the moment (healthcare!!), so I'm in kind of a petty mood this morning.

Yesterday, Michael Cannon of the CATO Institute (aka the guy behind the infamous King v. Burwell case), who describes himself on Twitter as "Obamacare's Single Most Relentless Antagonist", tweeted out the following:

Wow. | Business Roundup: KP to Acquire Seattle-based Group Health Coop - HealthLeaders Media https://t.co/OzivNilKB9

— Michael F. Cannon (@mfcannon) December 7, 2015

The article he links to is somewhat interesting...

Kaiser Permanente has announced that it will acquire Seattle-based Group Health Cooperative, a member-governed, nonprofit health system, in a deal worth $1.8 billion.

Sometime this week I'm expecting CMS to release a 2015 Q3 Effectuated QHP report showing how many people were still enrolled in (and paying for) ACA exchange policies as of September 30, 2015.

As you'll recall, for 2014 the flow was:

• 04/19/14 QHP Selections: 8.02 Million
• 08/15/14 QHP Enrollments: 6.90 Million (after being misreported by CMS as 7.3 million earlier)
• 10/15/14 QHP Enrollments: 6.70 Million (see above)
• 12/31/14 QHP Enrollments: 6.34 Million (scroll towards bottom)

For 2015, the flow so far has been:

Out of all of the 2,500+ blog entries I've posted over the past 2+ years here, the one I'm most proud of was "A Response to Avik Roy", from March 25, 2014 (written right in the thick of the crazy, frenzied final week countdown of the first ACA Open Enrollment Period). This was when the site was at its highest traffic level and I was at my highest point of media attention. I was doing nothing but updating the site for about 16 hours per day, interrupted only by eating, sleeping and being interviewed by every outlet under the sun. Needless to say, I was frazzled, exhausted and short-tempered, and in fact I ended up falling victim to a nasty case of shingles as a result immediately after the close of the April 15th "Overtime Period" a couple of weeks later.

The gist of the spat with Roy was this: He kept insisting that only 27% of those who had enrolled in private ACA exchange policies were newly insured. He based this claim on a study by the McKinsey Center for U.S. Health System Reform.

This is the first post I've written since Friday, partly because I had my kid's Lego® Robotics League event all day Saturday, partly because I came down with a 24-hour (I hope) flu yesterday.

Anyway, some not-so-cheery news to report today:

MICHIGAN WAIVER PUTS CMS IN TOUGH SPOT — The federal waiver Michigan needs to extend its Medicaid expansion has put CMS in a bind — either approve controversial conditions or let the program end next spring. Pro’s Rachana Pradhan writes, “The 2013 Michigan law expanding Medicaid included a provision requiring CMS to approve a waiver with drastically conservative changes by the end of this year. The waiver would require Medicaid enrollees earning above the poverty line to make a choice after four years of Medicaid coverage: Either enroll in a private subsidized plan on HealthCare.gov, or stay in Medicaid and pay up to 7 percent of household income toward health care costs — notably higher than the 5 percent ceiling CMS has held other states to.” If the waiver isn't approved, Medicaid expansion coverage is scheduled to end in April.

NOTE: Given last night's vote by the Republicans in the Senate to repeal the Affordable Care Act, I started to write a piece on this, then realized that I could simply duplicate the one I wrote back in February (when the King v. Burwell case was brewing) with a few simple edits.

The Republican Chair of the House Ways & Means Committee, Newly minted Speaker of the House Paul Ryan (who was also Mitt "Grandfather of Obamacare" Romney's running mate just 2 1/2 3 years ago, you might recall), has made it official: has made it official:

(Bloomberg) -- House Republicans won’t agree to fix Obamacare if the U.S. Supreme Court rules that the law bars health-insurance subsidies for millions of people, said House Ways and Means Committee Chairman Paul Ryan.

“There are a lot of other ideas out there, but what all conservatives can agree on is this: We think government should encourage personal responsibility, not replace it. We think prices are going up because people have too few choices, not because they have too many. And we think this problem is so urgent that, next year, we are going to unveil a plan to replace every word of Obamacare.”

A couple of weeks ago I posted an entry titled "UnitedHealthcare: Is loose SEP enforcement part of the problem?" in which I discussed the (supposedly widespread) problem of ACA exchange enrollees "gaming the system" by taking advantage of both the Special Enrollment Periods (aka "Off-Season Enrollments", as I prefer to call them) and/or the assorted grace periods allowed for under the ACA to deliberately sign up for private policies, quickly run up massive healthcare bills and then drop those policies soon afterwards, leading to massive actuarial disruption (ie, financial losses) for the carriers in their wake.

I gave a few examples of how this sort of thing might be happening, as well as my own suggestions for reducing such instances. Not being an expert on such issues, I limited myself to obvious, clear-cut ideas, mostly involving simple "date window" tightening, as well as tightening up of verification/enforcement:

I wasn't planning on posting anything else about yesterday's gun massacre in San Bernardino beyond my quick post last night, but I do have one more thing to add.

Yesterday (and today), a huge brouhaha broke out on Twitter about people (specifically right-wing politicians and pundits) once again offering nothing but "thoughts and prayers" as a response to the massacre.

This happens every time one of these horrors occurs; it's regular as clockwork. This time, though, many left-leaning folks got tired of the tired, boilerplate "thoughts and prayers" quips being given. Many on the right-wing side are now accusing left-leaners of "mocking" prayer, religion and/or God.

I've confirmed exactly 2,272,733 QHP selections nationally as of yesterday, but that only runs through last Saturday, while some states are missing entirely. My best guess as to the actual total as of 12/02/15 (32 days into the 2016 Open Enrollment Period) is around 3.14 million. That's an average of around 98,000 people per day signing up for private health insurance so far.

Meanwhile...

The National Instant Criminal Background Check System processed 185,345 requests on Nov. 27, one of the largest retail sales days in the country.

Bravo, America.

I've decided to start breaking out my official weekly projections for the upcoming week out separately from my analysis of the previous week; this way I'll have a "clean" entry to link to for all projections.

As I noted this afternoon, I came in 6.3% under for Week Four, making me exactly 1% under the actual cumulative total for the first 4 weeks:

• Week 4 Projection: 370K / Actual: 395K
• Cumulative Projection: 2.02 Million / 2.04 Million

Based on this, I'm once again bumping up my Week Five projection a bit, from 600K even to 670K for 11/29 - 12/05. If accurate, that will bring the grand HC.gov total up to 2.71 Million as of Saturday, December 5th. It should also bring the national total up to roughly 3.56 Million.

UPDATE 12/03/15: OK, strike that. This has been nagging at me all day. I'm bumping HC.gov Week Five projection up further to 840,000 for 11/29 - 12/05 (2.88 million cumulatively), or around 3.77 million nationally.

I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year, starting today.

I couldn't start doing this earlier because this is the first week that CMS has broken out the HealthCare.Gov QHP numbers by state. Now that they've started doing so, I have cumulative numbers for enough states for a chart like this to make sense.

It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Idaho, Kentucky, New York, Vermont and Washington. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).

In addition, there are two states (Connecticut and Rhode Island) where I have the opposite situation--they've jumped the gun and front-loaded their autorenewals of current enrollees, with the understanding that those folks can still drop their coverage or switch to a different policy between now and December 15th (CT) or December 23rd (RI).