In 2014, there was a tremendous amount of focus placed on whether or not "Obamacare Enrollments" (specifically referring to private ACA exchange enrollments) would or wouldn't hit the seemingly all-powerful target of 7 million people. Hell, the original (and still primary) focus of this website was specifically to do live tracking of private ACA exchange enrollments across all 50 states (+DC).
How did the "7 Million" figure become so all-powerful? As long-time readers (or anyone who remembers the past 2 years) will recall, "7 Million" took on an almost mystical quality. The media, along with detractors and supporters alike, began treating it as a make-or-break number; if the administration was able to hit the 7M mark, all would be well, and if they didn't, the earth would open up and swallow the entire nation whole.
Health Premiums Have Climbed $4,865 Since Obama Promised to Cut Them $2,500
Ouch. Sounds pretty bad, right? President Obama's "I'll cut premiums by $2,500 per family" promise has taken a lot of heat over the years, and rightly so. The figure originated in a back-of-the-envelope projection calculated by economist David Cutler, but referred to total healthcare costs:
We reached out to David Cutler, an economist who advised Obama during the 2008 campaign and helped calculate the $2,500 figure that appeared in Obama's speeches. He said the calculation encompassed total health care costs, not just premiums. These would include out-of-pocket costs, employer-provided insurance costs, and taxes to pay for public insurance programs.
In today's speech at the Howard University College of Medicine, HHS Secretary Sylvia Burwell started ramping things up for the 2016 Open Enrollment Season (which I'm gonna designate #ACA2016 unless someone else comes up with something better) by dropping some data points.
Among these was this one:
Almost half of the uninsured individuals who are likely eligible for Marketplace plans are between the ages of 18 and 34.
This is really important, because only about 28% of those who enrolled in exchange-based policies this year fall into the 18-34 range, which is a problem from an actuarial/risk pool perspective. Younger people are generally healthier, so the insurance companies prefer to have a higher percentage of them in their risk pools in order to help keep premiums/deductibles from increasing too quickly.
If "almost half" of the 10.5 million uninsured people eligible for the ACA exchanges are in the 18-34 range, that's roughly 5 million young adults who the exchanges need to target.
Secretary Burwell outlined the following key facts about Marketplace eligible uninsured:
About 10.5 million uninsured Americans are eligible for Marketplace coverage in the upcoming open enrollment.
While HHS will work to bolster enrollment across the nation, the Department’s top five target areas for outreach are Dallas, Houston, northern New Jersey, Chicago, and Miami – which are home to the highest numbers of uninsured who are eligible for Marketplace coverage.
Almost half of the uninsured individuals who are likely eligible for Marketplace plans are between the ages of 18 and 34.
Almost 40 percent of the uninsured who qualify for Marketplace plans are living between 139 and 250 percent of the federal poverty level (about $34,000 to $61,000 for a family of four).
Approximately one-third of the uninsured who qualify for Marketplace plans are people of color: approximately 19 percent are Hispanic, 14 percent are African American, and 2 percent are Asian American.
Secretary Burwell also described additional takeaways about the uninsured:
About half of the uninsured have less than $100 in savings.
Nearly three in five of the uninsured are either confused about how the tax credits work or don’t know that they are available.
At the time, I stated that as much of a supporter as I am of the ACA, I was a bit uneasy with this particular estimate, mainly due to the 2.3 million "Young Adults on Parents Plan" portion of it:
The first thing you'll notice right off the bat is that I'm treating the "additional" 2.3 million young adults in the second bullet point as a sort of afterthought.
This is not because I think that these people "don't count". Anyone who's been reading this site since I launched it a year and a half ago knows that I touted the "Sub26ers" as much as possible for the better part of a year.
Although nearly half of the country is covered by it, and the Affordable Care Act does impact it, I don't write much about Employer-Sponsored Insurance (ESI); there's a lot of facets to the ACA, and my main focus has obviously been primarily on the Individual Market (both on and off-exchange) as well as Medicaid (both expansion and "woodworkers").
Today, however, there are two big developments which relate directly to ESI:
When it comes to the Cadillac Tax, I know that it's supposed to help curb overall healthcare costs. I know that it's extremely unpopular with unions (which are obviously one of Clinton's core target constituencies). I know that it's supposed to be one of the main revenue sources for funding the rest of the ACA. Beyond that, I don't know much about it.
Economists love the idea of limiting the tax exclusion for employer-sponsored coverage. For one thing, subsidizing employer-based care is regressive — it's a tax subsidy paid, in effect, by people who don't have good jobs that give them health care. But perhaps more important, it encourages employers to spend more and more money on lavish health insurance, which in turn pushes up health-care costs across the system.
...But voters? They hate it. And employers really hate it. Coalitions have sprung up in Washington, DC, for the sole purpose of killing it. Hundreds of legislators on both sides of the aisle have backed a bill to repeal it. It's become one of Obamacare's central weaknesses — and thus one of the GOP's main targets.
That, however, is not the main point of this entry. This is:
Over at Forbes, virulently anti-ACA critics Josh Archambault and Jonathan Ingram have written a detailed analysis of What Went Wrong with Iowa's implementation of the Affordable Care Act's Medicaid expansion provision. While their tone is understandably hostile, from what I know of the situation, it seems to check out for the most part (granted, the only part of this piece I knew much about until now was the CoOportunity failure portion of it).
First, it's important to understand that Arkansas is not the only state which has been using a "private option" solution for their ACA Medicaid expansion program; Iowa opted for this as well. For some reason, Arkansas is the only state ever mentioned when this comes up, probably because they were the first ones to do so, I believe:
Iowa’s expansion was loosely modeled afterArkansas’ Obamacare expansion. Under Iowa’s “Marketplace Choice” waiver, able-bodied adults above the poverty line would receive Medicaid benefits through Obamacare exchange plans.
I've spent tons of time the past few months obsessing over the average percentageincrease in monthly premiums for ACA-compliant individual market policy enrollees, and as I wrap up this project, I've concluded that, assuming EVERYONE sticks with their current policies and doesn't bother shopping around, the overall national average increase will likely end up being between 11-15%.
However, aside from a few hypothetical examples, I haven't even touched on what this means in terms of the actual dollar amounts.
This is no small thing. "Percentage" changes can be very misleading, if you don't know what the actual dollar figure is in the first place. Consider this:
When patients need simple health care, they can get impatient about having to wait.
That’s prompted more health care systems to stress convenience.
This month, North Memorial Health Care will open two easy-access clinics in new Hy-Vee grocery stores in New Hope and Oakdale, hoping that shoppers might add treatment for warts, fever and other ailments to their grocery lists.
The resurgence of retail health clinics by hospital operators comes as they also pump money into online programs that let patients tap into care through computers and smartphones without leaving home.
This one is a heck of an eye-opener, considering the ongoing technical problems Vermont has had with their exchange website...
As always, once you're into the off-season, the total number of QHP selections is more of a symbolic milestone than anything, since the effectuated number is more significant...but it's the selections which cancel out attrition (whether voluntary, in the case of people not paying their premiums or moving on to other coverage; or involuntary, in the case of the several hundred thousand people kicked off of their policies due to legal residency verification issues).
