Yesterday I noted that if the Republican Party really wants to damage the Affordable Care Act, they could do so quite easily...byhelping the Affordable Care Act:
Put another way: 11.7 million people selected QHPs during 2015 open enrollment, of which roughly 10.3 million are currently enrolled nationally. If every state had expanded Medicaid as of the beginning of this year, only around 9.5 million people would have selected QHPs and only around 8.4 million would still be enrolled in them today.
That's right: As Sprung put it last March, by refusing Medicaid expansion, red state governors and legislatures drove almost 2 million private plan enrollees to federal exchange.
UPDATE 7/13/15: OK, looks like they've posted a "teaser" of the interview this morning; it's set to air this evening at 6pm; as you can see, in the text version, at least, they did a good job of including several of the key points I brought up, especially the "shop around" factor:
This led to a bit of confusion about just who does and doesn't fall into the "Medicaid Gap"...that is, people who don't qualify for Medicaid, but also don't make enough money to qualify for federal tax credits to enroll in private policies via the ACA.
As I noted yesterday:
...in states which expanded Medicaid, households earning less than 138% of the Federal Poverty Level (FPL) are eligible for Medicaid; anyone from 138% - 400% are eligible for federal tax credits to enroll in private Qualified Health Plans (QHPs) via the ACA exchanges.
Remember that massive Excel HC.gov enrollment spreadsheet file released last week? The one which broke out 2015 QHP selections by county, age group, metal level, income range and so on? Well, for those who don't have Excel, they've set up a web-based version of each.
OK, this is rather embarrassing (from the Office of the Inspector General):
CMS's internal controls did not effectively ensure the accuracy of nearly $2.8 billion in aggregate financial assistance payments made to insurance companies under the Affordable Care Act during the first 4 months that these payments were made.
Last week another healthcare reporter and I (I think I do count as a "reporter" by now, yes?) were discussing the fact that some of the 10.3 million people currently enrolled in private policies via the ACA exchanges would be eligible for Medicaid instead, if their states would simply expand Medicaid via the ACA.
How is this? Well, in states which expanded Medicaid, households earning less than 138% of the Federal Poverty Level (FPL) are eligible for Medicaid; anyone from 138% - 400% are eligible for federal tax credits to enroll in private Qualified Health Plans (QHPs) via the ACA exchanges.
However, in states which didn't expand Medicaid, households earning 100% - 400% are eligible for those private QHP tax credits (anyone below 100% are flat-out screwed if they don't already qualify for "normal" Medicaid in their state).
In nearly every state, the official "enrollment number" used in the HHS Dept's ASPE reports has been the number of QHP selections completed...whether or not the enrollee actually pays their first monthly premium. Naturally, this led to a lot of fuss and bother about "How many have PAID???" last year (and this year as well, though to a lesser extent). In the end, the answer in 2014 turned out to be roughly 88%, with an additional 4% or so gradually dropping their policies over the course of the year and another 5% dropping theirs once the 2015 season opened up. In 2015, so far it looks like the 1st-month-paid percent is a bit higher, more like 90%.
Most news outlets mushed the two figures (non-payments and attrition) together, but I keep them separate, and Washington State is one reason why. Unlike most states, the Washington ACA exchange only reports their exchange policies after the first monthly premium has been paid. As a result, while their official numbers seemed a bit weak back in February (160,732 vs. their stated goal of 230,000), the silver lining is that it was also a "cleaner" figure; I didn't have to lop off 10% of the total, since WA "pre-purged" it for me.
Spotlight here is on Alabama in my continuing close look at how many low income ACA private plan buyers accessed Cost Sharing Reduction (CSR) subsidies by buying silver plans. (Yesterday, HHS released detailed county-level data about buyers of private plans on healthcare.gov, the federal exchange, enabling a close look at state stats.)
CSR is available to buyers with household incomes below 251% of the Federal Poverty Level (FPL), and strongest for buyers under 201% FPL. It is available only with silver plans, the second-cheapest of four metal levels available on ACA exchanges -- a fact that's less than obvious to the average shopper, Buyers under 201% FPL are leaving a really strong benefit on the table if they don't buy silver plans (see the note at bottom for more detail). I consider the percentage of buyers under 201% FPL who select silver an important measure of how well the exchange is functioning in a given state. (Those in the 201-250% FPL range are likelier to have good cause to forego the relatively negligible CSR provided at that level.)
Nearly 2 months ago, I posted about Connecticut's insurance policy rate change requests from the 9 companies which plan on offering individual healthcare policies either on or off the ACA exchange, Access Health CT. The takeaway at the time was that, when weighted for the relative market share of each company, it looked like a statewide average requested rate increase of 7.7%, which isn't bad at all given the massive hikes being tossed around in some other states:
None of these have actually been approved yet, mind you...and in fact, just today it was announced that the CT Insurance Dept. will be holding public hearings to discuss the rate requests by three of the companies above: Anthem, ConnectiCare and Golden Rule.
Even before that happens, however, there's been some shifting: The first two companies, Anthem and ConnectiCare, have put in revisions to their earlier requests:
Needless to say, being Breitbart, they lay on the "OMG!! SKY IS FALLING!! MASSIVE RATE HIKES!!" stuff pretty thick, and as I've noted repeatedly, in some cases that may very well be true. I didn't bother reading most of it since I already know what it says.
However, there's one rather curious passage which did catch my eye:
Regulators for Covered California, the largest Obamacare exchange with 1.4 million members, have been mum on just how big their premium rate increase will be. But with the exchange already expected to lose $78 billion in the state fiscal year that began July 1, there is no state money for extra subsidies.
As I noted at the end of April, after climbing at a furious pace every week for months on end, Michigan's implementation of the Affordable Care Act's Medicaid expansion provision (aka "Healthy Michigan") plateaued at around 600,000 enrollees back in February, and then bobbled around the 600K level for several weeks straight. As I noted at the time, I'm still checking this figure weekly, but it has never deviated far from that number--sometimes a bit higher, sometimes lower.
