Note: I'm breaking this analysis into several sections:

Part 1Part 2 / Part 3 / Part 4 / Part 5 / Part 6 / Part 7

Now it's time to move on to the actual demographic breakout of the 2023 Open Enrollment Period (OEP) Qualified Health Plan (QHP) enrollees.

First up is breaking out new enrollees vs. existing enrollees who either actively re-enroll in an exchange plan for another year or who passively allow themselves to be automatically renewed into their current plan (or to be "mapped" to a similar plan if the current one is no longer available).

Note: I'm breaking this analysis into several sections:

Part 1Part 2 / Part 3 / Part 4 / Part 5 / Part 6 / Part 7

Now that the official press release is out of the way, it's time to dig into the actual final, official state-level data. The table below has the final, official 2023 Open Enrollment Period (OEP) numbers for both Qualified Health Plans (QHPs) in all 50 states + DC as well as Basic Health Plan (BHP) enrollment in Minnesota and New York only, compared to the 2022 OEP.

Note: I'm breaking this analysis into several sections:

Part 1Part 2 / Part 3 / Part 4 / Part 5 / Part 6 / Part 7

via the Centers for Medicare & Medicaid Services (CMS):

Biden-Harris Administration Celebrates the Affordable Care Act’s 13th Anniversary and Highlights Record-Breaking Coverage

According to the essential Louise Norris, there are currently just six states where being pregnant in and of itself makes someone eligible for a Special Enrollment Period outside of the official Open Enrollment Period:

In most states, pregnancy does not trigger a special enrollment period. HHS considered this, but clarified in 2015 that they had decided not to include pregnancy as a qualifying event. This means that in most states, the special enrollment period tied to having a baby does not begin until the baby is born.

But state-run exchanges (there are 18 of them as of 2022) can set their own rules for qualifying events and special enrollment periods. Some of them do allow a special enrollment period triggered by pregnancy. This gives a pregnant person access to health coverage during the pregnancy, rather than having to wait until the baby is born to obtain coverage. As of 2022, pregnancy is a qualifying event in the following state-run exchanges:

Just to prove that there's still some sane healthcare-related legislation coming out of Republican-controlled legislatures these days, Indiana state representative Mark Carbaugh (R) has introduced a bill which seems harmless enough and makes sense to me:

Transition from Marketplace plan to Medicare.

Requires an insurer or health maintenance organization that provides coverage under an Affordable Care Act Marketplace (Marketplace) plan to provide to each individual covered under the Marketplace plan, not more than two months before the birthday on which the individual will become 65 years of age, a written message that includes: (1) a statement that the individual will be eligible to enroll in Medicare during the individual's initial enrollment period, which begins three months before the individual becomes 65 years of age; (2) a statement advising the individual that, in most cases, someone covered by a Marketplace plan will want to end their Marketplace coverage upon becoming eligible for Medicare; and (3) detailed instructions that the individual may follow to cancel the individual's Marketplace plan.

Hawaii Senate Bill 842 was introduced in January by 10 Democratic state legislators.

I've grown to absolutely love the way Hawaii state legislation summarizes the situation being addressed by the bill in question; they don't hold any punches in explaining why the bill is necessary:

The legislature finds that obstacles to access to health care based solely on immigration status prevent many low-income immigrants and immigrants' families from obtaining affordable health care coverage through medicaid, the Children's Health Insurance Program (CHIP), and health insurance exchanges established under part II of the Patient Protection and Affordable Care Act.

As I noted last week, Washington State is the first in the nation to finally correct one of the dumbest provisions of the Affordable Care Act as it was originally passed:

(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.

Again, this doesn't just mean that they can't get federal financial help; it means they can't enroll via ACA exchanges at all:

Undocumented immigrants aren’t eligible to buy Marketplace health coverage, or for premium tax credits and other savings on Marketplace plans. But they may apply for coverage on behalf of documented individuals.

Connecticut House Bill 6616 was introduced to the state House in February with a total of 13 cosponsors (all Democrats). Since then it's had a public hearing and has been reported favorably out of the legislative commissioners' office and to the House Appropriations Committee.

The bill seems to expand Medicaid and/or CHIP eligibility ("Husky A, B or D") to a significant number of undocumented children in the state, but it's rather densely worded, making it difficult for me to be certain just how far up the age range it applies. However, according to Louise Norris, it would extend it from the current 12-year old limit for undocumented children up to age 20 by January 2024 and age 25 by later that year, as long as their household income is still below the thresholds currently in place for those populations:

Section 17b-261 of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2024):


I had heard that this was in the works, and with the recent trend of more & more states (most recently including Georgia) splitting off from the Federally Facilitated Marketplace (FFM) hosted via HealthCare.Gov, it's hardly surprising...but it's still a pretty big deal, especially given that Illinois is the 6th largest U.S. state by population. Via Amy Lotven of Inside Health Policy:

Illinois’ Department of Insurance would be authorized to operate a state-based exchange, starting in plan year 2026, under legislation introduced late Thursday by the Illinois Democratic House Majority Leader Robyn Gabel. Sources earlier this week told IHP they had heard state officials were working with lawmakers on exchange legislation and the bill could be unveiled by this week.


So, I've been combing through a mountain of healthcare & health insurance-related legislation which has been introduced by various state legislators around the country, and this one caught my eye:

OR HB3326

Relating to changing the name of the Oregon Health Authority; declaring an emergency.

The bill summary doesn't provide much more detail:

Changes name of Oregon Health Authority to Oregon Department of Health. Makes conforming changes. Becomes operative on January 1, 2024. Declares emergency, effective on passage.

OK, so it changes the name of the health department and...declares an emergency relating to that? Huh? What?

It was introduced about a month ago by GOP state representative Werner Reschke. It doesn't have any other cosponsors from either party so far.

I decided to take a look at the actual legislative text.