Note: I decided that while the original headline accurately reflected my feelings about this WSJ Op-Ed, it was a bit over the top, so I've changed it to something less crude.
For years, the Patient Protection & Affordable Care Act, generally shorthanded as the ACA or, more colloquially known as "Obamacare," was the top policy target of Republicans and other conservatives.
It seemed as though not a day went by without some right-wing opinion piece being published attacking the ACA for one thing or another. Once in awhile these attacks had some validity, but the vast majority were either completely baseless or grossly exaggerated.
And yet, after the dust settled on the infamous 2017 ACA "repeal/replace" debacle, it seemed as though the GOP had pretty much tired of their relentless assault on the healthcare law. They had failed to repeal it even with control of the White House, Senate, House of Representatives and Supreme Court, and ended up settling for zeroing out of the federal Individual Mandate Penalty as a consolation prize.
Back in late January, I crunched the numbers on the total number of Americans who currently have healthcare coverage directly via the Affordable Care Act. This includes three categories: Exchange-based Qualified Health Plans (QHPs); the Basic Health Plan (BHP) progams in Minnesota and New York; and Medicaid Expansion in the 38 states (+DC) which had implemented it as of that point.
I concluded that the total numbers for each were roughly 15.4 million QHPs, 1.2 million BHPs and 23.5 million Medicaid expansion enrollees, or around 40.1 million people total.
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) confirmed my estimates and even came in slightly higher, at around 40.2 million. They put effectuated QHPs at 15.6 million and Medicaid expansion enrollment at around 23.4 million.
A decade ago, when conservatives were attacking President Barack Obama’s Affordable Care Act as government encroachment in health care, they worked to amend state constitutions around the country to affirm a broad right for people to control their own medical decisions.
“Each competent adult shall have the right to make his or her own health care decisions,” reads section 38(a) of the Wyoming constitution’s Declaration of Rights, under the header “Right of healthcare access.” The provision was placed on Wyoming’s ballot by state lawmakers and approved by voters in 2012; voters saw ballot language that described the measure as preserving this right “from undue governmental infringement.”
Now these anti-ACA provisions—and their broad affirmations of a right to decide—have turned into an unlikely weapon in progressives’ fight against restrictions on abortion.
This is, of course, extremely important since household income is one of the most critical factors in calculating how much financial assistance enrollees receive, as well as whether or not they're eligible for Advance Premium Tax Credits (APTC).
If you've ever wondered why healthcare wonks (myself included) almost never even bring up the ACA's Catastrophic Level plans and why the only time I ever discuss Platinum Plans is in the context of high-CSR enrollees being eligible for "Secret Platinum" plans (labeled as Silver), this table should explain why.
Next up: Age brackets, gender, racial/ethnic groups and urban/rural communities. I'm also throwing in the stand-alone Dental Plan table for the heck of it since I don't know where else to include it.
I don't have a ton to say about any of these, really. It's always interesting to me to see that nearly 2% of ACA exchange enrollees are 65 or older. Not sure why they aren't on Medicare but I'm sure there are logical reasons.
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).
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.