CMS

It's been nearly a month since I posted my final estimate of the official national and state-level tally for the 2021 Open Enrollment Period (OEP). At the time, I pegged the final total at just barely over 12.0 million QHP selections nationally...the first time an ACA OEP had hit that threshold since the end of the Obama Administration (this seems fitting for obvious reasons).

Earlier today, the Centers for Medicare & Medicaid (CMS) issued the official 2021 OEP report, as well as the accompanying Public Use Files (PUFs) which break the data out in all sorts of ways. Let's dig in!

First, the topline numbers: 

Here's the formal kick-off announcement from HHS Sec. Becerra:

  • An average of three out of five eligible uninsured Americans can access $0 plans after advance payments of tax credits and an average of four out of five current HealthCare.gov consumers will be able to find a plan for $10 or less per month after advance payments of tax credits
  • Department also announces $50 Million Boost to Special Enrollment Period Outreach Campaign

Today, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced that additional savings and lower health care costs are available for consumers on HealthCare.gov. The American Rescue Plan (ARP) has increased tax credits available to consumers, helping to reduce premiums and giving consumers access to affordable health care coverage.

The Department also announced an additional $50 million in advertising to bolster the Special Enrollment Period outreach campaign. The campaign will run through August 15, 2021.

President Biden's nominee to run the Centers for Medicare & Medicaid Services (CMS) has been a hotly-debated topic among healthcare wonks for a couple of months now. He announced that he was picking California Attorney General Xavier Becerra as his HHS Secretary back in early December, but who would be running CMS (basically the 2nd most-powerful position within the HHS Dept.) has been a big unknown until a few days ago, when Dan Diamond and Amy Goldstein of the Washington Post scooped the story.

I admit to never having heard of her until her name was mentioned as a possible contender in a few articles last month, but if confirmed, I'll probably be mentioning her name fairly often over the next few years (likely even more frequently than Becerras), so I figured I should post a quick profile of her today.

Here's the official White House statement:

Normally I receive notices about these types of data reports directly from CMS via their mailing list, but this time around it wasn't emailed and in fact isn't even posted on the CMS newsroom archive  (at least not yet). Fortunately, my eagle-eyed colleague Andrew Sprung grabbed the link from a Health Affairs article and wrote up his own analysis of it.

via the Centers for Medicare & Medicaid:

Total national healthcare spending in 2019 grew 4.6%, which was similar to the 4.7% growth in 2018 and the average annual growth since 2016 of 4.5%, according to a study conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) and published today ahead of print by Health Affairs.

This report includes health expenditure data though 2019 and therefore does not include any of the effects of the coronavirus disease 2019 (COVID-19) pandemic on health care spending. Future reports for 2020 forward will measure health expenditures based on the latest available data and will reflect the impacts of the pandemic on total health care spending as well as on the distribution of spending among the services, payers, and sponsors of health care.

For the past few months, I've been keeping track, to the best of my ability, of how many people have been enrolling in ACA exchange policies utilizing the COVID-19-specific Special Enrollment Periods which have been offered by 12 of the 13 state-based exchanges (SBEs). My most recent update brings the grand total of confirmed SEP enrollments to at least 260,000 across 8 states, averaging around 3,500 per day.

The actual number is obviously higher than this, of course, since I don't have any data from the other four state exchanges (DC, New York, Rhode Island and Vermont), although three of those four are pretty small anyway...and even in New York, their unique "Essential Plan" (the Basic Health Plan program established under the ACA itself) has likely been sucking up the bulk of individual market enrollees earning up to 200% FPL anyway...and you can enroll in the Essential Plan year-round regardless of the pandemic. I therefore doubt that NY's COVID SEP numbers for those earning more than 200% FPL are that dramatic. All told, I'd expect NY, RI, VT & DC to only add perhaps another 25,000 or so QHP enrollees to the table below:

Me, 3/31/20, 1:14pm:

Well, today I received a likely answer which is depressing but not surprising at all: According to my sources, there isn't any technical, logistical, personnel or support reasons why HealthCare.Gov couldn't launch a formal COVID-19 Special Enrollment Period at any time. The only logical conclusion is that the White House has decided not to allow one for political reasons.

...The more people who come to rely on the Affordable Care Act--especially the ACA exchange operated by the Trump Administration itself--the more difficult it's going to be to justify the Trump Administration continuing to support a lawsuit with the sole purpose of attempting to have the ACA struck down by the Supreme Court...which they're continuing to try and do even in the middle of a pandemic.

Susannah Luthi, Politico, 3/31/20, 5:19pm:

Trump rejects Obamacare special enrollment period amid pandemic

Three weeks ago I reported that there were growing calls from many quarters for CMS Administrator Seema Verma and HHS Secretary Alex Azar to open up a federal Special Enrollment Period at HealthCare.Gov tied specifically to the COVID-19 pandemic.

Over the next week or so, more and more of the 13 state-based ACA exchanges announced just such a COVID-19 SEP; eventually 12 out of 13 state-based exchanges did so (Idaho is the odd man out), and eventually even the health insurance industry (which is normally opposed to allowing exceptions to the official Open Enrollment Period) were onboard with a COVID SEP. Two weeks ago I was 95% certain that HC.gov would be announcing one at any moment.

And then...nothing. Nothing last week. Nothing yesterday. Nothing as of this writing.

via CMS:

Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators. 

“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

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