As noted earlier, I've been a bit lax with posting for a few days as I've worked on my latest 2-part video explainer about risk pools and #ShortAssPlans.
However, there's been a lot going on, so I figured I should try and at least do a quick update on a few items. First up: Medicaid expansion!
Here in my home state of Michigan, I've written several posts about how the GOP-controlled state legislature trying to shove through a draconian "work requirement" bill for Healthy Michigan, our name for ACA Medicaid expansion program which has been working just fine, thank you very much, for nearly 5 years now. The bill easily passed the state Senate (where the GOP holds a supermajority), and is now under consideration by the state House (where they have a smaller but still solid majority at the moment). The good news is that GOP Governor Rick Snyder--who championed passage of Healthy Michigan in the first place and seems to think it's fine mostly the way it is--is likely to veto the senate version of the bill. The bad news is that it might simply be tweaked somewhat by the House.
A week or so I noted that activists in Utah had managed to secure enough ballot petition signatures to get full, no-strings-attached ACA Medicaid expansion placed on the ballot this November...superseding legislation signed by the Governor which would otherwise only expand it to fewer than half as many people, while also imposing a work requirement on enrollees:
If approved, the initiative would require the state to expand Medicaid to people making up to 138 percent of the federal poverty level, and would prohibit enrollment caps.
Under ObamaCare, the federal government would cover 90 percent of the costs of expansion. The state share would be funded through a 0.15 percent increase in the sales tax.
...The ballot initiative would cover more than 150,000 people.
To be honest, I'm not entirely sure I understand why Idaho would do this. Yes, of course the deep red state government opposes the ACA in general and sure, they want to "lower premiums" on the individual market, but Trump's recent "ShortAss Plan" executive order would do pretty much the same thing(allowing non-ACA compliant off-exchange "Short Term/Association Plans" which amount to the same thing...without putting GOP Gov. Butch Otter's fingerprints all over the ugly stories which would soon follow if/when people started actually enrolling in these types of policies. Besides, as much as Idaho claims to hate the ACA, they seem to be quite proud (and rightly so) of their own state-based ACA exchange, Your Health Idaho.
Well, it sounds like CMS Administrator Seema Verma was thinking along the same lines, because this unexpected story broke a few hours ago: Verma sent a letter to Otter and his state Insurance Commissioner shooting down their "state-based plans" idea as being flat-out illegal.
“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”
--Douglas Adams, The Hitchhiker's Guide to the Galaxy
Over a year and a half ago, I noticed that aside from the usual names being listed as insurance carriers offering individual market policies in various states (Humana, Molina, Blue Cross Blue Shield, etc), there was one other name which kept popping up over and over again: "Freedom Life":
Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.
So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.
Idaho is one of only 2 state-based exchanges which stuck with the "official" December 15th deadline for the 2018 Open Enrollment Period (the other was Vermont). Unfortunately, they haven't released an official, detailed demographic breakout report yet, but they did discuss some relevant stats in their December board meeting...which, as it happens, took place on December 15th, which means it's still missing a bit of final data. For now this is the best I can do:
d) Enrollment Update
Mr. Kelly said YHI’s goal in enrollments is to be flat year-over-year, and it is within reach. When we look at average enrollments for 2017 of around 90,000 Idahoan’s, we appear to be ahead of that for 2018. As of this morning, we have almost 96,000 enrollments. This week alone, we have gained over 6,000 enrollments, way ahead of our growth for the same time last year. We also had well over 2,100 calls into the support center yesterday.
Last year, after 7 years of doing everything in their power to undermine, sabotage and weaken the ACA, Congressional Republicans tried every which way they could to repeal the law. They tried passing AHCA , B-CRAP, ORRA, Graham-Cassidy and a few other variants along the way to no avail.
Finally, in late December, desperate for a win on "repealing Obamacare"--any type of win--they said "screw it" and just repealed the ACA's individual mandate all by itself. They didn't replace it with a reasonable inducement for people to get covered, mind you, against the advice of actuarial expert advice, mind you; they just...got rid of it.
The vote to repeal the mandate penalty was incredibly short-sighted and will almost certainly lead to negative consequences when it actually goes into effect (which won't be until next year, causing much confusion until then, but that's a different discussion)...but at least it's legal.
Despite Changes, Idahoans Flock to Health Insurance Exchange
2018 Enrollment Nears Record
BOISE, Idaho – Your Health Idaho announced today that nearly 102,000 Idahoans signed up for 2018 health insurance coverage on the exchange.
“This is a testament to Idaho’s model for operating an exchange. Despite the enormous uncertainty from Washington, combined with a shortened enrollment period, Your Health Idaho has been able to serve near record numbers of Idahoans,” said Pat Kelly, executive director of Your Health Idaho.
The enrollment numbers include new and returning customers. A significant difference for 2018 is the monthly premium pricing. Increased tax credits offset rising premiums to the extent that some Idahoans purchased plans for little to no monthly cost. Enrollments in these less expensive bronze plans increased by fifteen percentage points over the previous year. In total, 101,793 Idahoans enrolled in 2018 health coverage in just half the time of last year.