On Sunday, HHS Secretary Tom Price officially called it in Texas:

Health and Human Services Secretary Tom Price, MD, declared a public health emergency in Texas on Saturday as Hurricane Harvey was pounding the state's coast.

Harvey made landfall late Friday night with winds topping 130 mph. Forecasts called for the storm to hover over the state for 5 days or more, possibly drenching some areas with as much as 50 inches of rain. Hundreds of thousands were without power and the National Weather Service said parts of Texas could be "uninhabitable for weeks or months."

"Many Medicare beneficiaries have been evacuated to neighboring communities where receiving hospitals and nursing homes may have no health care records, information on current health status or even verification of the person's status as a Medicare beneficiary. Due to the emergency declaration and other actions taken by HHS, CMS is able to waive certain documentation requirements to help ensure facilities can deliver care," an HHS statement read.

Louisiana has 3 individual market carriers for 2018 (technically there's 4, but "Freedom Life" is basically just a shell company with a placeholder filing). Officially, they're requesting average rate increases averaging around 21.4%...but all three carriers state point-blank in their filing letters that a huge chunk of their request is due specifically to the CSR reimbursement and mandate enforcement issues. The Kaiser Family Foundation estimates the CSR issue alone adds around 20 points to Silver plans, and 71% of Louisiana exchange enrollees chose Silver, so that translatest into roughly 14.2 points across the whole market. This results in just a 7.2% average rate hike if CSR payments are made vs. 21.4% if they aren't:

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA).

It's early June now, so I checked in once more, and the numbers have continued to grow. I have the direct links for 5 states now (including New Hampshire)...

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA). By the end of March, the numbers in these 4 states had gone up by another 19,300.

It's the end of April now, so I checked in once more, and sure enough, the numbers continue to grow:

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.

Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:

Over the past month or so, I've been tallying up the number of people who would lose their healthcare coverage if and when the GOP actually does proceed with repealing the Affordable Care Act, breaking the totals out by both County and Congressional District in every state.

While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.

Case in point: Just two weeks ago, roughly 400.000 Louisianans were enrolled in ACA Medicaid expansion. As of yesterday that number had increased to nearly 406,000.

I'm updating the spreadsheet versions now, but in the meantime, here's the latest county-level breakout:

UPDATED 2/19/17 with more recent data (final OE4 exchange enrollment data & February 2017 Medicaid expansion data):

Louisiana just expanded Medicaid via the Affordable Care Act last July, and as of Februay 16th had over 400,000 residents enrolled in the expansion program. All of those people would be kicked right back off of that coverage again if the ACA is repealed. In just 7 1/2 months...

  • 58,713​ Adults have received preventive healthcare or new patient services

I know you're supposed to only use a brief paragraph or two, but this Sept. 19th AP/New Orleans Times-Picayune story only consists of five sentences anyway:

BATON ROUGE — The number of people who have signed up for Louisiana's Medicaid expansion program continues to grow, surpassing 300,000.

The Louisiana Department of Health released the latest figures Monday, saying more than 304,000 people are enrolled for the coverage that began July 1.

The department says nearly 12,000 Medicaid expansion enrollees have received preventive services through the government-finance insurance program so far, like cancer screenings, colonoscopies, and mammograms.

 The maximum number of Louisianans eligible for Medicaid expansion in the state is supposedly around 375,000. Enrollment began in June (though the program didn't actually go into effect until July), so that's 81% of the total enrolled within just 3 1/2 months.

A quickie: Just 5 days ago it was reported that...

As of the beginning of August265,723 low-income Louisianians have newly signed up for Medicaid, according to state officials.

Well, according to NOLA reporter Kevin Litten just now...

INBOX: Medicaid expansion in Louisiana topped 278,000 people on Wednesday. That leaves about 100k people to sign up to hit goal by 2017.

— Kevin Litten (@kevinlitten) August 10, 2016

That's a net increase of 12,277 people in just 9 days, or over 1,300 per day.

There are an estimated 375,000 Louisianans eligible for ACA Medicaid expansion. If they can enroll another 700/day, they'll have maxed out by New Year's Eve.

I'm finally taking a break for my final batch of 2017 Rate Request states to focus on some good news out of Louisiana:

Patients burst into tears at this city’s glistening new charity hospital when they learned they could get Medicaid health insurance.

In Baton Rouge, state officials had to bring in extra workers to process the flood of applications for coverage.

And at the call center for one of Louisiana’s private Medicaid plans, operators recorded their busiest day on record.

The outpouring began in June, when Louisiana became the 31st state to offer expanded Medicaid coverage through the Affordable Care Act, effectively guaranteeing health insurance to its residents for the first time.

Now, as Republican presidential nominee Donald Trump promises to repeal the healthcare law, Louisiana is emerging as a powerful illustration of the huge pent-up demand for health insurance, particularly in red states where elected officials have fought the 2010 law.

Supreme Court grants emergency order to block transgender male student in Virginia from using boys' restroom

A couple of weeks ago, I noted that Louisiana had seen jaw-dropping success with their ACA Medicaid expansion launch, enrolling over 175,000 people in the program in the first 12 hours of the floodgates opening. It later turned out that there was a reason for this astonishing figure: 

1. Virtually all of those enrolled as of yesterday, a total of 189,000 by day's end, were transfers from existing limited-benefit public plans. These include 132,000 enrollees in Take Charge Plus, a program focused mainly on family planning, along with a few free office visits; and 56,000 from the Greater New Orleans Health Connection (GNOHC), a no-cost primary care program for low income people in the greater New Orleans area. GNOHC does not provide drug or hospital coverage.

...which is perfectly fine as well; it still lifts a huge financial burden off of the state while streamlining and consolidating enrollees into the larger Medicaid program itself.

On Wednesday I noted that a whopping 175,000 Louisianans had somehow managed to enroll in the state's just-launched Medicaid expansion program within less than 12 hours of the floodgates being opened up. This was even more amazing when you consider that number represents 47% of the total people estimated to be eligible for the program state-wide (375K).

Now, obviously there's no way that 16,000 people per hour were individually visiting HealthCare.Gov or their local state health agency; on it's busiest day (December 15, 2015), HealthCare.Gov was averaging 25K/hour...but that was across 38 states, many of which are much larger than Louisiana. Instead, I assumed that LA had done something similar to Oregon/West Virginia's "fast-track" programs, where they use existing food stamp/welfare databases to automatically enroll people, not "officially" pulling the trigger until after the stroke of midnight.

This year, about 214,000 people selected QHPs via HealthCare.Gov in Louisiana, though this has likely dropped to around 182K by now. The state's total individual market (on+off exchange, as well as grandfathered/transitional policies) was around 225,000 in 2014, and has likely increased roughly 25% since then to perhaps 280,000 total, of which around 10% is likely comprised of grandfathered/transitional enrollees. That should leave roughly 250,000 ACA-compliant enrollees statewide.

With this in mind, here's how things stack up in Louisiana for the ACA-compliant individual risk pool rate hike requests:

This article lists most of the numbers above accurately, but there's a strange discrepancy with Blue Cross:

A few weeks ago I noted that thanks to the election of Democratic Governor John Bel Edwards (with an assist by David Vitter's diaper fetish), up to 375,000 lower-income Louisiana residents became eligible for the ACA's Medicaid expansion provision starting a month earlier than expected (June 1st instead of July 1st).

Enrollment officially started early this morning (not sure if it was right at midnight or if they had to wait until the state offices opened or whatever), and as of around 11:40am...

Gov. Edwards announces that there are already 175,000 Louisianans enrolled in the expanded Medicaid program. #lagov #lalege

— Gov John Bel Edwards (@LouisianaGov) June 1, 2016

Holy Smokes.

I've writte a lot about the so-called "woodworker effect" with Medicaid expansion over the past 2 1/2 years: People who were already eligible for Medicaid before the ACA, but who never signed up for it for a variety of reasons (they didn't know they qualified; didn't know the process for signing up; were too embarrassed to do so; etc etc). I estimated about 3 million "woodworker" enrollees in 2014, although I downshifted that later on and now have the tally estimated at around 3.8 million nationally as of the end of 2015. That's a lot of people being added to the system who would have been eligible for Medicaid even if the ACA had never been passed.

Last week, a major report from the National Bureau of Economic Research confirmed what I've been saying all along (although their estimates are somewhat lower--around 2 million in 2014 plus an unknown number for 2015), which was written about in a feature story by Kimberly Leonard of U.S. News & World Report.