The smallest of these, which is also the smallest state in the country, is Wyoming, which has had a long & storied history when it comes to Medicaid expansion fakeouts. The "Equality State" legislature has considered expanding Medicaid to the roughly 19,000 residents who would become newly eligible for the program eight times since the ACA was signed into law in 2010, only to see approval of it fail at one stage or another every time.
...over the past few years, the voters of some of those states have decided to take it upon themselves to force their legislators/governors to expand Medicaid anyway, via statewide ballot initiative campaigns:
Almost exactly ten years ago, in the federal National Federation of Independent Business v. Sebelius case which was the first of several high-profile federal lawsuits which attempted to eliminate or cripple the Patient Protection & Affordable Care Act, the U.S. Supreme Court spared the ACA...mostly:
The Supreme Court, in an opinion written by the Chief Justice, John Roberts, upheld by a vote of 5–4 the individual mandate to buy health insurance as a constitutional exercise of Congress's Taxing and Spending Clause (taxing power). A majority of the justices, including Roberts, agreed that the individual mandate was not a proper use of Congress's Commerce Clause or Necessary and Proper Clause powers, although they did not join in a single opinion. A majority of the justices also agreed that another challenged provision of the Act, a significant expansion of Medicaid, was not a valid exercise of Congress's spending power, as it would coerce states to either accept the expansion or risk losing existing Medicaid funding.
Today, the U.S. Department of Health and Human Services (HHS) released a new report that shows 31 million Americans have health coverage through the Affordable Care Act – a record. The report also shows that there have been reductions in uninsurance rates in every state in the country since the law’s coverage expansions took effect. People served by the health Marketplaces and Medicaid expansion have reached record highs.
That would put the national final QHP total at somewhere between 12.9 - 13.2 million people nationally as of January 31st, 2022; call it around 13.1 million.
...I completely forgot to mention BASIC HEALTH PLAN (BHP) enrollment in New York and Minnesota. It totalled 975,337 people during the 2021 OEP (883,451 in New York, 91,886 in Minnesota)...I'm willing to bet total BHP enrollment across both states will end up perhaps 10% higher year over year, which would put it at around 1.1 million.
When you add that to my QHP projection above, you get a grand total of perhaps 14.1 million QHPs + BHPs combined.
If this projection had proven accurate, it would have meant total ACA exchange enrollment was up ~9 - 10% year over year, which would have been impressive but not stellar.
Now that we have two weeks worth of 2022 Open Enrollment data under our belt (well...for 33 states, anyway), I thought this would be a good time for me to try and put together a spitball estimate of how many Americans are likely to enroll in ACA exchange coverage during the 2022 Open Enrollment Period (OEP).
There's really two main numbers to try and project: How many current enrollees will renew/re-enroll for 2022 (whether actively or automatically); and how many new enrollees will jump into the ACA exchanges?
For each of these, due to how the data is reported, I have to further break the states out between those using the federal ACA exchange (HealthCare.Gov) and those which operate their own state-based ACA exchanges (Covered California, NY State of Health, etc.) This is further complicated by the fact that three states (Kentucky, Maine and New Mexico) switched from the federal exchange to their own state-based exchange starting with the 2022 OEP.
Not too many changes were made in either market. I get a weighted average increase of 4.6% for individual market plans (MI DIFS puts it at 4.7%), while I get exactly +7.0% for small group plans (MI DIFS puts it at +7.1%).
As I noted in August, the other noteworthy changes are:
They also estimate that another 1.8 million uninsured Americans who are eligible for subsidized ACA exchange plans who would be eligible for Medicaid instead if those state actually did expand Medicaid (and perhaps another 100K in Missouri). That's nearly 4.0 million total...
So, how to crack this nut in these holdout states, all of which are either completely or partially controlled by Republicans who have adamantly refused to expand the program no matter what all these years?
Highlighting Michigan’s increasingly competitive health insurance market, the Michigan Department of Insurance and Financial Services (DIFS) has reported that consumers will have more health plan options from an increased number of insurers on the Health Insurance Marketplace for the upcoming open enrollment period.
“As we look toward the end of the pandemic and beyond, it is critical that Michiganders are able to get the affordable, high quality health coverage they need for themselves and their families,” said DIFS Director Anita Fox. “Consumers will have more options to choose from when shopping for health insurance coverage on the Marketplace during open enrollment later this year.”