In Michigan, 15,000 children and pregnant women poisoned by lead and other toxic chemicals in their water supply from penny-pinching austerity measures by Republican Governor Rick Snyder and his GOP colleagues in the state legislature are finally being enrolled in Medicaid. So, you know, yay.

In Oklahoma, meanwhile, 111,000 dirt-poor adults (mostly women) are being kicked to the curb thanks to...penny-pinching austerity measures by Republican Governor Mary Fallin and her GOP colleagues in the state legislature:

Just how grim the state’s budget situation has become was apparent Wednesday morning as the state House of Representatives discussed and ultimately agreed to a bill that would cut 111,000 Oklahomans, most of them women, from Medicaid.

Oklahoma is an example of how frustrating this rate review stuff can be, even when there's only a handful of companies involved and much of the data is easily accessible.

According to RateReview.Healthcare.Gov, Oklahoma only has a single company asking for rate hikes greater than 10%: Blue Cross Blue Shield of OK.

The main listing gives the requested rate increase as a jaw-dropping 43.95%...but the description below it says that "the range of rate increases by product is 22% to 34%".

Now, there are two additional BCBSOK listings on the Rate Review site which do appear to be included in the first one (all 3 list the total "members affected" as exactly 137,506)...but the other two have 22.64% and 33.83% listed as the "official" requested rate increase, both of which are still well below 44%.

How on earth you can have the individual product rate hikes range from 22-34% but average 43.95%, I have no idea. Obviously I'm missing something here.

At first, this article in the Washington Times doesn't look like anything special...it's basically one of dozens of stories about the potential political and real-world impact of the King v. Burwell decision on a specific state...in this case, Oklahoma:

OKLAHOMA CITY (AP) - While the U.S. Supreme Court considers a key case related to the Affordable Care Act, officials in Oklahoma have taken little action to prepare for a ruling that could threaten the tax subsidies nearly 90,000 residents are using to purchase health insurance.

HOWEVER, it's the next couple of paragraphs which made me do a double-take:

Because Oklahoma opted not to create a state exchange where residents could shop for health insurance, Oklahomans instead purchased their plans through a federal exchange, but opponents who are challenging the law, including Oklahoma Attorney General Scott Pruitt, argue the law only allowed for the subsidies through state exchanges.

Hot on the news that HHS Secretary Sylvia Burwell decided to channel the Bridgekeeper from Monty Python & the Holy Grail ("Right! Off you go then!!") when it came to Pennsylvania and Delaware's "state-based exchange" requests, here's what's going on in three other states facing possible tax credit loss from an adverse King v. Burwell decision:

ILLINOIS: Hospital group says Illinois could lease Healthcare.Gov

A hospital group in cash-strapped Illinois says the state might be able to set up a health insurance exchange at a lower cost by "leasing" the federal government's technology, an option that could appeal to as many as 34 states where subsides could be jeopardized by an unfavorable U.S. Supreme Court decision.

Hmmm...looks like I may have to dust off my "$360.00 GoDaddy Solution" after all...

A federal judge in Oklahoma ruled Tuesday that Obamacare subsidies provided on the federal HealthCare.gov exchange are invalid, agreeing with a ruling by a three-judge D.C. Circuit Court of Appeals panel against the subsidies.

The ruling, along with the fallout from the D.C. Circuit decision, could be a potentially significant defeat for the Obama administration.

On the one hand, this development probably makes it more likely that the SCOTUS will end up taking on the Halbig case (from the DC Circuit Court) after all (and/or the King case from the 4th Circuit...all three appear to focus on pretty much the same "federal exchange vs. state exchange" issue).

OK, I don't know what the requested rate changes for 2015 were in Oklahoma, but this appears to be the final word:

Health Insurers Submit Exchange Rates for 2015

OKLAHOMA CITY –Oklahomans shopping for individual health insurance policies through the federal exchange will be able to choose from six different companies offering multiple plans. Rate renewals for 2015 policies range from a decrease of 9.1 percent to an increase of 29 percent. The actual rate for an individual will depend on several factors, including age, geographical location and tobacco use.

“In the second year of the federal exchange, carriers have adjusted their rates to adequately reflect their utilization costs, comply with federal rules on medical loss ratios and reflect revisions to their provider networks,” said Oklahoma Insurance Commissioner John D. Doak.

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!