Pennsylvania

THIS JUST IN...

CMS today conditionally approved Delaware and Pennsylvania to operate State-based Marketplaces (SBMs)" #kingvburwell @charles_gaba

— Dan Mangan (@_DanMangan) June 15, 2015

Obama administration has approved Pennsylvania and Delaware’s blueprints to become state-based ACA exchanges next year.

— Dylan Scott (@dylanlscott) June 15, 2015

It appears that at while most of the 34 states on the federal exchange have spent the past 5 months wandering around aimlessly, at least two of them did pay attention last November when the Supreme Court, to the astonishment of anyone with an ounce of sanity, agreed to take up the King v. Burwell case.

Tom Wolf, the newly-elected (Democratic) Governor of Pennsylvania, announced back in March that yes, he would absolutely push to "establish" a state ACA exchange in the event of a King plaintiff win, and earlier this week he made good on this by formally submitting an application to the HHS Dept.:

Pennsylvania became the first state Tuesday to publicly put in motion a back-up plan to protect its federal health insurance subsidies in the event the Supreme Court dismantles a key part of President Obama’s health care law.

So, the good news is that new Democratic Pennsylvania Governor Tom Wolf, who has already scrapped his predecessor's unnecessarily confusing "alternative" Medicaid expansion plan in favor of regular expansion, has officially submitted a latter to the HHS Dept. stating that yes, if the Supreme Court does rule against the government in the King v. Burwell case, PA will indeed establish their own ACA healthcare exchange.

HARRISBURG, Pa. (AP) - Gov. Tom Wolf's administration advanced plans Friday to maintain federal health insurance subsidies for nearly 400,000 Pennsylvanians ahead of a U.S. Supreme Court decision that could wipe out the aid to insurance buyers in some states.

The Democrat wrote to U.S. Health and Human Services Secretary Sylvia Burwell to declare his administration's intent to take over operation of the insurance marketplace in 2016. The federal government currently operates the marketplace, which is a prominent feature of the 2010 federal health care law designed to extend insurance coverage to 35 million Americans.

This article is a bit outdated (it's from March 3rd); thanks to Andrew Sprung for finding it for me. Apparently over 200,000 people are now enrolled in Pennsylvania's "Healthy PA" program, which is the "alternative" Medicaid expansion plan set up by GOP Governor Tom Corbett prior to new Democratic Governor Tom Wolf taking charge. Wolf is in the process of flipping the program back to "standard" Medicaid expansion, but is running into a few snags:

Under former Gov. Tom Corbett's Healthy Pennsylvania program, the state built a second Medicaid managed-care system, separate from its HealthChoices Medicaid system that serves about 1.6 million residents. About 600,000 residents are eligible for the expanded coverage and about 200,000 have enrolled. 

Outgoing Republican Pennsylvania Governor Tom Corbett tried a desperate hail mary play to save his job: Expanding Medicaid via the Affordable Care Act, but doing it in an absurdly complicated and confusing way in order to appease his Republican base. It didn't work; he lost to Democrat Tom Wolf, one of the few bright spots for the Dems in an otherwise lousy 2014 election.

Wolf campaigned, in part, on the promise of scrapping the overly-complicated "Healthy Pennsylvania" plan enacted by Corbett in favor of simply expanding traditional Medicaid up to 138% of the Federal Poverty Level the way it was supposed to be in the first place. This is a good thing, as Corbett's program has had a growing mountain of technical and logistical problems since it kicked off.

Well, today, Gov. Wolf has made good on his promise:

Governor Tom Wolf today announced Pennsylvania’s transition to a simple traditional Medicaid expansion plan.

My most recent data for PA's "Healthy PA" program (their implementation of the ACA's Medicaid expansion provision) was 118K, so I wasn't going to post on this today, but a subsequent update says that the actual number is higher still, at 134,000:

State officials estimate that as of January 1, 2015 about 600,000 Pennsylvanians became eligible for Medicaid through its newly expanded Healthy Pennsylvaniaoption.

Enrollment began last month, and as of Monday, a spokesperson reported the state had received at least 114,000 household applications (it's unclear how many came from people who were previously uninsured).

.@sangerkatz just got another update - # of household applications for #HealthyPA went up to 134K (unclear how many previously uninsured).

— Elana Gordon (@Elana_Gordon) January 9, 2015

 

Pennsylvania's somewhat confusing version of ACA Medicaid expansion is off to an excellent start:

About 2.3 million Pennsylvanians are currently enrolled in Medicaid, Gillis said, and as of Dec. 22, about 88,000 households had applied for Healthy PA, with approximately 30,000 additional applications sent to the state from healthcare.gov. The number of applications from each county is not yet available, Gillis said.

The department is still processing applications but, she said, most of the new sign-ups are going into the Private Coverage Option, which is for people who are newly eligible because Healthy Pa.’s income limits — 133 percent of the federal poverty level, with a 5-percent income disregard — will be broader than Medicaid’s are.

PA has around 600K residents eligible for the expansion program, so that's about 20% who have already signed up so far.

As the article notes, just because someone applies for Medicaid doesn't mean that they'll be approved (or some in the household might while others aren't). Still, assuming that, say, 95% are approved and enrolled, and assuming 1.8x people per household on average (the Census Bureau says it's more like 2.5x), that should still be a good 125K Pennsylvania residents added to the tally in the first 2 weeks...or over 20% of the total eligible in the state:

Two weeks after enrollment began, the state has received tens of thousands of applications for health care coverage by way of the “Healthy PA” program, which offers subsidized, Medicaid-like insurance through private carriers to low-income Pennsylvanians.

As of the end of the day Wednesday, the state had received applications from nearly 44,000 households, according to the Department of Human Services. It also has received an additional 30,000 household applications referrals through the federal health care marketplace.

That doesn’t necessarily mean all those applicants will be eligible to receive coverage, though likely many of them will be, said Kait Gillis, a DHS spokeswoman.

I don't know exactly how many individual people a "household" represents, but I've typically used a 1.8x multiplier to be very cautious (the Census Bureau uses 2.63x).

That suggests the actual number of PA expansion enrollees is more like 49,000 people in just the first week, which would be a fantastic start.

The Corbett administration reached an agreement with the federal government this year to launch the Healthy PA program in lieu expanding Medicaid. Open enrollment in the program has started and coverage will take effect Jan. 1.  However Governor-elect Tom Wolf says he will scrap Healthy PA and opt in to Medicaid expansion.

The impending switch apparently has confused many low-income Pennsylvanians, and some are sitting on the sidelines rather than signing up for coverage.

“The most important things is for people to enroll and to get their names on the list,” said State Rep. Vincent Hughes (D- Philadelphia).  “If they are not on the list then they won’t get the coverage."

Despite the confusion, more than 27,000 households applied for coverage in the first week of enrollment, which began Dec. 1.

Pennsylvania is about to suffer from whiplash with their version of Medicaid expansion; outgoing GOP Governor Tom Corbett set it up as an Arkansas-style "private option" program, but incoming Democratic Governor Tom Wolf plans on switching everything back over to "standard" Medicaid expansion after he takes office, so things could get a bit confusing for awhile.

The good news, anyway, is that it's off to a great start:

Gillis said people have reached the call center, but calls were taking longer than expected, with some taking two hours or more.

Meanwhile, she said the online enrollment process is working well. She said the state received 11,500 applications during the first two days of enrollment. There is no enrollment deadline, but people who want coverage on the first day it's available, Jan. 1, must enroll by Dec. 15, Gillis said.

Last night I noted that both Alaska and Wyoming are strongly considering jumping in the ACA Medicaid expansion pool. If both go through, the number of states which have expanded the program would rise to 31 out of 51 (if you include DC). Tennessee is also considering an Arkansas-style "private Medicaid option".

I also mentioned in passing that one of the "existing" expansion states was Pennsylvania. I knew they were also talking about a "private option" program, but I wasn't sure what the status of the program was. I didn't think it was a done deal yet, but the Kaiser Family Foundation has already struck PA off of their "Medicaid Gap" list, so I'm including them in the tally.

Well, this morning, not one but two site supporters have confirmed that not only is PA definitely moving forward with that program, it might actually end up being "full" expansion instead of the "private option" after all...along with some other useful tidbits I didn't know about:

OK, I almost always cite my sources on data points, but in this case I can't. On the other hand, it's not anything eyebrow-raising either; someone in a position to know has confirmed that at least 1,000 people had enrolled in QHPs via at least one insurer in Pennsylvania as of 11/19.

Considering that PA enrolled over 300,000 people last year, and there are 10 companies participating on the exchange in the state anyway, this isn't a particularly shocking data point, so I'll leave it there, but I can at least add it to the spreadsheet for Pennsylvania, anyway.

VERMONT: Federal Law Raises Questions About Who Can Bid For IT Projects That Support The Exchange

A provision of the Affordable Care Act precluding health insurers or companies in the “same controlled group of corporations” as a health insurer from holding exchange contracts raises questions about Optum working on Vermont Health Connect.

Concerns regarding Optum were raised at the federal level by Sens. Orrin Hatch, R-Utah, and Chuck Grassley, R-Iowa, the ranking members of the Finance and Judiciary committees respectively.

IDAHO: Your Health Idaho to launch sign-up system

Basically just an overview of the new Idaho ACA exchange; ID is the only state moving from HC.gov to their own website for the 2nd year, giving them a unique perspective. Most interesting to me is that they're spinning the "autonomy/states-rights" angle, which was the whole reason for pushing states to set up their own exchanges in the first place:

Sarah Kliff at Vox broke the news a few hours ago, but I just received the official press release from CMS; there seems to be some discrepancy about the total number eligible, but it's fantastic news no matter what:

Pennsylvania has apparently struck a deal with the Obama administration to expand its Medicaid program to more than 300,000 poor residents, Joan Alker at Georgetown University tweets:

Pennsylvania would be the 27th state (not including the District of Columbia) to participate in Obamacare's Medicaid expansion, and Gov. Tom Corbett would be the ninth Republican governor to sign on.

According to the CMS Dept, however, the actual number eligible in Pennsylvania could top 500,000:

FOR IMMEDIATE RELEASE Contact: CMS Media Relations

August 28, 2014
(202) 690-6145 or press@cms.hhs.gov

CMS Statement on Approval of Medicaid Expansion in Pennsylvania

In Pennsylvania, the Medicaid "woodworker" effect has been specified as being roughly 18,000 people...which is actually higher than the 13,000+ that I had estimated for PA up until now:

Pennsylvania’s Medicaid enrollment is up by more than 18,000 people since the Oct. 1 launch of the Affordable Care Act’s online health plan marketplaces.

The state's enrollment bump in the program for low-income families and individuals is small, though it coincides with larger jumps being experienced in other Republican-led states. Supporters of the ACA are crediting the 2010 federal health care overhaul with encouraging more uninsured to examine their health coverage options. Subsequently they discover that they were already eligible for state-funded insurance programs.

It’s called the “woodwork” effect — people who may have been eligible for Medicaid or related children’s programs all along only learned of their eligibility during the six-month push to sign Americans up for health insurance.

In other words, they “came out of the woodwork.”

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