I haven't written much about the recent announcement by Vermont's governor that after years of pushing a single payer plan for the state, he's basically pulled the plug on it (at least for the time being). I noted the announcement but didn't have much to add myself.
Part of this is because I'm swamped with the actual ACA open enrollment itself, of course. Part of it is because it's too depressing a development for me to really think about right now. Part of it is because others far more knowledgeable than I am have much more to say about it.
One such person is Vox's Sarah Kliff, and she's written a fairly definitive explanation of what went wrong. The short version: Vermont's tax base is too small to support the initial costs, even if it would save gobs of money in the longer term.
In Vermont, this is massive: the state only raises $2.7 billion in taxes a year for every program it funds. Early estimates said that Vermont's single-payer plan might need $1.6 billion in additional funds — a huge lift. But $2.5 billion was impossible.
OK, strictly speaking this isn't directly ACA-related, but come on...
Shumlin: "The time is not right"
Vermont has long had a two-pronged approach to building a single-payer health care system. First, they would figure out what they would want the system to look like. Then, they would figure out how to pay for it.
The state passed legislation outlining how the single-payer system would work in 2011. And ever since, the state has been trying to figure out how to pay for a system that covers everybody. Most estimates suggest that the single payer system would cost $2 billion each year. For a state that only collects $2.7 billion in revenue, that is a large sum of money.
What Shumlin appears to be saying today is that the "time is not right" to move forward on the financing of the single-payer system. And that means putting the whole effort aside, with no clear moment when the debate would be reopened.
Ouch.
Thanks to Morgan True for the link to this PowerPoint report which explains why VT is pulling the plug on their ambitious Single Payer attempt:
As you can see from the graphic I posted yesterday (and had to revise several times throughout the day), the official enrollment deadline for private policies starting on January 1st, 2015 has now passed for all 37 states operating via HealthCare.Gov, as well as residents of DC, Hawaii and Kentucky. It's certainly possible that any or all of these will announce some sort of "special circumstances" allowance for those who didn't make the midnight cut-off (10pm in Alaska), but I'm assuming those would be done strictly on a case-by-case basis.
OK, so what about the remaining 11 states?
Well, 4 of them (MD, MA, RI & WA) had later deadlines for January coverage all along: Maryland on 12/18 (Thursday) and the other 3 on 12/23 (next Tuesday).
New York and Idaho bumped their deadlines out from yesterday until 12/20 (Saturday), although Idaho had previously claimed that their deadline was 12/23, but are now claiming that it was originally 12/15. I still don't understand what happened there, but so be it: 12/20 it is for ID.
California’s health insurance exchange extended its deadline for consumers wanting Obamacare coverage in effect by Jan. 1.
Peter Lee, executive director of Covered California, said people who start the application process or make some “good faith effort” by Monday will have until Dec. 21 to finish signing up. Monday at midnight had previously been the hard deadline.
“We are providing this window to get people across the finish line,” Lee said at an exchange board meeting Monday. “We know many of the people applying have never had insurance before, and these are individuals who need to sit down and talk with someone.”
Lee said many insurance agents and enrollment counselors were already fully booked with applicants Monday. He said the deadline extension will allow people to make appointments through Dec. 21.
Today I've been informed that the renewal number reached 4,415 as of 11/23, plus another 3,588 new applications. It was also specified that an "application" represents a household, not the total number of covered lives for whatever policy is eventually enrolled in.
Assuming an average of 1.8 people per household, and further assuming that roughly 50% of those who apply had also already selected a plan as of the date in question (this has been a consistent rule of thumb based on the Massachusetts data to date), that suggests that those applications represent roughly 6,400 actual people, and roughly 3,200 of them should have already selected their plans. Knocking 100 off in the interest of caution gives roughly 3,100 new enrollments on top of the 4,415 confirmed renewals, or around 7,500 total enrollments as of the 23rd.
Yes, these are renewals, but this is still extremely impressive, especially seeing how the number has doubled since Monday night:
A new open enrollment period began Saturday, and since then the system has taken in more than 600 new applications and processed more than 3,000 renewals of existing policies.
Vermont Health Connect spokesman Sean Sheehan says the system's performance hasn't been flawless, but he described its improvement over last year as like night and day.
I'm not sure whether the 306 "new coverage applications" refer to actual enrollments or not; going by my own post yesterday, I'll assume not until I hear confirmation otherwise:
The exchange processed 32 new coverage applications by 11:30 a.m., officials reported. By the close of business Monday, that number climbed to 306.
“We have not had any problems reported today,” said Lawrence Miller, chief of Health Care Reform, on Sunday.
...The exchange processed 1,515 renewals as of Monday evening. Those are a mix of people who submitted changes early and those being automatically reenrolled in their current plans.
For comparison, last year Vermont only had 38,000 QHP enrollees total.
Update: I've confirmed that, as I suspected, the 306 "new applications" are just that, not necessarily actual enrollments.
