ACA

Over at the JAMA Network, KFF Executive VP for health policy Larry Levitt has a piece which lays out the most likely actions (or in one case, lack of action) that the incoming Trump Administration & Republican-controlled Congress will take now that they have a second shot at repealing the Affordable Care Act:

With many tax cuts from the 2017 Tax Cuts and Jobs Act expiring at the end of 2025, a high-profile Congressional debate over extending those tax reductions and enacting new ones is likely. There will be pressure from some in Congress for spending cuts to help pay for those tax cuts. Trump has said that Social Security and Medicare cuts are off the table, and defense reductions are unlikely as well. That means almost half of federal spending would be protected from cuts, leaving Medicaid, which is the next largest source of federal spending, and the ACA as prime targets for spending cuts. The math is inescapable.

Currently, the Affordable Care Act's preventative services mandate requires most employer-provided & individual market healthcare policies to provide coverage for the following types of birth control products & services:

Plans in the Health Insurance Marketplace® must cover contraceptive methods and counseling for all women, as prescribed by a health care provider.

Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your  deductible

Covered contraceptive methods

FDA-approved contraceptive methods prescribed by a woman’s doctor are covered, including:

Last spring, I noted that total enrollment in healthcare policies either specifically created by or expanded to more people by the Affordable Care Act had broken 40 million Americans:

Across these 19 states alone, ACA Medicaid expansion enrollment is up 788,245 people since last March, or 6.7% overall. If you remove Missouri and Oklahoma, it's still up 4.28% since then, and again, this is still as much as 8 months out of date depending on the state. Assuming Illinois is wrong, removing it as well puts expansion enrollment up 5.4% since last March.

Assuming these states are representative, it's safe to assume that Medicaid expansion is up at least 4.3% nationally since March 2022, or around an additional 960,000 people. If you go with the higher end estimate (+5.4%), it would be up over 1.2 million nationally.

That puts the grand total at somewhere between 39.9 - 40.1 million people with ACA-enabled healthcare covered nationally.

Earlier this afternoon, the Centers for Medicare & Medicaid Services (CMS, which should really be CMMS) released a whole bunch of much-awaited (by healthcare wonks) Effectuated Enrollment data for Affordable Care Act on-exchange enrollment.

While nearly 21.5 million Americans selected Qualified Health Plans (QHPs) via the federal and state ACA exchanges/marketplaces during the official 2024 Open Enrollment Period (along with an additional 1.3 million signing up for a Basic Health Plan (BHP) program in New York & Minnesota, which CMS continues to inexplicably treat as an afterthought in such reports), not all of them actually pay their first monthly premium (for January) for various reasons:

Welp. With last weeks news that House Republicans have decided to once again go to war with the Affordable Care Act if they gain a federal trifecta this November, it's time once again to take a look at just how many of their constituents are at risk of losing their healthcare coverage entirely or, at best, facing massive premium increases (which in most cases would have the same effect by making their coverage cost far more than they could possibly afford).

Alongside this weekends release of the final, official 2024 ACA Open Enrollment Period (OEP) data, The Centers for Medicare & Medicaid Services (CMS) has also pulled together estimates of how many residents of each Congressional District selected ACA exchange plans during the 2024 OEP:

Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7

Finally, we come to HOUSEHOLD INCOME BRACKETS.

This is, of course, extremely important since household income is one of the most critical factors in calculating how much financial assistance enrollees receive (or if they're eligible for Advance Premium Tax Credits (ATPC) at all).

Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7

Next up: METAL LEVELS.

If you've ever wondered why healthcare wonks (myself included) almost never even bring up the ACA's Catastrophic Level plans and why the only time I ever discuss Platinum Plans is in the context of high-CSR enrollees being eligible for "Secret Platinum" plans (labeled as Silver), this table should explain why.

Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7

Next up: Age brackets, gender, racial/ethnic groups and urban/rural communities. I'm also throwing in the stand-alone Dental Plan table here for the heck of it since I don't know where else to include it.

I don't have a ton to say about any of these, really. It's always interesting to me to see that 1.7% of ACA exchange enrollees are 65 or older. Not sure why they aren't on Medicare but I'm sure there are logical reasons.

Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7

Next up: Premiums, Advance Premium Tax Credits (APTC) and Cost Sharing Reduction (CSR) assistance.

Nationally, the average unsubsidized premiums for 2023 exchange-based Open Enrollment Period enrollees is $605/month, exactly the same as 2023.

Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7

Now it's time to move on to the actual demographic breakout of the 2024 Open Enrollment Period (OEP) Qualified Health Plan (QHP) enrollees.

First up is breaking out new enrollees vs. existing enrollees who either actively re-enroll in an exchange plan for another year or who passively allow themselves to be automatically renewed into their current plan (or to be "mapped" to a similar plan if the current one is no longer available).