State government plays a critical role in today’s health care system. Every policy decision we make has an impact on the individuals, children and families who need care. The Governor’s FY20 budget proposal builds on this momentum, preserving vital ACA protections that promote market stability and help to keep uninsured rates low. There are no eligibility cuts or broad-based benefit impacts proposed.
Last year there was much hand-wringing by myself and other healthcare wonks about whether or not the Trump Administration would attempt to kill off Silver Loading (and its even-wonkier cousin, Silver Switching). HHS Secretary Alex Azar and CMS Administrator Seema Verma kept sending out mixed and confusing signals about their intentions.
Eventually, Azar decided that while he doesn't like the practice, there wasn't enough time to change the rules before the 2019 Open Enrollment Period was set to begin, so he decided to take a pass for the time being.
Well, in yesterday's NBPP release, the HHS Dept. addressed the issue of CSR reimbursement funding directly...but they also made it clear that they're letting Silver Loading slide for another year:
We propose a premium adjustment percentage of 1.2969721275 for the 2020 benefit year, including a proposed change to the premium measure for calculating the premium adjustment percentage. Under §156.130(e), we propose to use average per enrollee private health insurance premiums (excluding Medigap and property and casualty insurance), instead of employer-sponsored insurance premiums, which were used in the calculation for previous benefit years, for purposes of calculating the premium adjustment percentage for the 2020 benefit year. The annual premium adjustment percentage sets the rate of increase for several parameters detailed in the PPACA, including: the annual limitation on cost sharing (defined at §156.130(a)), the required contribution percentage used to determine eligibility for certain exemptions under section 5000A of the Code (defined at §155.605(d)(2)), and the employer shared responsibility payments under sections 4980H(a) and 4980H(b) of the Code.
Here's what this seeming gobbledygook means, as explained by Matt Fiedler of the Brookings Institute:
Currently, enrollees in plans offered through a Federally-facilitated Exchange or a State-based Exchange using the Federal platform can take action to re-enroll in their current plan, can take action to select a new plan, or can take no action and be re-enrolled in their current plan. Since the program’s inception, these Exchanges have maintained an automatic reenrollment process which generally continues enrollment for current enrollees who do not notify the Exchange of eligibility changes or take action to actively select the same or different plan.
How many government servers were not patched in the past month? How many applications and website frameworks were not updated? How many pentests were postponed? How many logs were not examined for intruders?
Issuers Urge CMS To Offer Guidance On 2020 Exchange Policy As Rule Stalled
Two associations representing health plans tell CMS that with the annual exchange rule stalled at the White House Office of Management and Budget (OMB) due to the government shutdown, the agency should immediately issue informal guidance that the plans need to understand regulatory and operational changes for the 2020 plan year. Issuers will likely be asked to submit applications in May, and it is critical to get guidance as soon as possible for adequate preparation, the Association for Community Affiliated Plans (ACAP) and the Alliance for Community Health Plans (ACHP) say in a Jan. 15 letter.
CMS typically released the draft Notice of Benefit and Payment Parameters (NBPP) in the early fall and it was generally finalized prior to the new year, although last year the final version was delayed until spring, which also frustrated plans. This year, the proposed rule didn’t land at the OMB for review until Nov. 28.
With the final Open Enrollment deadlines now having passed for Minnesota, California, Colorado and Connecticut (but some data still missing for CA and CT), it's time to check in once again to see where things stand at the state-by-state and national levels.
At least 13 states have now exceeded their 2018 Open Enrollment performance, 7 of which use state-based exchanges: Idaho, Oklahoma, Massachusetts, Minnesota, Mississippi, Colorado, Rhode Island, Florida, Maryland, Hawaii, Wyoming, New York and Utah.
Also worth noting: Four states (Colorado, Hawaii, Massachusetts and Minnesota) are part of the "Five Year Club"...all four have managed to break their previous enrollment records for five years in a row. Mazel Tov!
Connect for Health Colorado® Sees Increase in Number of Coloradans Receiving Financial Help in Sixth Open Enrollment Period
DENVER – More than 169,000 Coloradans selected health coverage for 2019 through the state health insurance Marketplace by the close of Open Enrollment Tuesday, an increase of 2 percent over the previous Open Enrollment period, according to new data released today by Connect for Health Colorado®, and the number getting financial help buying insurance grew sharply.
About three of every four people—77 percent – who chose health insurance through Connect for Health Colorado qualified to receive financial help to reduce their monthly premium. That is up from 69 percent in 2018 and 61 percent in 2017.
Back in April 2017, I compiled a 20-itme "ACA 2.0 wish list" which I titled "If I Ran the Zoo", which gained some amount of attention from the healthcare policy wonk community. To be clear, I wasn't the first one to come up with most of these ideas; it was mainly just pulling together a bunch of proposals to protect, repair and strengthen the ACA from various sources into a single, comprehensive collection.
MNsure reaches record-setting sign-up numbers in sixth open enrollment period
123,731 Minnesotans sign up for private health coverage
ST. PAUL, Minn.—MNsure reported strong numbers during its sixth open enrollment period, which ended Sunday. Nearly 400 more Minnesotans signed up for coverage than during the previous open enrollment period, which ended with 123,334 sign-ups.
Hmmm...just as with Colorado, MNsure's official numbers don't quite jibe with CMS's official report from last year, which put MN's tally at 116,358 QHP selections...nearly 7,000 fewer than MNsure's number.
If you encounter long hold times today and are unable to get through to our Customer Service Center on Jan. 15 to complete your enrollment, please contact our customer service center no later than 6:00 p.m. on Friday, Jan. 18 to complete your enrollment. At that time, you must let the representative know that you were unable to get through on Jan. 15.
Oddly, the message didn't include C4HCO's actual phone number: 855 752-6749
Gov. Newsom Urges Uninsured to Get Covered Before Midnight Deadline Tomorrow as Covered California Continues Promoting Enrollment
Consumers have through Jan. 15 to sign up and select a plan, through Covered California or directly with health plans, for Feb. 1 coverage.
Gov. Gavin Newsom promotes enrollment for the estimated 1.1 million uninsured Californians eligible to enroll in Covered California or Medi-Cal.
Covered California research shows that 82 percent of uninsured consumers surveyed, who are eligible for financial assistance, do not know that they qualify.
LOS ANGELES, Calif. — California Gov. Gavin Newsom on Monday urged Californians who need health insurance to enroll as Covered California continued promoting coverage statewide before the deadline to enroll on Jan. 15.
“Covered California is in the final two days of open enrollment. That means if you are without health insurance, you need to sign up by Tuesday, Jan. 15, to secure health coverage,” Newsom said.
With the clock ticking, Access Health CT’s latest statistics show they are closing in on last year’s numbers.
As of Friday afternoon there are now 109,126 Connecticut residents enrolled in insurance plans through the exchange. The deadline for enrolling was extended to Jan. 15.
Last year 114,000 Connecticut residents enrolled in plans sold on the exchange.
CT is just over 5,000 signups shy of last year's 114,134 QHP selection total. They probably added a couple hundred more over the weekend (weekends are always slower anyway), but the odds of matching last year's total by tomorrow (Tuesday) night are extremely slim. My guess is they'll end up between 110K - 111K.
Covered California’s Iconic Bus Tour Rolls into San Francisco to Promote Health Insurance Enrollment Ahead of Final Deadline
Covered California’s bus tour promotes enrollment and encourages consumers to see if they are eligible for financial help in obtaining quality health insurance.
The San Francisco visit coincides with the release of Governor Gavin Newsom’s budget which focuses on making health care more affordable through increased financial help and a state individual shared responsibility provision.
Consumers have through Jan. 15 to sign up and select a plan, through Covered California or directly with health plans, for Feb. 1 coverage.
An estimated 1.1 million uninsured Californians are eligible to enroll in Covered California and research shows that 82 percent of uninsured consumers surveyed, who are eligible for financial assistance, do not know that they qualify.
BLOCK GRANTS FOR MEDICAID — A Trump plan is in the works. Scoop today, behind the firewall right now. https://t.co/2PdVQKPoLH
The Trump administration is plotting a path for Medicaid block grants for states, a longstanding GOP goal to rein in spending on the entitlement program. News from me and @ddiamondhttps://t.co/EPkeqlPiSV
I haven't written anything about the developments in the #TexasFoldEm anti-ACA lawsuit in awhile, partly because I was out of the country for a couple of weeks and got backlogged. Then again, things are kind of at a standstill at the moment anyway, so perhaps that omission on my part isn't quite as big of a deal as I had feared.
Last chance: MNsure Open Enrollment Period Ends this Sunday, January 13
January 10, 2019
ST. PAUL, Minn.—Minnesotans have until midnight on Sunday, January 13, to secure health insurance coverage through MNsure for 2019. Those who enroll by the deadline will have coverage that begins February 1.
"MNsure is the only place to get financial help to save money on your monthly premium," said MNsure CEO Nate Clark. "More than half of all MNsure enrollees are receiving tax credits."
Reinstating the individual mandate penalty at the state level, as New Jersey, the District of Columbia, Vermont and Massachusetts have (VT's doesn't kick in until next year, and MA simply reverted back to their own pre-ACA mandate penalty), and
Enhancing ACA subsidies and expanding them to those earning 400-600% of the Federal Poverty Level
Newsom didn't include any details on either proposal, but I assumed that the mandate would simply reinstate what it was under the ACA before being repealed by Congressional Republicans in December 2017 ($695 per person or 2.5% of household income), and that the expanded subsidies would simply take the existing ACA formula (which limits the cost of benchmark Silver plans to no more than 9.86% of household income and provides subsidies to cover the difference after that), and raise the cut-off point from 400% FPL to 600% FPL.
That should mean that the average HC.gov premium is around $600 or so per month in 2018. The 3.5% surcharge hasn't changed for 2018, which means the federal exchange should take in something like $252/year per enrollee. Total enrollment in HC.gov plans was down 5% this year, so I'll assume average effectuated enrollment will be as well...somewhere around7.13 million per month. That means ~$1.8 billion in HC.gov revenue directly from the premium surcharge.
In the midst of the ongoing #TrumpShutdown, where hundreds of thousands of federal employees are either off the job altogether or having to work without being paid and hundreds of federal contractors are being stiffed for the work they've done in good faith, I just wanted to remind folks that Donald Trump also screwed over several hundred insurance carriers in October 2017 when he cut off contractually-owed Cost Sharing Reduction reimbursement payments to insurance carriers nationwide.
Gov. Jay Inslee and Democratic lawmakers Tuesday announced proposed legislation for a new “public option” health-care plan under Washington’s health-insurance exchange.
The proposal, which Inslee said is the first step toward universal health care, is geared in part to help stabilize the exchange, which has wrestled with double-digit premium increases and attempts by Republicans in Congress and President Donald Trump to dismantle the Affordable Care Act.
“We are proposing to the state Legislature that we have a public option that is available throughout the state of Washington so that we can increase the ability to move forward on the road to universal health care in the state of Washington,” said the governor, who is considering a run for president in 2020.
New York City will begin guaranteeing comprehensive health care to every single resident regardless of someone's ability to pay or immigration status, an unprecedented plan that will protect the more than half-a-million New Yorkers currently using the ER as a primary provider, Mayor Bill de Blasio said.
It's not health insurance, his spokesman clarified after the surprise announcement on MSNBC Tuesday morning.
"This is the city paying for direct comprehensive care (not just ERs) for people who can't afford it, or can't get comprehensive Medicaid — including 300,000 undocumented New Yorkers," spokesman Eric Phillips tweeted.
At a press conference Tuesday, de Blasio said the plan will provide primary and specialty care, from pediatrics to OBGYN, geriatric, mental health and other services, to the city's roughly 600,000 uninsured.
California’s Open Enrollment for Individuals Ends Jan. 15; Consumers Have One Week to Sign Up for Health Care Coverage
Consumers have through Jan. 15 to sign up and select a plan through Covered California or directly with health plans for coverage that will begin on Feb. 1.
The final week of open enrollment comes on the heels of Gov. Newsom’s announcing sweeping proposals, including a new requirement for having coverage and expanded subsidies.
While open enrollment ended for much of the nation in December, California’s final deadline is about two weeks earlier than it was in previous years, when open enrollment ran through the end of the month.
More than 238,000 consumers had selected a plan through Dec. 31.
Gov. Gavin Newson announced sweeping proposals to tackle the state’s healthcare needs shortly after taking office on Monday, outlining a dramatic Medi-Cal expansion that would cover young undocumented adults, a requirement that all consumers in the state carry health insurance and increased subsidies for middle-class families to help those who need it.
...Newsom campaigned on a universal healthcare platform and has said the issue would be among his top priorities. His announcement on Monday stopped short of the single-payer system demanded by activists that would cover all residents’ healthcare costs, but was characterized as the first step down that path.
According to the article, Newsom, who just took office a few hours ago, already plans on rolling out his proposed state budget on Thursday, which is expected to include, among other things:
Rural Counties Lead Connect for Health Colorado® 2019 Health Coverage Sign Ups; Many Have Already Passed 2018 Totals
DENVER – Rural counties are leading the way in Connect for Health Colorado® sign ups as the state health insurance marketplace heads to the last week of the 2019 Open Enrollment period.
Overall, 2019 health plan selections through Connect for Health Colorado are running about 3 percent ahead of the comparable period a year ago but many rural counties have already exceeded the number of plan selections made in the entire two-and-a-half-month Open Enrollment period in 2018.
By January 3, 2019, 30 of the state’s 64 counties had matched or exceeded the number of plan selections made during all of last year’s Open Enrollment.This year’s Open Enrollment runs through January 15.
CT still has another week to go, but I just received a partial update, as of January 4th.
That's a net increase of 6,286 QHP selections between 12/15/18 - 1/04/19, or around 300 per day on average. At that rate, they'd add around 3,300 more by the final 1/15 deadline, putting them 112,000...still around 2,100 shy of last year. On the other hand, that timeframe included both Christmas and New Year's Eve, when enrollment tends to drop through the floor, so there's still a chance of Access Health CT at least matching 2018, though exceeding the 114,134 tally would be a pretty tall order at this point.
For years now, I (and many other healthcare wonks) have been arguing that one of the most important fixes/improvements that the ACA needs regardless of the Next Big Thing® is to #KillTheCliff...that is, to eliminate the infamous "subsidy cliff" which hits those who earn just over the 400% Federal Poverty Level income cap for Advance Premium Tax Credit (APTC) assistance.
Once again: Under the ACA, if you earn between 100-400% FPL (between $12,140 and $48,560 for a single person), you're eligible for APTC assistance on a sliding scale. The formula is based on the premium for the Silver "benchmark" plan available in your area, which averages around $611/month in 2019.
Here's how the formula works under the current ACA wording:
Governor Northam Announces Medicaid Expansion Hits Milestone with More Than 200,000 Enrolled
Virginians can apply at any time of the year
RICHMOND—Governor Ralph Northam announced Friday that more than 200,000 Virginia adults are now enrolled and will have health coverage starting January 1. The achievement marks a major milestone in the Medicaid expansion initiative approved last summer.
“This bipartisan initiative has empowered men and women across the Commonwealth to take an active role in improving their health,” said Governor Northam. “The historic response from our citizens demonstrates the need for access to health coverage that will benefit our families, our communities and Virginia’s economy. I encourage uninsured individuals to learn more about this new health coverage opportunity and to apply today.”
OK, with the FINAL HC.gov Report having been released, I can now fill in even more blanks in the 2019 Open Enrollment Period: A grand total of 11.24 million11.3 million QHP selections nationally so far. That includes 8.41 million on the federal exchange, plus another 2.82 million2.9 million on the 12 state-based exchanges.
If the counting were to stop right here, the total would be 3.9% 3.8% lower than last year nationally, which would actually be pretty good all things considered.
Press Release: NY State of Health Announces Qualified Health Plan Enrollment Tops January 31, 2018 Level
Jan 4, 2019
Still Time to Enroll
Consumer Demand for Affordable Coverage is High
ALBANY, N.Y. (January 4, 2019) - NY State of Health, New York’s official health plan Marketplace, today announced that as of January 1, 2019 more than 254,000 New Yorkers have enrolled in a Qualified Health Plan (QHP). With less than one month to go in the 2019 Open Enrollment Period, the number of QHP enrollees has already exceeded QHP enrollment at the end of the 2018 Open Enrollment Period.
So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet. 2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!
In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st
For four years now, I've been meticulously tracking and analyzing the annual premium rate change filings on the individual market (and usually the small group market) for pretty much every insurance carrier in every state, then consolidating all of that data into tables which break out the weighted average premium increases (or decreases, in some cases) on a state-by-state and national basis. Each year I've been proven to be pretty damned accurate:
It's been pretty obvious for the past two years that the states which fully control their own ACA exchanges (including their own marketing and outreach budgets and their own exchange website platform) seem to be outperforming the states hosted by the federal exchange, HealthCare.Gov, in terms of open enrollment numbers year after year.
However, this can be a bit tricky to compare because some of the states have shifted back and forth...four states which ran their own platform for the first one to three years (Hawaii, Kentucky, Nevada and Oregon) moved home to the mothership in later years, while one state (Idaho) did the reverse--they stuck with HC.gov for 2014 but then broke off onto their own platform after that.
Yeesh...when it rains, it pours! Right on top of updated and/or final 2019 Open Enrollment numbers 41 states (Idaho, Rhode Island and the 39 states hosted by HealthCare.Gov) comes yet another updated tally from Massachusetts:
As of today:
274,317 enrollments for January
2,997 enrollments for February or March
3,763 plans selected (1st premium not paid but not due yet)
Retention rate is 91 percent, up 2.6 percent from last year.
As I warned back on December 19th when CMS released the Week 7 HealthCare.Gov Enrollment Snapshot Report, the final, official enrollment tally for the 2019 Open Enrollment Period was almost certain to end up slightly lower than the Week 7 cumulative numbers indicated. There are several reasons for this: Some people who were auto-renewed contact HC.gov to cancel their 2019 renewals, while others had their enrollments involuntarily denied or otherwise cancelled due to problems with verifying their identity, address or legal residency status.
EAST PROVIDENCE, R.I. (WPRI) — Rhode Islanders have just a few hours left to obtain health insurance through the state.
The deadline to sign up for and renew coverage for 2019 is Monday, Dec. 31.
The state's health insurance marketplace, HealthSource RI, plans to keep its call and walk-in center open until 7 p.m. Monday.
The center is located at 401 Wampanoag Trail in East Providence and the hotline is 1-855-840-4774.
Rhode Islanders have until midnight Monday to sign up for coverage online through HealthSource RI's website.
"Enrollment is up from last year, which we're very excited about, so that to us is a sign that the ACA is working in Rhode Island, and everybody is understanding the value of having health coverage," HealthSource RI COO Meg Ivatts said.
Now that I've brought everyone up to speed about my disappearing act, it's time to delve back into the ACA & healthcare developments of the past few weeks. There've been quite a few to talk about, but for now I'll just focus on updating the OE6 enrollment books a bit...starting with one of the two states which, until now, hasn't provided any 2019 enrollment data: Idaho.
As I noted a few weeks ago, this is the first time I've gone without posting any updates to the site for more than a few days since I launched this project over five years ago. Obviously a tremendous amount has happened since I went off the grid--some good, some bad--and there's no way I can catch up with all of it, but I'll try and recap a few of the developments most relevant to the ACASignups.net readership in my next post.
Before that, though, I'm sure all of you (well, some of you...ok, perhaps one or two of you?) are wondering where I was, so lemme start with that.
Unlike Islam and Mecca, there's no specific commandment under Jewish law which states that every Jew must visit Israel at least once in their lifetimes. Most Jews, however, do want to visit Israel at least once, and it's something which has been on my Bucket List since I was a kid. The day my wife and I found out she was pregnant, we decided right then and there that we were going to take our son on a family trip to Israel for his Bar Mitzvah.