Charles Gaba's blog

I just updated AccessHealthCT's numbers a week ago; it looks like they only added 428 more people over the next seven days:

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.

From Covered California:

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.

This just in from the MA Health Connector:

Update from us, as of last Friday:

  • 277,029 paid enrollments
  • 7,615 plans selected/unpaid
  • 284,969 total, per CMS enrollment definition
  • We have 47,573 new enrollees.

Once again: Massachusetts has managed to outperform their ACA enrollment numbers every year for five years running:

  • 2014: 31,695 (major technical problems)
  • 2015: 140,540 (complete platform overhaul)
  • 2016: 213,883
  • 2017: 266,664
  • 2018: 267,260
  • 2019: 284,969 and counting...

Just as impressive, if not more so: 97.2% of Massachusetts ACA enrollees have already paid their first monthly premium, which is well above the ~90% national average.

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 @ddiamond https://t.co/EPkeqlPiSV

— Rachana D. Pradhan (@rachanadixit) January 11, 2019

— Dan Diamond (@ddiamond) January 11, 2019

Per admin sources, CMS has guidance to states in the works on the topic. Officials also very aware of the political sensitivities surrounding such a plan.

— Rachana D. Pradhan (@rachanadixit) January 11, 2019

Yesterday I wrote about the current status of several federal lawsuits against the Trump Administration over the decision to stiff contractors (i.e., health insurance carriers) out of nearly $2 billion in Cost Sharing Reduction reimbursement payments.

This morning I wrote about the current status of the infamous #TexasFoldEm lawsuit brought by 20 Republican Attorneys General and Governors against the ACA, and the impending appeal of Judge O'Connor's ruling in their favor.

But there's more Big Deal ACA litigation in the works as well...and while the Trump Shutdown has brought some of them to a standstill, Harris Meyer of Modern Healthcare reports that others are still churning along:

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.

Anyway, here's some of what's happened since Judge O'Connor's lousy ruling on December 14th:

A federal judge in Texas who recently declared the Affordable Care Act unconstitutional has stayed his ruling to allow for appeals.

That means “Obamacare” remains in effect while litigation continues.

REMINDER from MNsure.org...

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."

Minnesotans can see if they qualify for financial help, while also comparing medical plans side by side, by using MNsure's plan comparison tool.

MNsure has extended Contact Center hours in the days leading up to the final deadline:

Earlier this week, newly-sworn-in Governor Gavin Newsom announced several proposals for improvements to California's implementation of the Affordable Care Act along with some other important healthcare-related measures. The most important ACA-specific ones were:

  • 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.

ACASignups.net, February 11, 2018:

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.

All of this brings me to my question:

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.

Once again, the very short version is this:

Something is definitely in the water this week, and I believe it's called "Democrats hitting their stride on healthcare reform":

And now, this:

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.

I...really don't know what to do with this announcement:

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.

This Just In from Covered California...

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.

Some awesome news out of the Golden State today:

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:

This just in from Connect for Health Colorado...

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.

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