A year ago I wrote up my own "wish list" of 22 recommendations for fixing, improving, strengthening and expanding the Affordable Care Act (it's officially 20 items but two of them really should have been split into two entries apiece). I called it "If I Ran the Zoo", and it received quite a bit of praise, even though I didn't come up with most of them myself; it was mostly a compilation of ideas which had been floating around progressive healthcare wonk circles for awhile.
In any event, now that the Republican "ACA stabilization bill" (Alexander-Collins) appears to be dead and buried, I figured it might be helpful to line up both the House and Senate versions of the ACA 2.0 bills to see how they compare to each other as well as to my own list of recommendations.
NOTE: I've modified the headline to clarify that it's CSR reimbursements which are dead, not the actual CSR subsidies. Those eligible for CSR assistance will still receive it from the insurance carriers..it's just that the carriers aren't/won't be reimbursed for doing so. In response, they've jacked up the premium rates on others to cover their losses.
As I understand it, this means that unless a standalone bill of some sort passes, there will be no significant legislative changes to the ACA exchange/individual market status for the 2019 Open Enrollment Period at the federal level...and that's extremely unlikely to happen this year.
The House ACA 2.0 bill would check off a half-dozen or so of the 20 items on my (now outdated) wish list of ACA fixes/improvements...but also includes another half-dozen provisions on top of that (many of the additional items would cancel out Trump/GOP sabotage efforts which hadn't even happened when I wrote my "If I Ran the Zoo" wish list a year ago).
A few days ago I warned Congressional Democrats that while I agree that appropriating CSR reimbursement payments at this point would be a net negative move thanks to the clever Silver Load/Silver Switcharoo workaround developed last year, there's one possible cloud surrounding that silver lining, so to speak: What if the Trump Administration were to attempt to put the kibosh on Silver Loading altogether?
I don't know the legality of such a move, mind you, but It has been thrown around the rumor mill of late, so I figured I should remind them to keep that possibility in mind.
New legislation will allow Vermont insurers to load cost of CSR only onto on-exchange silver plans for 2019
For 2018 coverage, Vermont, North Dakota and the District of Columbia were the only states that didn’t allow insurers to add the cost of cost-sharing reductions (CSR) to premiums after the Trump Administration cut off federal funding for CSR. In most states, insurers were allowed to either add the cost of CSR to all silver plan premiums, to all on-exchange silver plan premiums, or, in a few cases, to all metal-level plan premiums. But in Vermont, North Dakota and DC, insurers simply had to absorb the cost of CSR, estimated at $12 million a year in Vermont.
It's not about healthcare. It's not about "freedom". It's not about "tyrrany". It's not about "choice". It's about a tiny cadre of absurdly wealthy plutocrats being upset about a tiny fraction of their hoard being used to help out the least-fortunate among us. Via the Congressional Budget Office (graph via Axios):
Minnesota's 2018 Open Enrollment Period was a month longer than the official half-length period pushed by HealthCare.Gov, but was still over 2 weeks shorter than it had been in prior years, ending on January 14th, 2018. Even so, they reported a slight increase in year-over-year policy enrollees, ending OE5 with 116,358 QHP selections.
Typically, you'd see the official QHP selection number drop off noticeably by the end of the first quarter...usually by around 13% or so. Roughly 10% of those who select policies don't ever actually pay for their first monthly premium, and another 2-3% generally drop off after only paying for the first couple of months.
We released our End of Open Enrollment report this week, our most detailed look at the impact we are having across Colorado. This year, you will see that more of our customers are receiving help through the Advance Premium Tax Credit – 69 percent, compared to 61 percent last year – and the average level of monthly tax credit help climbed to $505 from $369 last year.
Not surprising...the 34% average rate increases (about 6 points of which is due specifically to CSR reimbursement payments being cut off...much lower than most states) meant that a lot more people qualified for tax credits in the first place, and of course the amount of credits went up accordingly...a bit more, actually (37% on average).
Consumer Choice Continues to be a Hallmark of the Marketplace
ALBANY, N.Y. (March 14, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released data showing 2018 health plan enrollment by insurer. Statewide, 12 health insurers offer Qualified Health Plans (QHP) to individuals and 15 health insurers offer coverage to Essential Plan (EP) enrollees through the Marketplace. Ten health insurers participate in all individual market programs offered through NY State of Health allowing consumers a smooth transition if their program eligibility changes. Throughout the 2018 Open Enrollment Period, most consumers had a choice of at least four health insurer options in every county of the State.
As regular readers will recall, after three years of full 3 month Open Enrollment Periods across every state, last year the Trump Administration slashed the official Open Enrollment Period in half, down to just 6 weeks, from November 1 - January 31 down to November 1 - December 15th.
In response, most of the state-based exchanges announced that they were sticking with a longer period anyway, ranging anywhere from a 7th week all the way out to the full 3 month period, in the case of California, New York and the District of Columbia...each of which kept things going all the way through January 31st as had become the norm.
California even went one step further, passing a state law specifically mandating a 3-month Open Enrollment Period for 2018 and beyond.
Until today, I've been operating on the assumption that they'd be sticking with the November/December/January schedule which had become the default.
So there you have the enrollment results of full-bore on-exchange silver-loading of CSR costs in one state. In all, 49,993 on-exchange enrollees with incomes up to 400% FPL chose plans other than silver. About 48,000 of them were subsidized. That's 31.2% of all enrollees, within striking distance of Aron-Dine's upper bound of 36% for all marketplace enrollees.
HealthSource RI, Rhode Island's ACA exchange, released preliminary 2018 Open Enrollment data awhile ago, but this morning they released their final, official demographic data breakout, and there's a lot going on here:
HealthSource RI sees 5% enrollment increase and nation leading lowest benchmark plan cost
State-based marketplace sees rise in enrollment of “young invincibles”
Under the Guise of “Health Insurance Stabilization,” Congress Should Not Axe Financial Help for Low-Wage Families
In negotiations over stabilizing the individual health insurance market, lawmakers are considering slashing federal health care assistance for low- and moderate-income consumers by more than $27 billion a year. In dollars terms, this would be a greater blow than completely eliminating, in one stroke, the Low-Income Home Energy Assistance Program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Child Care and Development Block Grant, the Community Development Block Grant, and federal grant programs for community-based mental health services and substance abuse prevention and treatment.