Charles Gaba's blog

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.

When I last checked on Access Health CT, Connecticut's ACA exchange, their 2019 Open Enrollment Period tally was about 10% short of their final number from 2018, by around 11,700 people. However, they still had a solid month left to make up the gap, with the enrollment deadline extended out until January 15th, 2019.

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:

*(Yes, that's sarcasm...it's been anything BUT "just like that" in Maine...)

Openly racist and mini-Trump GOP Maine Governor Paul LePage spent the better part of the past eight years blocking the expansion of Medicaid under the Affordable Care Act. First, he vetoed the Medicaid expansion bills passed by the state legislature a whopping seven times. Then, when Maine voters finally had enough and successfully passed a statewide ballot initiative to force the issue, LePage spent another full year continuing to fight against actually implementing the expansion provision via legal challenges and flat-out violation of court orders.

This happened while I was out of town, but it's welcome news nonetheless...

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 million 11.3 million QHP selections nationally so far. That includes 8.41 million on the federal exchange, plus another 2.82 million 2.9 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.

HOWEVER, it isn't over yet. Deadlines in several state-based exchanges haven't expired yet. New York and DC are open for business until January 31st, and many people in Alaska, Georgia and Florida still have time to enroll due to last fall's earthquake and hurricanes.

Here's what it looks like as of right now:

New York State of Health just became the 6th State-Based Exchange (SBE) to officially surpass last year's final Open Enrollment Period total:

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.

Minnesota's ACA exchange, MNsure, last reported having enrolled over 113,000 people in Qualified Health Plans (QHPs) as of the first December 15th deadline, putting them just 3,300 enrollees behind last year's final total of 116,358 QHPs.

However, MN is one of the states sticking with an extended deadline this year, which means their 2019 Open Enrollment Period is still going on through January 13th...and they just reported having broken last year's total with 11 days remaining for Minnesotans to #GetCovered:

There is Still Time to Get Covered—MNsure's Open Enrollment Period Ends January 13
January 3, 2019

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 yet2019 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

ALSO...

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.

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