It's finally here, and just in the nick of time for the U.S. Senate's big vote on whether to scrap the Individual Mandate or not.
In around 15 minutes, I guarantee that you’ll understand how the ACA’s 3-legged stool works and why the Individual Mandate, while being about as popular as a root canal, still serves an important function. Don’t forget the popcorn!
(Oh, and if you'd like to help support my work, please feel free to do so via either my Patreon or GoFundMe accounts, thanks!)
Given the whole Silver Load/Silver Switcharoo craziness, I was mildly surprised to see that the ratio between Bronze, Silver and Gold have barely changed year over year, and in fact Silver has inched upward by a few points...until I remembered that Colorado is among the few states which went with the "broad load" model, spreading the additional CSR cost across all metal levels both on and off the exchange. This makes the similar metal level spread more understandable, but it also makes the 25% enrollment increase even more surprising, since subsidized enrollees will pay pretty much the same (no more or less) than this year, but unsubsidized enrollees are seeing their rates shoot up no matter where they go. As you can see below, the average premiums for unsubsidized enrollees ("NFA" = "Non-Financial Assistance) is 36.6% higher this year than last.
(St. Paul, MN) -- More than 100-thousand Minnesota residents have enrolled in the state's MNSure health insurance purchasing exchange. And about 50-thousand families are expected to get average tax credits of 72-hundred dollars to help pay for their coverage. Credits are higher in southeast and southwest areas. MNSure C-E-O Allison O'Toole says they can make the difference between "unhealthy and healthy" for thousands of people -- and yet, she says too many residents are not taking advantage. The open enrollment for MNSure runs through January 14th -- and O'Toole says that for at least a couple years, the tax credits will remain in place regardless of what happens to Obamacare in Congress.
That's the enitre article...it's dated yesterday (11/24), so I'm assuming the 100K figure was as of Thursday evening (Thanksgiving, Nov. 23rd).
The Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight (CCIIO), part of the Department of Health & Human Services (DHHS), provides national leadership in setting and enforcing standards for health insurance that promote fair and reasonable practices to ensure that affordable, quality health coverage is available to all Americans. The center also provides consumers with comprehensive information on coverage options currently available so they may make informed choices on the best health insurance for their family.
...but among other things, they're the folks who actually implement the ACA, including, among other things, HealthCare.Gov (I'm not sure if it's the same team that operates HC.gov or not...probably a lot of overlap between the two?).
Consumer Information and Insurance Oversight
Ensuring the Affordable Care Act Serves the American People
On the one hand, I nailed the Week Three HC.gov number almost perfectly (I projected 2.3 million, the actual number is 2,277,079). Yay, me! Only off by 1%! On the other hand, I seriously underestimated the first two weeks, so I'm not patting myself on the back too much. It's an insane year with too many unknowns for me to do much more than throw darts at the board. Still, I'll take credit where I can.
I used to track the monthly Medicaid/CHIP enrollment reports issued by CMS, watching as the numbersrosedramatically thanks to ACA Medicaid expansion.
I pretty much stopped doing that about a year ago, however, since the expansion numbers have mostly petered out. ACA Medicaid expansion actually has continued to climb a bit more since January, and is likely somewhere around 16 million people as of now, but it's also been partly cancelled out by a slight drop in standard Medicaid enrollment as the economy has continued to improve in general. In short, there's little reason to keep writing the same update every month.
As part of their Godawful "tax reform" bill, Congressional Republicans have decided to toss repealing of the ACA's individual mandate penalty into the mix, partly because they've always hated it but mainly because doing so would allegedly save the federal government $338 billion over the next decade...which in theory would be enough to keep the total increase in the federal deficit bythe tax bill below the $1.5 TRILLION mark (yes, you read that correctly: $1.5 TRILLION, with a "T").
Press release from the Massachusetts Health Connector...
BOSTON – November 20, 2017 – With a stable system and user process complemented by a proactive outreach and education effort, the Massachusetts Health Connector has seen members and new applicants more active in the first two weeks of Open Enrollment compared to last year.
Through Nov. 15, plans selected and enrollments are more than 40 percent higher than last year at the same time, new program determinations for Health Connector are up nearly 70 percent, and plans selected and enrollments by new members are up more than 15 percent.
“It is encouraging to see people hearing our message to shop for new coverage, and taking early advantage of Open Enrollment and finding the plan that best fits their needs for the new year,” said Louis Gutierrez, the Executive Director of the Massachusetts Health Connector. “We hope all of our current members take time to review their coverage for next year, and people who don’t currently have health insurance sign up so they have the health and financial security that comes with having coverage next year.”
Total Enrollments (active renewal, passive renewal, new): 130,556 (up 3% vs. last year)
Active Enrollments (renewals + new): 29,478 (up 98% over last year)
New Enrollments: 10,900 (up 10% over last year)
Applications: 275,790 (up 13% over last year)
Mobile App Visitors: 74,744 (up 110% over last year)
OK, the MD exchange breaks out their numbers slightly differently than I do, but they've provided the numbers necessary to reformat. Like a few other states, they're "front-loading" their auto-renewals, giving the following:
18,578 Active Renewals
10,900 NEW Enrollees
130,556 TOTAL Enrollments
For clarification: When the MD exchange says that 130,556 is "3% higher than last year", they're talking about at this point in time. Subtract 3% and you get roughly 126.7K as of 11/17/16. Maryland's total enrollment by the end of the 2017 Open Enrollment Period was 157,832.
Insurers That Filed Wrong Rates Told By CMS They Can't Sell Plans Through Mid-November
An issuer whose final CMS-approved rates don’t account for the loss of cost-sharing reduction payments is being told by the agency that they won’t be able to sell plans until healthcare.gov data is refreshed– even though this would mean the carriers are even more crunched for time to sell their plans during the shortened open enrollment period.
A few days ago I noted that I had seriously misunderstood the Congressional Budget Office's individual market premium projections in the event the ACA's individual mandate is repealed: Yes, it'd be ugly, but not nearly as bad as I thought, although they still expect up to 13 million people to lose coverage as a result.
While I have my own doubts about some of the CBO's assumptions, there can be no doubt that premiums would increase substantailly, millions of people would end up without healthcare coverage, and the $25 billion in Medicare cuts do appear to be locked in if the GOP's bill were to become law:
I know there’s a lot going on in The Graph (see below), so lemme break it down:
The pale blue lines show the enrollment trend for the 2016 ACA Open Enrollment Period via the 38 HealthCare.Gov states (the lower line) and all 50 states + DC (the higher line). This was the all-time record for the ACA: 9.7 million via HC.gov, 12.7 million nationally.
The pale red lines show the enrollment trend for the 2017 Open Enrollment Period via 39 HC.gov states & all 50 +DC (Kentucky moved from their own exchange to the federal exchange last year). This was down a bit from 2016: 9.2 million / 12.2 million.
The dotted black lines are my “official” projections for the 2018 Open Enrollment Period: 7.5 million and 10.0 million respectively, both way down from both of the prior years.
The filled-in green/blue sections are the actual, confirmed 2018 enrollment numbers to date. Note that there are still enrollments missing: HC.gov only runs through 11/11, while other states range from no data at all all the way through 11/15. I’ve confirmed 1.71M to date, but suspect the total is actually closer to 3.0 million as of today.
The little blue dots are my current projections through this Saturday the 18th: 2.3M and 4.0M respectively.