2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

*....pending an immediate appeal, all the way up to the Supreme Court over the next year or so, which means a LOT of lawyers are about to make a LOT of billable hours.

Before you read anything else: DON'T PANIC. An injunction against the ACA was not included with the ruling (at least, not yet). The 2019 Open Enrollment Period is still ongoing through Saturday night in 44 states and longer than that in the other 6 + DC.

If you haven't enrolled for 2019 healthcare coverage yet, now is still the time to do so.

This Just In via Bloomberg News...

Obamacare Core Provisions Ruled Unconstitutional by Judge
By Tom Korosec and Kartikay Mehrotra
December 14, 2018, 7:42 PM EST

Now that the Democrats have officially retaken control of the U.S. House of Representatives, everyone's expecting them to try and save and improve the ACA. I stress "try", of course, because without the Senate, it's unlikely that any bill to protect or improve the law will get passed...and even if it did somehow, the odds are high that it would then be vetoed by Donald Trump (or Mike Pence, in the unlikely-but-still-conceivable event that Trump is removed from office before January 20, 2021).

HOWEVER...they can certainly at least try. With a likely 235:200 advantage in the House and a caucus which is far more progressive on healthcare issues than it was a decade ago, the Dems shouldn't have too much trouble passing a fairly robust healthcare reform package even knowing that it's unlikely to go anywhere in the Senate. The question is how robust?

#1: The 2019 Open Enrollment Period runs from November 1st - December 15th...in most states.

  • In California, open enrollment already started on Oct. 15th, and will run through Jan. 15, 2019.
    • If you enroll by Dec. 15th, your coverage will start Jan. 1st, 2019.
    • If you enroll between Dec. 16th - Jan. 15th, coverage will start Feb. 1st, 2019.
  • In Colorado, open enrollment runs through Jan. 15, 2019.
    • If you enroll by Dec. 15th, your coverage will start Jan. 1st, 2019.
    • If you enroll between Dec. 16th - Jan. 15th, coverage will start Feb. 1st, 2019.

Immediately after last night's bombshell* announcement of the ruling in the Texas Fold'em lawsuit by right-wing judge Reed O'Connor, one of the numerous parts of the outrage was over the timing of the decision being announced. Just about everyone, myself included, assumed that O'Connor would either...

This Just In, via Louise Norris...

On December 15, Access Health CT announced a one-month extension for 2019 enrollment. The exchange had planned to end enrollment on December 15, but the new deadline is January 15. People who enroll between December 16 and January 15 will have coverage effective February 1, 2019.

This one may surprise you...

*WHITE HOUSE: OBAMACARE LAW REMAINS IN PLACE PENDING APPEAL

— Laura Litvan (@LauraLitvan) December 15, 2018

The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.

— Administrator Seema Verma (@SeemaCMS) December 15, 2018

The Trump Administration's Dept. of Justice was guilty of dereliction of duty when they refused to defend the law of the land against the #TexasFoldEm lawsuit in the first place, and went so far as to support the overall thrust of the plaintiffs.

"Open enrollment is full-steam ahead in California and continues in other states for several more weeks. No one in America should let this TX District Court ruling discourage them from enrolling in health coverage or be worried about using the coverage they have. This case will wind its way through the courts and I’m confident the Supreme Court will once again do the right thing and uphold the Affordable Care Act,"

--Peter Lee, executive director of Covered California

Pelosi Statement on District Judge Ruling in GOP Lawsuit Against Pre-Existing Condition Protections and the Affordable Care Act

“Tonight’s district court ruling exposes the monstrous endgame of Republicans’ all-out assault on people with pre-existing conditions and Americans’ access to affordable health care.

Signups for the 2019 ACA Open Enrollment Period have been lagging behind on HealthCare.Gov until this week. Nevertheless, as happens every year, things are heating up as people scramble to #GetCovered ahead of tomorrow's deadline.

Joshua Peck was the head of marketing for HealthCare.Gov under the Obama Administration and is now one of the folks in charge of Get America Covered, a third-party organization devoted to filling in ever since the Trump Administration's CMS (deliberately) dropped the ball. He's been checking in on HC.gov all week and keeping folks abreast of the server load/wait time/hold time situation. There were some serious issues a couple of days ago but it sounds like they've finally gotten straightened out:

7:40 AM ET and the @HealthCareGov call center already has a 20 minute wait to speak to a representative today.

— Joshua Peck (@JoshuaFAPeck) December 14, 2018

A couple of weeks ago I reported that the Washington Health Benefit Exchange had enrolled over 196,000 people in ACA exchange policies as of November 28th, putting them about 3% ahead of last year's tally as of the same date.

Today they issued another unofficial update which pegs their total at "more than 200,000 Washingtonians" (there's no exact number provided):

OLYMPIA, Wash. — The Washington Health Benefit Exchange is alerting all customers today that less than 72 hours remain before the deadline to sign up in 2019 health and dental coverage through Washington Healthplanfinder. Customers who have not yet selected a plan have until the close of open enrollment at 11:59 p.m. this Saturday, Dec. 15 to select their coverage for next year.

This just in...

Consumer Interest Surges as First Key Deadline Approaches for Covered California and the Individual Market

  • More than 150,000 new consumers selected a plan through Dec. 12.
  • Consumer interest is surging, with more than 28,000 consumers selecting a plan during the past three days.
  • Consumers must sign up by Dec. 15 in order to have their coverage start on Jan. 1, 2019. Open enrollment in California continues through Jan. 15.

SACRAMENTO, Calif. — Covered California announced today that 150,191 new consumers signed up for coverage through Dec. 12. Consumer interest is once again surging ahead of a key deadline, with more than 10,000 people signing up on Wednesday, and more than 28,000 selecting a plan within the past three days.

Last week I acquired the DC Health Link enrollment data for the first two weeks of 2019 Open Enrollment. It showed that DC, unlike most of the other state-based exchanges, was lagging behind last year for the first two weeks (although not as much as most of the HC.gov states).

Well, I just received updated data out of DC and the enrollment situation over the following four weeks didn't improve (if anything they dropped off slightly more):

  • Nov. 1 - Dec. 11, 2017: 19,252 QHP selections
  • Nov. 1 - Dec. 11, 2018: 17,825 QHP selections

That's a drop of around 7.4% year over year so far.

As with most other state-based exchanges, the numbers for both years include auto-renewals, which means the vast bulk of 2019 enrollments are likely already baked in. Last year's final tally was 19,289; DC has already reached 92% of that as of 12/11. Keep in mind that DC's Open Enrollment Period does not end on Saturday the 15th; it continues for another 47 days after that, through January 31st.

So, how likely is HC.gov to reach last year's total in the final week? Well...not very likely, but let's do the math anyway. Again, this is for the 39 states hosted by HC.gov only; it does NOT include the 12 state-based exchanges, which are mostly AHEAD of last year so far.

  • Last year, 8,743,642 people selected QHPs via HC.gov total:
    •  4,580,782 actively re-enrolled
    • 1,702,429 were auto-reenrolled
    • 2,460,431 were new enrollees
  • Of those 8.74 million total, there are likely around 6.16 million currently enrolled as of December
  • Last year, 97% of those still enrolled as of December re-enrolled (actively or passively). If that holds true this year, that'll be around 5.97 million total renewals
  • That means HC.gov would need 2.77 million new enrollees total

So, where did things stand as of 12/08?

Week 6 via CMS:

Week 6, Dec 2-8, 2018

In week six of the 2019 Open Enrollment, 934,269 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.  Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

Definitions and details on the data are included in the glossary.

Unfortunately, Vermont is one of the three states (along with Idaho and Maryland) which hasn't released any 2019 Open Enrollment data yet, so I don't have any numbers to report on that front. However, they did just post this "Open Letter" which I found interesting. The two things to keep in mind about Vermont are: 1) they include their own subsidies on top of ACA subsidies; and 2) they were among two states (North Dakota is the other one) which upgraded their premium pricing in 2019 from "no load" to full #SilverSwitcharoo status.

You can read about the wonky mechanics of this here, but the bottom line is that Vermont residents who qualify for subsidies have substantially better deals available this year, while unsubsidized enrollees have an important workaround to avoid being stung with extra CSR costs:

An Open Letter to Everyone Who Has Helped Vermonters Get into the Right Health Coverage

So, my wife and I finally got around to renewing our own ACA exchange plan the other day (yes, I'm realize how ironic it is that I've spent the past 41 days screaming at everyone else to #GetCovered while waiting until the last week to do so myself. We're a bit busy this month. Don't @ me.)

Anyway, we went through a lot of research and discussion (including assistance from fantastic folks who know more about this stuff than me like Louise Norris and David Anderson) about whether to stick with our existing Gold HMO (we have some pricey issues to deal with) or to switch to a Bronze HMO...but with a Health Savings Account.

I know very little about HSAs, but Dave and Louise suggested I look into one so we did. In our particular case, we decided to stick with the Gold plan in the end for reasons I'd rather not get into...but along the way, while researching our actual 2018 medical claims and expenses, I noticed something rather important. See if you can figure out what it is:

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