Last week, in my latest exclusive entry at healthinsurance.org, I crunched the numbers to see just how many people would likely lose their healthcare coverage if congressional Republicans, along with Republican President-elect Donald Trump, were to follow through with their explicit promise to repeal the Affordable Care Act (otherwise known as "Obamacare") early next year.
As I noted, the GOP is still incredibly vague about what exactly they'd replace the ACA with. No matter what they claim, it's only the "repeal" part which they've been clear about so far. All indications are that they plan on pushing the "repeal" part through almost immediately upon Trump taking office. Therefore, I focused specifically on what would happen if the ACA were repealed, in full, in early 2017 with immediate effect (as opposed to this weaselly 2-3 year delay business they've been bandying about which could potentially be even worse for the healthcare market as a whole in some ways).
Remember, there are four categories of people who would lose coverage:
11.3 million12.3 million: People enrolled in Medicaid/CHIP specifically thanks to the ACA's expansion provision in 32 states + DC
9.0 million: People enrolled in ACA exchange (Individual Market) policies who are receiving heavy federal subsidies via the ACA exchanges*
1.4 million: Young adults 19-25 years old enrolled in their parents' plans (via group or non-group markets) specifically thanks to the ACA provision
470,000: People enrolled in ACA-funded Basic Health Plans in Minnesota & New York
But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.
The Republican Party already has their playbook for how to repeal the Affordable Care Act, cause massive disruption and damage to the healthcare market, kick potentially up to 29 million people off their healthcare coverage and get away with it by blaming it on the law itself (and, of course, President Obama). They're so certain that their plan will work that some of them are openly admitting the jaw-dropping chutzpah of it all:
Republicans are going to kill Obamacare — but first they might have to save it.
The already fragile Obamacare markets — beset by soaring premiums and fleeing insurers — are likely to collapse unless Republicans take deliberate steps to stabilize them while they build consensus on a replacement plan, say health care experts. That could lead to a mess for the roughly 10 million Americans currently getting coverage through the government-run marketplaces — and backlash against the GOP.
I haven't written a single word about Maryland since early October. Last year their ACA exchange was very good about posting fairly regular enrollment updates; this year they've been dead silent about it so far, which is rather surprising (and no, I don't think it's because their numbers are bad...every other state I have data for seems to be doing pretty well or even better than last year so far).
Anyway, there's one bit of news out of the Old Line State (yes, I had to look it up to find out what their nickname is) today which is disappointing but not surprising when you understand the circumstances:
The Maryland Insurance Administration barred Evergreen Health from selling health insurance policies for individuals until federal and state regulators decide whether to allow the cooperative to convert to a for-profit insurer and receive a much-needed cash infusion.
Today I've received the latest enrollment data out of the Bay State:
As of Dec. 6, we have 10,210 new plans selected, plus an additional 13,251 new enrollments. That’s a total of 23,461 new plans selected so far in Open Enrollment.
That doesn’t include an additional 3,291 plans selected or enrollments by “returning” members. These would be people who had Health Connector coverage at some point, but for whatever reason do not right now and are coming back for 2017.
OK, that's 26,752 new enrollees (I define "new" as anyone signing up who isn't already currently enrolled in an effectuated exchange policy, even if they used to be and dropped it a few months earlier). That's more than 3.5x as many as 3 weeks earlier; impressive.
"We’ll get to that next year," Ryan told reporters when asked how long the transition away from Obamacare would be. "We just had a meeting with all our authorizers this morning about working on this with the Senate and the transition team. Those talks are ongoing."
..."We’re going to have these kinds of conversations. I don’t have an opinion on exactly what that timeline will be," he said. "There’s a lot of moving parts, and we have a lot of dialogue that we have to have with just our friends in the Senate and with the White House on the transition. So it’s just premature to suggest that we know how exactly long this transition is."
Oh, good. I'm sure this will make all those healthcare actuaries feel better.
There's exactly 7 days to go before the first major 2017 Open Enrollment Period deadline (the 12/15 deadline in most states for coverage starting January 1st), so let's see where things stand.
I've confirmed 2,903,199 QHP selections nationally, of which 2,137,717 are via the federal exchange and 765,482 are via the dozen state exchanges.
However, most of this only runs through November 26, and I still have no enrollment data at all for DC, Idaho, Maryland, New York, Vermont or Washington State.
I estimate that the actual national total broke through 4.5 million last night, and should break 5.0 million by tomorrow (Friday) night.
Enrollments should have started ramping up dramatically as we go into the final few days before the big 12/15 deadline, culminating in around 7.7 million by the 15th.
After that, the HC.gov auto-renewals should be tacked on somewhere around 12/17 - 12/18.
As recently as 11/26/16, enrollments on both the federal and most state exchanges was either pacing or somewhat ahead of my projections, with no "Trump Factor" to speak of. I won't know for sure whether this is still the case until the HC.gov Week 5-6 Snapshot report is released, which likely won't be until next Wednesday.
I've been posting so many stories about the ugly implications of the ACA being repealed that it's kind of nice to get back to actually reporting on the number of people enrolling for ACA coverage again (hey, it's right there in the title of this site and everything...)
Rhode Island, which issued regular weekly enrollment reports last year, has been unusually silent so far this year...until today:
HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, December 3, 2016 for Open Enrollment.
INDIVIDUAL/FAMILY ENROLLMENT As of December 3, 2016
The nation’s hospital industry warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”
The two main trade groups for U.S. hospitals dispatched a letter to the incoming president and Capitol Hill’s top four leaders, saying that the government should help hospitals avoid massive financial losses if the law is rescinded in a way that causes a surge of uninsured patients.
“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”
As anyone who's visited the site the past few days knows, I've spent countless hours digging up data to find out exactly how many people are enrolled in Medicaid/CHIP specifically due to the ACA's expansion provision. This is much more difficult than you'd think for a variety of reasons. For one thing, each state seems to have different methodology for how they track and report Medicaid enrollees (some weekly, some monthly, some quarterly, etc). For another, there's a wide variety of eligibility thresholds under pre-ACA Medicaid for different groups of residents in each state (pregnant women, infants, children, parents, etc), and since the funding mechanism varies depending on whether the enrollee qualifies for "normal" Medicaid or "ACA expansion" Medicaid, categorization can be tricky. Finally, due to the churn factor (people moving up and down the income scale as well as gaining or losing job-based or other forms of coverage), the numbers can jump around from month to month or even week to week.
Earlier today I posted fully broken-down estimates of just how many people would be directly impacted by a full & repeal of the Affordable Care Act this spring, assuming that the repeal took immediate effect and there was no replacement plan in place for the various provisions of the law.
The largest single category of enrollees in my estimates are those enrolled in Medicaid/CHIP due specifically to the ACA's Medicaid expansion provision. I estimated this to be roughly 11.3 million people nationally.
Now that we're past Thanksgiving weekend and the big December 15th deadline (for January coverage) is coming up fast, OE4 enrollments should have started ramping up significantly, on the order of 250,000 per day or more nationally (around 190K via HC.gov).
The Connecticut ACA exchange, AccessHealthCT, issued a press release today reminding Connecticut residents in general of the December 15th deadline for January 1st coverage. They also stressed, however, that while most current enrollees will be automatically renewed into either their existing policy, there are about 26,000 current enrollees who can't be auto-renewed because their carrier is leaving the exchange in 2017:
On December 1st, AHCT’s automatic renewal process began. The AHCT eligibility system will automatically enroll into 2017 coverage customers who have selected auto-renew and whose plans are still available. “But, there are 26,000 people who currently have coverage through AHCT who cannot auto-renew and must take action to renew their 2017 plans,” Wadleigh noted. Wadleigh reminds all customers “they should shop around and compare your options for 2017– that’s the purpose of the marketplace.”