Charles Gaba's blog

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...

Back in April 2017, I compiled a 20-itme "ACA 2.0 wish list" which I titled "If I Ran the Zoo", which gained some amount of attention from the healthcare policy wonk community. To be clear, I wasn't the first one to come up with most of these ideas; it was mainly just pulling together a bunch of proposals to protect, repair and strengthen the ACA from various sources into a single, comprehensive collection.

Since then, several bills have been introduced by Democrats in either the House or the Senate which addressed one or more of these recommendations, and last spring there were two bills (one in the House, one in the Senate) which tackled over a half-dozen of them in a package deal. None of these bills have gone anywhere since then, of course; with the Dems having retaken the House, it's a lot more viable that one or more will do so this year, although getting any of them through the Senate is obviously a much tougher climb.

A pop-up message appeared on the home page of Connect for Health Colorado on Tuesday the 15th:

If you encounter long hold times today and are unable to get through to our Customer Service Center on Jan. 15 to complete your enrollment, please contact our customer service center no later than 6:00 p.m. on Friday, Jan. 18 to complete your enrollment. At that time, you must let the representative know that you were unable to get through on Jan. 15.

Oddly, the message didn't include C4HCO's actual phone number: 855 752-6749

Colorado was already within 0.5% of surpassing last year's enrollment total as of January 3rd (just 712 enrollees shy); I'm certain they've beaten that number already.

Gov. Newsom Urges Uninsured to Get Covered Before Midnight Deadline Tomorrow as Covered California Continues Promoting Enrollment

  • Consumers have through Jan. 15 to sign up and select a plan, through Covered California or directly with health plans, for Feb. 1 coverage.
  • Gov. Gavin Newsom promotes enrollment for the estimated 1.1 million uninsured Californians eligible to enroll in Covered California or Medi-Cal.
  • Covered California research shows that 82 percent of uninsured consumers surveyed, who are eligible for financial assistance, do not know that they qualify.

LOS ANGELES, Calif. — California Gov. Gavin Newsom on Monday urged Californians who need health insurance to enroll as Covered California continued promoting coverage statewide before the deadline to enroll on Jan. 15.

“Covered California is in the final two days of open enrollment. That means if you are without health insurance, you need to sign up by Tuesday, Jan. 15, to secure health coverage,” Newsom said.

I just updated AccessHealthCT's numbers a week ago; it looks like they only added 428 more people over the next seven days:

With the clock ticking, Access Health CT’s latest statistics show they are closing in on last year’s numbers.

As of Friday afternoon there are now 109,126 Connecticut residents enrolled in insurance plans through the exchange. The deadline for enrolling was extended to Jan. 15. 

Last year 114,000 Connecticut residents enrolled in plans sold on the exchange.

CT is just over 5,000 signups shy of last year's 114,134 QHP selection total. They probably added a couple hundred more over the weekend (weekends are always slower anyway), but the odds of matching last year's total by tomorrow (Tuesday) night are extremely slim. My guess is they'll end up between 110K - 111K.

From Covered California:

Covered California’s Iconic Bus Tour Rolls into San Francisco to Promote Health Insurance Enrollment Ahead of Final Deadline

  •  Covered California’s bus tour promotes enrollment and encourages consumers to see if they are eligible for financial help in obtaining quality health insurance.
  •  The San Francisco visit coincides with the release of Governor Gavin Newsom’s budget which focuses on making health care more affordable through increased financial help and a state individual shared responsibility provision.
  •  Consumers have through Jan. 15 to sign up and select a plan, through Covered California or directly with health plans, for Feb. 1 coverage.
  •  An estimated 1.1 million uninsured Californians are eligible to enroll in Covered California and research shows that 82 percent of uninsured consumers surveyed, who are eligible for financial assistance, do not know that they qualify.

This just in from the MA Health Connector:

Update from us, as of last Friday:

  • 277,029 paid enrollments
  • 7,615 plans selected/unpaid
  • 284,969 total, per CMS enrollment definition
  • We have 47,573 new enrollees.

Once again: Massachusetts has managed to outperform their ACA enrollment numbers every year for five years running:

  • 2014: 31,695 (major technical problems)
  • 2015: 140,540 (complete platform overhaul)
  • 2016: 213,883
  • 2017: 266,664
  • 2018: 267,260
  • 2019: 284,969 and counting...

Just as impressive, if not more so: 97.2% of Massachusetts ACA enrollees have already paid their first monthly premium, which is well above the ~90% national average.

BLOCK GRANTS FOR MEDICAID — A Trump plan is in the works. Scoop today, behind the firewall right now. https://t.co/2PdVQKPoLH

The Trump administration is plotting a path for Medicaid block grants for states, a longstanding GOP goal to rein in spending on the entitlement program. News from me and @ddiamond https://t.co/EPkeqlPiSV

— Rachana D. Pradhan (@rachanadixit) January 11, 2019

— Dan Diamond (@ddiamond) January 11, 2019

Per admin sources, CMS has guidance to states in the works on the topic. Officials also very aware of the political sensitivities surrounding such a plan.

— Rachana D. Pradhan (@rachanadixit) January 11, 2019

Yesterday I wrote about the current status of several federal lawsuits against the Trump Administration over the decision to stiff contractors (i.e., health insurance carriers) out of nearly $2 billion in Cost Sharing Reduction reimbursement payments.

This morning I wrote about the current status of the infamous #TexasFoldEm lawsuit brought by 20 Republican Attorneys General and Governors against the ACA, and the impending appeal of Judge O'Connor's ruling in their favor.

But there's more Big Deal ACA litigation in the works as well...and while the Trump Shutdown has brought some of them to a standstill, Harris Meyer of Modern Healthcare reports that others are still churning along:

I haven't written anything about the developments in the #TexasFoldEm anti-ACA lawsuit in awhile, partly because I was out of the country for a couple of weeks and got backlogged. Then again, things are kind of at a standstill at the moment anyway, so perhaps that omission on my part isn't quite as big of a deal as I had feared.

Anyway, here's some of what's happened since Judge O'Connor's lousy ruling on December 14th:

A federal judge in Texas who recently declared the Affordable Care Act unconstitutional has stayed his ruling to allow for appeals.

That means “Obamacare” remains in effect while litigation continues.

REMINDER from MNsure.org...

Last chance: MNsure Open Enrollment Period Ends this Sunday, January 13
January 10, 2019

ST. PAUL, Minn.—Minnesotans have until midnight on Sunday, January 13, to secure health insurance coverage through MNsure for 2019. Those who enroll by the deadline will have coverage that begins February 1.

"MNsure is the only place to get financial help to save money on your monthly premium," said MNsure CEO Nate Clark. "More than half of all MNsure enrollees are receiving tax credits."

Minnesotans can see if they qualify for financial help, while also comparing medical plans side by side, by using MNsure's plan comparison tool.

MNsure has extended Contact Center hours in the days leading up to the final deadline:

Earlier this week, newly-sworn-in Governor Gavin Newsom announced several proposals for improvements to California's implementation of the Affordable Care Act along with some other important healthcare-related measures. The most important ACA-specific ones were:

  • Reinstating the individual mandate penalty at the state level, as New Jersey, the District of Columbia, Vermont and Massachusetts have (VT's doesn't kick in until next year, and MA simply reverted back to their own pre-ACA mandate penalty), and
  • Enhancing ACA subsidies and expanding them to those earning 400-600% of the Federal Poverty Level

Newsom didn't include any details on either proposal, but I assumed that the mandate would simply reinstate what it was under the ACA before being repealed by Congressional Republicans in December 2017 ($695 per person or 2.5% of household income), and that the expanded subsidies would simply take the existing ACA formula (which limits the cost of benchmark Silver plans to no more than 9.86% of household income and provides subsidies to cover the difference after that), and raise the cut-off point from 400% FPL to 600% FPL.

ACASignups.net, February 11, 2018:

That should mean that the average HC.gov premium is around $600 or so per month in 2018. The 3.5% surcharge hasn't changed for 2018, which means the federal exchange should take in something like $252/year per enrollee. Total enrollment in HC.gov plans was down 5% this year, so I'll assume average effectuated enrollment will be as well...somewhere around7.13 million per month. That means ~$1.8 billion in HC.gov revenue directly from the premium surcharge.

All of this brings me to my question:

In the midst of the ongoing #TrumpShutdown, where hundreds of thousands of federal employees are either off the job altogether or having to work without being paid and hundreds of federal contractors are being stiffed for the work they've done in good faith, I just wanted to remind folks that Donald Trump also screwed over several hundred insurance carriers in October 2017 when he cut off contractually-owed Cost Sharing Reduction reimbursement payments to insurance carriers nationwide.

Once again, the very short version is this:

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