Charles Gaba's blog

The 2020 Open Enrollment Period may have ended (for real this time) for HealthCare.Gov and some other states, but it continues for residents of California, New York and the District of Columbia. Combined, they represent over 60 million people, or 18% of the entire U.S. population:

I just received the final 2020 Open Enrollment report from the Massachusetts Health Connector (via email, no link):

Here’s where we are:

  • We have 290,105 January enrollments
  • 22,493 February and March enrollments
  • 7,014 plans selected
  • For a total of 319,612

New enrollments currently total 57,044.

I wish every ACA exchange would break out their numbers this way. Simple and to the point, but also with relevant details...not only "renewals vs. new" but also how many are enrolled for January vs. February or March coverage and even how many have/haven't paid yet! The last is a bit unfair since Massachusetts is one of only two states, I believe, which actually handle premium payments (Rhode Island does as well...Washington State used to but doesn't anymore).

Here's what's truly impressive: Massachusetts is the only state to increase their ACA exchange enrollment each and every year for six years running:

This just in from the New York State of Health ACA exchange:

Press Release: New Yorkers Have More Time to Get Covered in 2020: NY State of Health Open Enrollment Deadline Extended to February 7

  • Enroll Now for Affordable, High-Quality Health Coverage in 2020
  • Free, In-Person Enrollment Help is Available: Click Here to Find a NY State of Health Certified Assistor

ALBANY, N.Y. (January 28, 2020) – NY State of Health, the state’s official health plan Marketplace, announced that consumers will have an additional week to enroll in a Qualified Health Plan (QHP) for 2020. The Open Enrollment deadline has been extended until February 7 to give consumers more time to enroll. NY State of Health’s Customer Service Center representatives and in-person assistors are available to help individuals find the best plan for themselves and their families.

Huh. That's unexpected.

Statement from Connect for Health Colorado® Regarding Supreme Court Decision on the Public Charge Rule

Jan. 27, 2020 

Denver – Connect for Health Colorado® Chief Executive Officer Kevin Patterson released the following statement in response to today’s Supreme Court decision on the Public Charge Rule:

“I am disappointed about the overall impact this ruling will have on all of us, but especially on our friends, neighbors and co-workers seeking a permanent residency status. This rule will force people to get health care in more expensive ways and will cause worse health outcomes for Coloradans; exactly the opposite of our mission and the work our state has led to increase access, affordability and choice in health. 

via KIVI Boise:

The number of Idaho residents who have signed up for Medicaid under the state’s voter-approved expanded coverage has passed 60,000.

The Idaho Department of Health and Welfare posted updated numbers Thursday. The agency estimates 91,000 residents meet requirements.

Coverage started January 1, but enrollment is year-round. Those who sign up for Medicaid will be covered for doctor visits that occurred earlier in the same month.

Voters authorized Medicaid expansion in 2018 with an initiative that passed with 61% of the vote after years of inaction by state lawmakers. In 2019, lawmakers added restrictions requiring five waivers from the U.S. Department of Health and Human Services.

Waivers are required when states want to deviate from Medicaid rules. Federal officials have yet to approve any of Idaho’s requested waivers.

If the anticipated 91,000 people do eventually sign up, it would cost Idaho about $400 million, with the federal government paying 90%.

 

Not Joe Biden. Not Pete Buttigieg. Not Amy Klobuchar. Not Michael Bloomberg. Not Tom Steyer. Not Michael Bennet.

Nope. This is none other than Senator Bernie Sanders of Vermont from July 2009, issuing a strong and vigorous argument in favor of adding a Medicare-like Public Option to the U.S. healthcare system to offer a "level playing field" and "fair competition" with private insurance.

I've cued up the video to the relevant starting point, but if it starts at the beginning for some reason, scroll up to 4:55 in. It runs until around 6:13.

Here's the transcript of Bernie during the section in question:

“No one is talking about a government-run healthcare system. No, they’re not. What they’re talking about is a public option that will compete and give people the choice! The choice of whether they want a public plan or a private plan! Why are you afraid of that? If the private plans are so much better, people will go into the private plan. If the public plans are more cost effective, more reasonable, if people prefer a Medicare-type program they’ll go into that. Why are you afraid of the competition?

(I have no idea who created this image...I'll give credit if someone can point me towards the artist)

I'm a bit embarrassed to admit that I don't seem to have written much about the Trump Administration's repulsive proposed "public charge" policy over the past year or so. Here's a general overview from last fall via Nicole Narea of Vox:

The US has been able to reject prospective immigrants who are likely to become a “public charge” — dependent on the government for support — since 1882, but since World War II, few immigrants were turned away using that criteria. In 1999, the Clinton administration issued guidance that said only cash benefits, which very few immigrants use, would be considered in making the determination.

Last March I wrote an analysis of H.R.1868, the House Democrats bill which comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

Last March I wrote an analysis of H.R.1868, the House Democrats bill which comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

Last March, I wrote about a clever and absurdly simple (on the surface) bill being passed through the Maryland state legislature which could result in the state lowering their uninsured rate substantially...by up to as many as an estimated 120,000 people:

In early 2018, Maryland state legislators introduced a bill which included a twist on the coverage mandate penalty--those who failed to sign up had another option: They could either pay the penalty or they could choose to have the penalty amount be used to automatically enroll them in the lowest-cost insurance policy available. If they qualified for ACA subsidies, those would even be baked into the equation as well. This was a clever way of softening the blow, while also increasing enrollment and helping out the ACA risk pool.

I spent most of last week in Washington, D.C. for the 25th Annual Families USA Health Action Conference:

Families USA, a leading national, non-partisan voice for health care consumers, is dedicated to achieving high-quality, affordable health care and improved health for all. Our work is driven by and centered around four pillars: value, equity, coverage, and consumer experience. We view these focus areas — and the various issues unique to each area — as the cornerstones of America’s health care system.

Public policy analysis that is rooted in Hill and administration experience, movement-building advocacy, and collaboration with partners are deep-rooted hallmarks of our work. In turn, our work promotes a health system that protects consumers’ financial security as much as it does their health care security.

As we advance our mission by combining policy expertise and partnerships with community, state, and national leaders, we forge transformational solutions that improve the health and health care of our nation’s families and speak to the values we all have in common.

This came out while I was in DC for the Families USA conference...

Covered California’s New Enrollment Surges Past Last Year’s Mark with More than a Week Before the Upcoming Jan. 31 Deadline

  • More than 318,000 consumers have newly enrolled during the current open-enrollment period, surpassing last year’s open enrollment total.
  • However, new research shows that many Californians – particularly the uninsured – are unaware of a new state law which requires people to have health insurance or face a penalty.
  • In addition, many Californians are unaware of the new financial help that is available for the first time this year, including first-in-the-nation assistance for middle-income consumers.
  • Open enrollment, which continues through Jan. 31, is the one time when people can sign up for health insurance in the individual market without needing a qualifying life event.

SACRAMENTO, Calif. — Covered California announced new enrollment data as it moved into the final week of open-enrollment and continued to reach out to consumers about the new state penalty and additional financial help that went into effect with the new year.

As of Wednesday, Jan. 22, more than 318,000 consumers had newly signed up for health insurance through Covered California during the current open-enrollment period, which surpassed last year’s total of 295,000.

Head's up, readers...next week, for the third year in a row I'll be attending the Families USA Health Action conference in Washington, D.C...and for the first time, I'll actually be on one of the panels:

Friday, January 24th, 2:00pm-3:15pm • Workshops / Session 4

WHAT'S NEXT? COVERAGE AND AFFORDABILITY OPPORTUNITIES IN RED, BLUE, AND PURPLE STATES

Description: A surprisingly broad range of resources and options are available to streamline enrollment and to lower consumers’ health care and coverage costs in the individual market. Learn about promising, innovative strategies tailored to fit very different political conditions.

Speakers:

  • John-Pierre Cardenas, MSPH, Independent Health Policy Adviser, formerly Maryland Health Benefits Exchange
  • Charles Gaba, ACASignups.net
  • Heather Howard, J.D., Center for Health & Wellbeing, Woodrow School of Public and International Affairs, Princeton University
  • Holly Hernandez, Harris Health

Moderator: Stan Dorn, J.D., Families USA

via Covered California...

he commemoration of Dr. King’s 91st birthday will include parades in both Los Angeles and Sacramento where Covered California will participate.

Covered California representatives, including executive director Peter V. Lee, will join members of Charles Drew University of Medicine and Science in participating in Los Angeles’ Kingdom Day Parade.

In addition, Covered California staff will join thousands of others in Sacramento’s March for the Dream parade.

Covered California is committed to ensuring that the rich diversity of people in the state have access to quality health care.

Open enrollment is underway, and people have through Jan. 31 to sign up for coverage and see if they are eligible for financial help.

SACRAMENTO, Calif. — Covered California will help celebrate the 91st birthday of Martin Luther King Jr. on Monday, by having a contingent of leaders honor the civil rights icon by participating in parades in both Los Angeles and Sacramento.

 

I've written several times before about how health insurance risk pools work. I even whipped up a crude video explainer about them a couple of years back. The healthiness or lack thereof of a given risk pool is the biggest factor involved in determining how expensive or inexpensive insurance policy premiums will be.

This year, my own family became a perfect example of this. Unlike most health insurance horror stories you often hear about, the final results in our case are positive...although we did go through a brief panic attack period before getting there.

My wife and I are both self-employed, and have a few recurring medical issues. We have one child, a teenager with Asperger's syndrome and a (fortunately fairly mild) case of cerebral palsy, which means long-term physical therapy and some other recurring medical expenses. Since we'd max out the deductible on a Silver plan each year, we've been enrolled in an ACA exchange Gold HMO plan since 2015. It's expensive even with partial subsidies, but we don't want to risk a major hole in coverage if at all possible.

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