END OF 2018 OPEN ENROLLMENT (MASSACHUSETTS)

Time: D H M S

Charles Gaba's blog

*UPDATE: Some have accused me of hyperbole in the headline because a) it's a "state-approved health or financial literacy" course, not a "can you read" test and b) because it would only be required if they're unable to meet the requirements in other ways. I guess I can see their point, but it strikes me as splitting hairs:

First, "literacy course" was their wording, not mine (I guess there's a distinction between "completeing a course" and "passing a test"?).

Second, there doesn't appear to be any real description of the "courses" in question--how long it is, what the criteria for measuring "completion" is, who would be conducting the course, whether you'd have to attend classes in person (vs doing so online?), how many sessions there'd be and so forth. Here's the description as laid out in the waiver request itself:

h/t to Mike Bertaut for the head's up on this:

Landmark lawsuit: ACA employer mandate case costs Dave & Buster’s $7.4M

...After trying — and failing — to get a high-profile lawsuit dismissed, Dave & Buster’s agreed to pay $7.425 million to settle the suit, which accused the restaurant and entertainment chain of illegally cutting staffers’ hours to prevent them from receiving healthcare benefits.

...As HR Morning covered previously, the ERISA lawsuit was the first case in which an employer was accused of intentionally interfering with employees’ hours to avoid the ACA’s employer mandate.

The lawsuit hinged on a very specific section of ERISA — the employees sued under ERISA Section 510.

Granted, ERISA was written primarily to apply to retirement plans. But Section 510 can be applied to a number of benefit plans as well — including healthcare coverage.

Section 510 says (the critical parts are in bold):

Whenever I write or talk about the 3-Legged Stool of the ACA and the actual flaws in the law (as opposed to the ones deliberately created by the GOP), I usually focus on two "gaps" in the legs: The APTC subsidies getting cut off at 400% FPL and being too stingy below that level, and the individual mandate not being large enough (and not being properly enforced). As it happens, part of the first problem has already been unintentionally "solved" thanks to Trump's ham-handed CSR reimbursement cut-off (which ended up increasing APTC tax credits for those below the 400% cut-off), while the second problem has just been made a whole lot worse thanks ot the GOP repealing the mandate altogether.

However, in focusing on the legs of the stool, I often forget to mention another important issue: The width of the seat itself. That is, how wide the network of doctors and hospitals which accept the policy is. The Affordable Care Act does give some guidelines/regulations about how wide ACA-compliant policy networks have to be, like so:

Of all the state-based exchanges, the one in DC has gone the longest without a formal enrollment update; the last one only included data through December 5th, a whopping 5 weeks ago. Fortunately, the DC board of directors held their monthly meeting last night and produced the following update.

As shown, the tally as of 1/8/18 is 21,352 QHP selections, slightly below last year's 21,437 as of the same date. Since DC (along with California and New York) are sticking with the full 3-month Open Enrollment Period, it should provide a good apples-to-apples comparison (and the fact that very few DC enrollees have CSR assistance also means there's a nominal CSR loading impact, either).

The final, official DC ACA exchange tally last year was 21,248, so technically speaking they've already surpassed that figure...but again, it was 21,437 as of 1/8/17, which means there were at least a few hundred people who were dropped off at the tail end due to cancelling or non-payment of their first premium.

Last week the Congressional Budget Office reported that funding the CHIP program for 5 years, which they had previously estimated would increase the federal deficit by about $8 billion over the next decade, would instead only increase it by about 1/10th as much: Roughly $800 million, a rounding error when it comes to the federal budget. The reason for this isn't that funding CHIP had suddenly become less expensive, it was instead, ironically, because due to the GOP repealing the ACA's individual mandate starting in 2019, NOT funding CHIP has suddenly become more expensive.

OK, first of all, here's the actual press release from CMS about it:

CMS announces new policy guidance for states to test community engagement for able-bodied adults
Will support states helping Medicaid beneficiaries improve well-being and achieve self-sufficiency

CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries. The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities – including skills training, education, job search, volunteering or caregiving – would be a condition for Medicaid eligibility for able-bodied, working-age adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.

In other words, work requirements for Medicaid expansion enrollees are now officially on the table.

Over at Politico, reporter Jennifer Haberkorn has a pretty impressive scoop about an internal Trump Administration memo from last March which lays out a list of 10 different executive measures Trump planned on taking to muck around with the ACA exchanges and the 2018 Open Enrollment Period:

Trump’s secret plan to scrap Obamacare

Early last year as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health law using executive authority.

The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it.

MNsure, Minnesota's ACA exchange, has just posted their latest official enrollment numbers. It's only a minor update from this unofficial 110K figure a week ago, but every enrollment counts.

111,667 QHP selections bumps them up another 1,667, with 5 days left to go for Minnesota residents to #GetCovered for 2018. It's worth noting that enrollment in MinnesotaCare, MN's name for the ACA's Basic Health Program, has actually dropped slightly since the last hard number update I confirmed back in mid-November (93,049).

Michael Bertaut is a conservative healthcare economist in Louisiana. He and I disagree on most political issues, and he's obviously not a fan of the ACA, but he seems to be intellectually honest about his positions, and he and I have found some common ground over ACA-related stuff in the past.

Case in point: The individual mandate. Bertaut may not care for the ACA overall, but he does recognize, as I do, that if you're going to utilize the "3-legged stool" model for individual market enrollment, it has to include both a positive and negative inducement to encourage (or goad) people into enrolling...aka the Carrot and the Stick. More to the point, if you're going to have a Stick (i.e., the Individual Mandate), it has to be large enough and well-enforced enough to be effective.

Presented without comment because I don't really have much to add aside from yes, this is a good idea which should happen for EVERY state, really:

Kreidler proposes bill to stabilize individual market, reduce premium costs
Contact Public Affairs: 360-725-7055

January 8, 2018

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler is proposing legislation to help provide stability and confidence that over 300,000 people are able to maintain coverage in Washington’s individual health insurance market.

Kreidler’s proposed reinsurance program would encourage more health plan options in the 2019 individual market and lower premium increases by up to 10 percent.

(sigh) This is a bit disappointing; just as HealthCare.Gov's "final" enrollment tally dropped by about 78,000 a week later when enrollee cancellations were accounted for, something similar has happened with Massachusetts since Christmas Day: Their tally went from 262,534 on 12/25 to 256,342 QHP selections as of yesterday (01/09), a net drop of about 6,200 people.

This puts the state 10,323 enrollees away from breaking last year's record of 266,664 QHP selections with 14 days left to go before the Jan. 23rd deadline, or a net increase of around 737 enrollees per day.

It's important to keep in mind that not only is the individual mandate still in place for 2018 nationally, Massachusetts still has their own individual mandate penalty on the books regardless, so Bay Staters really should think twice before deciding to take a pass.

UPDATE 01/15/18: Since I originally posted this, the deadlines for 2 more states have passed (CO & MN), and I have minor, non-final enrollment updates for MA, MN, DC & WA. Everything in this post has been updated accordingly, including the table below.

UPDATE 01/16/18: Updated table and writeup to include final Colorado numbers, which just came out today.

UPDATE 01/17/18: Updated table & writeup to include final Maryland numbers, which just came out today.

As I keep stressing, the 2018 Open Enrollment Period is still going on across 6 states 4 states 3 states (+DC). Colorado's deadline is Friday night. Minnesota's is Sunday, followed immediately by Washington State on Monday. Eight days later, Massachusetts closes the books on the 23rd. Finally, eight days after that, OE5 officially ends for the last three state-based exchanges in California, DC and New York State.

I'm a little late with this one (spent pretty much the entire day dealing with cleaning up the aftermath of my Terrible, Horrible, No Good Very Bad Day), but Connect for Health Colorado, the CO ACA exchange, issued their first update since December 17th with 3 days left to go before Open Enrollment ends for 2018:

Connect for Health Colorado® Reports Increase in Healthcare Plan Selections for 2018; Open Enrollment Deadline is Friday
Posted on Tuesday, January 9, 2018

DENVER — More than 158,000 Coloradans selected healthcare coverage for 2018 through the state health insurance Marketplace through January 8, 2018, a rate 2 percent ahead of signups one year ago, according to new data released today by Connect for Health Colorado®, days ahead of the enrollment deadline.

Note: Obviously none of this remotely compares to, say, being without electricity for over three months or being deported to El Salvador after living here legally for over a decade for no reason, but I think I'm entitled to vent a bit once in awhile...

Yesterday morning I was using the snowblower when I hit a rolled-up newspaper buried under the snow (in a plastic sleeve) which promptly got jammed in the impeller and likely burned out the auger belt.

Then, I noticed my front driver's side tire was really low, but I had to pick up my kid from school so didn't have time to fill it with our air pump before doing so. I figured I could get there and back, but also turned out to be really low on gas, so on the way back, we stopped at a nearby gas station where I figured I'd use their air pump as well. Got gas but the air pump was broken.

No official press release yet but AccessHealthCT just released a series of tweets with their official final numbers...

114,134 CT residents have enrolled in a health plan for 2018 - 2.3% more than last year! #AHCT

— Access Health CT (@AccessHealthCT) January 8, 2018

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