Charles Gaba's blog

Over the past year or so I've written numerous entries about Michigan Republicans pushing through an ineffective, inefficient, cruel and pointless work requirement addition to Michigan's implementation of Medicaid expansion under the Affordable Care Act, culminating in this one:

New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.

Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.

That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.

Sometimes I don't have anything particularly useful to add to a data point. New Hampshire is one of the very few states which don't operate their own ACA exchange which does keep track of (and, more importantly, report) ACA exchange enrollment on a regular basis, via a monthly report.

New Hampshire enrolled 44,581 people in individual market QHPs during open enrollment this year, so the 40,728 enrolled as of May shows an impressive 91% retention rate.

Their SHOP enrollment is around ~1,300 people working for ~230 small businesses.

Last night I wrote a long entry noting that Pennsylvania, which has a Democratic Governor but a Republican-controlled state legislature, is taking swift action today to pass a bill allowing PA to establish their own state-based ACA healthcare exchange:

Pennsylvania is moving to take over the online health insurance exchange that’s been operated by the federal government since 2014, saying it can cut health insurance costsfor the hundreds of thousands who buy the individual Affordable Care Act policies.

New legislation unveiled Tuesday has high-level support in Pennsylvania's House of Representatives, with the chamber's Republican and Democratic floor leaders as the bill's lead co-sponsors.

A House committee vote was scheduled for Wednesday, underscoring the urgency of the legislation.

The bill is backed by Gov. Tom Wolf, a Democrat, and his administration says it would make two important changes to reduce premiums for the 400,000 people who purchase health insurance through the Healthcare.gov online marketplace.

Until now there's only been one state which started out hosted by HealthCare.Gov which has gone on to break off onto their own platform: Idaho, which made the move with no drama back in 2014

In Idaho's case, this was always the plan from the start; they simply didn't have time to launch their own exchange before the 2014 Open Enrollment Period, so they bumped it back a year. Idaho is about to lose that unique status, however, in a big way.

Back in March, the House Democrats held a press event in which they officially rolled out the "Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act", or #PPECMHMAA for short. That's a simply terrible title and an even worse hashtag, so I've simply shorthanded it as #ACA2.0.

The bill is actually a suite of a dozen smaller bills. Nearly all of them are sponsored purely by Democrats, which isn't surprising...but there's one exception:

I was surprised to realize that I haven't written a word about Wisconsin since before the midterm election last fall, when Democrat Tony Evers defeated Republican incumbent Scott Walker. Since then, the state has actually gone through a lot of turmoil regarding healthcare policy (and every other policy as well, of course). The GOP still controls both the state House and Senate, so during the lame duck session they tried to pull a whole mess of crap legislation to strip Evers of his authority before he even took office...as well as that of incoming Democratic state Attorney General, Josh Kaul, to prevent him from withdrawing from the plaintiff's side in the #TexasFoldEm lawsuit, among other things.

Lawsuits were filed, and a judicial tug of war has since ensued, and the last I heard, the state Supreme Court (which leans conservative by one vote) held a hearing over the mess. I'm not sure if they've issued their final ruling yet. 

In the 5 1/2 years that I've been running this website, I've received several honors and accolades, ranging from interviews and profile pieces, to being a finalist in the National Institute for Health Care Management (NIHCM) digital media awards, to even having my work included in not one, but two comic books.

Today I'm honored and humbled to note that I've now had...my portrait painted for an art exhibit. No, seriously.

I wrote about Theresa BrownGold a few months ago:

Politically, it's generally better to underpromise and overdeliver. Unfortunately, when it comes to the actual legislative process it's usually the other way around.

Case in point: Connecticut.

It was just twelve days ago that Connecticut Governor Ned Lamont rolled out his proposed ACA improvement policy package, which included a bunch of key elements including the ballyhooed "Connecticut Option"...a Public Option which would have opened up the existing state employee healthcare plan to anyone on the individual or small group markets.

The full suite was supposed to include nine major provisions:

This actually happened back in March but I missed it at the time:

Lawmaker proposes Medicaid buy-in and individual mandate for Oregonians

Representative Andrea Salinas, the new Chair of the House Health Care Committee, recently filed a bill that aims to establish a Medicaid buy-in option for Oregon residents. The bill, HB 2009, would also establish a “shared responsibility penalty,” or an individual mandate for Oregonians.

HB 2009 would essentially allow individuals who do not qualify for Medicaid, or for premium tax credits under the Affordable Care Act, to enroll in CCOs by paying premiums to cover their health services.

(Note: "CCOs" = "Coordinated Care Organizations", which I believe is how Oregon designates their Medicaid program.)

Last week I reported that California and New Jersey were pushing through a long list of "Blue Leg" ACA protections at the state level; it turns out that Rhode Island has been quietly pushing through their own suite of ACA protection legislation as well! This is from May 16:

PROVIDENCE — The state Senate approved legislation Thursday intended to protect Rhode Islanders’ access to health insurance in the face of threats to the federal Affordable Care Act.

The legislation was sponsored by Sen. Joshua Miller, D-Cranston, chairman of the Senate Health and Human Services Committee. The House version of the bill was sponsored by Rep. Joseph M. McNamara, D-Warwick,  chairman of the House Health, Education and Welfare Committee. The bill aims to ensure that the standards of the Affordable Care Act remain in effect in Rhode Island, even if the courts or Congress were to eliminate the federal laws that created it.

This Just In via the Washington State Insurance Commissioner's office...

Thirteen health insurers request record-low increase of less than 1%; Two new insurers join individual market in 2020

June 3, 2019

OLYMPIA, Wash. – Thirteen health insurers filed a record-low average proposed rate increase of 0.96% for the 2020 individual health insurance market. Also, two new insurers — PacificSource Health Plans and Providence Health Plan — are joining Washington’s market next year.

All 39 counties will have at least one insurer selling inside the Exchange, Washington Healthplanfinder.

Over at Axios, Drew Altman of the Kaiser Family Foundation has posted about a new focus group study which has some depressing, if not surprising findings:

...voters were only dimly aware of candidates’ and elected officials’ health proposals.

  • ...These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
  • Many had never heard the term “Medicare for all”...

Thanks to Dan Goldberg for the heads up; this Just In via the New York Dept. of Financial Services:

2020 INDIVIDUAL AND SMALL GROUP REQUESTED RATE ACTIONS

5/31/2019 - Health insurers in New York have submitted their requested rates for 2020, as set forth in the charts below. These are the rates proposed by health insurers, and have not been approved by DFS.

* Indicates the Company offers products on the NY State of Health Marketplace.

The NY DFS website also includes handy links to the actual enrollment numbers for every carrier on both the Individual and Small Group market, allowing me to break out the numbers further:

So far, only 4 states have released their preliminary 2020 ACA-compliant individual market premium rate filings: Maryland, Virginia, Vermont and Oregon.

So what's the deal with the other 46 states (+DC)? Well, here's a handy 2020 Submission Deadline table from SERFF (the System for Electronic Rates & Forms Filing, a database maintained by the National Association of Insurance Commissioners).

However, it's a bit overly cumbersome: It stretches out over 5 full pages, and includes columns for Standalone Dental Plans as well as a bunch of info regarding the Small Group Market. I used to try tracking Small Group rates as well, but that got to be too difficult to keep up with, and I haven't really done much analysis of standalone dental plans at all. Let's face it: About 90% of the drama, controversy and confusion regarding ACA premiums is all about the individual market.

To my readers:

As many of you know, I've been operating ACASignups.net since October 2013. At first the project was intended purely as a volunteer part-time hobby. The site quickly consumed virtually all of my time and energy, and that has never stopped in the 5 1/2 years since.

My official job as a freelance website developer began to suffer, and several years ago I pretty much gave up website development in order to devote full time to my work analyzing/blogging about healthcare policy in general while also educating people and advocating for progressive healthcare policy reform.

For a long time I've survived on a combination of the my banner ad arrangement with the Robert Wood Johnson Foundation, the generosity of individual donors, and the occasional freelance writing gig. And while I'm eternally grateful for all of these, there's always still been an income gap which I've never been quite able to fill.

Welp. That didn't take long...just a week ago, Connecticut Governor Ned Lamont announced that he and the state legislative leaders had put together a robust package of impressive healthcare reform bills, including:

  • expanding subsidies to at least some of those eanring more than 400% of the Federal Poverty Level (like California is in the process of doing)
  • expanding Medicaid up to 170% FPL (it used to be 201% FPL but was dropped down to 155% a couple of years ago)
  • reinstating the ACA's individual mandate penalty (similar to what Massachusetts, New Jersey and DC have done and what California is in the process of doing)
  • implementing a state-level reinsurance program (as over a half-dozen states, including several GOP-controlled ones, have done)

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