Monday, January 13, 2014

The enemies of the ACA are failing

A couple of days ago, I noted that while the state-run Affordable Care Act exchanges were collectively outperforming, that apparent performance gap had been exaggerated by the lag in reporting by states relying on the Federal exchange. Since was barely functioning until early December, and some health exchanges were working well much earlier, I noted that the gap should continue to close as new numbers came in.

Today, HHS released state-by-state exchange signup numbers through 12/28. states are indeed catching up.  The fourteen states running their own exchanges, along with Washington D.C. (also running its own), encompass just about about one third of the U.S. population (slightly over 100 million people). Their 956,000 signups as of 12/28 comprised about 44% of the total of 2,152,000 signed up on the exchanges.(Honestly, I should have noted a ratio close to this in the prior post, as HHS has for some time claimed about a million signups on that it hadn't yet ascribed to specific states.)

Signup rates are impressive in many large states in which Republican governors and legislatures have worked actively to undercut the law. On 12/28, the open enrollment period (Oct. 1 - Mar. 31) was just shy of half over -- and signups were miniscule through the first week of December. Any state that had reached more than say one third of the CBO projection for first-year exchange signups might be deemed more or less on course. Major non-cooperating states that passed that threshold (as tracked by Charles Gaba's invaluable spreadsheet) include Florida (33% of CBO projection, 158.0k signups), Michigan (47%, 75.5k), New Jersey (36%, 34.7k), North Carolina ((56%, 107.7k), Pennsylvania (39%, 81.3k), Virginia (35%, 44.6k) and Wisconsin (52%, 40.7k).

More good news: only about 20% of those choosing plans on the exchanges have opted for the cheapest bronze plans, where deductibles average $5,000 per person. Benefits are benchmarked to the second cheapest silver plan in each state, and subsidies that reduce deductibles. and maximum out-of-pocket costs, offered to buyers with incomes below 200% of the federal poverty level, are only available to silver plan buyers. Further, 79% of those who have enrolled in plans thus far have qualified for subsidies. Put those numbers together and it appears that most exchange buyers thus far may indeed find their coverage and care affordable. Add in that most enrollees with children will find the children enrolled in CHIP, further reducing their out-of-pocket costs though not their premiums. More worryingly,  among those who have completed applications but not yet enrolled (excluding those eligible for Medicaid), nearly half are not eligible for subsidies (thanks to Corey Husak for pointing this out -- and see update below for Megan McArdle's take on these numbers).

That infamous "disastrous rollout" is fast shrinking behind us. So, perhaps, is prospect that the passive and active resistance to implementation thrown up by GOP state governments and the whole right-wing smear machine will severely impede takeup. Though clear early success is far from assured -- the jury is still out on everything from the composition of state risk pools to consumer experience with the marketplace plans (see Jonathan Cohn and Sarah Kliff on age-mix worries) --  Democratic lawmakers should get out of their crouch and start singing the law's praises with confidence.

(Updated 1/14 with info about the composition of the enrollment pool to date.)

Update 2: Megan McArdle puts the subsidy-eligible signup numbers in perspective:
Five million people were deemed eligible to buy a policy on the exchanges; 2.7 million, or 54 percent of them, were eligible for subsidies. But of people who actually selected a plan, 1.68 million, or 80 percent, were subsidized. To put it another way, 62 percent of the people eligible for subsidies selected a plan, but only 8.5 percent of those who weren't eligible for subsidies actually purchased one.
Update 3: Kevin Drum seems to have reached a psychological tipping point re the ACA rather like mine.

Just what has a single mother of three lost in Wisconsin?
A CHIP off the old block in the ACA
The ACA's preexisting condition
A country struggling to share too-high healthcare costs

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