Monday, February 27, 2023

A broker briefing on OEP 2023 in the ACA marketplace

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ACA marketplace enrollment is up 13% nationally in 2023; 19% in the 33 states using the federal exchange, HealthCare.gov states; 23% in states that have not expanded Medicaid (all of which use HealthCare.gov), and 32% in Texas. Who’s buying in? In advance of the detailed enrollment data that CMS typically releases in spring, I spoke to health insurance brokers based in Texas and New Jersey.

High-income enrollees entering the marketplace

I touched base first with Dallas-area health insurance broker Jenny Hogue, president and CEO of KG Health Insurance, who had noted on Twitter in late 2021 that a number of higher-income people who had been priced out of the ACA marketplace before the American Rescue Plan Act removed the income cap on subsidy eligibility were buying in. Jenny’s perceptions were borne out by 2022 enrollment data, which showed enrollment at income over 400% FPL had more than doubled year-over-year in HealthCare.gov states, including Texas. I wanted to know if the surge was continuing this year.

Monday, February 13, 2023

Legislative and administrative love (and its opposite): Health Policy Valentines 2023

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I can’t believe that this my tenth year offering up #HealthPolicyValentines — a tradition kicked off by Emma Sandoe, the country’s leading Medicaid enthusiast, in 2012, when she was a CMS spokesperson. Emma is now a Medicaid official in North Carolina, no doubt deeply invested in a not-so-funny legislative rom-com as the state House and Senate struggle to align not-quite-compatible bills to enact the ACA Medicaid expansion. The NC House may deliver the ultimate #HealthPolicyValentine this week, passing its expansion bill on V-Day itself.

I have no such substantive gifts to offer, but I can celebrate some goodies served up by legislators (federal and state) and administrators in the last year. Let the doggerel begin.

* * *

Roses are red,
Violets are blue.
I got no surprise bills
in 2022.

Roses are expensive,
Dandelions are free.
I'll get no surprise bills
in 2023.

In the U.S., alas,
there’s always an asterisk,
so an ambulance remains
a major financial risk.

* * *

Progress is fragile,
progress is slow,
but the uninsured rate’s
at an all-time low.

Alas, costs keep rising
so we needn't ask why
the underinsured rate's 
at an all-time high.

* * *

Congress showered cash
but states must play their part (um…)
to provide young moms and babes
a year’s coverage postpartum.

* * *

Love to CMS
for reducing the immensity
of Medicare Advantage
coding intensity.

* * *

Love (and its opposite) in the states

In New Mexico, for sure,
but I didn't expect this:
Strict silver loading
enacted in Texas.

* * *

Some states will be cruel,
some states will be kind
when the starting whistle blows
for the Medicaid unwind.

* * *

100% FPL
is the cruelest of gates,
but Obamacare's on fire
in nonexpansion states.

Perhaps those excluded
have grown sick of rejections
and learned to adjust
their income projections.

* * *

In our founding fathers’ house
there’ll be one more mansion
when NC enacts
the Medicaid expansion.

* * *

New Jersey got it done --
that is, built the apparatus
to cover kids regardless
of immigration status.

* * *

New York,
defrosting pork,
and seasoning it well,
will cook the Essential Plan
to 250 FPL

* * *

Glutton for punishment? Browse my Health Policy Valentines archives: Flowers in the graveyard (2022), Institutional edition (2021), But love grows old and waxes cold (2020), The Water is Wide: Health Policy Valentines (2019),  HPV (2018), Love Knows No Repeal (2017),  Love in the Time of Obamacare (2016), love, 2015, and Romance of the Rose, Health Policy Edition (2014).

Thursday, February 02, 2023

Why ACA marketplace enrollment surged at incomes above 400% FPL in 2022: A Houston illustration

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In 2022, the first plan year in which the enhanced ACA marketplace subsidies created by the American Rescue Plan Act (ARPA) were available in the Open Enrollment Period, enrollment at incomes above 400% of the Federal Poverty Level more than doubled in the 33 states using HealthCare.gov. Pre-ARPA, enrollees with income above 400% FPL were ineligible for premium subsidies; ARPA removed that eligibility cap.

I have a post up at Healthinsurance.org that charts the enrollment increase at high incomes in HealthCare.gov states in 2022 and the ARPA impact on premiums at high incomes in Houston in 2023. Just to tease here, a couple of charts: