Confirmed Exchange QHPs: 11,776,046 as of 4/15/15
Estimated: 12.15M (9.26M via HCgov) as of 4/15/15

Estimated ACA Policy Enrollment: 32.3M
(10.69M Exchange QHPs, 8.38M OFF-Exchange QHPs, 330K SHOP, 12.9M Medicaid/CHIP)

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After one botched vote, two years and an all-out resistance blitz by the Koch Bros and their ilk which was so obnoxious that they managed to alienate local Republicans, the Medicaid expansion provision of the Affordable Care Act has finally officially passed both the state House and Senate of Montana, and should be signed into law by the Democratic governor any moment now.

HELENA (AP) – The state Legislature has passed a bill expanding Medicaid eligibility to about 70,000 low-income Montana residents.

The bill approved Saturday heads to Gov. Steve Bullock, who is expected to sign it into law.

Florida Gov. Rick Scott announced Thursday that his administration will file a lawsuit against the federal government for threatening to withhold more than $1 billion in funding for hospitals if the state fails to expand Medicaid.

“It is appalling that President Obama would cut off federal health care dollars to Florida in an effort to force our state further into Obamacare,” Scott said, citing a 2012 Supreme Court ruling that said the federal government couldn’t put a “gun to the head” of states to force them to expand Medicaid under the health care law.

The Obama administration quickly accused Scott of misconstruing that court decision because the state is not being forced to do anything. And White House spokesman Josh Earnest blasted the governor for putting politics above people.

The seminar is not open to the public (it's only for members of the Society of Actuaries), but I'm kind of geeked about it as this is my first non-local speaking engagement:

Best Actuarial Practices in Health Studies Seminar

1:00 – 2:00 p.m.
Session 1 – How Making Numbers Accessible and Data Visualization Made One Person’s Website Newsworthy at the National Level

Should be pretty cool!

The HHS Dept. reported that exactly 97,079 people had selected private policies in Idaho via their all-new state-based exchange during 2015 Open Enrollment (including the "standing in line" period).

Unlike most states, Idaho chose not to participate in any sort of special tax filing season enrollment period (MA & CO are the other two which didn't do so; every other state is still allowing enrollment for people who had to pay the fine last year and didn't make the cut this year until April 30th, except for WA which cuts things off today and VT which bumped theirs out until the end of May).

While Idaho, like every state, does still allow people to enroll during the off-season if they have a major life change (getting married/divorced, having a baby, moving, losing other coverage, etc), that tends to be cancelled out by other people dropping their coverage for similar reasons.

Now that Florida GOP Senator Marco "Dry Lips" Rubio has officially launched his 2016 Presidential campaign, my long-time obsession with his ill-fated "Florida Health Choices" project from his days as the Speaker of the FL House have taken on a bit more relevance.

As of December 2014, this exciting new example of the superiority of "free-market" solutions had been operating for about a year. They weren't selling actual health insurance; it was more along the lines of "discount coupons" for dental visits, eyeglasses and the like. Discount coupons which are actually kind of scammy, it turns out:

Prescription drug discount plans are controversial because they sometimes charge fees for the same savings consumers could get without them. A 2012 Consumer Reports study said discount plans made it difficult to comparison shop and many national retail chains offer their own steep discounts on common generic drugs.

A little while ago, Greg Sargent of the Washington Post asked the following via Twitter:

Serious Q for wonks: If O'care expanded coverage by 16 million, & SCOTUS guts 5 million, Ocare still covering over 10 million, right?

— Greg Sargent (@ThePlumLineGS) April 16, 2015

As I recently noted, I actually question the 16 million number; by my count it's actually more realistically like 14-15 million, so there's that.

I also noted in response that the fallout of the plaintiffs winning King v. Burwell will cause a lot more than 5 million people to lose their healthcare coverage. Technically speaking, here's the hard numbers:

Yesterday a good half-dozen people sent me the link to this video, posted by a guy named James Webb a couple of days ago. Talking Points Memo gives an overview of the 3 1/2 minute clip:

"Hello, YouTube. I'm kinda having a difficult decision," Webb lamented in the 3-minute video. "I don't know which party to vote for. ... I don't know whether to go for a Republican or a Democrat -- and I'm serious. Because I asked myself, I said, 'Which party has helped me out the most in the last, I don't know, 15 years? Twenty?' And it was the Repub-, err, Democrat Party. The Democrats."

"I mean if it wasn't for Obama and that Obamacare, I would still be working," Webb continued. "With Obamacare, I got to retire at age 50. Because if it wasn't for Obamacare I would had to work till I was 65 and get on Medicare because health insurance is expensive."

Webb stressed how valuable it was that he'd been able to retire so early and still had health care coverage. He also noted that Obamacare reimburses him for his gym membership.

The ACA exchange enrollment reports out of Hawaii have been continually confusing as hell. One day it's 16,000 (more than twice 2014's total); a month later it's only 13,300; then just hours later, I receive "confirmation" (directly from the exchange director, supposedly) that it's actually 23,000...specifically for 2015 policies.

While this was screaming out as a big red flag, I grudgingly accepted it...only to have the rug yanked out from me when the official ASPE report came out in March, giving the official final number as 12,625...which is right in line with what I was expecting in the first place (around a 50% increase over their total in April 2014, and 17% over their total as of September 2014).

OK, this isn't a huge thing, but it's noteworthy.

Historically, Medicaid (and to a lesser extent, the CHIP program for children) has carried a certain stigma, since it's traditionally been reserved for the very poor. Many people enrolled the program have been embarrassed/ashamed to admit that they needed the assistance, and many who qualified for the program even under the pre-ACA rules never actually signed up based on the "shame" factor (still others didn't enroll because they simply didn't know that they qualified or didn't understand the procedure/paperwork for doing so).

With that Affordable Care Act, that all changed (well, in the states which expanded Medicaid, anyway). Yes, it's still limited to the poor, but there's a difference between being "dirt poor" and "working poor" (and yes, I understand that many "dirt poor" people work their butts off...I'm talking about general societal perception here). Suddenly, millions of people who considered themselves "lower middle class" (or otherwise "not poor", anyway) found themselves being able to enroll in Medicaid alongside the "dirt poor".

Hmmm...this is a bit surprising. The last report out of MNsure stated that they had added 1,405 QHP selections in the 15 days from 2/21 - 3/08, or 94 per day. I assumed that as today's tax filing deadline approached, this rate would increase as procrastinators scrambled to get their taxes filed under the wire. Instead, however, this is their latest report:

61,874 - 61,109 = Just 765 people enrolling over the 36 days since the prior report, or just 21 people per day. ACA exchange enrollments have actually slowed down substantially over the past month compared to the prior 2 weeks (which were after open enrollment ended). If this slowdown is representative of the whole country, then instead of several hundred thousand #ACATaxTime enrollees, we might be looking at fewer than 100K. However, this isn't nearly enough to draw any conclusions from yet.

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