Confirmed 2016 Exchange QHPs: 1,853,657 as of 11/25/15
Estimated 2016 Exchange QHPs: 2.44M as of 11/25/15 (1.86M via HCgov)

Projected Exchange QHPs: 2.65M by 11/28/15 (2.02M via HC.Gov)
Projected #OE3 QHP Selections: 14.70M nationally (11.23M via
Projected #OE3 QHP Selections by State

Me on Monday:

Last year, during the third week of Open Enrollment, 618,548 people selected QHPs via the federal exchange (HealthCare.Gov). This year, I'm pretty sure that right around 500,000 people selected QHPs during the third week.

CMS, just moments ago:

Health Insurance Marketplace Open Enrollment Snapshot Week 3: November 15 – November 21, 2015

During the third week of Open Enrollment, consumers continued to explore their health insurance options by reaching out to a call center representative at 1-800-318-2596, attending enrollment events in their local communities, or or There are about three weeks remaining ahead of the December 15 deadline.

The Maryland Health Benefit Exchange has released a new updated tally:

Nearly 25,000 people have enrolled in private qualified health plans (QHP) through Maryland Health Connection for 2016.

As of Nov. 23, 19,675 Marylanders had enrolled in private coverage with some or most of their premium costs next year to be offset by advance tax credits. Another 5,310 enrolled in qualified health plans without tax credits. Nearly 72 percent, or 17,960, were enrolled in SIlver plans.

That's 24,985 QHPs total in 23 days, or 1,086 per day.

In addition, 1,708 people have enrolled in stand-alone dental plans and 5,235 more have enrolled in dental along with health coverage for a total of 6,943 with dental coverage next year.

Also, 87,941 were enrolled in Medicaid since Nov. 1 through Maryland Health Connection.

As I note every week, between Rhode Island's tiny population, tinier ACA exchange numbers and especially their decision to "front-load" autorenewals of all current enrollees ahead of the 12/23 deadline for January coverage, their official QHP selection tally is only going up a few hundred per week. Week Three is no diffferent:

PROVIDENCE – HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, November 21, 2015, for Open Enrollment.


31,012 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.

Nearly all of these individuals are current HSRI enrollees that have been autorenewed into a 2016 plan. 920 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.

My latest exclusive piece for is mainly a quick reminder that the tax penalty for not having ACA-compliant heatlhcare coverage in 2016 is up to 7x as high as it was for 2014, depending on your income and situation.

The Carrot refers to the federal tax credits available to more than 8 out of 10 of those who enroll; the Stick is the increasing Shared Responsibility Tax Penalty, aka the Individual Mandate tax.

I've been quick to crow about improving national support for the ACA in the past, so it would be disingenous of me to ignore it when there's a negative development:

Views on Obamacare have taken a negative shift, according to a November Kaiser Family Foundation poll released Tuesday.

Forty-five percent of Americans now say they have a negative view of the Affordable Care Act, while 38 percent have a positive view. This represents a reversal from earlier this year when, for the first time in three years, a greater number of Americans were in favor of the law than against it.

In October, a KFF poll found opinion evenly split on the law at 42 percent. The foundation's September poll showed a more narrow divide, with a 41 percent favorable to 45 percent unfavorable rating. A KFF survey conducted in August showed opinion skewed more favorably, with 44 percent of Americans stating they had a positive view and 41 percent stating they had a negative one.

From an email I received today:

FROM: (name)
Organization: Sinclair Broadcast Group

Mr. Gaba,

I am working on an article about UnitedHealth Group saying it may drop out of Affordable Care Act exchanges in 2017. I am trying to get a sense of how significant this and other recent news surrounding the law really are. I see you have written several posts about these developments. If you are interested and available to talk about that on the phone for a few minutes today, please let me know. Thank you.


My response:

Dear (name)--

I appreciate your interest.

Unfortunately, I couldn’t help but notice that your organization is the same one which produced and broadcast the anti-John Kerry propaganda film “Stolen Honor: Wounds That Never Heal” [ie, part of the infamous "Swift Boating" smear] in 2004.

...and various reporters will breathlessly report about how this is 20% lower than the same third week during last year's Open Enrollment Period, and OMG THIS MEANS OBAMACARE IS FAILING!!!

Yep, it's true: Last year, during the third week of Open Enrollment, 618,548 people selected QHPs via the federal exchange (HealthCare.Gov). This year, I'm pretty sure that right around 500,000 people selected QHPs during the third week.

However, here's what you have to keep in mind: The first week was 17% higher this year than last (543K vs. 462K). The second week was a whopping 77% higher than last year! (535K vs. 303K).

Why the massive discrepancies? Simple: The calendar. Last year, Open Enrollment started on November 15th. The second week was also Thanksgiving week, which meant that enrollments dropped off to practically zilch for that Thursday and Friday.

This year, Open Enrollment started 2 weeks earlier, on November 1st. That means two important differences:

Presented Without Comment:

U.S. adults are slightly more likely to say it is the responsibility of the federal government to ensure all Americans have health insurance coverage (51%) than to say it is not the government's responsibility (47%). The percentage who believe the government has that obligation is up six percentage points from 2014. This year marks the first time since 2008 that a majority of Americans say the government is responsible for making sure all citizens have health insurance.

Hat tip to someone named "Chuck" (no last name or organization given) for the tip.

Yet Another Post® about UnitedHealthcare, I'm afraid. Healthcare pundits/reporters have found last week's United announcement extremely oddly-timed, especially given that they were giving a very positive outlook for the ACA exchanges just a month earlier.

In short: UHC sat out the ACA exchanges in 2014, dove into half the states head first for 2015, expanded into another 11 states for 2016...but then suddenly announced that they "may" drop out of the exchanges completely in 2017? Furthermore, they made this announcement a month after painting a glowing outlook in their official quarterly report and did so in the middle of the 2016 open enrollment period? Something doesn't sound right here.

Well, today I've learned another tidbit which seems odd to me, although it's possible that there's nothing amiss here:

Over at Inside Health Policy, Amy Lotven takes a deeper look at one part of last week's UnitedHealthcare announcement which slipped by a lot of people:

United Notes Customer Churn As It Mulls Exiting Exchanges

...United in a Thursday morning call said it is seeing a high number of people who are purchasing exchange plans, receiving services, and then dropping their policies. Aetna, which last month announced it would scale back its offerings in 2016, also recently said is has seen an increased number of enrollees coming in and out of the exchange, especially through the special enrollment periods.

...Aetna Chief Financial Officer Shawn Guertin made similar comments in a Nov. 10 investors meeting at Credit Suisse. The phenomena that really we're seeing now is a lot more people coming in and out of the system, and in particular people coming in during a Special Enrollment Period and then staying for only a few months and dropping, is really part of what's draining the system, Guertin said.

After UnitedHealthcare freaked everyone in the health insurance investor community out (along with enrollees, politicians, healthcare reporters/pundits, etc.) with their Thursday morning announcement that they might drop off the ACA exchanges in 2017, just 2 years after entering the exchanges and just 1 month after painting a rosy picture of the situation, several other major players in the individual market decided to calm everyone the hell down:

U.S. health insurers Aetna Inc and Anthem Inc on Friday sought to reassure investors that their Obamacare businesses had not worsened after UnitedHealth Group Inc warned of mounting losses in that sector.

Aetna and Anthem said their individual insurance businesses, which include the plans created by President Barack Obama's national healthcare reform law, had performed in line with projections through October. Both backed their earnings forecasts for 2015.

The huge political story this morning is Democrat John Bel Edwards winning the Louisiana gubernatorial race by a whopping 12 points.

Much is being written about What This Means for Democrats Next Year®, blah blah blah. The reality is, as happy as I am about the outcome (sort of the Yang to the recent Yin in Kentucky), most of the specifics of the Louisiana results probably don't mean much nationally. As Matthew Yglesias notes at Vox this morning:

Louisiana was a perfect storm

A number of different factors came together to power Edwards' win. One is that Edwards, as a former Army Ranger with deep family ties to Louisiana state politics, had the right kind of biography to win in a red state. The other is that Vitter's rather unusual history with paid sex gave him the wrong kind of biography to win in any state. Add on to that the fact that the Louisiana Republican Party is divided and factionalized and the GOP has a firm grip on the state legislature, so some Republicans aren't exactly weeping to see Vitter lose.

Last but by no means least, the Louisiana economy is suffering from the global trend toward cheaper oil in a way that naturally helps challengers.

Two days ago I wrote about UnitedHealthcare telling their insurance broker network that they're slashing commission payments by up to 80% for exchange-based individual policy enrollments. Just a few hours later I wrote a similar story about another small insurer in Arizona, Phoenix Health Plans, telling their brokers to go pound sand completely with regard to exchange enrollees.

Given the one-two punch in the same 24-hour period, I titled the second entry "Has the Great Insurance Broker Purge begun?"

I was being partly tongue-in-cheek, but it appears that the answer to that question is, in fact, "Yep."

Insurance broker Josh Dickerson, who also gave me the heads up re. UnitedHealthcare and Phoenix, just forwarded a third "your services are no longer needed" letter from HealthSpan (an Ohio-based carrier) to their broker network...and this one has a slight twist:

Just a few hours ago, I was amused to note that HealthCare.Gov took my advice by adding a short explanatory message to one of the first screens you see on the window shopping tool. While a seemingly tiny thing, this one simple improvement could potentially increase 2016 enrollments by a few thousand people (or, at the very least, make the process slightly less annoying for many more).

Anyway, that alone would've been enough to make my day...but then, just moments ago, the CMS division sent out the following list of Proposed Improvements for the 2017 Marketplace (ie, for next year):

The Centers for Medicare & Medicaid Services (CMS) today issued the proposed annual Notice of Benefit and Payment Parameters for 2017, governing participation in the Health Insurance Marketplaces. The proposed rule seeks comment on proposals that will provide continued choice and competition for consumers, and a vibrant and growing market for affordable, quality health plans. The proposed rule seeks to improve the consumer experience, both when individuals shop for health insurance and when they use it.

Some Guy, October 26, 2015:

Late last night I posted a quick walk-thru of the all-new 2016 HealthCare.Gov Window Shopping tool. For the most part, it's a major improvement over the 2015 version (which itself was, of course, a massive improvement over the buggy, 78-screen original version launched for 2014 open enrollment).

However, there are a few improvements which can always be made, and for me, one of the biggest ones is right at the beginning. Immediately after entering your Zip Code, the very first question which pops up is "Are you enrolled in a 2015 Marketplace health plan?"

Aside from the fact that some people may not even know whether or not their current plan is "through" the ACA healthcare exchange or not ("Marketplace" is a pretty generic term, after all...) the problem is that if you choose "Yes", here's what pops up: