With all of the doom & gloom surrounding last week’s announcement that UnitedHealthcare has decided to take their ball and go home in over 2 dozen states next year, I thought folks might appreciate some positive ACA/healthcare-related news.
First up: Last fall was a brutal time for the ACA-created Co-Ops. As the only remaining remnants of the original “public option” when the law was signed in 2010, the Co-Ops were pretty much designed to fail in many ways; underfunded, tight controls on advertising, trying to enter a mature existing market filled with major players who had money to burn, the odds were heavily stacked against them from day one.
Then, after the first two chaotic years had pummeled most of the Co-Ops into barely treading water, Marco Rubio and his GOP colleagues delivered the coup de grace by cutting off the ACA’s “risk corridor” program at the knees. This was the final straw for many of the Co-Ops, and over half of them collapsed one by one over the course of September and October. Of the other 11 which survived, most still remain on very shaky ground.
This context is important to understand when I say that just today it was announced that at least three of the remaining Co-Ops, based in Maryland, New Mexico and Massachusetts, are reporting profits for the first quarter of 2016.
According to Adam Cancryn of SNL Financial:
Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.
Maryland-based Evergreen Health Cooperative Inc. finished the quarter with $547,000 of net income, it said April 26, in a turnaround from its $2.3 million loss in the same period a year ago. That represented the first profitable quarter in the company's short history.
New Mexico Health Connections generated $420,000 of first-quarter earnings, CEO Martin Hickey said in an email, compared with a $2.3 million loss in the 2015 first quarter. Massachusetts' Minuteman Health Inc. will also finish the quarter in the black, according to a person familiar with the company's financial results. The company lost $3.8 million in the year-ago period.
The early profitability comes as the co-ops' exchange membership continues to grow. Evergreen Health boasted 40,000 enrollees as of March 31, up from 29,679 at the end of 2015, while Hickey said that New Mexico Health Connections grew its customer base to about 48,000, from 32,000 on Dec. 31, 2015. Minuteman's enrollment, meanwhile, will show an 85% jump to about 26,000 members, the source familiar with the results said.
It’s very important to note that there are a lot of caveats here. A single quarter could be a fluke. The fallout from the ACA's "risk adjustment" program could wipe out any profits. The fourth quarter of the year could see a massive spike in insurance claims as enrollees try to squeeze in as many treatments/surgeries as possible, and so forth. If so, that impressive enrollment growth could end up biting the Co-Ops on the ass at the end of the year.
Even so, this is still a quantum leap better than where things stood a year ago. A few of the Co-Ops might survive & thrive yet, and if so, they are allowed to expand into other states (and a few of them have already done so). Keep your fingers crossed!
Meanwhile, in California:
About a year ago I wrote about a bill working it's way through the California state legislature which, if passed and signed into law, would have allowed all of California's 1.5 million uninsured, undocumented immigrants to either enroll in Medi-Cal (CA's name for Medicaid) or in ACA exchange policies via Covered California (with the state picking up the tab for the APTC/CSR financial assistance). Since the ACA specifically prohibits any federal dollars from being used, the state would be on the hook for 100% of the cost.
The bad news is that this ambitious bill didn't end up making it through the process. The good news is that a stripped-down version of it did become law:
Ever since Obamacare took effect two years ago, many California legislators have been fighting to get health insurance for those it left out — the quarter of all immigrants in the country illegally who live within the state's borders.
Note: The actual number of undocumented immigrants in CA is estimated to be 2.67 million later in the article; about 1.2 million of them are currently covered via one means or another).
Next month, California will make a sizable dent in that effort when immigrants younger than 19 who are here without papers begin receiving free health coverage through Medi-Cal, the state's low-income health program. State officials estimate that 170,000 residents will be eligible.
But insuring children is an easy battle to win, experts say, because of kids' emotional appeal and their low medical expenses. California isn't blazing the way here. Massachusetts, Illinois, New York, Washington and Washington, D.C., already have extended coverage to children in the country illegally.
The remaining frontier — covering adults — will be a much tougher sell — and a more significant test of California's larger push to provide additional services to those here illegally.
Again, not all 170K of these children will be newly covered; some are already covered via the "My Health L.A." program and/or other state/local programs; they'll be shifted over to Medi-Cal instead. Still, it sounds like this could result in a net coverage increase of over 100,000 more kids.
Approximately 115,000 youths also get coverage for emergencies through Medi-Cal, according to state officials. They will be rolled into the newly expanded program on May 16, but will be covered retroactively from May 1, Cava said.
As many as 27,500 children who have not yet been signed up for Medi-Cal are expected to enroll in the first year, Cava said. For minors to qualify, a family must earn less than 266% of the federal poverty level — or less than $53,626 for a family of three or $75,650 for a family of five.
I actually suspect that the first-year enrollment tally is going to end up being much higher than that, if enrollment in ACA Medicaid expansion in other states is any guidance.
OK, so this law lops off about 11% of the state's uninsured undocumented immigrant issue. As for the rest...
Sen. Ricardo Lara (D-Bell Gardens) recently introduced a bill in Sacramento that would ask the federal government for permission to allow unauthorized immigrants to buy insurance from the state's health exchange, Covered California. California would be the first state in the nation to do this, but the move would be mostly symbolic, because immigrants still wouldn't get subsidies to help them afford coverage.
In other words, if it was approved, undocumented immigrants would be allowed to enroll in ACA exchange policies...but wouldn't receive any financial assistance if they did so, which is the only real reason to bother going thorugh the process as opposed to enrolling directly via the carrier. That's why 85% of exchange enrollees receive APTC assistance.
Still, every little bit helps…
P.S. I’m running for County Commissioner here in Michigan. Any assistance you could offer would be greatly appreciated!