Thread by @charles_gaba

⚠️ THREAD: When the dust settles on the 2019 Open Enrollment Period, total enrollments will likely be ~11.4M on exchange, plus perhaps 3M off-exchange. Of the 14.4M total, around 13M (90%) will actually pay their premiums. 1/

Of those 13M people, around 4.2 million will be unsubsidized & have to pay full price...and that full price will average around $49/month higher in 2019 than it would have been if Trump & the GOP hadn't repealed the individual mandate & opened the floodgates on #ShortAssPlans. 2/

This is the case even in states where 2019 premiums are *dropping* in 2019 (or staying flat)...they would have gone down *even more* without those changes. Many of the carriers have stated this specifically in rate filings, w/many including actuarial data to support it. 3/

So here's a bit of math: 4.2 million x $48.50/month x 12 months = $2.44 billion in extra premiums being charged to enrollees in 2019 alone. That $2.44 billion doesn't provide anyone with better healthcare coverage. 4/

Note that I put my off-exchange est. at just 3M. That's down nearly a million people who were priced out of the ACA market *this* year due to *last* year's sabotage, primarily Trump's CSR cut-off & other factors, which I estimate caused ~17 points of *this* year's hikes. 5/

The good news is that *last* year's sabotage was partly mitigated thanks to #SilverLoading by carriers/regulators, which actually *helped* several million *subsidized* folks...and by #SilverSwitching, which held several million *unsubsidized* folks harmless to the CSR cuts. 6/

HOWEVER...#SilverSwitching is hard to explain, and millions either never heard about it or didn't understand the benefit. Plus, only about half the states did silver switching for 2018. Most states are doing so for 2019, but it's still overlooked by millions. 7/

And again, none of that has anything to do with the *latest* batch of sabotage efforts. Several states have cancelled out a small part of it by restricting or eliminating #ShortAssPlans, while MA, NJ & DC have cancelled out the rest by reinstating their own mandate penalties. 8/

This has had mixed results. In MA, where they already had a mandate since 2007 anyway & are used to it, they launched a huge awareness campaign about it and it's worked perfectly: Their uninsured rate is already down to 2.5%, yet they *still* broke their ACA enrollment record. 9/

In NJ, the mandate reinstatement was VERY successful in knocking premiums down (by around $500 per enrollee for the year!), but may not have been effective at shoring up enrollment; NJ looks like it'll be down around 8% for the year, in the middle of the pack. Why? Well... 10/

I don't know how much visibility/awareness there is in NJ that they have their own mandate penalty, but my sources there have indicated that it was pretty lackluster--one press conference, a notice on the website (which you wouldn't see unless you visited the site), etc... 11/

But the thing about the mandate is that it's only effective at getting people to enroll IF PEOPLE KNOW IT EXISTS. If people in New Jersey heard the federal mandate was gone but *didn't* hear that it had been reinstated locally, they'll assume it's gone and voila, impact lost. 12/

Of course, @xpostfactoid raises another difference between these states: MA provides their own additional subsidies to many enrollees, while NJ doesn't (although they do have a reinsurance program which lowered premiums *another* $1,000 per enrollee). 13/

https://twitter.com/xpostfactoid/status/1076114425709580288

Anyway, these are just some things to keep in mind as the final 2019 Open Enrollment numbers come in. CMS should release a "cleanup" report for the 39 HCgov states next week. I expect the current total (8.45M) will be reduced by around 75K people for various reasons. 14/

Meanwhile, the enrollment train continues to roll on for fully 25% of the population: You can still #GetCovered in CA, CO, CT, DC, MA, MN, NY & RI: acasignups.net/18/12/19/its-n…

Certain populations can also still #GetCovered in Alaska (earthquake victims) and Vermont (those who had problems ahead of the 12/15 deadline). acasignups.net/18/12/17/alask…

UPDATE: D'oh! I forgot to Show My Work® at the start of the thread! Here's the state-by-state summary table...
acasignups.net/18/11/08/updat…

...here's a link to each individual state analysis (scroll down); in some cases I ran a preliminary analysis in April - August and then a final analysis in September - October... acasignups.net/rate-hikes/2019

...here's an explainer of my methodology for each state...
acasignups.net/18/06/05/my-of…

and finally, here's the @UrbanInstitute projections of the impact of mandate repeal + #ShortAssPlans. My estimates, which are partly based on their projections, are HALF of theirs on average nationally (8.1% vs. 16.6%):
urban.org/research/publi…

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You know you want a 3-Legged Stool Doggie T-Shirt, right?
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