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I realize that this is the 3rd diary I've posted tonight, but this one is kind of important to me on a personal level. I'm one of those who tore Luis Lang apart in the first place, so it behooves me to give this follow-up at least as much exposure.
Over the past 3 weeks, I've written not one, not two, but 5 different lengthy screeds about Luis Lang of Fort Mill, South Carolina.

My first three posts pretty much tore him and his wife to pieces.

The fourth post, written in response to an interview he did with my colleague Harold Pollack over at healthinsurance.org, was a bit more forgiving, but still brought out my nasty snark.

Then, a few days later, Lang dropped the bombshell: He and his wife were renouncing the Republican Party and openly calling for Single Payer healthcare.

Needless to say, I was beyond stunned. While thrilled to hear this news, this also obviously left me in a rather awkward position: Do I apologize to the guy for my earlier attacks, or were they justified? In addition, in the back of my head there was obviously the possibility that his seemingly miraculous 180˚ ideological stance was simply some sort of con to get progressives/lefties to donate even more money to his campaign.

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Yeah, I know, two King v Burwell posts in a single day...but we're ramping up to the big decision announcement and it's important that people know ALL of the potential ramifications, even the unlikely ones.

With that in mind, here's the TRUE "worst-case" scenario. Understand that this is VERY unlikely to come to pass even if the Supreme Court does rule in favor of the plaintiffs...but I'm presenting it as more of a legal thinking exercise than anything else:

For months now, I and many others have been sounding the warning bells re. the absurd King v. Burwell ACA case, currently awaiting a decision by the Supreme Court.

Until now, many people have pointed out that in a worst-case scenario situation, anywhere from 6 - 7 million people across 34-37 states enrolled in healthcare policies via HealthCare.gov would lose their federal tax credits, and thus, in nearly all cases, their policy as well...since they'd no longer be able to afford it. The actual number who are currently enrolled as of July (the earliest point that the credits could be cut off) will be roughly 6.5 million people (assuming that Oregon, Nevada & New Mexico are in the clear) or 6.7 million (assuming those 3 states aren't).

In addition to these 6.5 million or so folks, I've also estimated that an additional 1-2 million more would also lose their policies indirectly...because the massive price spikes (up to 50% in some cases) resulting from the first 6-7 million dropping their policies would likely price them out of the market as well.

Finally, I've also pointed out that another 5 million or so people (mostly enrolled in off-exchange individual plans) would likely keep their policies...but pay through the nose to continue to do so.

So...around 8.5 million or so losing their coverage completely and another 5 million facing crushing premiums. Pretty bad, right?

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Reading this story by Sarah Ferris at The Hill reminded me of the closing scene from Glengarry Glen Ross (starting at around 2:50 in):


WILLIAMSON: Where have you been, Shelly? Bruce and Harriet Nyborg?? Do you want to see the memos...? They're nuts... they used to call in every week. When I was with Webb. And we were selling Arizona...they're nuts...did you see how they were living? How can you delude yourself??

LEVENE: I've got the check...

WILLIAMSON: Forget it. Frame it. It's worthless.

LEVENE: The check is no good?

WILLIAMSON: You stick around; I'll pull the memo. I'm busy now.

LEVENE: Wait a minute...their check's no good? They're nuts...?

WILLIAMSON: You wanna call the bank, Shelly?  I called them.  I called them four months ago when we first got the lead. (pause) The people are insane. (pause) They just like talking...to salesmen.

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Whenever I post about King v. Burwell, I have a tendency to lump all 34 states together into collective numbers (around 6.5 million losing their tax credits, plus another couple million being priced out of the market due to the resulting premium spikes, plus another 4-5 million having to pay through the nose to keep theirs).

However, I decided to break this out by individual state. First, I used the HHS Dept's. official ASPE report from March 10th. This includes all people who selected a QHP via HC.gov as of 2/22/15.

Next, I assume my standard 88% payment rate. Ironically, the higher this percentage is, the more people who could actually get royally shafted by a King plaintiff win.

Then, I estimate how many people will be enrolled in effectuated policies as of July 1st. That's important because of the churn factor--people are constantly enrolling and dropping their policies for unrelated reasons, even during the off season. I estimate that as of July, this will likely be around 2% fewer than the number who paid up (normal attrition would be more like 4% but that was partially cancelled out by the 147,000 people who enrolled via the Tax Filing Season special enrollment period via HC.gov). That brings the grand total down to around 7.4 million.

Next, we have to look at what percentage of enrollees are actually receiving federal tax credits in each of these states. The overall percentage is around 87%, but that varies from as low as 70% in New Hampshire to as high as 93% in Florida and Mississippi. That brings it down to around 6.43 million without NV/NM/OR or 6.63 million with them included.

With all that done, here's the state-by-state breakdown of how many people I expect will be receiving federal tax credits for their ACA exchange-purchased healthcare policy as of July 1st, 2015:

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Two weeks ago I posted a diary about an attorney named Chad Boonswang who appeared to have pulled a pretty tacky ambulance-chasing stunt by sending tasteless notes to the families of the victims of the Amtrak crash in Philadelphia.

Boonswang claimed to be innocent, but a week went by without him providing any sort of explanation as to what might have happened.

So, a few days ago I posted a follow-up in which I explained why this incident had struck such a nerve with me personally, even though I have no connection to any of the victims or their families.

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Some Guy, early December:

In other words, every one of the following states--along with the other 2 dozen not already running their own exchanges--should be running, not walking towards at least getting their ducks in a row in case SCOTUS lowers the boom...and instead, every damned one of them appears to have decided to twiddle their thumbs for the next 6 months or so.
Some Guy, late January:
Anyway, let's suppose that #1 and #2 are squared away. Against all odds, the Republican governors and legislators of these states get their heads out of their asses and actually approve all of the above.

That leaves #3: Time. Even if everything was streamlined and fast-tracked (and lord knows that's unlikely), it would still take substantial amounts of time to do all of this.

According to consulting firm Leavitt Partners (via the Center for American Progress), it would take up to 18 months for a state to set up their own "full" exchange (website/platform et al). Using the "HC.gov piggyback" method which I'd imagine most states would go for (again, assuming it's allowed), it might take less time--perhaps 6 months or so from the point that such legislation is passed and signed.

And that's the problem. Again, as the CAP notes:

A ruling in June would be only months before open enrollment for 2016 begins in October, leaving little time for states to act.

Of the states that would lose tax credits, only eight have legislative sessions that extend beyond June. Because states need to have the legal authority to set up a marketplace—and because most governors do not have the statutory authority to act on their own—state legislatures would need to act.

In other words, even if the various state legislatures and/or Governors wanted to go ahead and slap something together, almost all of them would have to do so BEFORE the Supreme Court ruling.

That is, they'd have to start RIGHT NOW...and even then it would be awfully tough timing.

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Last week, I noted that the number of ACA exchange-based QHP selections has officially passed the 12 million mark nationally. I also mentioned that:

Of course, when you throw in the missing tax season SEP / off-season enrollments, the actual total should be closer to 12.4 million or higher, and should finally reach my personal Open Enrollment Period target of 12.5 million by the end of May.
Well, it's a week later, and I'm feeling confident enough (especially with the support of new data out of California) to state that the actual total number should indeed have passed the 12.5 million mark nationally sometime over Memorial Day weekend (or today at the latest, since most exchanges were closed for the holiday).

On the one hand, this is yet another milestone to celebrate, and holds special meaning for me personally, since 12.5 million was my official projection for the 2015 Open Enrollment Period last fall/winter. I can't feel too smug about this, of course, since it ended up taking 3 months longer to reach this number than I was expecting...

On the other hand, this likely doesn't really impact the number of effectuated enrollees, since most of the new additions are likely being cancelled out by an equal number of enrollees dropping their policies for similar reasons. The actual number of people enrolled via ACA exchange-purchased policies at any given moment is likely to be holding steady at around 10.1 million or so for most of the summer and fall at this point, although it might be up to half a million or so higher if I was interpreting the payment rate for Covered California properly last week (and if that CA data is representative of most other states as well).

I should also note that assuming at least an 88% payment rate (similar to last year), this means that another milestone should now be achieved: At least 11 million paid QHP enrollments (including those currently effectuated as well as those who paid have already dropped coverage since February).

In any event, here's what The Graph looks like today...and I've added a special shaded area for the 2nd half of the year to reflect the uncertainty regarding the impending King v. Burwell Supreme Court decision.

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IMPORTANT: SEE UPDATE ON THIS STORY FROM 5/27/15
About a week ago, I posted an off-topic entry called "Attorney Chad" is about to have a really bad weekend.

It appears that after the tragic Amtrak derailment a couple of weeks ago, a Philadelphia-based personal injury attorney named Chad Boonswang (allegedly) decided to send out hand-written "sympathy cards" to the families of not just one, but at least two different victims. The "sympathy cards" actually contain no words of sympathy, but instead are crass ads pushing his litigation services at a discounted rate. What a bargain!!

Adding insult to injury, at least one of the victims and their families happen to be Jewish, making the embossed cross on the outside of the card doubly tacky.

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Fri May 22, 2015 at 06:06 PM PDT

A Week in the Life of ACA Signups

by Brainwrap

I've been sending out these weekly digests to my mailing list for months now, but figured some here might be interested in it as well (and most of the compilation work is already done so what the heck!)

It there seems to be enough interest I'll keep posting the weekly digests here at dKos as well; let me know!

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Cross-posted at ACASignups.net
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Wow. All I can say is...good for him, seriously:

Lifelong Republican Turns On His Party, Embraces Obamacare

Luis Lang, who is currently crowdfunding for medical expenses that he can’t afford because he didn’t sign up for insurance under Obamacare, has become a viral sensation. However, the 49-year-old South Carolina resident says he doesn’t want to be the poster child for the Republican Party’s opposition to health care reform anymore.

Many people both here and over at ACASignups.net have criticized me, either for donating a few bucks ot Mr. Lang in the first place or alternately, for coming down so hard on the guy in my blog posts. Some thought it was a waste of time (and money) to help the guy out, while others thought it was an equal waste of time/breath to chastize him, figuring that it'd fall on deaf ears. Still others thought that it's inappropriate to donate money with one hand while berating him with the other. Well, guess what?
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This Just In...

After all the fuss and bother made over the #ACATaxTime Special Enrollment Period by myself and others, the final number of QHP selections was announced in the most understated way possible:

From March 15 to April 30, 147,000 consumers signed up for coverage through http://t.co/... using the tax special enrollment period.
— HealthCare.gov (@HealthCareGov) May 19, 2015
No splashy press release, charts or graphs; just a simple number. In the end, while it was still far lower than my original spitball take (600K+), it was also slightly higher than my revised estimate of 135K - 140K.

Unfortunately, there's still no state-by-state breakout. However, combined with the other off-season/tax SEP numbers reported from (most) of the state exchanges, this (including today's Minnesota update of 64K QHPs) does bring the grand total number of confirmed 2015 QHP selections up to exactly: 11,995,315.

Technically speaking, they're still about 5,000 QHPs shy of the 12 million mark, but give me a break; this number doesn't include normal Off-Season Enrollments (via life changes) in nearly every state since 2/22 or the tax season SEP enrollments from a half-dozen state-based exchanges.

Therefore, it's quite safe to call it:

2015 ACA Exchange-based QHP Selections have officially broken the 12.0 million mark, with over 9.0 million coming from HealthCare.Gov.finally reach my personal Open Enrollment Period target of 12.5 million by the end of May.

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