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The Trump administration announced in April that it would cut the Affordable Care Act's open enrollment period in half.
Typically, the government has given health law enrollees 90 days to sign up for coverage in the fall. This year, they will have just 45 days to enroll in marketplace plans, from November 1 through December 15.
States that like Obamacare are starting to push back on this change. Louise Norris at HealthInsurance.org (are you following her on Twitter? You should!) reports that six states have extended their open enrollment periods to look a lot like the pre-Trump era. This includes:
- Colorado (open enrollment extended until January 12)
- Minnesota (open enrollment extended until January 14)
- Rhode Island (open enrollment extended until January 1)
- Washington (open enrollment extended until January 15)
- California (open enrollment extended until January 31)
- District of Columbia (open enrollment extended until January 31)
These are six states that run their own health insurance marketplaces, meaning they have the flexibility to change the rules — for example, run a longer open enrollment period than what the federal government has proposed.
Twelve states and the District of Columbia run their own insurance marketplaces. The rest are run either completely by or in partnership with the federal government, and rely on the Healthcare.gov platform. These states have significantly less ability to change the rules around their marketplaces.
Over the past few years, we saw a handful of states switch from running their own marketplaces to handing that work over to the federal government. Building insurance marketplaces turned out to be remarkably hard work (Exhibit A: Healthcare.gov) and there didn't seem to be much advantage to doing that work if the federal government was offering to step in and take over.
States could offload a responsibility to the government and, in 2014 and 2015, a handful did. Once Healthcare.gov seemed stable, states like Oregon and Hawaii — both supportive of the health care law — switched over to the federal platform.
At the time, the decision seemed to make sense. I often wondered why other states didn't follow in their footsteps. Why replicate the work that the federal government was willing to do for free? During the Obama administration, there didn't seem to be a huge difference between running one's own marketplace or leaving the task to the feds. Both administrators wanted to build a marketplace that worked, which was what seemed to matter the most.
But the states that held onto their state-based marketplaces are now seeing the advantages of this decision. This flexibility matters to states attempting to Trump-proof their insurance marketplaces.
California, one of the states that extended its open enrollment period, is one of the best examples of this right now. Along with the longer sign-up period, it is spending an additional $5 million on marketing to counter the current uncertainty over the law's future that might have some enrollees thinking their coverage no longer exists.
For the past few years, the marketplaces that states run and the marketplaces the federal government runs have looked relatively similar. But this year could well be the start of a divergence, where state-run marketplaces act differently than Healthcare.gov. They do things to encourage robust enrollment when the White House does not.
And if this is indeed the case, it will be the state that supported Trump that will get hurt the most. These are places like Kentucky, which used to have a state-run marketplace but defaulted to Healthcare.gov in 2016 under the leadership of Republican Gov. Matt Bevin. They will have shorter enrollment periods and less outreach, which near certainly will lead to fewer sign-ups. The places that have held onto control of the health care law seem to have a much better shot at success.
Chart of the Day
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Most Americans want Trump to continue ACA outreach — including Republicans. While you see a partisan split in who wants to continue enforcing the individual mandate, there is clear support on both sides of the aisle for the Trump administration continuing health law outreach in the latest Kaiser Family Foundation poll. Read the full results here.
Kliff’s Notes
With research help from Caitlin Davis
Today's top news
- “Dems ask Trump officials for briefing on ObamaCare”: “Top Democrats on committees overseeing healthcare are requesting a briefing on the administration’s plans for ObamaCare’s open enrollment season, which begins Nov. 1, amid uncertainty over how President Trump will administer the law.” —Rachel Roubein, the Hill
- “Bernie Sanders’ first draft of “Medicare for All””: “There's been a lot written lately about how Democrats are going to have to start working out details about single payer if they're serious about running on it. Now, we're getting a better idea of how Bernie Sanders will address some of them — though not all of them — in the "Medicare for all" bill he hopes to introduce next month.” —David Nather, Axios
- “Mylan, Department of Justice finalize $465 million settlement over EpiPen, Medicaid drug rebates”: “Mylan and Mylan Specialty will pay $465 million to settle allegations they knowingly misclassified renowned epinephrine auto-injector drug EpiPen as a generic drug to avoid paying Medicaid rebates in violation of the False Claims Act, the Department of Justice announced Thursday.” —Beth Jones Sanborn, Healthcare Finance
Analysis and longer reads
- “Time Crunch Among Hurdles for Bipartisan Senate Push to Bolster ACA”: “The leaders of a key Senate committee say they are cautiously optimistic about reaching a deal to shore up the Affordable Care Act’s individual marketplaces, but even with a bipartisan effort, it is far from certain whether they can hash out an agreement in time.” —Jon Reid, Morning Consult
- “Most hospices fare well in first public release of Medicare quality scores”: “In a press briefing Wednesday, Kate Goodrich of the Centers for Medicare & Medicaid Services said the effort will provide a “snapshot on the quality of care delivered by each provider” that will “help consumers make informed decisions.” Scores for the vast majority of hospices were near the top end of the quality range — so good, in fact, that some observers questioned whether consumers will find the data useful for comparison shopping.” —Cheryl Clark, STAT
- “Managed Care Companies Should Publish Lessons Learned From Studying Their Own Big Data”: “Managed care companies have an imperative to participate in quality improvement initiatives, conduct rigorous, transparent research with our data, and widely share and disseminate those findings so that others may learn from and build on our experiences.” —Stuart L. Lustig and Liana D. Castel, Health Affairs
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