Come for the politics, stay for the snark.

It’s a doggy dog world.

Conservatism: there are people the law protects but does not bind and others who the law binds but does not protect.

Fear or fury? The choice is ours.

An unpunished coup is a training exercise.

Not so fun when the rabbit gets the gun, is it?

“I never thought they’d lock HIM up,” sobbed a distraught member of the Lock Her Up Party.

Pessimism assures that nothing of any importance will change.

The choice is between normal and crazy.

It looks like winning debates is a black job!

When do we start airlifting the women and children out of Texas?

We’ll be taking my thoughts and prayers to the ballot box.

If senate republicans had any shame, they’d die of it.

The real work of an opposition party is to oppose.

So it was an October Surprise A Day, like an Advent calendar but for crime.

This blog will pay for itself.

Wow, I can’t imagine what it was like to comment in morse code.

At some point, the ability to learn is a factor of character, not IQ.

Trump makes a mockery of the legal system and cowardly judges just sit back and let him.

A lot of Dems talk about what the media tells them to talk about. Not helpful.

He wakes up lying, and he lies all day.

Republicans: slavery is when you own me. freedom is when I own you.

Marge, god is saying you’re stupid.

Damn right I heard that as a threat.

I also would like a pony to improve my balloon juice experience.

You are here: Home / Anderson On Health Insurance / Partisanship and enrollment changes on Healthcare.gov

Partisanship and enrollment changes on Healthcare.gov

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Charles Gaba outlines what happened on Healthcare.gov for final enrollment. The numbers came in lighter than expected.

Then, Donald Trump actually took office…and in a one-two punch, not only signed an executive order which specifically instructed the HHS Dept. to do everything in their power to sabotage the implementation of the ACA, but also attempted to pull the plug on the critical last-minute advertising blitz which is so vital to reminding procrastinators (particularly young ones…you know, the ones who help the risk pool?) to get off their duffs and actually sign up.

The CMS numbers:

On January 31, 2017, Open Enrollment for 2017 coverage ended with more than 9.2 million plan selections in states that use the HealthCare.gov eligibility and enrollment platform.

I was curious about something over the weekend but I was with my kids. I had to chase them and learn about rocket ships.

At the state level, does partisanship have a relationship to enrollment levels. Would states with a higher Trump vote percentage have greater declines in enrollment?

My data is here for any and all to view:

https://drive.google.com/open?id=0B0shrhgU2x-pZ0VXRE9YczZKd1E

I excluded Kentucky from the analysis as they transitioned from Kynect to Healthcare.gov.  I also suppressed Louisiana as they had a mid-year Medicaid expansion so we should expect a massive drop in Louisiana enrollment no matter what (and that is what happened).

UPDATE 1: Removing Hawaii as an outlier transforms the relationship from statistically significant to not significant

The short answer is yes, and significantly so.It is not a perfect relationship as South Dakota and Utah each saw significant gains.  But each point of Trump voters led to 4.5 basis points less enrollment.  A state that perfectly mirrored Trump’s actual popular vote total would have had effectively not lost enrollment.  A 50/50 state would have lost 2.5% of the QHP’s.

What is the mechanism?  I don’t know.  I would bet that elite cuing and partisan information channels would be a major part of this explanation.  Trusted sources in red states were telling people that the markets were blowing up and outreach efforts were either hobbled or sidelined so the marginal people who were making the last buy/no buy decisions were making incremental no buy decisions.  I think if we see an older than expected risk pool, that will be a chunk of evidence in support of that idea.

Reader Interactions

13Comments

  1. 1.

    ArchTeryx

    This article sort of buries the lede: That in a lot of red states, partisanship is so strong it literally trumps people’s desire for health coverage. I’m sure most of them don’t think in these terms, but these people are literally offering themselves up as cannon fodder for their ideology. When some sizable fraction of them gets cancer, heart disease, diabetes or some other lethal, chronic condition, will they go to their early graves blaming Obama and the Democrats?

    Talk about a self-culling herd!

    Not for the first time do I wish chronic illness was far more prevalent. It all comes down to not enough people *know* someone suffering from chronic illness, or are suffering themselves. We’re a marginalized minority like any other, to the point that people aren’t afraid enough to get health insurance if it clashes with their ideology.

    And it’s powerful. Here’s my little bit of anecdata.

    I had to threaten to terminate the relationship of my now-fiancee before she’d get on Expanded Medicaid. She has no thyroid. Not having health care would be *lethal* for her, same as me, and yet she’d been raised in the right-wing tradition of never, ever accepting government handouts, and she was willing to take that to her grave.

    I told her that I wasn’t willing to watch her kill herself for sake of a bankrupt ideology. That was enough of a wake-up for her to get on Expanded Medicaid, and it kept her alive until she found a job.

    How many of these deluded souls won’t be so lucky?

  2. 2.

    greennotGreen

    Correlation doesn’t equal causation, of course. Perhaps there’s one other factor that explains both the drop in enrollment and the conservative-controlled state governments: the citizens of those states are sack-of-hammers-dumb.

    – a Tennessean, so I know whereof I speak.

  3. 3.

    ArchTeryx

    @greennotGreen: In this case, causation is almost irrelevant. These are people who are basically partisanshipping themeselves into an early grave, maybe a VERY early one. They’re voluntary martyrs for their own cause. That may be because they’re dumber then my ginger cat and can’t see cause and effect if it hits them in the face like a thrown rock. But the end will be the same.

  4. 4.

    David Anderson

    @greennotGreen: But the sack of dumb-shittedness should be fairly invariant within a state year over year. It shifts but it is a slow shifter not a fast shifter.

    Holding dumb-shittedness constant some number of people signed up in 2016 and some people signed up in 2017. There is variance. Why?

  5. 5.

    Nunca El Jefe

    I don’t have access to work with your data right now, so I will just ask, what happens to your fit and model if you exclude that point from Hawaii?

  7. 7.

    BBA

    It’s also possible that people figured with Trump taking office Obamacare would be shut down immediately and there’d be no point in buying insurance that would instantly go away at noon on January 20th.

    Now you and I know that it doesn’t work that way. But your average person on the street doesn’t know that.

  11. 11.

    Mnemosyne

    I know that California continued their advertising blitz for Covered CA (our state exchanges), so I’m guessing that may be part of the calculus. If states that have their own exchanges continued advertising, then they would have better enrollment than states that rely solely on Healthcare.gov to get the word out.

  12. 12.

    sunny raines

    just more early deaths and degraded lives on republican hands (small as they are, they are enormous when it comes to facilitating innocent deaths.)

  13. 13.

    Clem

    You are looking at 39 states and missing the states with their own exchanges. Wonder how the 11 states compare to the 39 states and what would all 50 states look like?

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