CMS released their current count of new enrollees due to the Special Enrollment Period that opened up in February for the ACA Exchanges:
Over 2 million people have signed up for ACA coverage since President Biden reopened enrollment.
Medicaid and CHIP enrollment is up by over 10 million during the pandemic.
It's hard to even imagine what could have happened to health coverage in the absence of this safety net.
— Larry Levitt (@larry_levitt) July 14, 2021
Honestly, I did not think that the ACA SEP would have done this much. I think I was wrong because I had not internalized the importance of the combination of navigators, outreach, advertising and elite political support. My entire research career has been in a low outreach, low advertising universe with elite indifference or intense opposition to the law.
The public health finance programs have absorbed a lot of shocks. There are significant differences in the ability to absorb employment and attention shocks between states, most notably between states that have expanded Medicaid and not expanded Medicaid. Expansion states have less ACA enrollment than non-Expansion states likely because a lot of people who earn under 138% FPL are moved directly into Medicaid instead of $0 premium silver plans on the exchange. More importantly, a lot of folks who earn under 100% FPL have a guaranteed safety net in expansion states while the safety net in non-Expansion states looks like a large drift net that is dolphin safe.
The Special Enrollment Period for the ACA ends in August. After that, typical life changing event SEPs (moving, divorce, marriage etc) will still be available. Open Enrollment for 2022 will start in November. I would think that there will be some attrition as many people who lost insurance this year and used the Exchanges will have new jobs in December but intertia will keep a lot of people enrolled who were not covered because they were not paying attention despite being eligible for decent size subsidies that lead to low premiums.
boatboy_srq
It’s actually very easy to imagine the alternative. Look at Missouri, and Texas, and at Brazil, and combine the worst elements of all three experiences.
rikyrah
@boatboy_srq:
So true.
justaguy02
CMS outreach and advertising is welcome, but don’t discount the work done by finance departments at hospitals and group practices that understand the options and direct people who aren’t insured to available programs every day. A trip to the ER or convenience care can focus attention on getting insured.
rikyrah
Will you do an analysis of the bill from the Senators from Georgia, who want to find a way to get healthcare to those in states that refuse to expand Medicaid?
David Anderson
@rikyrah: The TLDR read of the Warnock/Ossoff bill is:
“We’re ready to drown you in money to do the right thing… and if not, we’ll do it for you….”
I think the Feds will end up doing it for most of the hold-out states.
krackenJack
While elite support is great, how much of it is due to conservative media shaping public opinion? If Faux News was still flogging ACA like Critical Race Theory would enrollment be lower?
There might be a natural experiment with the begrudging states vs the new converts, but that would depend on whether the advertising, etc. was national.
David Anderson
@krackenJack: Good question.
I think that elite support matters on both operational questions as well as verbal messaging. Paul Shafer and I found a 24% to 30% drop in expected enrollment in the last two weeks of the 2016-2017 OEP that ended 1/31/17 compared to OBAMA only trend from 11/1/16 to 1/15/17 and the entire 2015-2016 OEP. The big shock is the switch in administration with attendant operational and elite messaging changes.
read.dukeupress.edu/jhppl/article-abstract/44/5/715/139047/The-Trump-Effect-Postinauguration-Changes…
I agree that your research design idea is quite plausible and would love to think about actually executing that in 2022 when I have head space — want to co-author?