But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.
For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions.
Note: Yes, I'm aware that the upcoming MAGA trifecta will likely make much of this moot over the next couple of years, but that's kind of the point: To see where things stand as of this moment.
Seven years, two administrations, one federal insurrection and one global pandemic later, I figured it was time to finally update the breakout of what I've since decided to refer to as the Psychedelic Donut, and did just that in 2023.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
I watched the full 3 hours of the hearing and liveposted the entire thing on Bluesky. Needless to say, there are some typos and grammatical errors, and much of what I posted is paraphrasing, but it's as accurate as I could make it in the moment:
Here comes Round 2 of RFK Jr's confirmation hearings.
Sen. Bill Cassidy (R) is the chair. Sen. Bernie Sanders (I) is the ranking member.
Nomination of Robert F. Kennedy, Jr. to serve as Secretary of Health and Human Services | The U.S. Senate Committee on Health, Education, Labor & Pensions
The U.S. Senate Committee on Health, Education, Labor & Pensions
However, for no particular reason, I included the methodology for Medicaid & CHIP data in with the ACA enrollment post, since it ACA Expansion Medicaid overlaps with that.
Covered California Reaches Record-Breaking 1.9M Enrollees Before Open Enrollment’s Jan. 31 Deadline
SACRAMENTO, Calif. — Covered California has surpassed 1.9 million enrollees, bolstering its record-high enrollment before open enrollment’s Jan. 31 deadline for California’s remaining uninsured.
This open enrollment, 299,060 Californians have signed up for 2025 coverage as of Jan. 26, a 13 percent increase over the same period last year.
Another 1,638,954 Californians have renewed their health insurance plans, a 10 percent jump over the same date last year, with more than 100,000 total enrollees in 2025 as compared to the record enrollment in 2024.
Combined, that's 1,938,014 QHP selections thru 1/26, or 8.6% higher than last year's final OEP tally of 1,784,653 QHPs.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
The first official press release from the Centers for Medicare & Medicaid Services (CMS) under the Trump 2.0 Administration is out, and not only is it pretty innocuously worded...it's actually complimentary of the Inflation Reduction Act, which is noteworthy given that the IRA was passed & signed into law exclusively by Democrats & President Biden:
CMS Statement on Lowering the Cost of Prescription Drugs
Lowering the cost of prescription drugs for Americans is a top priority of President Trump and his Administration. In accordance with the statutory requirements of the Inflation Reduction Act, the Centers for Medicare and Medicaid Services (CMS) released the list of 15 drugs selected for the second cycle of the Medicare Drug Price Negotiation Program on January 17, 2025.
Early Monday evening I received a copy of a memo that will impact thousands of institutions supported by funding from the federal government.
A copy of the memo from the Office of Management and Budget (OMB) was provided to The Handbasket at approximately 5pm ET by a source whose anonymity is being protected for fear of professional retribution. The memo was sent to the heads of executive departments and agencies with the subject, “Temporary Pause of Agency Grant, Loan, and Other Financial Assistance Programs.” I shared the news on Bluesky at 6:04pm ET, and my reporting was confirmed by the Washington Post a few hours later.
It is a truly unhinged document that sounds like it was written by the world’s most petty 4Chan poster—but then again, that’s who’s currently running our federal government. Here’s the first paragraph to get a feel for it (emphasis mine):
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
Below I'm posting a similar breakout of total ACA Medicaid Expansion enrollment from January 2014 - June 2024, via the Centers for Medicare & Medicaid Services quarterly Medicaid Budget & Expenditure System reports (warning: That link could be broken or blank by the time you read this under the Trump Administration).
Unfortunately, the MBES reports currently only run through June of last year, so the last half of the year is missing.
No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the people represented here would have been utterly screwed from early 2020 - early 2023 without the Affordable Care Act being in place when the pandemic hit.
Click the image for a higher-resolution version. I'm not bothering to include the state labels since some would be too difficult to make out, but it starts with Alaska at the bottom and works its way up to West Virginia at the top (remember, neither Alabama nor Wisconsin or Wyoming have expanded Medicaid under the ACA). It also includes Guam, Puerto Rico and the U.S. Virgin Islands.
There's still likely up to perhaps ~30,000 or so Qualified Health Plan (QHP) enrollments to be added to the 2025 Open Enrollment Period (OEP) tally from the states which haven't reported their final, data (in fact, CA, DC, NJ, NY & RI haven't ended theirs yet), but I decided to throw this together today for the hell of it.
The table below charts the the first twelve years of ACA Open Enrollment Periods, broken out by state. I've also included Basic Health Plan (BHP) enrollment in Minnesota, New York and (new last summer) Oregon, the only states where BHP programs have been implemented to date.
No further analysis or comment here; I just think this is a pretty cool graphic which demonstrates visually how the ACA has grown over time to become firmly embedded into the U.S. healthcare landscape. Source: CMS Marketplace Open Enrollment Period Public Use Files for 2014 - 2024; Semi-final OEP Snapshot Report for 2025 (along with some nominal updates from a few of the state-based exchanges):
Connect for Health Colorado Sets a New Record: 282,483 People Enrolled in Health Insurance for Plan Year 2025
Denver, Colo. – Connect for Health Colorado, the state’s official health insurance marketplace, announced today a record 282,483 Coloradans have enrolled in health insurance for plan year 2025, with 80% receiving financial assistance to reduce the cost of their premiums.
The total number of people who enrolled in health insurance plans for 2025 is 19% higher than the number who enrolled in 2024.
Over 110,000 Nevadans got enrolled, marking the largest enrollment in the history of Nevada’s marketplace
CARSON CITY, Nev. – Nevada Health Link has achieved a historic milestone this year with its record-setting Open Enrollment Period for Plan Year 2025. With over 110,000 Nevadans enrolling in affordable and comprehensive health and dental coverage through the state-based marketplace, this achievement underscores the critical importance of providing accessible and affordable health insurance options to Nevadans across the state.
“Reaching the highest enrollment numbers in Nevada Health Link’s history is a milestone we’re incredibly proud of,” said Russell Cook, Executive Director of Nevada Health Link. “Health insurance is more than just a safety net in case of a medical emergency – it's peace of mind, financial security, and, ultimately, a pathway to better health outcomes for individuals and families across our state. This record-setting enrollment underscores the importance of our mission to prioritize the well-being of Nevada’s communities.”
Vulnerable House Republicans warn leaders against cutting Obamacare
The group of centrists also said the party needed to be careful about deep cuts to social safety net programs.
House Republicans in competitive districts warned GOP leaders Thursday: We could lose our seats if you gut Obamacare to pay for a massive border, energy and tax bill.
A group of about a dozen centrist Republicans...worry GOP efforts to pare back the Affordable Care Act could pour fuel on the fire.
...Instead, they argued, Republicans needed to embrace the GOP’s role as the working class party. Leaders would counter that message by slashing programs working Americans rely on, they said. GOP lawmakers in the room included Rep. Brian Fitzpatrick (Pa.), Young Kim (Calif.), David Valadao (Calif.), Andrew Garbarino (N.Y.), Tom Barrett (Mich.) and Don Bacon (Neb.).
Health care spending in the US reached $4.9 trillion and increased 7.5 percent in 2023, growing from a rate of 4.6 percent in 2022. In 2023, private health insurance and Medicare spending grew faster than in 2022, while Medicaid spending and enrollment growth slowed as the COVID-19 public health emergency ended. The health sector’s share of the economy in 2023 was 17.6 percent, which was similar to its share of 17.4 percent in 2022 but lower than in 2020 and 2021 during the height of the COVID-19 pandemic.
A flurry of scientific gatherings and panels across federal science agencies were canceled on Wednesday, at a time of heightened sensitivity about how the Trump administration will shift the agencies’ policies and day-to-day affairs.
Several meetings of National Institutes of Health study sections, which review applications for fellowships and grants, were canceled without being rescheduled, according to agency notices reviewed by STAT. A Feb. 20-21 meeting of the National Vaccine Advisory Committee, a panel that advises the leadership of the Department of Health and Human Services on vaccine policy, was also canceled. So was a meeting of the Presidential Advisory Council for Combating Antibiotic-Resistant Bacteria that was scheduled for Jan. 28 and 29.
The scope of the cancellations was unclear. It was also unclear whether they were related to the Trump administration’s freeze on external communications until Feb. 1.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
On his first day in office, Donald Trump issued dozens of Executive Orders. Some of these are mostly symbolic; some won't have any effect without legislative action; some are blatantly unconstitutional & are already being challenged in court. Many, however, are terrifying and will have horrific consequences for thousands or potentially millions of Americans and non-Americans alike.
Along with issuing his own new ones, Trump has also already rescinded over 60 XOs issued by President Biden. In this post I'm going to focus on three of them which pertain specifically to healthcare policy.
Again, all three of the following have now been RESCINDED BY DONALD TRUMP:
US exit from WHO could see fifth of budget disappear
US President Donald Trump has signed an executive order to begin the process of withdrawing the US from the World Health Organization (WHO).
"Oooh, that's a big one," the newly inaugurated US president said as he approved the document after arriving back at the White House. It was one of dozens of executive actions he put his signature to on day one in office.
...Under the Biden administration the US continued to be the largest funder of the WHO and in 2023 it contributed almost one-fifth of the agency's budget.
The organisation's annual budget is $6.8bn (£5.5bn).
It is possible that funding could disappear almost immediately, and it is not clear that other nations will step up to fill the gap.
A US withdrawal could have an impact on WHO's ability to respond to emergencies such as an Ebola outbreak, or MPOX – let alone another Covid-19-style pandemic.
But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.
For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions.
Pennie Sees Record-Breaking 2025 Enrollments at Nearly Half a Million; But Without Federal Action, Some Enrollees Will Face Higher Costs Next Year
More people than ever enrolled in health coverage through Pennie, however if critical affordability policies are not extended, premiums will sharply increase for many Pennie enrollees in 2026.
Harrisburg, PA – Pennie, PA’s official health insurance marketplace, concluded its 2025 Open Enrollment Period with a record-breaking enrollment of 496,661. This marks the largest marketplace enrollment ever in Pennsylvania and reflects Pennie’s ongoing success in helping Pennsylvanians access affordable, high-quality health coverage. This means more Pennsylvanians can see their doctor, fill their prescriptions, and be protected against the extraordinary costs of a medical emergency.
Record-setting 167,163 Minnesotans Used MNsure to Sign Up for 2025 Health Plans
ST. PAUL, Minn. — MNsure Chief Executive Officer Libby Caulum today announced that over 167,000 Minnesotans signed up for 2025 health plans using Minnesota’s official health insurance marketplace.
At the close of MNsure’s annual open enrollment period just before midnight on January 15, 167,163 residents had successfully signed up for private health insurance plans – a 14 percent increase over last year, which was also a record-setting open enrollment period. Sign-ups include consumers who are new to MNsure as well as current enrollees who selected a plan for 2025.
Enrollment increased by 16% over last year – seventh annual increase in a row.
BALTIMORE (Jan. 17, 2025) – Nearly a quarter-million Marylanders enrolled for 2025 through Maryland Health Connection – a new record for the state-based health insurance marketplace.
A total of 247,243 enrolled during the open enrollment period that began Nov. 1, 2024 and ended Wednesday. That was up 16% from 213,895 enrollments one year ago. An additional roughly 150 people who were in line with the Maryland Health Connection call center at midnight Wednesday may be in the process of completing their enrollments this week.
This marked the seventh consecutive year of enrollment increases in the health insurance marketplace that Maryland established in 2013 following the passage of the Affordable Care
Act. Total enrollment is up 56% since the pandemic.
The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) will release biweekly updates on plan selections through CoverME.gov, Maine’s Health Insurance Marketplace.
Plan selections provide a snapshot of activity by new and returning consumers who have selected a plan for 2025. “Plan selections” become “enrollments” once consumers have paid their first monthly premium to begin insurance. These numbers are subject to change as consumers may modify or cancel plans after their initial selection.
The deadline to select a plan for coverage beginning January 1, 2025 is December 15, 2024. Consumers who select a plan between December 16, 2024 and January 15, 2025 will have coverage beginning February 1, 2025.
Federal and state subsidies are driving record enrollment
OLYMPIA, Wash. – More Washingtonians than ever before have signed up for health and dental insurance for 2025 through Washington Healthplanfinder. Washington Health Benefit Exchange runs Washington Healthplanfinder, the state’s online marketplace for Affordable Care Act (ACA) coverage.
As of the close of open enrollment on Jan. 15, more than 308,000 Washingtonians had selected health and dental plans for 2025. This preliminary number includes people renewing their coverage and nearly 50,000 new customers.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
IMPORTANT: See caveats below regarding the impact of Medicaid Unwinding & other enrollment changes over time on these estimates.
12/12/24: Note: ACA Medicaid Expansion data has been updated by 3 months for most states, from March 2024 to June 2024.
With another GOP trifecta and Trump's Project 2025 promising draconian cuts to federal spending, there's a very good chance that the Affordable Care Act is, once again, on the chopping block.
I have no idea what's going to happen to either it, Medicaid, Medicare, the Children's Health Insurance Program (CHIP), the VA or the Indian Health Service, but whatever it is probably isn't gonna be pretty.
With that in mind, I figured it would be helpful to take stock of just how many Americans are actually receiving healthcare coverage through the ACA...and while I've crunched this number several times before, I'm taking it several steps further this time and breaking it out not only by state, but by Congressional District (CD).
But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.
For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions.
I recently published an ambitious spreadsheet which attempted to compile a comprehensive & up to date tally of total ACA healthcare coverage (including both exchange-based Qualified Health Plans (QHPs), Basic Health Plans (BHPs) and ACA Medicaid expansion enrollment), broken out by not just state but by Congressional District.
Doing this on a state-by-state level is easy. Doing so by Congressional District (CD) gets a lot trickier.
As I noted in my prior article, for state level ACA enrollment I'm using official data reports from the Centers for Medicare & Medicaid Services (CMS) for the "baseline" numbers, supplemented by more recent state-level data from some of the state-based ACA exchanges & state Health & Human Services departments.
There's only a single CD in Alaska, Delaware, Montana, North Dakota, South Dakota, Vermont and Wyoming, as well as one non-voting House member in the District of Columbia, so no further work is needed for those. For the other 43 states, however, breaking the enrollment data out by CD gets trickier.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
SACRAMENTO, Calif. — Covered California has announced a special-enrollment period for residents of Los Angeles and Ventura counties, where a state of emergency has been declared due to the Palisades and Eaton Fires that have destroyed over 12,000 homes and displaced hundreds of thousands of Californians.
“These fires have caused unprecedented destruction and have upended the lives of so many living in Southern California,” said Covered California Executive Director Jessica Altman. “Everyone who is uninsured and has been affected by these fires, directly or indirectly, will have an extended opportunity to obtain health insurance through Covered California or Medi-Cal over the next two months.”
Californians have 60 days from the date that the state of emergency was declared in their county to sign up for coverage, so this special-enrollment period will last until March 8.
Other resources made available to Californians affected by the fires can be found here:
A week or so ago the Centers for Medicare & Medicaid Services (CMS) issued a semi-final 2025 ACA Open Enrollment Period report, which noted that 23.6 million Americans had selected 2025 plan year coverage via the various ACA marketplaces since November 1st...as of either January 4th or December 28th, depending on the state.
Those thru dates are important, of course, because the 2025 OEP was still ongoing in every state except Idaho at the time...and in fact it's still going on in several of them, including CA, DC, MA, NJ, NY, RI & VA. In some of these states the final deadline is still up to 2 weeks away.
The biggest program on the hit list, however, is Medicaid, which would make up nearly half of the $5 TRILLION in budget cuts Republicans have in mind in order to pay for...massive tax cuts for corporations & the wealthy, of course.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
In October 2024, 79.3 million individuals were enrolled in Medicaid and CHIP.
72.1 million individuals were enrolled in Medicaid, and 7.2 million individuals were enrolled in CHIP.
41.7 million adults were enrolled in Medicaid, and there were 37.6 million Medicaid child and CHIP enrollees.
Medicaid and CHIP Applications Received
In October 2024, Medicaid, CHIP, Human Services agencies, and State-based Marketplaces received 2.6 million applications, or 2 percent more applications, as compared to September 2024.
The number of applications received has increased by 20 percent since October 2023 and increased by 66 percent since October 2022.
Total Medicaid/CHIP enrollment in October 2024 still dropped very slightly from September...by just 55,000 people.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
Number of People Who Have Ever Enrolled in ACA Marketplace Coverage, 2014-2024
The Affordable Care Act (ACA) created Health Insurance Marketplaces in all states starting in 2014. Eligible partcipants can purchase individual health insurance plans in the ACA Marketplaces, and qualifying individuals can receive Premium Tax Credits (PTC) to help offset the cost of coverage. The PTC was expanded in both generosity and eligibility startng with the American Rescue Plan Act in 2021, with these enhancements extended in the Inflaton Reducton Act in 2022. The ACA Marketplaces enable Americans to purchase comprehensive, affordable health insurance that they may not have access to through their employers or through programs such as Medicare or Medicaid, including when they experience brief or longer-term gaps in the availability of other coverage.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year.
Massachusetts residents have [9] days of Open Enrollment remaining, with the window for enrolling in health insurance through the Health Connector closing on Jan. 23.
Open Enrollment started Nov. 1 and is when anyone who needs health insurance can get covered through the Health Connector. The Jan. 23 state deadline is later than the federal government’s Jan. 15 deadline.
“Massachusetts requires everyone to have health insurance, so if you don’t have coverage, now is the time to enroll,” said Audrey Morse Gasteier, the Executive Director of the Massachusetts Health Connector. “The Health Connector provides help paying for coverage for many people, which means residents can get a plan that gives them access to the care and services they need. We are here to help enroll anyone without health insurance so they can kick off the new year with the peace of mind that comes with affordable, high-quality health coverage.”
Not only is New Mexico's exchange enrollment up a whopping 28% vs. the same point last year, it's 20% higher than the 2024 OEP's final total of 56,472.
The Centers for Medicare & Medicaid Services (CMS) announced today [January 10th] that additional resources and flexibilities are available in response to the 2025 Southern California Wildfires. CMS is working closely with the State of California and federal partners to put these flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most.
On Jan. 8, 2025, President Biden determined that an emergency exists in California due to the emergency conditions resulting from the 2025 Southern California Wildfires beginning Jan. 7, 2025, and continuing. Additionally, on Jan. 10, 2025, Department of Health and Human Services (HHS) Secretary Xavier Becerra determined that a Public Health Emergency (PHE) exists in California and has existed since Jan. 7, 2025.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
via the NJ Dept. of Banking & Insurance (via email; no link yet):
Residents Urged to Sign up for Health Coverage before Open Enrollment Deadline on January 31
TRENTON — Get Covered New Jersey, the state’s Official Health Insurance Marketplace, continues to draw record sign ups for 2025 coverage, topping 481,000 in the first nine weeks of the Open Enrollment Period that started on November 1, 2024, New Jersey Department of Banking and Insurance Commissioner Justin Zimmerman announced today.
The Department also continues to hold pop-up enrollment and assistance events at several New Jersey shopping malls throughout the state in January to boost awareness, provide resources and encourage residents to enroll in 2025 health coverage before the end of Open Enrollment on January 31.
The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) will release biweekly updates on plan selections through CoverME.gov, Maine’s Health Insurance Marketplace.
Plan selections provide a snapshot of activity by new and returning consumers who have selected a plan for 2025. “Plan selections” become “enrollments” once consumers have paid their first monthly premium to begin insurance. These numbers are subject to change as consumers may modify or cancel plans after their initial selection.
The deadline to select a plan for coverage beginning January 1, 2025 is December 15, 2024. Consumers who select a plan between December 16, 2024 and January 15, 2025 will have coverage beginning February 1, 2025.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
A record 450,000+ Pennsylvanians have signed up for affordable, high-quality healthcare coverage through Pennie, the Commonwealth’s low-cost health insurance marketplace.
Philadelphia, PA – The Pennsylvania Insurance Department (PID) and Pennie, Pennsylvania’s official health insurance marketplace, today jointly remind Pennsylvanians – especially those who do not have health coverage – to explore their options and enroll through Pennie before the January 15 Open Enrollment deadline. The Open Enrollment Period is the only time of year when Pennsylvanians can enroll in affordable, high-quality health plans for coverage in 2025.
Apply and select a health and/or dental plan by Jan. 15 for coverage beginning Feb. 1
Just one week left to secure individual health and dental insurance beginning Feb. 1. Customers who visit Washington Healthplanfinder by Jan. 15 can shop, compare and find more affordable coverage for 2025.
“Federal enhanced premium tax credits are still available to help reduce monthly costs through 2025 for many Washingtonians,” Washington Health Benefit Exchange CEO Ingrid Ulrey said. The Exchange runs Washington Healthplanfinder, the state’s online marketplace for Affordable Care Act coverage.
“Premium tax credits have been instrumental in helping a record number of Washingtonians sign up for insurance through Washington Healthplanfinder. Your health is our priority, and we don’t want you to miss out on the opportunity to access tax credits that help you save on your monthly premiums”
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
The graph purported to break out "Obamacare applications by state for 2025" by states which voted for Donald Trump vs. those which voted for Kamala Harris in November 2024. Here's what it looked like:
As I noted at the time, this graph was technically accurate...while simultaneously being jaw-droppingly misleading, for several reasons, including:
Across 38 states, a total of around 19.5 million people have selected Qualified Health Plans (QHPs) via either the federal or state-based exchanges as of anywhere from 12/05 - 12/18. Collectively, this is roughly 16.6% higher than the same/nearly the same dates a year ago.
It's important to remember that Georgia moved from the federal exchange to its own state-based marketplace this year, which is why ~1.2 million enrollees have been subtracted from the 2024 HC.gov total. Note that the HC.gov numbers are rounded off to the nearest 100K, per CMS's press releases both years.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
Customers who enroll on or before Jan. 15, 2025 will have coverage beginning Feb. 1, 2025
HARTFORD, Conn. (Jan. 6, 2025) — Access Health CT (AHCT) today announced the deadline to enroll in health and dental coverage starting Feb. 1, 2025 is Jan. 15, 2025. This is the final deadline for the 2025 Open Enrollment Period.
The Open Enrollment Period for Connecticut residents to shop, compare and enroll in health insurance or renew their coverage began Nov. 1, 2024. Customers may enroll in either health or dental coverage, or both.
AHCT is the only place state residents can get financial help to pay for their health insurance. Nearly 90% of customers received financial assistance last year. Some customers might qualify for the Covered CT Program. This program provides no-cost coverage for eligible residents.
Not only is New Mexico's exchange enrollment up a whopping 28% vs. the same point last year, it's actually already 16.6% higher than the 2024 OEP's final total of 56,472!
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
I don't want to get out over my skis here; a single Senator saying that she supports something in an interview is a far cry from them actually voting to do so, especially when you'd need several more members of both the House and Senate (including the leadership of both chambers) to even hold that vote.
Even so, this is still a pretty significant development, given how thin the odds are of the improved subsidies included by the IRA getting extended are at the moment.
Nathaniel Herz: On the specific issue of the enhanced tax credits for the premiums for the individual marketplace health insurance plans — it seems like there is a real question about whether those continue...
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
In August 2022, President Biden signed the Inflation Reduction Act (passed with into law with purely Democratic votes).
While the IRA included a long list of landmark provisions, in addition to the critical upgraded ACA premium subsidieswhich are unfortunately set to expire at the end of 2025, other healthcare-related ones include:
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
