CMS

For the past couple of weeks, I've been on a marathon session of analyzing and graphing out total enrollment in Medicaid in every state for each month from 2014 until now (using estimates based on the best available data for the first part of 2021).

Now that I've completed this for all 50 states +DC, I'm bringing it all together into a single national graph showing how enrollment has changed over time.

Aside from the initial ramping up of enrollment after ACA Medicaid expansion went into effect in most states starting in early 2014 (and an odd drop-off/jump in California in the third quarter of 2017), enrollment was pretty steady at the national level...until COVID struck in early 2020.

Since then, the combination of sudden, massive unemployment combined with the Families First & CARES COVID Relief acts (which boost federal funding of Medicaid programs while also prohibiting states from disenrolling current Medicaid enrollees during the public health crisis) have resulted in overall Medicaid enrollment rising dramatically over the past year and a half.

via the Centers for Medicare & Medicaid Services (CMS):

Today, Department of Health and Human Services (HHS) Secretary Xavier Becerra kicked off Asian Pacific Heritage Month by announcing that HHS will be partnering with select, national organizations the first week in May to support and enhance outreach and enrollment efforts for this population during the HealthCare.gov Special Enrollment Period (SEP). During the Asian American and Pacific Islander (AAPI) Week of Action, which runs May 3-7, 2021, HHS and partnering organizations will provide education and enrollment assistance to AAPI consumers and use social media to encourage them to enroll in affordable, quality health coverage available through HealthCare.gov. 

CMS is targeting specific populations more closely in order to reduce racial healthcare coverage inequality:

Department of Health and Human Services (HHS) Secretary Xavier Becerra announced commitments from national organizations to support Black American outreach and enrollment efforts during the Special Enrollment Period (SEP) made available on HealthCare.gov by President Biden due to the COVID-19 Public Health Emergency. Black Americans represent roughly 13% of the U.S. population but 16% of the uninsured.

As part of the Black American Week of Action, April 25 – May 1, HHS and its partnership organizations will combine social media efforts to inform Black American consumers and spur enrollment in affordable, quality health plans through HealthCare.gov. An estimated 66% of Black uninsured adults now may have access to a zero-premium plan and 76% may be able to find a low-premium plan as a result of expanded coverage.

This was actually announced last week, but I was mainly focused on the 2021 OEP enrollment report at the time:

Today, the U.S. Department of Health and Human Services (HHS) announced that to continue its efforts to increase access to enrollment assistance for consumers, the Centers for Medicare & Medicaid Services (CMS) will make $80 million available in grants to Navigators in Federal Marketplaces for the 2022 plan year. The funding, which will be used for outreach and education efforts, is the largest allocation CMS has made available for Navigator grants to date and represents an eight fold increase in funding from the previous year. CMS invested $10 million annually in the Navigator program beginning with funding awarded in 2018 for the 2019 plan year. CMS awarded $36.2 million in 2017 for the 2018 plan year, down from a high of $63 million awarded in 2016 for the 2017 plan year.

It's been nearly a month since I posted my final estimate of the official national and state-level tally for the 2021 Open Enrollment Period (OEP). At the time, I pegged the final total at just barely over 12.0 million QHP selections nationally...the first time an ACA OEP had hit that threshold since the end of the Obama Administration (this seems fitting for obvious reasons).

Earlier today, the Centers for Medicare & Medicaid (CMS) issued the official 2021 OEP report, as well as the accompanying Public Use Files (PUFs) which break the data out in all sorts of ways. Let's dig in!

First, the topline numbers: 

Here's the formal kick-off announcement from HHS Sec. Becerra:

• An average of three out of five eligible uninsured Americans can access $0 plans after advance payments of tax credits and an average of four out of five current HealthCare.gov consumers will be able to find a plan for $10 or less per month after advance payments of tax credits

• Department also announces $50 Million Boost to Special Enrollment Period Outreach Campaign

Today, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced that additional savings and lower health care costs are available for consumers on HealthCare.gov. The American Rescue Plan (ARP) has increased tax credits available to consumers, helping to reduce premiums and giving consumers access to affordable health care coverage.

The Department also announced an additional $50 million in advertising to bolster the Special Enrollment Period outreach campaign. The campaign will run through August 15, 2021.

After the Trump Administration slashed the ACA's Navigator/Certified Application Counselor program budget by 90%, this is certainly welcome news! Via the Centers for Medicare & Medicaid Services (CMS):

CMS Announces Additional Navigator Funding to Support Marketplace Special Enrollment Period

President Biden's nominee to run the Centers for Medicare & Medicaid Services (CMS) has been a hotly-debated topic among healthcare wonks for a couple of months now. He announced that he was picking California Attorney General Xavier Becerra as his HHS Secretary back in early December, but who would be running CMS (basically the 2nd most-powerful position within the HHS Dept.) has been a big unknown until a few days ago, when Dan Diamond and Amy Goldstein of the Washington Post scooped the story.

I admit to never having heard of her until her name was mentioned as a possible contender in a few articles last month, but if confirmed, I'll probably be mentioning her name fairly often over the next few years (likely even more frequently than Becerras), so I figured I should post a quick profile of her today.

Here's the official White House statement:

Normally I receive notices about these types of data reports directly from CMS via their mailing list, but this time around it wasn't emailed and in fact isn't even posted on the CMS newsroom archive  (at least not yet). Fortunately, my eagle-eyed colleague Andrew Sprung grabbed the link from a Health Affairs article and wrote up his own analysis of it.

via the Centers for Medicare & Medicaid:

Total national healthcare spending in 2019 grew 4.6%, which was similar to the 4.7% growth in 2018 and the average annual growth since 2016 of 4.5%, according to a study conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) and published today ahead of print by Health Affairs.

This report includes health expenditure data though 2019 and therefore does not include any of the effects of the coronavirus disease 2019 (COVID-19) pandemic on health care spending. Future reports for 2020 forward will measure health expenditures based on the latest available data and will reflect the impacts of the pandemic on total health care spending as well as on the distribution of spending among the services, payers, and sponsors of health care.