The major development regarding the Affordable Care Act occurred within the Senate and passage of their tax reconciliation legislation. The legislation does away with the individual mandate. Based on an analysis by the CBO and the Joint Committee on Taxation, that action will increase the number of uninsured and will increase premiums. The decreased coverage happens in two ways: some healthier individuals will simply stop buying insurance and that in turn will make the insurance pool a higher risk and drive up costs for people who do need it. That increase in premiums will drive additional people off because they will be the individuals who can’t qualify for federal tax credits.

Because of that impact Senator Susan Collins (R-ME) sought assurances that the Congress would enact the Alexander-Murray bill which had been drafted earlier this fall to guarantee payment of the insurance subsidies (Cost Sharing Reductions). The President has cut off those subsidies. Collins was also seeking assurances that another bill by her and Senator Bill Nelson (D-FL) to provide some backup catastrophic insurance would also be passed. Even with that action—if it happens—was reviewed by CBO that not much would change in the impact of repealing the individual mandate that,

…4 million in 2019 and 13 million in 2027 [would lose coverage]. In addition, the agencies estimated that average premiums in the nongroup market would increase by about 10 percent in most years of the decade…”

There is also no guarantee that the House of Representatives will go along with the Senate leadership’s commitment to Senator Collins.
In other developments, just over 500,000 individuals enrolled in coverage during Thanksgiving week, or about 72,000 per day, a significant slowdown from previous weeks. Roughly 110,000 individuals per day have signed up for coverage in the 39 states that rely on for enrollments since the sign-up period started on Nov. 1. That’s a pace that would result in 4.7 million enrollments by the time it concludes on Dec. 15, although there’s expected to be a surge in the final days.

Florida has seen the most enrollments by far, with more than 600,000 residents signing up for coverage. Texas had the next largest pool, with roughly 330,000 enrollments.

…On November 21, the state of California took issue with some of the information that HHS is putting out regarding the ACA. Covered California, the ACA exchange in that state, flagged recent data and reports by the Office of Assistant Secretary for Planning and Evaluation (ASPE), that the letter said was, not accurate and that could mislead.

“ASPE and HHS are responsible for ensuring the effective implementation of the Patient Protection and Affordable Care Act in all 50 states. And, the extent to which state-based efforts to implement the Affordable Care Act are more or less effective is a vital piece of information that should inform the Secretary and policy makers at the national and state levels.”

Peter Lee, Executive Director detailed his frustrations over two recent ASPE reports: “Individual Market Premium Changes: 2013-2017″ and “Health Plan Choice and Premiums in the 2018 Federal Health Insurance Exchange.”

Overall signups have surged through without problems.