4.29% enrollment loss is the cost of Trump’s First Day EO

I’ve been playing a bit more with the 2016 and 2017 QHP data in an attempt to figure out the incremental cost of the Trump Executive order.  I think 4.25% is a good lower estimate.

My data is still here:

Data and Methods

I again excluded Kentucky and Louisiana.  Kentucky was switching from Kynect to Healthcare.gov while Louisiana had a mid-year Medicaid expansion.  I wanted to isolate the effect of the executive order from whatever the general trend in enrollment was.  I used the CMS enrollment snapshot for 2016 and 2017 that contained January 14th.  2016 was goes through January 16 while 2017 only goes through January 14th.  The 2016 report contains two extra days worth of data and more importantly, 2016 contains a deadline day as people who buy coverage by the 15th would see their policy start on February 1st.  We know deadlines spur enrollment.

CMS recognized this problem:

More than 8.8 million Americans were signed up for 2017 coverage through HealthCare.gov as of January 14, 2017. This compares to about 8.7 million sign-ups as of January 14 last year, as Americans continue to demonstrate strong demand for 2017 Marketplace coverage.

So on the 14th of each year, 2017 was running slightly ahead of 2016.  My data due to timing constraints will show 2016 running slightly ahead of 2017.   This is fine as the known flaw in the data favors the argument that the executive order had no impact.

So the question is what was the deviation from 1/15 to 1/31? If the Executive Order and the dropping of advertising and potentially elite knowledge networks disseminating anti-enrollment messaging or more likely fear, uncertainty and doubt about PPACA being a good play?

Analysis and Conclusion

2017 using my known flawed data was running .96% behind 2016 on the January 14th inclusive update.  2017 ended up running 5.25% behind 2016 on Healthcare.gov states.  The increment (using favorable to the null hypothesis data) slowdown in pace that can be attributed to Trump Administration actions is 5.25-.96 or 4.29% of enrollment was lost due to the executive order and other Trump administration actions such as shutting down some outreach and advertising in the last eleven days of enrollment.

4.29% is a minimal level of enrollment loss.  Using the January 14th pace, 2017 was running 1.1% ahead of 2016.  Charles Gaba is collecting data from the state based exchanges.  The state based exchanges ran their own marketing campaigns that did not get shut off on 1/20/17.  He is showing at least a 1.5% enrollment increase.  So more aggressive baselines can credibly argue that the Trump Administration actively discouraged 6% of the market from signing up.

Finally, here are some charts that I had fun creating as I worked through this problem.

34 replies
  1. 1
    Clem says:

    Check the gaba link

  2. 2
    DAVID ANDERSON says:

    @Clem: his site has been funky on links… I will revisit and relink after coffee

  3. 3
    Clem says:

    Odd the republicans want to sabatage the ACA so badly. They gain what? A veneer for their disaster claims? Got a letter from my rep. She hates the ACA enough to use some obnoxious boiler plate. But of course the new republican replacement will be bipartisan. The dems just need to agree to the republican plan. And of course the false claim that the republicans have no plan is a BIG LIE created by ACA supporters who refuse to accept that the ACA is a complete disaster.

  4. 4
    MomSense says:

    @Clem:

    They are stuck in this because they’ve been stringing their base along for so many years scaremongering about it and promising repeal. Now they have run out of excuses. It’s exactly the situation Obama warned them about when he spoke to their caucus in 2009.

  5. 5
  6. 6
    MomSense says:

    @albertZ:

    I think the job losses will be greater. The only reason I have made some home improvements, purchased a car, etc. is because I have had insurance. Without health insurance I have to cut back significantly just to cover prescriptions, the required school physicals, lab work, and so on. If something major happens well I’m totally screwed but I think people are forgetting just how economically dire it is without health insurance.

  7. 7
    rikyrah says:

    thanks for the news, Mayhew. even though it is not positive news, it’s the truth

  8. 8
    Ben Vernia says:

    And that 4.25% equals how many deaths on Trump’s hands?

  9. 9
    rikyrah says:

    @MomSense:
    it is all connected. when you don’t have insurance, it never leaves your mind

  10. 10
    rikyrah says:

    @Clem:
    They will own Trumpcare. lock, stock and barrel

  11. 11
    Clem says:

    The new management scrubbed ACA facts and figures pages from the Hhs.gov website. The new site gives no facts while the original pages had info useful to counter their ACA disasrer story. Oh well, out with the old, in with the new.

    https://webcache.googleusercontent.com/search?q=cache:FCTQkVpVaXAJ:https://www.hhs.gov/healthcare/facts-and-features/state-by-state/how-aca-is-working-for-washington/index.html+&cd=1&hl=en&ct=clnk&gl=us

  12. 12
    Shalimar says:

    @Clem: Republicans don’t gain anything by actually gutting the ACA. They get primaried out of office if they can’t at least convince their base they have gutted the ACA, whether they really do it or not.

  13. 13
    FlipYrWhig says:

    @Clem:

    Odd the republicans want to sabatage the ACA so badly. They gain what?

    They want their voters to think it’s welfare, and that they stopped black and brown people from getting a free ride at their expense. Because the only thing that keeps Republicans together is intense racial resentment.

  14. 14
    Brachiator says:

    Heard on the radio news this morning that Covered California enrollments were significantly up this year.

  15. 15
    waysel says:

    I’ve been with ACA coverage since the roll out. My year starts Jan.1st, so in Dec. 2016 I chose a new plan. I was anxious about re-enrolling because I have no idea, as they destroy this thing, if I will be left on the hook for the subsidy part of it. Perhaps even retroactively.I can’t afford full priced coverage, I would have to do without just as I did pre-ACA. I’m still concerned about that possibility. I suspect some folks didn’t enroll based on similar concerns.

  16. 16
    Clem says:

    Immigration is the top issue for republicans, more important than healthcare. Immigration= xenophobia. kaiser poll

  17. 17
    MomSense says:

    @rikyrah:

    I wonder what the health cost is for so many people experiencing daily stress from the uncertainty and worry that going uninsured creates. There are also a lot of people who have started businesses and made work decisions based on access to health insurance. What will all of those people do?

  18. 18
    Clem says:

    @waysel: republicans are really heated up over the cost of premiums. They want lower premiums even if it mean less Medicaid and Medicare. See the Kaiser poll.

  19. 19
    FlipYrWhig says:

    @Clem: “I want more and better stuff for less money. This sounds like something Donald Trump and Paul Ryan can accomplish!”

  20. 20
    Another Scott says:

    @Clem: The free Internet Archive (and their partnership site Archive-It) have many/most of the Obama administration’s web sites including Healthcare.gov. The information is out there, and will remain out there, even if Trump and his minions want to scrub it.

    It’s more persistent than Google’s cache, also too. :-)

    Cheers,
    Scott.

  21. 21
    Clem says:

    What would the legends be for the chart colors?

  22. 22
    waysel says:

    David Anderson, I have a question. My long time doctor, a solo private practice internist, bemoans ‘Obamacare’, claiming that her health insurance is $2-3 thousand a month and doesn’t cover anything. She claims previously she could purchase a catastrophic for cheap. Question is , are there REALLY some business owners or individuals that honestly got dinged hard by ACA, or is she bullshitting me? I didn’t press her for details, she has a husband and 2 kids, I think.

  23. 23
    Walker says:

    @waysel:

    Doctors only need catastrophic because they often get almost everything else free via professional courtesy.

  24. 24
    waysel says:

    @Walker: I see. Those catastrophics are no longer available, I assume. Still, a $150 to $300k/year income family of 4 would pay $3k a month for a crap bronze plan? Non ACA plans are not available now in Florida? I’m just curious, in that I’d like to have some knowledge to push back when people are exaggerating or lying about the evils the ACA has forced them to suffer. Some Facebook friend of a friend claimed their coverage was great and unchanging fro years prior to ACA, then the price skyrocketed for way less benefits. I asked for details and they wouldn’t respond. Repeating Fox or Reddit scripts to demonize Ocare, I presume.

  25. 25
    Yarrow says:

    @MomSense:

    There are also a lot of people who have started businesses and made work decisions based on access to health insurance. What will all of those people do?

    This is a real issue. I fail to understand how the BBB or Chamber of Commerce or some organization like that–or a new organization!–doesn’t keep pounding about the anti-business result of taking away health insurance. It hurts entrepreneurs. It will kill businesses. I know the current law isn’t perfect but it’s way better than before when we had nothing.

  26. 26

    @Clem: For the scatter plots — Orange = State Trump won, Blue =Clinton state

    Bottom bar graph — Red comparison of Jan 14 inclusive YoY update file
    Blue is comparison of end of Open Enrollment YoY

    These were some of my attempts at thinking through the problem

  27. 27

    @waysel: Yes, if you were early 20s to early 50s and healthy as a horse, you are paying a lot more.

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  30. 30
  31. 31
    Brachiator says:

    @Clem:

    Immigration is the top issue for republicans, more important than healthcare. Immigration= xenophobia.

    Immigration is the top issue for Americans who support Trump’s agenda. Immigration was always given lip service by the Chamber of Commerce wing of the Republican leadership, which allowed Trump to flip priorities and make the Congressional GOP own it.

    I think that a chunk of Americans still get health insurance through their employers, and you have a cohort of younger, healthy people who can (they think) go without insurance, so I could see how healthcare might appear to be a lower priority than other issues.

    And people foolishly believe that Republicans will do better on healthcare than Obama and the Democrats. And people foolishly believe that Republicans won’t do anything bad to Social Security and Medicare. All these things lead people into thinking that healthcare can be a lower priority.

  32. 32
  33. 33
    Ken Kelly says:

    I’m curious about the SBMs that use healthcare.gov as their enrollment platform (AR,NM,NV,OR). Do they do their own outreach (advertising in particular)? If so, they should be grouped with the other SBMs in your analysis.

  34. 34

    @Ken Kelly: Damn good question and I don’t know how they do their marketing

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