Good morning … It's officially here: The Affordable Care Act's fifth open enrollment period.
This will likely be the worst ACA sign-up period yet, in terms of the total number of people getting coverage — and also the weirdest. It's been weird to see a federal department constantly attacking a program it oversees; it'll be weird to watch it oversee that program anyway.
The fallout: The politics of health care has also been totally unsettled all year long, and that has produced a surprising set of twists and turns on the ground.
Here's what else to expect, today and over the next six weeks:
The website will probably work. Despite the Trump administration's reticence to carry out much of the ACA, testing for HealthCare.gov proceeded as usual during September and October.
Overall enrollment will probably fall. No one is sure how big a drop-off to expect. In terms of the markets' stability, the mix of healthy and sick consumers is more important than the overall number of enrollees. But the two go hand-in-hand: the people who need insurance the most are the ones least likely to miss the enrollment window or let their coverage lapse.
The Trump administration is not looking for silver linings. As far as it's concerned, failure is success.
It pays to shop around. This is always the case, but it's especially true this year.
Insurers' big message, per AHIP's Turek: Despite all the political turmoil over the ACA, the process of shopping for and buying coverage is pretty much the same. Insurers will be doing their own outreach campaigns, with an emphasis on keeping their existing customers as well as signing up at least some new ones — especially younger, healthier enrollees.
The House is likely to vote Friday on a slightly revised version of a GOP bill to reauthorize federal funding for the Children's Health Insurance Program. The new bill includes some different spending offsets than the original bill put forward in committee.
But Democrats see the changes as only making the bill worse. Energy and Commerce Committee Democrats and House Democratic leadership are urging members to vote no, according to a committee spokesperson for the minority.
Where things go from here, per my colleague Caitlin Owens:
The Trump administration has approved a waiver from Iowa, effective Nov. 1, that says the state will not have to provide Medicaid coverage to low-income people for the three months before they applied.
Between the lines: Conservatives say the waiver from Medicaid's three-month retroactive eligibility will encourage people to sign up for Medicaid quickly and prevent people from only applying once they are sick. But consumer advocates are worried the move, which will deny retroactive benefits to 40,000 Iowans to save $37 million, will lead to high medical bills for seniors and people with disabilities.
Be smart: This is one of the first major Medicaid waivers approved under Seema Verma, who helped engineer several other states' waiver applications before taking the helm at the Centers for Medicare & Medicaid Services.
Jonathan Cohn of the Huffington Post has a smart, widely shared piece on why the Iowa ACA market is in so much trouble. And no, it's not because of the teenager whose care costs $1 million a month.
The real problems in Iowa, per Cohn:
What we're watching today: HealthCare.gov.
What we're watching this week: Energy and Commerce subcommittee hearing Thursday on federal oversight of dangerous pathogens. Brookings event Friday on policy answers to the opioid crisis.
Place your bets: How many people will select a plan during this open enrollment period? We're counting HealthCare.gov plus state exchanges, and plan selections, not effectuated enrollments. Send me your guesses: firstname.lastname@example.org