ACA/Obamacare: The Price of the Medicaid Expansion Component of ACA is 49% Higher Than Advocates Claimed

‘The implementation of major legislation such as the Affordable Care Act (ACA) often results in fiscal outcomes that differ significantly from prior projections. Whenever this happens it leads to many questions, much confusion, and several claims and counter-claims. Rarely is it immediately clear whether the law is working differently than envisioned, or whether the unexpected outcomes are due to inevitable projection errors having nothing to do with the law.

On rare occasion, however, a prior projection proves so far off that its significance must be noted. Two weeks ago my colleague Brian Blase uncovered such a development with respect to the ACA’s Medicaid expansion. Recall that the ACA considerably expanded Medicaid eligibility – an expansion made optional for the states in a later Supreme Court ruling. It turns out that the 2015 per-capita cost of this Medicaid expansion is a whopping 49% higher than projections made just one year before.

This disclosure can be found on page 27 of the 2015 Actuarial Report for Medicaid, released this July. Here is how the report described the issue:

“While the newly eligible adult per enrollee costs in 2014 were slightly lower than estimated in last year’s report ($5,488 compared to $5,517, or about 1 percent lower), the estimated per enrollee costs for 2015 in this year’s report are substantially greater ($6,366 compared to $4,281, or about 49 percent higher).”’ - The Soaring Costs of the ACA’s Medicaid Expansion, economics21.org, 08/01/2016

Link to the entire essay appears below:

http://www.economics21.org/html/soaring-costs-aca%E2%80%99s-medicaid-expansion-1989.html

Medicaid Block Grants v. Current Funding Program: Reversing Perverse Politico Incentive System

ACA/Obamacare: And About the Price of the Medicaid Expansion Component of ACA ……..

‘The implementation of major legislation such as the Affordable Care Act (ACA) often results in fiscal outcomes that differ significantly from prior projections. Whenever this happens it leads to many questions, much confusion, and several claims and counter-claims. Rarely is it immediately clear whether the law is working differently than envisioned, or whether the unexpected outcomes are due to inevitable projection errors having nothing to do with the law.

On rare occasion, however, a prior projection proves so far off that its significance must be noted. Two weeks ago my colleague Brian Blase uncovered such a development with respect to the ACA’s Medicaid expansion. Recall that the ACA considerably expanded Medicaid eligibility – an expansion made optional for the states in a later Supreme Court ruling. It turns out that the 2015 per-capita cost of this Medicaid expansion is a whopping 49% higher than projections made just one year before.

This disclosure can be found on page 27 of the 2015 Actuarial Report for Medicaid, released this July. Here is how the report described the issue:

“While the newly eligible adult per enrollee costs in 2014 were slightly lower than estimated in last year’s report ($5,488 compared to $5,517, or about 1 percent lower), the estimated per enrollee costs for 2015 in this year’s report are substantially greater ($6,366 compared to $4,281, or about 49 percent higher).”’ - The Soaring Costs of the ACA’s Medicaid Expansion, economics21.org, 08/01/2016

Link to the entire essay appears below:

http://www.economics21.org/html/soaring-costs-aca%E2%80%99s-medicaid-expansion-1989.html

ACA/Obamacare: Total Uninsured Remains at 11.9% -or- Sound and Fury Signify Nothing

“In 2014, after accounting for attrition after the end of the first open-enrollment period (March 31, 2014), 6.7 million individuals had enrolled by December 31. In 2015, 2.6 million additional individuals enrolled (and remained on their plans), raising the total to 9.3 million people enrolled on December 31. If similar trends hold, total enrollment on the ACA exchanges will hit 10 million on December 31, 2016.

Overall, ACA-exchange enrollment has been lower than expected; in 2016, the gap between actual and forecasted enrollment is likely to widen further. For instance, in 2014, the ACA exchanges’ first year, enrollment (6.7 million) exceeded the CBO’s February 2014 forecast (6 million). But in 2015, total enrollment (9.3 million) lagged behind the CBO’s March 2015 forecast (11 million). And if current trends hold, total enrollment in 2016 (about 10 million) will be dramatically less than the CBO’s March 2015 forecast (21 million).

Are these lower-than-anticipated ACA-exchange enrollment figures the result of uninsured individuals securing coverage by other means — such as by enrolling in employer-sponsored coverage or Medicaid? Start with the former. As the Department of Health and Human Services has noted, in a growing economy, employer-sponsored coverage typically rises as more people acquire jobs. Instead, from the fourth quarter of 2013 to the fourth quarter of 2015, employer-sponsored coverage in the U.S. declined.

Or take Medicaid. Enrollment in this government-insurance program for the poor expanded during the aforementioned period; but such expansion largely matched the CBO forecast — and, therefore, was also incorporated into the CBO forecast for ACA-exchange enrollment. Indeed, if the ACA exchanges’ meager enrollment numbers were caused by a rise in coverage obtained elsewhere, America’s overall uninsured rate would have declined in 2015. Instead, it barely budged, hovering around 11.9 percent.” - Why Obamacare Is Failing at "Universal Coverage", foundation for economic education, 04/17/2016

Link to the entire essay appears below:

https://fee.org/articles/why-obamacare-is-failing-at-universal-coverage/


　

　


　

ACA/Obamacare and the Medicaid Expansion Component

“Medicaid enrollment has surged 19% nationally since ObamaCare’s expansion—50% in New Mexico, 65% in Oregon, 81% in Kentucky—and spending is exploding. So taxpayers ought to be grateful that the Supreme Court declined 5-4 on Tuesday to convert this entitlement—and all the others—into a private right.

Medicaid, the joint state-federal program originally meant for the poor and disabled, sets price controls for all health-care services. And in the law that created the program, Congress instructed the states to “assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers” equal to those available to the general population. In Armstrong v. Exceptional Child Center, a group of in-home care companies sued Idaho for setting reimbursement rates too low, thus purportedly violating this amorphous standard.”

“Medicaid’s fire-sale reimbursement rates often result in inferior care and distort markets, but they might be more generous if the program was limited to its original purpose of helping the poor. Also recall that Medicaid is an entitlement for providers as much as beneficiaries, and they don’t have to participate.

Armstrong was a backdoor bid to reflate the judicial rate-setting that providers have long sought but the Court rebuked in 2002 in Gonzaga v. Doe, holding that spending programs do not create judicially enforceable rights like those in the Constitution. So mark this one down as a victory for judicial and fiscal restraint.” - Close Encounters of the Medicaid Kind, WSJ, 04/01/2015

Link to the article appears below:

http://www.wsj.com/articles/close-encounters-of-the-medicaid-kind-1427846690?KEYWORDS=medicaid

ACA/Obamacare: Spending Figures Released on the Medicaid Component of Obamacare

‘WASHINGTON (Reuters) - One part of the Affordable Care Act is going according to plan, with U.S. states receiving and spending more money on the Medicaid health insurance program, a report released by the National Association of State Budget Officers on Thursday showed.’

‘"The large increase in federal funds to states in fiscal 2014 was almost solely due to additional Medicaid dollars, mainly resulting from the expansion of Medicaid in a majority of states under the Affordable Care Act," the association found. "While federal Medicaid funds to states increased $41.8 billion in fiscal 2014, all other federal funds to states are estimated to have declined $3.4 billion."‘

‘Medicaid spending rose the most of all states' budget areas, increasing 11.3 percent in fiscal 2014, but the federal government shouldered most of the burden. Federal funding for Medicaid increased 17.8 percent, and state dollars directed to the program only grew 2.7 percent, according to NASBO.’ - U.S. states get more, spend more on Medicaid under Obamacare: report, 11/20/2014, yahoo news.com

Link to the entire article appears below:

http://news.yahoo.com/u-states-more-spend-more-medicaid-under-obamacare-051651014--business.html

ACA/Obamacare: When the Taxing Authority Taxes Itself

"When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers.

But with an $8 billion tax on insurers due Sept. 30 — the first time the new tax is being collected — the industry is getting help from an unlikely source: taxpayers.

States and the federal government will spend at least $700 million this year to pay the tax for their Medicaid health plans. The three dozen states that use Medicaid managed-care plans will give those insurers more money to cover the new expense. Many of those states — such as Florida, Louisiana and Tennessee — did not expand Medicaid as the law allows, and in the process turned down billions in new federal dollars.

Other insurers are getting some help paying the tax as well. Private insurers are passing the tax onto policyholders in the form of higher premiums. Medicare health plans are getting the tax covered by the federal government via higher reimbursement.

State Medicaid agencies say they have little choice but to pay the tax for health plans they hire to insure their poorest residents. That's because the tax is part of the health plans' costs of doing business. Federal law requires states to pay the companies adequate rates.

"This situation results in the federal government taxing itself and taxing state governments to fund the higher Medicaid managed care payments required to fund the ACA health insurer fee," said a report by Medicaid Health Plans of America, a trade group." - Who's paying the new Obamacare tax? You, USA Today, 08/30/2014



The entire article appears in the link below:

http://www.usatoday.com/story/news/nation/2014/08/30/obamacare-tax-healthcare-taxpayers-eight-billion/14861405/



　

Related: ACA/Obamacare: When the Taxing Authority Pays Its Own Imposed Tax. Huh? No Way! Way!

http://thelastembassy.blogspot.com/2014/04/acaobamacare-when-taxing-authority-pays.html

And About Those Emergency Room Visits Supposedly Declining Under ACA. Maybe Not So Much. How About An Increase in ER Visits! Yes, Very Much.

“It wasn't supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month.

That 12 percent spike in the number of patients — many of whom aren't actually facing true emergencies — is spurring the hospital to convert a waiting room into more exam rooms.

"We're seeing patients who probably should be seen at our (immediate-care centers)," said Lewis Perkins, the hospital's vice president of patient care and chief nursing officer. "And we're seeing this across the system."

That's just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they've seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend.”


"Experts cite many reasons: A longstanding shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won't accept Medicaid. And poor people often can't take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.


Plus, some patients who have been uninsured for years don't have regular doctors and are accustomed to using ERs, even though it is much more expensive. Others have let illnesses and injuries fester so long they have become emergencies.


"It's a perfect storm here," said Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physician group."We've given people an ATM card in a town with no ATMs." '



"For many who research health care, the ER crunch is no surprise.


Studies have shown that Medicaid patients were among the most frequent ER users before health reform, and becoming newly insured only increases ER use by giving an avenue to get treatment to patients who had been forgoing care because they couldn't afford it.


A 2007 issue brief from the Kaiser Family Foundation said Medicaid patients made up 9 percent of the general population at the time but accounted for 15 percent of emergency visits. Researchers concluded that the most frequent users weren't substituting ERs for primary care, but rather suffered from chronic conditions and required more health care in general." - More patients flocking to ERs under Obamacare, courier-journal.com, 06/09/2014


Upon further review, the “experts” are claiming the ER is being used due to the lack of primary care physicians accepting Medicaid. Yet Medicaid recipients, according to Kaiser Family Foundation,
in 2007, found Medicaid patients made up an inordinate amount of total ER visits. The Kaiser 2007 finding would be prior to ACA/Obamacare.

If the trend/pattern of group M is to inordinately rely on facility E, and one purposely increase the size of group M, then one would assume, given the established trend and pattern, the increased size of group M would increase the inordinate reliance on facility E. One might state: As M rises E rises, given trend/pattern.

Which then begs the question of: What ACA “experts” predicted a decline in ER usage due to the advent of ACA/Obamacare and its major subcomponent which is the expansion of Medicaid? Apparently it is another episode for Math Quest!


Link to the courier-journal article appears below:


http://www.courier-journal.com/story/news/2014/06/07/patients-flocking-emergency-rooms-obamacare/10181349/

ACA/Obamacare: New Zeniths In Suspect Data

Math Quest!

　
‘President Barack Obama said Thursday that eight million people had picked health-insurance plans through the Affordable Care Act, a number that significantly outstripped initial projections and emboldened him to step up criticism of Republicans seeking to repeal the law.

The president, in a surprise Thursday afternoon appearance in the White House briefing room, employed markedly more aggressive rhetoric in defending his signature legislative achievement, language that should help bolster Democratic candidates who have been on the defense.

The eight million sign-ups go beyond earlier projections by the Congressional Budget Office that six or seven million people would enroll through the exchanges in 2014. Mr. Obama pointed to the number to declare the law a success and that Republicans should stop trying to overturn it.

"The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working and I know the American people don't want us spending the next 2½ years refighting the settled political battles of the last five years."

Some 35% of those who signed up through the federal health-insurance exchange were in the coveted under-35 demographic, Mr. Obama said. The participation of younger, relatively healthy people is needed to balance out the cost of medical claims from older and sicker ones.

The announcement contained few other new details about enrollment. Republicans quickly pointed to missing information—such as the number of people who had actually gained coverage after being uninsured, as opposed to those replacing an existing policy—to suggest the figures could be overblown as a measure of success.’

‘GOP lawmakers continued to emphasize information not contained in the numbers, including how many people have paid their first month's premium, the final step in enrolling for insurance.

"How many of those who have signed up were among the millions who had their plans canceled? How many were already insured but forced to sign up for an Obamacare plan?" said Sen. Lamar Alexander (R., Tenn.). "This law promised to insure the uninsured, let those who liked their insurance keep it, and lower the cost of insurance—let's talk about what the law was supposed to do instead of how many millions of people the president has so far forced into Obamacare."‘

‘The president's announcement didn't include state-by-state information about enrollment, which will be key to determining premiums for 2015 and beyond since each state's insurance market is different and rates are based on the makeup of people who sign up within each.

White House officials said Thursday that 28% of the enrollees in the federally run exchanges serving 36 states are in the 18-34 demographic. Some 7% are children covered by family plans. The administration didn't release demographic information for the 14 states running their own exchanges.

Insurance officials previously said 80% to 85% of enrollees paid the first month's premium, a proportion that would suggest the administration will ultimately hit enrollment targets for the exchanges for 2014 even if some people drop out or have picked more than one plan and are overrepresented in the numbers, especially since some people who have a change in their life circumstances such as a divorce or job loss are still allowed to sign up after March 31.

The figures represent a slight increase in young people compared with the previous five months. The administration said earlier that through Feb. 28, about 4.2 million people were covered by plans picked via the federal and state-run exchanges. Of those, 25% were 18 to 34, and 6% were children covered by family plans.

The mix of younger people buying coverage is considered by health plans to be crucial in determining future insurance prices. Under the law, insurers no longer can charge premiums based on health histories, and are restricted in how much more they can charge older consumers.’ (1)

　


Those Pesky Math Problems

　
‘You can't manage what you don't measure, as the great Peter Drucker used to say, and for the White House that seems to be the goal. Out of the blue, the Census Bureau has changed how it counts health insurance—at the precise moment when ObamaCare is roiling the insurance markets.

Since 1987, the Current Population Survey, or CPS, has collected information on the health-insurance coverage status of Americans. The annual reports are widely cited because their large sample sizes improve accuracy, the data are gathered constantly, and they tease out state-by-state details. But this year the Census revamped the CPS household insurance questions, muddying comparisons between the pre- and post-ObamaCare numbers. The results of the new method will be disclosed this fall.

The FDA would never approve a new drug whose maker completely changed the clinical trial protocol in the middle of the experiment, yet that is what the White House has done. How many people gained or lost insurance under ObamaCare? Did government crowd out individual insurance? What about employer-sponsored insurance? It will be much harder and in some cases impossible to know.

Robert Pear of the New York Times obtained internal Census documents that note that the new CPS system produces lower estimates of the uninsured as an artifact of how the questionnaire is structured. One memo refers to the "coincidental and unfortunate timing" and that, "Ideally, the redesign would have had at least a few years to gather base line and trend data."‘ (2)

　


　
Those Pesky Math Problems Part Deux

　
‘The White House and its media phalanx are claiming the Census Bureau fracas is nothing more than a search for a conspiracy where none exists. Yet revising its health insurance survey design will make it harder to measure ObamaCare's performance over time, and now we've learned that the choice to do so is even worse than we first wrote.

The White House is right that the new questions have been in the works since the Bush Administration, and the Current Population Survey (CPS) revisions are said to produce better estimates of how many people lack coverage. The problem is that resetting the insurance CPS in this year of major insurance disruption means that the old data series can't be compared to the new one going forward. It's a statistical break that prevents researchers from identifying before-and-after trends with precision and validity.

It would have been less disruptive to either delay the update or else to run the old and new CPS in parallel for a few years. As we wrote Wednesday, the second option would preserve the value of three decades of old information, while still producing more accurate statistics going forward.

We've since learned that this hybrid method is precisely what the Census Bureau proposed to do for its data collection about income and poverty in the Annual Social and Economic Supplement, or ASEC. Census announced this change at the same time it proposed the new health insurance questions in the Federal Register in September 2013.

Let the Census explain: "The ASEC 2014 data collection instrument will have a split-design structure, with two separate treatments for the income-related section. . . . Five-eighths (5/8) of the sample will have income questions from the 'traditional' design, while three-eighths (3/8) will have income questions from the 'redesigned' ASEC. This split-design will enable Census Bureau analysts to create a 'cross-walk' when analyzing the effects of the redesigned ASEC on income and poverty estimates."

So why not follow the same procedure for asking about health insurance, erring on the side of more information, not less? The new questions were road-tested in previous surveys in 2010 and 2013, though the CPS is viewed as reliable because it has produced a stable baseline for comparison for so long. Other surveys of insurance, both public and private like Gallup, are more volatile.’ (3)


Checking The Long Form Division

‘Barack Obama wasted little time last week declaring victory as the deadline for enrollment in Affordable Care Act exchanges expired – well, more or less, anyway. The White House celebrated as it announced that 7.1 million consumers had signed up for health insurance through the federal and state exchanges, slightly exceeding their original goals and significantly outpacing expectations after the disastrous rollout of Obamacare last October. “The debate over repealing this law is over,” President Obama told the press on April 1. “The Affordable Care Act is here to stay.”

Last week, that sounded like wishful thinking. Two new studies released this week prove it.

Before we get to these studies, though, we should recognize why we need outside organizations to validate White House claims in the first place. The Department of Health and Human Services still has no way to quantify important data about those consumers signing up for health insurance through state and federal exchanges.

More than six months after the initial rollout of Obamacare -- and four years after the ACA’s passage -- the systems designed by HHS still cannot determine basic and critical information about enrollments such as whether a premium payment has been made. Without a premium payment, a sign-up in the web portal does not mean coverage has been extended.

Furthermore, the systems were not designed to collect important demographic information such as pre-existing coverage, current health status, or even definite age ranges, even though the success of the Obamacare structure depends on getting previously uninsured healthy Americans locked into expensive comprehensive insurance.

Without the “young invincibles” providing new funding for risk pools that now have to cover older and less-healthy consumers under “community pricing” restrictions, premiums will escalate rapidly, forcing more consumers out of the system and triggering the dreaded “death spiral” for insurers.

In order to determine the scope of the celebration, then, we need outside surveys to give us an idea of the size and composition of the actual enrollment population in Obamacare. The first of the independent studies comes from the RAND Corporation, which studied the changes in the health insurance market between September 2013 – just before the rollout of the state exchanges – and the end of the open-enrollment period at the end of last month.

While the White House can claim credit for a net increase of 9.3 million insured and a lowered uninsured rate from 20.5 percent to 15.8 percent, the data provides a significantly different picture than that painted by President Obama and the ACA’s advocates.

First, a significant amount of this increase comes from Medicaid enrollments, not private insurance. Almost six million people enrolled in Medicaid, and earlier studies showed that a relatively small number of those came from the expansion built into the ACA; most of these would have been Medicaid-eligible prior to the reform.

Another 8.2 million more people enrolled in employer-provided health care, as 7.1 million left the “other” category and another 1.6 million left the individual insurance markets. Only 3.9 million actually enrolled in insurance plans through state or federal exchanges – not 7.1 million as claimed by Obama. That number falls far short of even the lowered expectations issued by HHS and the White House earlier this year.’ (4)


McMath?

‘Today President Obama announced that as of April 15, 8 million people have enrolled in the insurance exchanges set up by Obamacare. But that’s not all. According to a White House fact sheet:

3 million young adults stayed on their parents plan,
3 million more people had enrolled in Medicaid, with more on the way, and
5 million people enrolled in plans outside the insurance exchanges.

The news was so good that even Republicans should, in the president’s words, admit that the Affordable Care Act is working.

Maybe not. What the administration has not told us is how many of those 19 million people already had coverage and lost it because of the Affordable Care Act. Or how many of them would have been covered by insurance this year and changed plans to get a big subsidy. Or how many of them thought they were going to get a better health plan but found out that their doctor is not in the network. Or how many of them spent more on insurance than they felt they could afford because there were no lower-cost alternatives. Or how many will find out that the taxpayer subsidy they are receiving will turn out to be too high—they might get a raise in a few months or work some overtime and will make a little too much money this year, or it might just be that the government’s computers didn’t get it right—and will have to repay the Treasury hundreds and perhaps thousands of dollars?’ (5)

　


　

Notes:

(1) Obama Says Health-Insurance Enrollees Reach 8 Million, President Criticizes GOP, Saying 'Repeal Debate Is and Should Be Over' - WSJ, 04/17/2014

http://online.wsj.com/news/articles/SB10001424052702304810904579507922881089460?KEYWORDS=OBAMA+HEALTH+CARE+TALK&mg=reno64-wsj


　

　

(2) Cooking the ObamaCare Stats, Suddenly, the Census Bureau changes how it counts insurance - WSJ, 04/16/2014

http://online.wsj.com/news/articles/SB10001424052702303663604579503652766287652?KEYWORDS=obamacare&mg=reno64-wsj


　

(3) None Dare Blame ObamaCare, The Census Bureau's statistical changes are worse than we thought - WSJ, 04/17/2014

http://online.wsj.com/news/articles/SB10001424052702303626804579507820306300440?KEYWORDS=obamacare&mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702303626804579507820306300440.html%3FKEYWORDS%3Dobamacare&cb=logged0.8406738588705886


　

(4) Two New Studies Raise Red Flags on Obamacare, The Fiscal Times, 04/10/2014

http://www.thefiscaltimes.com/Columns/2014/04/10/Two-Studies-Raise-Red-Flags-Obamacare-s-First-Round


(5) Lots of sign-ups for Obamacare — and almost as many questions, American Enterprise Institute, 04/17/2014

http://www.aei-ideas.org/2014/04/lots-of-sign-ups-for-obamacare-and-almost-as-many-questions/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+aei-ideas%2Fposts+%28AEIdeas+Posts%29


　

　


　

Kathleen Sebelius: Four and One Half Minutes of Political Spin …..Then Spin-Brain-Freeze. Oops!

The entire interview can be seen here: http://www.news9.com/category/116601/video-page?autostart=true&clipId=10001484

ACA/Obamacare: The Deadline Passed for Individual Health Insurance…But Not for Expanded Medicaid

ACA is a scheme predicated on exchange based policies, private exchange based policies and Medicaid. Hence the supposed enrollment numbers appearing in/on various news outlets include Medicaid enrollees.

Open enrollment for exchange based policies ended 03/31/2014 at midnight. Individuals wanting to apply for individual health insurance, for the exception of a life event such as loss of job and health insurance, marriage, child birth, etc., one can no longer purchase an exchange based policy until the next open enrollment. Therefore, if you have the money to purchase coverage or one’s own money along with a taxpayer subsidy to purchase coverage, you have no availability to procure coverage, until the next open enrollment period. Or in the words of the ACA exchange:

　
Coverage options outside Open Enrollment


Open Enrollment for 2014 coverage is over. But you may still have options to get health coverage, including:

Buying a private health plan through the Marketplace — only if you qualify for a special enrollment period
Applying for Medicaid and the Children’s Health Insurance Program (CHIP) — you can do this any time, all year.(1)
　
However, if you are applying for coverage under the expanded Medicaid option available in roughly half of the states, no such deadline exists:

　

Medicaid and CHIP. Medicaid and the Children’s Health Insurance Program (CHIP) are joint state and federal programs that provide coverage to millions of Americans with limited incomes and some people with disabilities.

There is no limited enrollment period for Medicaid and CHIP. You and your family can enroll in Medicaid and CHIP any time during the year if you qualify.
Whether you qualify depends on what state you live in, your household size and income, or other factors including pregnancy, family situation, and disability.
Your children could qualify for coverage through CHIP even if you don’t qualify for Medicaid.(2)


Notes:

(1) and (2) https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/