2018 MIDTERM ELECTION

Time: D H M S

Sunday Short Cuts

I haven't actually done Short Cuts in awhile, letting dozens of significant ACA-related stories disappear into the Memory Hole. Will try to be better about this going forward:

Normally this is exactly the sort of story which I'd post a full point-by-point debunking of (see McConnell, Mitch), but frankly I've had a lousy weekend and am just too damned tired to bother. It's like playing whack-a-mole, anyway; sometimes it's just not worth the effort.

Fortunately, Jason Easley of PoliticsUSA clears up at least a couple of the whoppers John Boehner spewed this morning:

1. Of the net 14 million or so people who've gained insurance since the ACA exchanges launched, yes, it's true that probably 8-9 million are due to Medicaid expansion. However, the other 5-6 million are enrolled in private policies via the exchanges (or newly-added to ACA-compliant off-exchange policies).

2. Despite all the hand-wringing by the business community prior to the ACA provisions kicking into play, 3/4 of businesses surveyed say that the law hasn't impacted their hiring practices and 85% say they don't expect it to going forward. (I should also note that business owners not impacted by it have no reason to lie about it, whereas the ones who claim that they are impacted have ample reason to do so as an excuse for complaints from prospective employees or from stockholders).

Hawaii lawmakers advanced a bill Friday that would appropriate $2 million in general funds to the Hawaii Health Connector — $3.4 million less than originally consideredby legislators, and $8 million less than the exchange originally requested.

Yikes. The $2M is better than nothing, of course, but that's only 20% of what they were hoping for.

It's a similar story in Washington State...

Financial challenges are threatening the survival of Washington’s Healthplanfinder insurance exchange.

First, the marketplace is facing a state budget proposal that would provide roughly two-thirds of the money that exchange officials say they need.

...as well as Rhode Island:

A House Finance hearing Wednesday night will explore the new "health reform assessment" that Governor Raimondo has proposed -- and provide a stage for public reaction.

The new surcharge on premiums would not be limited to HealthSource RI's roughly 30,000 customers. It would be assessed on the premiums of all health plans purchased in Rhode Island by individuals (at a projected rate of 3.8 percent) and small employers (1 percent).

All of this leads naturally to this story out of the Washington Post the other day:

Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act.

Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are weighing turning over part or all of their troubled marketplaces to the federal exchange, HealthCare.gov, which now works smoothly.

This is the same point I posted a month ago. As I noted at the time:

Yup, there's no denying that all of this sounds like a whole big bag of hurt. Installation, configuration, maintenance and improvement of technical infrastructure costs money, time and know-how.

However, I also noted that this could prove to be much ado about nothing, because...

The funny thing is, if the King v. Burwell plaintiffs are shot down and if Healthcare.Gov ends up in the free and clear to continue operations including providing the federal tax credits, I, for one, would have no problem with some or all of the state-based exchanges making the move to HC.gov.

It's certainly more fiscally efficient (HC.gov has cost somewhere around $250-$300 per enrollee to date, as opposed to the several thousand dollars per enrollee that most of the state exchanges are costing....or, to use an extreme case, the $57,000 per person that Marco Rubio's Republican "Anti-Obamacare" Brainchild, "Florida Health Choices" has cost to date).

The main advantage of running their own exchange, aside from the King v. Burwell Sword of Damocles hanging over their heads, is that SBMs have more flexibility to do things like offer additional financial assistance to enrollees (as Vermont and Massachusetts do) or even stronger healthcare coverage mandates (Hawaii currently has a state law requiring employers to provide coverage to employees working 20 hours or more, vs. the 30 hour threshold that the ACA requires).

Overall, however, it seems to me that in addition to the economic economy of scale/efficiency advantages of running the exchange via HC.gov, it also simplifies the marketing of the exchange: Instead of promoting a bunch of different websites which no doubt confuses the heck out of some people, every state can just promote Healthcare.Gov, period.

A negative view of New York's recent announcement that they're launching a Basic Health Service (along the lines of Minnesota's version). I don't know that I agree with all of Jed Graham's conclusions, but he seems to be the only reporter at Investor's Business Daily with any integrity, so I'm giving him a shout-out here.