2018 MIDTERM ELECTION

Time: D H M S

Wednesday Short Cuts

Remember that massive Excel HC.gov enrollment spreadsheet file released last week? The one which broke out 2015 QHP selections by county, age group, metal level, income range and so on? Well, for those who don't have Excel, they've set up a web-based version of each.

OK, this is rather embarrassing (from the Office of the Inspector General):

CMS's Internal Controls Did Not Effectively Ensure the Accuracy of Aggregate Financial Assistance Payments Made to Qualified Health Plan Issuers Under the Affordable Care Act

CMS's internal controls did not effectively ensure the accuracy of nearly $2.8 billion in aggregate financial assistance payments made to insurance companies under the Affordable Care Act during the first 4 months that these payments were made.

We determined that CMS's internal controls for calculating and authorizing financial assistance payments were not effective. Specifically, we found that CMS's reliance on issuer attestations did not ensure that advance cost-sharing reduction (CSR) payment rates identified as outliers were appropriate, CMS did not have systems in place to ensure that financial assistance payments were made on behalf of confirmed enrollees and in the correct amounts, CMS did not have systems in place for State marketplaces to submit enrollee eligibility data for financial assistance payments, and CMS did not always follow its guidance for calculating advance CSR payments and does not plan to perform a timely reconciliation of these payments.

New York state has decided to let pregnant women sign up for insurance outside of enrollment periods, arguing poor birth outcomes matter too much to let people go uninsured. California and others could be following.

When people buy insurance policies through an Affordable Care Act (ACA) exchange, they have to do it during a set enrollment period unless they've just gotten out of prison, gotten married, lost previous coverage, had a baby or experienced some other "qualifying event." Being pregnant, however, isn't one of those events. "A lot of people have assumed that meant 'if I'm pregnant, I'm having a baby and I can sign up,' so we've had to do some consumer education to clarify that," said Christina Postolowski of the group Young Invinciles, which advocates for millenials.

Speaking of the ACA and pregnancy issues...

The Affordable Care Act (ACA) mandates that private health insurance plans cover all FDA-approved prescription contraceptives with no cost-sharing. A new study in Health Affairs by LDI Fellow Nora Becker and LDI Executive Director Dan Polsky finds that the mandate saved women on average $255 per year for the oral contraceptive pill and $248 per year for the intrauterine device (IUD).  With an estimated 6.88 million privately insured oral contraceptive users in the United States, this means approximately $1.4 billion per year in out-of-pocket savings on the pill alone.

Now a large set of data — from Enroll America, the group trying to sign up people for the program, and from the data firm Civis Analytics — is allowing a much clearer picture. The data shows that the law has done something rather unusual in the American economy this century: It has pushed back against inequality, essentially redistributing income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

With Obamacare preserved by the Supreme Court, the White House is sounding confident. "The Affordable Care Act is here to stay," President Obama said after the ruling. Time to move on.

But congressional Republicans are not going to leave the law alone. They will keep trying to chip away at it and pick off unpopular or controversial pieces of the Affordable Care Act. For the White House, that means at some point it will have to decide whether its renewed swagger means it can reject anything and everything the GOP comes up with, whatever the circumstances.