2018 MIDTERM ELECTION

Time: D H M S

No biggie. Just CMS Admin Verma allegedly trying to extort insurance carriers.

Over at the L.A. Times, Noam Levey has a fantastic story which underscores everything I've been shouting from the rooftops for months now regarding Trump/GOP sabotage of the ACA exchanges, through both active and passive measures:

Health insurers and state officials say Trump is undermining Obamacare, pushing up rates

Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues.

At the same time, state insurance regulators — both Democrat and Republican — have increasingly concluded they cannot count on the Trump administration to help them ensure that consumers will have access to a health plan next year.

The growing frustration with the Trump administration’s management — reflected in letters to state regulators and in interviews with more than two dozen senior industry and government officials nationwide — undercuts a key White House claim that Obamacare insurance marketplaces are collapsing on their own.

Instead, according to many officials, it is the Trump administration that is driving much of the current instability by refusing to commit to steps to keep markets running, such as funding aid for low-income consumers or enforcing penalties for people who go without insurance.

There's plenty of juicy quotes in Levey's story, and it's not just Democrats bashing Trump/the GOP; many quotes are from Republicans and/or insurance carriers.

But it's this part at the end which is raising the most eyebrows:

Insurance industry officials and state regulators have met repeatedly in recent months with senior Trump administration officials in an effort to explain that administration’s actions are jeopardizing health coverage for millions of Americans.

But in many cases, the meetings only left insurers and regulators more confused about the administration’s plans, according to attendees.

At one recent meeting, Seema Verma, whom Trump picked to oversee the federal Medicare and Medicaid programs, stunned insurance industry officials by suggesting a bargain: The administration would fund the CSRs if insurers supported the House Republican bill to repeal the Affordable Care Act.

“It made no sense,” said one official at the meeting.

Huh.

Um...yeah, there's a slightly larger problem here than her proposal "not making sense".

Is it legal for HHS/CMS to promise (as story suggests) to pay subsidies only if insurers endorse AHCA? @NormEisen @Dan_F_Jacobson @ASlavitt https://t.co/V8CxcROCDh

— Jacob Leibenluft (@jleibenluft) May 18, 2017

Great moments in extortion https://t.co/RZ1paXpj8p

— Josh Marshall (@joshtpm) May 18, 2017

Jonathan Chait in New York Magazine:

The Trump administration has pursued policies that are extremely friendly to incumbent businesses. But there is a discretionary quality to Trump’s governance that is ripe for abuse. Which firms will he call out for eliminating jobs? Which ones will he praise? Trump’s ability to hand out discretionary favors to pliant firms is a power to coerce large segments of the business community to endorse, or at least not oppose, his agenda.

David Anderson of Balloon Juice:

I am curious about a few things on this alleged offer.

  • Are there contemporaneous notes/memos/summaries of the meeting and alleged offer in the files of multiple insurers?
  • Has the HHS Inspector General been made aware of this allegation?
  • If this offer was made why did Verma think it was a good deal?

That last point is purely a cynical point. The AHCA takes out ~$850 billion dollars from Medicaid over ten years. Over 70% of Medicaid is administered by private insurers. Medicaid managed care is profitable. Medicaid managed care is fairly predictable. A decent MCO should make 2% to 4% a year on this line of business. Exchange is much smaller than Medicaid managed care. Cost Sharing Reduction subsidies is an even smaller of the individual market revenue pool. So the deal is take a small pool of money for a still uncertain line of business in exchange for supporting very significant cuts to a steady, profitable business segment. Why is this a plausible deal?

It's also important to remember that CSR reimbursements are not some sort of new financial agreement being added to the ACA in order to sweeten the pot for the carriers. This is money which is legally owed to them under the terms of their contracts with the federal government. The lawsuit (filed, remember, by the House Republicans themselves) is about whether or not the HHS Dept. has the Constitutional right to make the payments, not about whether the payments themselves are legally owed; that's a critical distinction.

In short, assuming Levey's story is accurate (and it certainly sounds like it), the administrator of the Centers for Medicare & Medicaid attempted to extort political favors from corporations in return for agreeing to pay them money which they're already legally entitled to.

I'm no lawyer, but can anyone explain to me how this is any different from your boss threatening not to give you your paycheck unless you vote for the political candidate of their choice?

As an aside, this is depressing for another reason: Until yesterday, I was starting to think that Seema Verma might be one of the few upper-level Trump Administration officials who may actually be trying to do their jobs properly. Her moves on ACA programs such as the SHOP exchanges and WBEs earlier this week suggested that while I may disagree with her decisions in many cases, she at least seemed to be taking the challenges of administering the ACA seriously (albeit from a Conservative perspective).

The anecdote relayed by Levey above, however ,completely blows that perception out of the water.