Can't I leave you people alone for 48 hours without all hell breaking loose?

Wed, 06/07/2017 - 9:22am

So, I got back from my trip to the NIHCM awards dinner in DC late last night, and am groggily attempting to bone up on all the healthcare stuff which happened while I was gone (ironic, of course, given that I was attending a healthcare-related event filled with other healthcare wonks/reporters).

In the past 2 days...

New York Governor Andrew Cuomo announced that he's taking my advice (see #12 on my If I Ran the Zoo list) and issuing an executive order which would require any insurance carrier offering Managed Medicaid in the state to also participate in the ACA individual market exchange. This could be legally problematic, however, since current MCO (Managed Care Organization) contracts apparently run through 2019 and changes have to be approved by CMS...i.e., the Trump Administration. Cuomo also took steps to "mandate insurers to cover the 10 essential benefits outlined in the Affordable Care Act and prohibit discrimination against customers with preexisting conditions." as a backstop in case the GOP does in fact cram through their dumpster fire "repeal" bill through the Senate (see below).

The Nevada state legislature quietly, and surprisingly, passed a Medicaid buy-in option for anyone in the state. I wrote about this back in April, but even I didn't think much of it at the time--I assumed it was more of a symbolic proposal than anything, or that it would die in committee at most. The details are important, of course, but assuming they make sense, this is exactly the sort of approach I would recommend in trying to gradually transition to some type of universal single-payer like system. The biggest questions I'd want answered are 1) What type of coverage does Medicaid actually have in Nevada? It varies widely from state to state, so if NV's is pretty comprehensive, awesome, but if it's skimpy, that's not very helpful; 2) What sort of premiums/deductibles/co-pays would buy-in enrollees be looking at?; 3) What sort of impact would this have on the state budget?; and most significantly, 4) How many Nevada doctors/hospitals would accept these enrollees? Remember, the reason a significant chunk of healthcare providers don't accept Medicaid patients is because it only reimburses them around 50¢ on the dollar compared to private insurance.

In Ohio, Anthem announced that they're dropping out of the individual market (both on and off-exchange, although they'll technically still offer a single catastrophic policy in a single county (Pike), off-exchange only, in order to allow them to re-enter the market in 2019. This is a Big Deal, since not only will 10,500 existing enrollees have to shop around, it could also leave 20 counties "bare" next year if no one else jumps in, and because Anthem is one of the Big Kahunas in the individual market; they could potentially leave other states as well, which would be an even bigger problem. It's important to note that, once again, Anthem is placing a huge chunk of the blame for this development squarely on Donald Trump and Congressional Republicans, stating in their FAQ:

They once again specifically call out the CSR issue as a major cause of their decision, and "an increasing lack of overall predictability" pretty obviously refers to the Trump Uncertainty Factor regarding other issues like enforcement of the individual mandate, the GOP's repeal/replace efforts and so forth. It clearly doesn't refer to the "normal" state of the individual market risk pool, since 4 years in the carriers know what that looks like. They also all but say point-blank that if Congress formally makes good on the CSR payments they'll likely jump back in later this summer.

And finally, the U.S. Senate Parlimentarian apparently surprised many by declaring that the House GOP's AHCA bill does in fact pass the smell test for a simple "reconciliation" vote in the Senate, meaning it would only require 51 votes (or 50 votes plus VP Mike Pence as the tie-breaker) to pass. This, combined with a lot of reporting by various in-the-know people, strongly suggests that Mitch McConnell is going to try to cram through a Senate version of the bill which, in spite of all of the posturing otherwise, will likely be very close to the collossal piece of garbage squeaked through the House a month ago.

Oh, one more healthcare-related item: Eric Trump (Donald's "other" son) apparently literally stole $100,000 from children with cancer:

...The best part about all this, according to Eric Trump, is the charity's efficiency: Because he can get his family's golf course for free and have most of the other costs donated, virtually all the money contributed will go toward helping kids with cancer. "We get to use our assets 100% free of charge," Trump tells Forbes.

That's not the case. In reviewing filings from the Eric Trump Foundation and other charities, it's clear that the course wasn't free--that the Trump Organization received payments for its use, part of more than $1.2 million that has no documented recipients past the Trump Organization. Golf charity experts say the listed expenses defy any reasonable cost justification for a one-day golf tournament.

Additionally, the Donald J. Trump Foundation, which has come under previous scrutiny for self-dealing and advancing the interests of its namesake rather than those of charity, apparently used the Eric Trump Foundation to funnel $100,000 in donations into revenue for the Trump Organization.

And while donors to the Eric Trump Foundation were told their money was going to help sick kids, more than $500,000 was re-donated to other charities, many of which were connected to Trump family members or interests, including at least four groups that subsequently paid to hold golf tournaments at Trump courses.

All of this seems to defy federal tax rules and state laws that ban self-dealing and misleading donors. It also raises larger questions about the Trump family dynamics and whether Eric and his brother, Don Jr., can be truly independent of their father.

Especially since the person who specifically commanded that the for-profit Trump Organization start billing hundreds of thousands of dollars to the nonprofit Eric Trump Foundation, according to two people directly involved, was none other than the current president of the United States, Donald Trump.