Charles Gaba's blog

This is sheer insanity.

Russia, if you're listening, I hope you can find the GOP health bill that is missing, you will probably be rewarded mightily by our press

— Dan Diamond (@ddiamond) March 2, 2017

@charles_gaba Geraldo Rivera is on the case #ACAReplacementIsInCaponesVault pic.twitter.com/6YOL0AI1uo

— Brett Krasnov (@brett5355) March 2, 2017

The bill was in our hearts the whole time

— Adam Cancryn (@adamcancryn) March 2, 2017

The plot of literally the most boring National Treasure sequel is playing out in the Capitol right now and I can't believe I'm missing out

— Adam Cancryn (@adamcancryn) March 2, 2017

 

Sometimes the joke just writes itself.

“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”

--― Douglas Adams, The Hitchhiker's Guide to the Galaxy

via Jonathan Chait of New York Magazine:

Over the past month or so, I've been tallying up the number of people who would lose their healthcare coverage if and when the GOP actually does proceed with repealing the Affordable Care Act, breaking the totals out by both County and Congressional District in every state.

While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.

Case in point: As of January 20th,, roughly 706.000 Pennsylvanians were enrolled in ACA Medicaid expansion. As of February 17th that number had increased to over 716,000.

I don't have a county-level breakout of the updated number, but I'm assuming that each county/congressional district has increased roughly proportionately:

Over the past month or so, I've been tallying up the number of people who would lose their healthcare coverage if and when the GOP actually does proceed with repealing the Affordable Care Act, breaking the totals out by both County and Congressional District in every state.

While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.

Case in point: Just two weeks ago, roughly 400.000 Louisianans were enrolled in ACA Medicaid expansion. As of yesterday that number had increased to nearly 406,000.

I'm updating the spreadsheet versions now, but in the meantime, here's the latest county-level breakout:

Over the past month or so, I've been tallying up the number of people who would lose their healthcare coverage if and when the GOP actually does proceed with repealing the Affordable Care Act, breaking the totals out by both County and Congressional District in every state.

While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.

Case in point: As of the beginning of January, roughly 640,000 Michiganders were enrolled in "Healthy Michigan", our name for ACA Medicaid expansion. By the end of January, that number had increased to just over 646,000.

 

For the most part, Republican Michigan Governor Rick Snyder has taken a fairly hands-off approach when it comes to both the Affordable Care Act and Donald Trump. He pushed for both Medicaid expansion and a state-based ACA exchange, but while he managed to get the former through the GOP-controlled state legislature (albeit 3 months late and with a few conservative trimmings), he failed on the latter front, and pretty much shrugged it off after that. Since then, Michigan's implementation of ACA Medicaid expansion has quietly been pretty damned successful, with 646,000 Michiganders (strike that...it's now up to 666,000!) enrolled in the program...over 6.5% of the entire state's population. Beyond that, however, Snyder has been fairly quiet about the ACA overall to my knowledge.

For weeks now, one of the rallying cries in Congressional and Senatorial Town Halls across the country has been "Care, not Chaos!". There's a whole website about it and everything. There's a bunch of different organizations dedicated to preserving the Affordable Care Act...but some of them are taking a different approach, by reasonably stating that if the GOP is absolutely dead-set on repealing the law, they should at least make sure there's a decent replacement plan ready to go the moment that the ACA is shredded:

Thirty million people will lose their health insurance. Insurance premiums will skyrocket. Hospitals will lose billions. And if the Medicaid program is cut, state and local governments could raise taxes on hardworking families to make up the difference.

We must work together to make healthcare better and more affordable for all. Our healthcare system is far from perfect, but repealing our healthcare without an immediate replacement plan that protects our care will put the health and financial security of millions of Americans at risk.

 

Via Vox, but also a whole mess of other outlets within the past hour:

In remarks at a press preview of his budget priorities on Monday, President Donald Trump teased the idea that, after working with his team and in consultation with Republican governors, he is nearly ready to unveil his plan to repeal and replace the Affordable Care Act.

“We have come up with a solution that’s really, really, I think very good,” he said, before proceeding to say nothing about what that solution looks like. One issue, according to Trump, is that health insurance policy is difficult. “It’s an unbelievably complex subject, nobody knew that health care could be so complicated.”

Needless to say, this is utter horseshit. Many, many people know just how complicated healthcare policy can be (and yes, I prefer to use the single word "healthcare" as opposed to "health care". Get over it).

However, until around October 2013, I was not one of them.

As I wrote just over a year ago:

So, this headline over at the Washington Examiner caught my eye this morning...

Obamascare: 60% of online Obamacare defenders 'paid to post' hits on critics

A majority of online and social media defenders of Obamacare are professionals who are "paid to post," according to a digital expert.

"Sixty percent of all the posts were made from 100 profiles, posting between the hours of 9 and 5 Pacific Time," said Michael Brown. "They were paid to post."

His shocking analysis was revealed on this weekend's Full Measure with Sharyl Attkisson, broadcast on Sinclair stations and streamed live Sunday at 9:30 a.m. Her upcoming show focuses on information wars and Brown was describing what happened when he had a problem with Obamacare and complained online.

Brown said that social media is used to manipulate opinion, proven in the last presidential election.

OK. First of all, "social media is used to manipulate opinion" isn't exactly a "shocking analysis".

 

This is sheer brilliance, especially the "thong" metaphor. Trust me; watch all 18 minutes.

The Center for American Progress has apparently sneaked a peek at the CBO's initial analysis of Paul Ryan and the House GOP's replacement plan for the ACA, and it's not pretty:

Last week, the House majority released an outline for repealing the Affordable Care Act, or ACA. Although the document provides no new details, it does provide enough information to evaluate the adequacy of financing, the likely policies needed to pay for new tax credits for health insurance, the likely effects on tax credit levels, and the political hurdles to such an approach. This analysis is based exclusively on numbers from the nonpartisan Congressional Budget Office, or CBO.

Here's CAP's main findings; in short, Ryan's repeal bill would....

When the ACA exchanges were first launched in October 2013, there were roughly 10.6 million people enrolled in pre-ACA individual market policies. These fell into two categories:

  • Those still enrolled in the same policy they had been as of March 2010 (when the ACA was signed into law)
  • Those who enrolled in policies between April 2010 - September 2013

Those in the first category were allowed to hold onto their existing policies for as long as they wished (or at least until they died or their carrier voluntarily chose to discontinue them). These policies were "grandfathered" in pretty much forever.

Pew Research just released another new survey about the Affordable Care Act, and like several other recent ones, the turnaround regarding public opinion on the ACA has shifted dramatically...just in time for it to (supposedly) be repealed (maybe):

Republicans divided on whether GOP leaders should modify health care law or scrap it entirely

As I noted earlier, much of this falls into the category of "You don't know what you've got 'til it's gone". Fully 85% of Democrats and 53% of Independents now "approve" of the ACA, with only 2% and 15% wanting to scrap it. Meanwhile, while Republicans still don't like Obamacare as it stands now much at all (only 10% want to keep it), only 44% of them now want it fully repealed.

Welp (via Politico):

Boehner: Republicans won't repeal and replace Obamacare

Former House Speaker John Boehner predicted on Thursday that a full repeal and replace of Obamacare is “not going to happen.”

Boehner, who retired in 2015 amid unrest among conservatives, said at an Orlando healthcare conference that the idea that a repeal-and-replace plan would blitz through Congress was just “happy talk.”

Instead, he said changes to former President Barack Obama’s signature legislative achievement would likely be relatively modest.

...“I started laughing,” he said. “Republicans never ever agree on health care.”

In the end, “Most of the framework of the Affordable Care Act … that’s going to be there,” he concluded.

Over the past few weeks, a whole bunch of polls have come out showing that support for Obamacare has miraculously shot up substantially now that there's a very strong possibility that it will actually be repealed for real. Obviously there's a lot of "You don't know what you've got 'til it's gone" stuff going on here.

For all the arguing and debate about the benefits and downsides of the ACA, however, there's one major positive which received some attention when it first passed but hasn't been talked about much of late: Rescission.

Rescission, as you may recall, was an ugly little gimmick that insurance companies used to use in order to utterly screw over people who had been paying them premiums for years or even decades. Here's how it would work:

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