2018 MIDTERM ELECTION

Time: D H M S

Charles Gaba's blog

Over the past few months, my Congressional District Breakdown tables estimating how many people would likely lose healthcare coverage if the ACA were to be "cleanly" repealed (with no replacement) have gotten a lot of attention. This was followed by the Center for American Progress (CAP) running their own estimates of how many would likely lose coverage if, instead of a "clean" repeal of the ACA as a whole, the ACA were to be partially left in place, with the GOP's AHCA (Trumpcare) bill, which dramatically changes the ACA, being signed into law instead.

UPDATE: As I've been warning for months, at least one of Maryland's carriers has openly stated that perhaps 40% of their requested rate hike is due specifically to concerns about the Trump administration & the GOP's ongoing sowing of confusion and outright sabotage of the ACA and the individual market.

Maryland is the 2nd state to post their initial 2018 rate filings.

Last year they had 6 carriers participating in the individual market; this year it looks like all 6 are still planning to participate:

  • CareFirst Blue Choice, Inc​
  • CareFirst of Maryland Inc.
  • Group Hospitalization and Medical Services Inc. (GHMSI)
  • Cigna Health and Life Insurance Co.​​
  • Evergreen Health, Inc.​​
  • Kaiser Foundation Health Plan of the Mid-Atlantic States​​

The initial 2018 filings for four of the six carriers are pretty straightforward. Two of them are a bit tricky, though: Kaiser Permanente and Evergreen Health.

UPDATE: As I've been warning for months, at least one of VA's carriers has openly stated that perhaps 40% of their requested rate hike is due specifically to concerns about the Trump administration & the GOP's ongoing sowing of confusion and outright sabotage of the ACA and the individual market.

A couple of weeks ago I noted that Virginia is one of the first states to post their initial premium rate hike filings. At the time, they hadn't posted the actual filings but at least listed the insurance carriers which were planning on participating in the individual and small group markets next year, both on and off the ACA exchange:

There are so many stories I could be writing right now about the fallout, potential fallout, next steps and so forth of yesterday's House vote on the AHCA. But this one in particular really says it all.

Here's an article in the Buffalo News regarding New York Republican Congressman Chris Collins (NY-27), who voted for the bill:

Watch: Chris Collins admits he didn't read health care bill

WASHINGTON – Rep. Chris Collins told CNN that he didn't read the entire Republican health care bill that the House passed Thursday.

And then he told The Buffalo News that he was unaware of a key provision in the bill that decimates a health plan that serves 635,000 New Yorkers.

Asked by CNN's Wolf Blitzer if he had read the entire health bill, Collins, R-Clarence, said: "I will fully admit, Wolf, that I did not. But I can also assure you my staff did. We have to rely on our staff. ... I'm very comfortable that we have a solution to the disaster called Obamacare."

Welp. I've done everything I can to help stop them, but it looks like the House Republicans have decided to go ahead and vote on their big ol' dumpster fire of a bill after all.

No CBO score. No review. No debate. No transparency. No time for anyone to read the bill. Everything they falsely accused the Democrats of 7-8 years ago (yes, I gave a range of 7-8 years, because there was a solid year of debate, discussion, meetings, arguments and so forth before the final votes were cast).

Maybe they'll pull it off. Maybe they won't. If it passes the House, what'll happen to it in the Senate? Who the hell knows, but the fact remains that anyone who votes for this piece of crap doesn't deserve to hold office any more than the racist, misogynistic, xenophobic con-artist moronic pussy-grabbing asshole who leads their party.

So be it.

Remember this mess in November 2018.

Linda Qui is a NY Times Fact Checker, formerly of PolitiFact. She cited me as a fact-check source twice for PolitiFact: Once in October 2015 and again just before the election last fall (I can't find the link for that one). The first time around it was about Donald Trump's claim that premiums were skyrocketing (again, this was back in 2015, referring to 2016 rates increases). After a phone discussion, here's what I wrote her:

Yes, some people in some plans through some carriers in some states are, indeed, looking at rate hikes of “35 - 50%” if they stick with those plans in 2016. Alaska, Minnesota and Hawaii, for instance, are all looking at 30-40% average hikes, and individual plans (or individual carriers) in a few states are indeed jacking up rates by that much.

However, by my current estimates, here’s the state-by-state breakdown:

Back in January, I wrote a long rant about High Risk Pools. The general thrust was that in theory HRPs aren't necessarily a horrible idea; on paper they can be made to work...assuming the math adds up and they're properly funded on a permanent basis.

However, I also pointed out that due to the very nature of HRPs (i.e., segregating out a small, highly vulnerable group of people from the rest of society), it's incredibly easy for legislators not to properly fund or maintain them, especially after the initial funding comes up for renewal.

Wow. Thanks to Bob Herman of Axios for the heads up:

Molina Healthcare Announces Leadership Changes

CAO Joseph W. White Named Interim CEO and Appointed CFO
Board Initiates Permanent CEO Search

Dale B. Wolf Named Chairman of the Board

Pre-Releases First Quarter 2017 GAAP Net Income Per Share

 

No real analysis here, just some choice tweets from this morning on the latest insanity. I'll likely tack on a few more as the day progresses.

.@SteveScalise says the repeal bill has "layers of protection" for peeps w/pre-existing conditions. That's the new GOP talking point, guys

— Rachael Bade (@rachaelmbade) May 2, 2017

"Layers of protection." As Jeffery Young of the Huffington Post noted...

You always test out new talking points when you're winning. It's a sign of great confidence in the policy and politics of your situation. https://t.co/CTgnppDP01

— Jeffrey Young (@JeffYoung) May 2, 2017

Speaking of having tremendous confidence...

Ryan tells fellow Republicans behind closed doors to pray for the health vote they may be about to take this week.

The latest iteration of the AHCA is supposedly being scheduled for a vote (for real, this time) sometime this week. The pressure is high on both sides, the whip counts are bouncing around, the tension is palpable, etc etc.

The first time around, the biggest tug-of-war was over Medicaid expansion. This time, the major issue seems to be Pre-Existing Condition coverage...and along with it, Guaranteed Issue and Essential Health Benefits; the three have to be pretty much joined at the hip, since removing one effectively makes the other two pointless in practice. It doesn't do most people much good to be told that yes, they'll be covered even if they have cancer if that coverage is gonna cost them $50,000/month.

Anyway, people are furiously scrambling to call their member of Congress and lighting up social media spreading the word...while Donald Trump, MIke Pence and Paul Ryan are running around DC desperately trying to squeak out 216 "Yes" votes from the Republican caucus.

And then, Monday, four amazing things happened.

Regular visitors know that I write an occasional freelance piece for healthinsurance.org. The only problem is that both that site and mine have pretty narrow audiences, comprised mainly of those who are already actively seeking out analysis/opinion about health insurance matters, as opposed to the general public.

I also cross-post my diaries frequently over at Daily Kos, where the ACA Signups project originated, of course.

I'm therefore pleased to announce that this morning I've had my first publication on a non-healthcare or political-oriented website: Cracked.com.

I've attempted to fully explain how absurdly complex the U.S. healthcare system is (and thus why it's so difficult to make major changes to it) in a way which is easy for the average Joe to get (with a few poop jokes thrown in to keep within the Cracked tradition).

Anyway, I'm a long-time fan of Cracked, so I'm pretty geeked about this. Check it out!

CBS News. Face the Nation. This morning:

JOHN DICKERSON: Let me ask you about health care -- Tucker Carlson interviewed you about six weeks ago when you were in the middle of health care negotiations. And you agreed with him that the health care bill wasn't going to help your supporters. That those who lived in rural areas, the older, were going to get hurt by that bill. And you told him--

PRESIDENT DONALD TRUMP: Excuse me, the health care bill is going to help my supporters.

"F*ck anyone who didn't support me, though."

JOHN DICKERSON: Well, hold on. Let me just finish the question, if I may, sir--

PRESIDENT DONALD TRUMP: Otherwise, I'm not going to sign it. I'm not going to do it.

JOHN DICKERSON: Well, this is why I wanted to ask you. You said to Tucker, "We will take care of our people, or I am not signing it." You said you were going to negotiate.

PRESIDENT DONALD TRUMP: Well, that's what I just said.

JOHN DICKERSON: So tell me what in the bill you've been negotiating to get--

PRESIDENT DONALD TRUMP: But let me--

Here's yesterday's press release from Covered California referred to by Dan Mangan of CNBC a little while ago:

New Analysis Shows Potentially Significant Health Care Premium Increases and Drops in Coverage If Federal Policies Change

  • California’s premiums could rise by 28 to 49 percent in 2018, and up to 340,000 consumers could lose individual market coverage if changes are made to existing federal policies.
  • The potential rate increase would mean billions of dollars in additional federal spending. The 1.2 million consumers who do not receive subsidies would bear the entire brunt of these increases.
  • The potential decrease of 340,000 insured consumers would not only represent many individuals losing access to potentially life-saving care, but it would result in a sicker risk mix in the individual market and higher premiums for everyone.

SACRAMENTO, Calif. — A new analysis shows the dramatic consequences facing Californians if federal policies are changed from the current structure and there is no longer direct federal funding of cost-sharing reduction (CSR) reimbursements and the individual shared responsibility payment is not enforced when a consumer chooses not to purchase coverage.

The analysis found that Covered California health plan premiums could rise up to 49 percent if two key elements that have been in place for the past four years are changed: Cost-sharing reduction reimbursements are no longer directly funded as reimbursements to carriers, and the shared individual responsibility payment is not enforced.

 

I noted a week or so ago that according to David Anderson of Balloon Juice, rumor has it that many insurance carriers are making their actuaries work overtime to put together multiple rate filings for 2018 based on several different outlooks:

  • Trump/Price/GOP quit screwing around, officially fund CSR reimbursements, enforce the mandate penalty and generally implement the ACA in good faith.
  • Trump/Price/GOP cut off CSR funding but otherwise enforce the law somewhat reasonably
  • Trump/Price/GOP cut off CSR, don't enforce the mandate, keep mucking around with half-assed repeal/replacement bills
  • (etc, etc...several possible scenarios)

Today the California Insurance Commissioner, Dave Jones, made a formal announcement that this is exactly what CA insurance carriers will be allowed to do, and he isn't pussyfooting around with the reasons for the policy change either:

Ben Sasse is a Republican U.S. Senator from Nebraska. As you might imagine, he's not a fan of the ACA.

About an hour ago, he tweeted the following:

Just heard from small-biz owner--whose plan was cancelled by ObamaCare--that he's been forced into this:
$13k/yr deductible
$15k/yr premium

— Ben Sasse (@BenSasse) April 28, 2017

...which I thought would be the first tweet in a brief thread including some additional details, such as:

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