*(Disclaimer: No, that's not a direct quote from Dr. Molina, but it's a pretty damned spot-on paraphrase).
A couple of weeks ago I noted that a buttload of heavy players in the healthcare field sent a joint letter to Trump, Tom Price and everyone else under the sun making it pretty clear how vital resolving the CSR issue is, and what the consequences would be if Congress and Trump don't make good on them.
Today, Molina Healthcare, which has around 1 million ACA exchange enrollees at the moment (roughly 9% of all effectuated enrollees) lowered the boom even harder (via Bob Herman of Axios):
Molina will exit exchanges if ACA payments aren't made
WH to Dems: We’ll continue paying ObamaCare subsidies
The Trump administration has told Democrats it will continue paying controversial ObamaCare insurer subsidies, lowering fears that a fight over the issue could cause a government shutdown.
The move marks something of a shift for President Trump, who had threatened earlier this month to withhold the subsidies, known as cost-sharing reductions, as a way to move Democrats to negotiate on a healthcare overhaul.
"A shift"? He shifts so often he should be in the next Fast & Furious movie.
Rep. Tony Cardenas (D-Calif.), for one, said Wednesday that he doesn’t trust the president enough to take him at his word.
With the future of any other replacement plans uncertain, this month’s survey also gauges who the public views as responsible for the 2010 health care law going forward. A majority (61 percent) of the public say that because President Trump and Republicans in Congress are in control of the government, they are now responsible for any problems with the ACA moving forward. About three in ten Americans (31 percent) say that because President Obama and Democrats in Congress passed the law, they are responsible for any problems with it.
(sigh) Yes, this is the third time I've used the exact same clip from "Dead Again". That's no coincidence; Zombie Trumpcare keeps shuffling back every few weeks, but this time they appear to actually be serious about it (again).
In strategy and substance, the American public disagrees with the course that President Trump and congressional Republicans are pursuing to replace the Affordable Care Act with conservative policies, according to a new Washington Post-ABC News poll.
Large majorities oppose the ideas at the heart of the most recent GOP negotiations to forge a plan that could pass in the House.
...Public sentiment is particularly lopsided in favor of an aspect of the current health-care law that blocks insurers from charging more or denying coverage to customers with medical conditions. Roughly 8 in 10 Democrats, 7 in 10 independents and even a slight majority of Republicans say that should continue to be a national mandate...
A new Kaiser Family Foundation analysis finds that the average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies.
Again, that's an average onf 19% on top of whatever the carriers would otherwise be increasing rates for other reasons.
The feds would have to approve the state's waiver proposal in order to enact the governor's plan, but the feds will only move forward if legislation is already in place. That's the reason for the special session: The governor will ask the legislature to pass laws granting him the authority to seek the waiver and his plan will be spelled out, in broad terms, in legislative language in these laws. Most expect that the governor will be able to get legislative approval relatively easily (he needs a simple majority). Note that some of the fine print will still have to wait for the state's actual waiver proposal and the terms and conditions if the Trump administration grants the waiver.
Here are some of the changes that Hutchinson will be pushing in the special session:
I used to write about Kentucky quite a bit shortly after incoming GOP Governor Matt Bevin made good on his promise to disassemble their beloved and award-winning "kynect" state ACA exchange. I haven't written much about the state since then, however, until now.
Bevin made two major campaign promises while running to replace former Democratic Governor Steve Beshear (who expanded Medicaid and established kynect via executive order): He said he'd kill kynect and get rid of ACA Medicaid expansion. He stuck to his guns on the former, and while it's a damned shame that he did so for a number of reasons (it was working perfectly well, had a high public image and awareness, etc), it didn't cause too much damage, since KY simply shifted to the federal exchange instead (HealthCare.Gov). Enrollment did drop off by over 13% year over year, but a few other states saw similar drops, so the move probably wasn't a major factor.
As I posted yesterday, here's a rough overview of what total Individual Market Enrollment has looked like since 2010, and how Trump's threat to cut-off CSR reimbursements would impact it:
The blue section is off-exchange enrollees...around 7 million people today, all of whom are paying full price. This includes perhaps 1.8 million people still enrolled in Grandfathered or Transitional plans (which are part of a separate risk pool), although that number is highly speculative.
A couple of weeks ago, I crunched the numbers from a major state-by-state study by the Milliman actuarial firm and concluded that the overall individual market was somewhat smaller than I had previously thought, and was likely around 17.7 million people total as of today. The key thing to keep in mind is that the enrollment numbers can fluctuate quite a bit over the course of the year due to the high churn rate and other factors. As a result, the average annual enrollment can be quite different from the snapshot in time total.