Charles Gaba's blog

This Just In from Ian Millhiser at Think Progress:

In July, two Republican judges on the United States Court of Appeals for the District of Columbia Circuit handed down a decision defunding much of the Affordable Care Act (ACA). This effort to implement Sen. Ted Cruz’s (R-TX) top policy priority from the bench was withdrawn on Thursday by the DC Circuit, and the case will be reheard by the full court — a panel that will most likely include 13 judges. In practical terms, this means that July’s judgment cutting off subsidies to consumers who buy insurance plans in federally-operated health exchanges is no more. It has ceased to be. It is, in fact, an ex-judgment.

(Bonus points to Millhiser for the Monty Python nod.)

OK, so this means that the case will simply get bumped up to the SCOTUS, right? Well, not necessarily:

If it seems like I keep posting Minnesota's latest every few days, that's because...well, frankly, I am, for two reasons: First, they're updating it every few days (almost odometer-like); and second, MNsure is pretty much the only one posting updates on a regular basis (again, Oregon is now the only one doing so more frequently than once a month).

On the up side, those MN numbers keep increasing at a pretty impressive rate, with another 294 QHPs added and 5,848 more added to Medicaid/CHIP in just the past 6 days:

latest enrollment numbers

September 2, 2014

Health Coverage Type Total Enrollments
Medical Assistance 191,568
MinnesotaCare 69,671
Qualified Health Plan (QHP) 54,354
TOTAL 315,593

For some perspective, this means that Minnesota's total ACA exchange enrollments have gone up over 5.1% in just the past 12 days.

Larry Levitt of the Kaiser Family Foundation tweets:

CMS actuaries are now projecting that health spending will be $529 billion lower in 2019 than they thought four years ago.

— Larry Levitt (@larry_levitt) September 3, 2014

I'm pretty sure this is related to this story:

In a historical aberration, out-of-pocket spending on health care is expected to decrease in 2014, according to a new report from the Centers for Medicare and Medicaid Services, because of expanded insurance coverage under Obamacare.

CMS actuaries, writing in Health Affairs, projected that Americans' out-of-pocket spending would decrease by 0.2 percent. While that's a small drop, it's a big change from the historical trend of steadily increasing out-of-pocket spending. Out-of-pocket spending increased by 3.2 percent in 2013. According to the Kaiser Family Foundation's Larry Levitt, such spending has only decreased in 1967 (Medicare and Medicaid took effect) and in 1994 and 2009 under slowing economies.

(Note: I said Anthem may stink. Then again, maybe they don't. That's kind of the point of this entry)

The following letter to the editor appeared in yesterday's Fresno Bee, supposedly written by a "William Haskel of Fresno, California":

I signed up for Anthem Blue Cross to meet the May deadline. My previous employer also was Anthem Blue Cross, with prescription drug benefits. As I am starting a new business, I chose to go with Covered California through Anthem Blue Cross. The same company, without the drug coverage — or so I thought. Here's what I got:

Cost $845 a month, $5,000 deductible.

Family physician doesn't take the plan.

Wife's gynecologist doesn't take the plan.

Dermatologist doesn't take the plan.

Dentist doesn't take the Covered California dental plan.

So for $10,140 in annual premiums and $5,000 deductible, I am now searching for new doctors for my family.

This Just In...3 out of the 5 insurers operating on the New Mexico ACA exchange are dropping their 2015 premium rates. A fourth is increasing theirs, and the fifth one is new. The overall average is a 1-2% drop, although I can't tell whether that's a weighted or unweighted average (neither the enrollee breakdown nor the actual % change for the individual companies is included in the article):

Individual health insurance premiums in New Mexico will drop by an average of 1 to 2 percent in 2015 for those who buy on the state’s health insurance exchange, New Mexico Superintendent of Insurance John Franchini said Wednesday.

Franchini’s office released the new individual rates from the five insurers that will be selling on the exchange. Three of those insurers – New Mexico Health Connections, Blue Cross and Blue Shield of New Mexico and Molina Healthcare of New Mexico – saw some decreases in their overall rates from this year, said Aaron Ezekiel, head of Affordable Care Implementation for the Office of the Superintendent of Insurance.

Presbyterian Health Plan had some increases, Ezekiel said. CHRISTUS Health Plan is new to the exchange.

Another ancillary benefit of the Affordable Care Act: It's helping influence healthy changes in industries not directly impacted by the law:

As of midnight on Tuesday, all 7,700 CVS locations nationwide will no longer sell tobacco products, fulfilling a pledge the company made in February, as it seeks to reposition itself as a health care destination.

The rebranding even comes with a new name: CVS Health.

The decision to stop selling cigarettes is a strategic move as pharmacies across the country jockey for a piece of the growing health care industry. Rebranding itself as a company focused on health could prove lucrative for the drugstore as it seeks to appeal to medical partners that can help it bridge the gap between customers and their doctors.

The New York Times has an story this morning about the challenges facing the ACA exchanges as they head into Year Two of Open Enrollment. For the most part it's pretty good, but there's one bit of flawed reasoning which caught my eye. I was planning on writing an extensive response, but Xpostfactoid (whom anyone who visits this site regularly should also be reading) beat me to the punch:

No one can or will try to ensure eight million renewals, because a very large proportion of 2014's enrollees -- perhaps half or more -- will not need to renew their coverage. They will be covered by new employers, or new spouses, or newly employed old spouses, or they will lose income and become eligible for Medicaid, or they will go on disability, or die, or, or, or...

Read his whole piece. I'm only posting anything here in the hopes of gaining some exposure for his analysis.

This Just In...

Thanks to Rachana D. Pradhan for the heads up. The HHS Department has just posted a 50-page PDF which lays out the regulations for insurers participating on the 2015 Federal ACA exchange.

I haven't read it yet (it literally went live just moments ago, and a lot of it is likely over my head anyway), but have at it...lemme know if you find anything noteworthy in it:

DEPARTMENT OF HEALTH AND HUMAN SERVICES
45 CFR Parts 146, 147, 148, 155, and 156
[CMS-9941-F]
RIN 0938-AS32
Patient Protection and Affordable Care Act; Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs; Health Insurance Issuer Standards under the Affordable Care Act, Including Standards Related to Exchanges

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule.

(sigh) Here we go again. Over at Forbes, Avik Roy has decided that his contribution to celebrating the labor movement should be to trash the Affordable Care Act again, even though it's based primarily on his old boss's policy in Massachusetts.

There are some areas of his latest which I'm not equipped to address, but there are two points which jump out at me:

First, he brings up 2 surveys from the Federal Reserve Bank of New York about how business owners feel about the impact of the ACA on their expenses and employment.

I should first note that Roy refuses to refer to the healthcare law by anything close to its actual name. He doesn't call it the "Patient Protection & Affordable Care Act". He doesn't call it "the Affordable Care Act". He doesn't even call it "the ACA", which would make the most sense...not even once.

Nope, he refers to it as "Obamacare". Not just in the headline, not just once or twice in the article, but twenty-five times. I counted.

Now, I don't happen to have a problem with the "Obamacare" moniker. I think in the long run the GOP will regret tying the law to Barack Obama's name so closely. But THEY think it's an insult, and keep throwing it around as often as possible.

Thanks to the Kaiser Family Foundation's Larry Levitt, who linked to a PDF from the Florida Health Insurance Advisory Board. This report has data which has made the news twice already: First, because of the 13.2% "weighted average" premium increase for the state (which has come under fire for "weighting" based on projected membership instead of current membership), and secondly because of the exchange QHP enrollment number in June, which is 22.5% lower than the 4/19 total (but which, as I've already shown, isn't nearly as bad as right-wing outlets like the Daily Caller are claiming).

Levitt has noted a third interesting data point in this report:

Two-thirds of those buying their own insurance in Florida are now in ACA-compliant plans. http://t.co/JYVo1UXkvf

— Larry Levitt (@larry_levitt) September 2, 2014

I took a look to see what he's referring to, and it's interesting indeed:

This piece by Salon's Simon Maloy pretty much nails it on the head:

At this point it’s near-impossible to maintain the fiction that the Affordable Care Act is failing or that the Republicans have a coherent strategy for unmaking it. One by one, Republican-led states are abandoning their opposition to implementing the ACA.

This is obviously an unwelcome trend for groups like Americans for Prosperity, the Koch brothers’ main outlet for political activism.

...Now contrast AFP’s treatment of Pence with how the group reacted to Rick Snyder, the Republican governor of Michigan...AFP Michigan opposed the plan from the get-go.

...So what explains the disparate treatment? It may be that AFP is finally starting to see the writing on the wall and coming to grips with the slow, steady erosion of the Republican anti-Obamacare bulwark. But it could also be the fact that Mike Pence is the Koch brothers’ golden boy.

Several great ACA-related stories were written over the holiday weekend. First up is the NY Times' Austin Frakt, who looks into what sort of impact the addition of more companies onto the ACA exchanges is having on insurance premiums. Spoiler: More competition = lower prices (or at least less of an increase):

As a candidate in 2008, President Obama promised that health reform would reduce family premiums by up to $2,500, equivalent today to about a 15 percent reduction from the 2013 level. Though Mr. Obama might have been including the effects of premium subsidies in his calculation, a key premise of the Affordable Care Act is that competition among health insurers will drive premiums downward. So it’s worth asking: How much savings can additional competition produce?

...recent analysis by the Urban Institute found higher premiums in less competitive markets.

The good news is that markets will be more competitive in many exchangesin 2015, as more insurers offer plans. UnitedHealthcare has announced it will enter as many as 24 markets, for example.

Minnesota continues to quietly crank along...

latest enrollment numbers

August 27, 2014

Health Coverage Type Total Enrollments
Medical Assistance 187,112
MinnesotaCare 68,279
Qualified Health Plan (QHP) 54,060
TOTAL 309,451

For any tech geeks like me out there curious as to how the original HC.gov website mess happened, this gives you an idea of how crazy the project became...

Healthcare.gov faltered last fall in large part because it was built by a crowd of uncoordinated contractors with no one in charge of making sure all the interlocking pieces fit together.

As the White House tries to prevent a repeat catastrophe, government watchdogs are investigating why the Obamacare marketplace failed in the two months after it opened on Oct. 1, 2013. A new report (PDF) details the 60 separate government contracts, awarded to 33 companies, that contributed to building healthcare.gov. The chart above shows how much each contractor was awarded."

Of course, the Obama Administration also sent in an "Apollo 13" emergency tech wizard team to clean up the mess and salvage the project in November, and the rest is history, but it's still important to understand how the federal exchange came so close to failure in the first place...

This. Is. Awesome. News.

A little-known Obamacare tax on health insurance executives' salaries raised $72 million in new revenue last year.

For decades now, the United States has limited the corporation tax deduction for executive pay to $1 million for the company's top four employees. That deduction cap, however, excluded performance bonuses, creating a massive loophole allowing companies to pay their top employees more than $1 million without facing a higher tax burden.

Obamacare quietly changed the rules for health insurance executives. It lowered the cap to $500,000 — and, in that amount, now includes all forms of compensation. The health insurers' regulation also widens the scope of who it hits: while the general deduction cap only applies to the company's top four employees, the Obamacare rule hits any executive earnings more than $500,000.

These new limits kicked in last year. The Institute for Policy Studies ran the numbers and found that this one change resulted in the 10 largest insurers paying an additional $72 million in taxes in 2013.

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