Charles Gaba's blog

With the idiotic #TexasFoldEm lawsuit coming up for oral arguments in just two weeks and the midterms in just ten, Senate Republicans appear to be in a bit of a panic over how to deal with the massive negative fallout if they win their court case (technically it was brought by 20 GOP attorneys general, not the Senators themselves, but they've spent the past 8 years trying to accomplish the same goal).

As a quick reminder: The #TexasFoldEm case uses the World's Flimsiest Excuse to try and eliminate the Affordable Care Act's critical health insurance coverage protections for the 130 million Americans who have pre-existing conditions.

In response, Republican Senators Tillis, Alexander, Grassley, Ernst, Murkowski, Cassidy, Wicker, Graham, Heller and Barrasso have introduced a new bill which they claim would ensure pre-existing coverage protections. Unfortunately, it...doesn't.

Busy day today! State insurance regulators around the country appear to have decided to start posting approved 2019 ACA rate filings all at once; within the past week, Vermont, Ohio, Delaware and North Carolina have posted theirs...and now you can add Georgia to the list:

The Obamacare rates for next year are in, and it’s a first: Rates are going down.

Following years of steep price hikes, two of the four companies that offer plans on the Affordable Care Act exchange in Georgia, also known as Obamacare, have proposed to lower their rates next year from what they charged in 2018.

According to figures for the individual insurance market released Thursday by the state Department of Insurance, Blue Cross Blue Shield of Georgia is proposing a tiny decrease in premiums for next year, with 2019 premium prices that are on average 0.3 percent lower than 2018’s premiums. Alliant Health Plans is decreasing its premiums by 10 percent.

North Carolina has three insurance carriers offering individual market policies next year: Blue Cross Blue Shield, which holds a whopping 96% of the individual market; Cigna, which holds the remaining 4%, and newcomer Ambetter (aka Centene).

I ran a write-up on BCBSNC's preliminary 2019 rate request at the end of July. While they're lowering their 2019 premiums by 4.1%, they also made it very clear that yes, they'd be lowering rates even further if not for the ACA's individual mandate penalty being repealed:

BLUE CROSS NC FILES TO LOWER ACA RATES BY AVERAGE OF 4.1 PERCENT

Durham, N.C. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced today it requested an overall average rate decrease of 4.1 percent for 2019 Affordable Care Act (ACA) plans offered to individuals. The reduction marks the first rate decrease in the history of Blue Cross NC since entering the current individual market more than 25 years ago.

...Many factors went into the Blue Cross NC’s rate filing:

It's been a year and a half since my last exclusive piece for healthinsurance.org, but I'm back, baby!

In my latest story for them, I explain that while the "ACA Sabotage!" card which Democrats have been playing against the GOP all year is very much real, it's also harder to explain to people in light of seemingly modest premium rate changes for 2019.

To understand both the reality and the difficulty in conveying it, read on!

As I noted back in June, the Ohio Insurance Dept. doesn't seem to like providing a whole lot of detail about their insurance rate filings on their website; at the time, they only stated the following regarding the preliminary 2019 individual market rate filings:

In 2018, 8 companies sold health insurance products on the exchange in Ohio and 42 counties had just one insurer with an additional 20 counties having only two.

For 2019, 10 companies have filed rates and forms for the Department to review and all 88 counties will have at least one insurer. Preliminary filings show 16 counties with just one insurer and 33 counties with two.

Huh. This is very odd. Delaware has only a single insurance carrier, Highmark, participating in the individual market next year. They requested an average 2019 rate increase of 13%.

Not only was 13% the amount on the filing form itself, it's also the average increase requested according to the summary at RateReview.HealthCare.Gov:

CMS Administrator Seema Verma is difficult to get a read on. On the one hand, she glories in trashing the ACA every chance she gets while happily endorsing nearly every effort to undermine or sabotage it, including repeal of the individual mandate, slashing the marketing and outreach budgets and so forth. Last year she was even busted trying to (effectively) blackmail the insurance carriers at large by offering to push through CSR reimbursement payment in return for them supporting the GOP's Obamacare repeal bill.

At the same time, she--like Trump's first HHS Secretary, Tom Price--also seems to have a soft spot for one particular type of ACA improvement program: Reinsurance.

 

via Elana Schor of Politico, a week or so ago:

Kavanaugh confirmation hearings set for Sept. 4

Supreme Court nominee Brett Kavanaugh's Senate confirmation hearings will start on Sept. 4 and last between three and four days, Judiciary Chairman Chuck Grassley (R-Iowa) announced on Friday.

That scheduling tees up the GOP to meet its goal of getting President Donald Trump's pick seated on the high court by the time its term begins in early October, barring unforeseen obstacles or a breakthrough by Democrats who are pushing to derail Kavanaugh's confirmation.

The Supreme Court battle so far has focused on documents related to Kavanaugh's five years in the George W. Bush White House. Democrats have excoriated the GOP for declining to seek records from the nominee's time as Bush's staff secretary and condemned the Republican decision to rely on a Bush-driven review process for the early round of vetting, while the majority party hails the vast scope of documents that are set for release.

Golf Cart on blocks

Dear Secretary Azar:

I read with great interest your Op-Ed piece in yesterday's Washington Post extolling the virtues of "Short-Term, Limited Duration" plans and how awesome it is that the Trump Administration is hoping to flood the individual health insurance market with them. I figured you might appreciate a bit of fact-checking.

Obamacare forgot about you. But Trump didn’t.

For all the discussion of Obamacare since its passage, it is too rarely known that the law effectively split the United States’ individual insurance market in two.

Yes and no. What split the market in two was the fact that premiums have increased faster than expected. Those earning more than 400% of the Federal Poverty Level (FPL)--around $48,000/year for a single adult or $98,000/year for a family of four--don't qualify for financial assistance and have to pay full price.

 

Note: Much of this entry is a repeat of yesterday's, but I felt it was worth a separate entry.

This metaphor will take a bit, but bear with me.

On March 16, 1981, CBS aired the 17th episode of Season 9 of M*A*S*H. For those of you too young to remember, M*A*S*H, set at a U.S. Army medical camp in Korea during the Korean War, was one of the most successful TV shows in history, running 11 seasons. I believe the series finale remains the most highly-viewed broadcast in history. While M*A*S*H started out primarily as a sitcom, it evolved over the years into more of a drama with comedic moments.

Anyway, in S9 Ep17, "Bless You, Hawkeye", the main character, Dr. Benjamin Franklin "Hawkeye" Pierce (played by Alan Alda) finds himself stricken with a sudden, unexplained and violent allergic reaction to something. He spends much of the episode trying standard medical solutions, but his fits of sneezing and coughing become so bad that eventually a recurring character, psychiatrist Dr. Sydney Freedman, is brought in to see if there might be a psychological cause.

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