OK, this probably won't be the most exciting Congressional hearing in the world, but it's a pretty important one both historically and for practical purposes. Any major healthcare reform bill will have to first be run through the Congressional Budget Office's scoring process...and before the CBO can do that, they first have to lay out the ground rules, which they did earlier this month.
Anyway, you can watch the hearings above; here's the details...which are pretty simple: Three CBO wonks will be testifying and questioned.
Key Design Components and Considerations for Establishing a Single-Payer Health Care System
WARNING: I can not emphasize enough just how many assumptions I'm making here. I could be ABSURDLY off at either end of the scale; the actual cost could turn out to be half as much as I project here...or twice as much. This is purely a crude, early attempt to game out the basic framework for determining the actual cost, and there's a lot of missing data, which means having to make some pretty big assumptions about the current situation, much less projecting things forward.
Had a great time discussing #MedicareForAll opposite @charles_gaba on Medicare for America for Ferndale Dems. Happy to report no one was called a neoliberal or a Bernie bro.
Your Health Idaho, the only red state standalone ACA exchange in operation since Kentucky's kynect exchange was shuttered a few years back, doesn't post updates very often, but when they do there's usually a few noteworthy items. Back in March they held a semi-annual board meeting which included a few items:
8. OPEN ENROLLMENT 2019 UPDATE
Mr. Kelly said YHI’s effectuations as of the end of January are just over 101,000 and prelim February results at 98,700. There were significant enrollment shifts between the carriers specifically with SelectHealth gaining membership due to a low-price position. Modest growth continues for the dental carriers overall with significant growth for Delta Dental. Strong seasonality is seen in effectuation trends in January and February. And as expected, the average premium is just under $500 which was anticipated with the rate increase of about 5 percent.
NY State of Health Releases 2019 Open Enrollment Report
Essential Plan and Qualified Health Plan Enrollment Reach Record Levels
ALBANY, N.Y. (May 9, 2019)—NY State of Health, the state’s official health plan Marketplace, today released detailed demographic data on the more than 4.7 million New Yorkers enrolled in comprehensive health coverage through the close of the sixth open enrollment period on January 31, 2019. Marketplace enrollment is now at its highest point ever, and Essential Plan and Qualified Health Plan enrollment reached record levels of more than 1 million people.
“It’s evident in the numbers released today that there is high demand for quality, affordable health coverage,” said NY State of Health Executive Director, Donna Frescatore. “The 2019 record enrollment levels are proof that New York’s Marketplace remains strong.”
NY State of Health 2019 Open Enrollment Report Highlights
I didn't write about this yesterday because I was both swamped and a little confused about how the various bills were being packaged and voted on, but I think I have it straightened out now.
Back on March 26th, the House Democrats formally rolled outH.R. 1884. The official title of this bill is the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019", or PPECMHCMAA, which is terrible, so I've simply shorthanded it as "ACA 2.0".
HR 1884 is actually more of a catch-all collection of a dozen or so smaller, standalone ACA improvement bills, each of which either repairs an ACA provision which has been damaged or sabotaged in the past; protects an existing ACA provision from future sabotage; or strengthens & enhances the ACA going forward.
In early 2018, Maryland state legislators introduced a bill which included a twist on the coverage mandate penalty--those who failed to sign up had another option: They could either pay the penalty or they could choose to have the penalty amount be used to automatically enroll them in the lowest-cost insurance policy available. If they qualified for ACA subsidies, those would even be baked into the equation as well. This was a clever way of softening the blow, while also increasing enrollment and helping out the ACA risk pool.
Over the past year or so I've written numerous entries about Michigan Republicans pushing through an ineffective, inefficient, cruel and pointless work requirement addition to Michigan's implementation of Medicaid expansion under the Affordable Care Act, culminating in this one:
New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.
Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.
That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.
Long-time readers of this site may remember that I have a "special place" in my heart (more like in the pit of my stomach) for Ralph Hudgens, the now-former Georgia state Insurance Commissioner, ever since I read about this ugly incident way back in 2013:
“Let me tell you what we’re doing (about ObamaCare),” Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month: “Everything in our power to be an obstructionist.”
After pausing to let applause roll over him, a grinning Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.
Salem, OR—Oregon consumers can get a first look at requested rates for 2020 individual and small group health insurance plans.
In the individual market, seven companies submitted rate change requests ranging from an average 3.2 percent decrease to an average 13.5 percent increase, for an average of 3.3 percent. In the small group market, nine companies submitted rate change requests ranging from an average 0.3 percent decrease to an average 13.1 percent increase, for an average of 8.7 percent.See the chart for the full list of rate change requests.
“It’s early in the process, but we are encouraged to see carriers providing more options to Oregonians by expanding into both rural and coastal communities, and the market stabilizing in spite of uncertainty at the federal level,” said Insurance Commissioner Andrew Stolfi. “Now it is time to start our open and thorough review process that allows Oregonians to provide input on the filings that affect them.”
Last year, the two insurance carriers offering individual market policies in Vermont, BCBS and MVP, originally requested rate increases averaging 7.5% and 10.9% respectively, or a weighted average of 8.6%. These were eventually whittled down to 5.8% and 6.6% respectively, for a weighted average increase of 6.1% in 2019.
It's important to keep in mind that Vermont is one of only two states (the other is Massachusetts) which merges their Individual and Small Group risk pools into one.
Two states in two days...just 24 hours after the Washington State Insurance Commissioner pulled the plug on the "Aliera Healthcare" and "Trinity Healthshare" healthcare sharing ministries for fraud, the New Hampshire Insurance Dept. is issuing a similar warning (although they don't appear to be actually shutting the operation down just yet):
Consumer Alert on Potential Unlicensed Health Insurance Company
CONCORD, NH – As a result of a recent Georgia court order, the New Hampshire Insurance Department is advising consumers that Aliera, a company that markets itself as a health care sharing ministry, may be operating illegally in New Hampshire.
A health care sharing ministry is an organization that facilitates sharing of health care costs between individual members who have common ethical or religious beliefs in the United States. A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance polices on behalf of its members.
Members of health care sharing ministries are exempt from the individual responsibility requirements of the Patient Protection and Affordable Care Act, often referred to as Obamacare. This means members of health care sharing ministries are not required to have insurance as outlined in the individual mandate.
Bottom line: I was pretty damned close, coming within 2% of the actual average premium in 27 states and within 5% in 42 states. Nationally, I was off by 2.0%, projecting an average monthly premium of $611 vs. the $599 actual average.
Every year for 4 years running, I've spent the entire spring/summer/early fall painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.
The actual work is difficult due to the ever-changing landscape as carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it next to impossible to find the specific data I need.
The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:
