Charles Gaba's blog

Graphic credit to @MikeEMort

So, earlier today, as I've been hyping for several weeks now, I participated in a healthcare panel at Netroots Nation with five other healthcare activists: Laura Packard, Elena Hung, Matt Cortland, Dr. Sanjeev Sriram (aka "Dr. America") and German Parodi. It was even livestreamed via Facebook (you can watch the replay here, and you can download a full PDF version of the slideshow).

For the most part it went pretty well--we had a pretty full house and only went a bit over time, which is pretty impressive given that we were trying to cram about 10 hours' worth of wonky data about three different healthcare policies and a federal lawsuit into a single hour. The feedback I received from both those in attendance as well as comments on Twitter and Facebook from people who watched the livestream seemed extremely positive.

However, there was one incident which marred the event, and it was my fault.

The Minnesota Commerce Dept. just posted their preliminary 2020 Individual and Small Group rate changes. The actual rate changes are pretty straightforward...a mere 1.6% average rate increase on the ACA Individual Market, and a 5.5% increase on the Small Group market.

Unfortunately, the actual effectuated enrollment for each carrier (which I use to calculate the weighted average) was provided in either the MN Commece website post or even in the currently-available raw SERFF rate filing forms, so I had to put together estimates based on last year's market share numbers, modified for 2019 based on the on-exchange portion of the total enrollment for the Indy market (for the small group market I just went with the straight 2018 shares).

OK, it feels a bit surreal to post about California's 2020 ACA premiums--and especially mentioning the fact that they're reinstating the ACA individual mandate penalty at the state level--on the very same day that the entire ACA itself is on the brink of complete oblivion (again), due specifically TO the fact that Congressional Republicans repealed the federal mandate penalty..

And yet, here we are:

California’s Initiatives Will Lead to Hundreds of Thousands Gaining Health Care Coverage With Lower Premiums and New Financial Help

In March 2019, Linda J. Blumberg, Matthew Buettgens, John Holahan and Clare Wang Pan of the Urban Institute ran a detailed analysis to determine what the impact on healthcare coverage would be in every state if the Texas vs. U.S. lawsuit (aka Texas vs. Azar or #TexasFoldEm) caused the Patient Protection & Affordable Care Act (ACA) to be repealed with immediate effect.

They also attempted to calculate how much federal funding every state would lose each year if the ACA were to be repealed. Nationally, they concluded that the U.S uninsured rate would increase by nearly 20 million people, while the 50 states (+DC) would collectively lose out on nearly $135 billion in federal funding.

A few months back I posted a request for folks to vote for a healthcare panel I was hoping to be included at this summer's Netroots Nation conference in Philadelphia.

I'm happy to report that our panel did indeed make the final cut, and will be happening this Friday, July 12th:

FIX THE DAMN HEALTHCARE: SORTING OUT ACA 2.0, MFA, MED4AM AND MORE!

  • Friday, Jul. 12 4:30 PM, Room: 118C

The healthcare landscape is confusing and exciting in 2019. Reining in Big Pharma, strengthening the ACA, adding public options, “Medicare for America” or “Medicare for All”… the alphabet soup of plans can be confusing. Can improvements be implemented before 2021 at the federal level or is it all up to the states? And what about the latest lawsuit looming over everything? We’ll go beyond the slogans and into the details: How are the proposals similar and different, and what do patients, caregivers and other invested parties think.

Over the past few years I've had a somewhat contentious relationship with some die-hard single payer/"Medicare for All" activists over the feasibility, logistical practicality, fiscal and political realities and so forth of transitioning to a "pure" universal single payer healthcare system versus other healthcare expansion/improvement measures.

However, I've also developed great relationships with a few M4All activists, including friendships.

With that in mind, I wanted to share with you the story of Rebecca Wood and her adorable daughter Charlie. I've had the opportunity to meet Rebecca twice and Charlie once so far, and they're both remarkable people.

This Just In from the Delaware Insurance Dept...

Dover, DE -- Highmark Blue Cross Blue Shield of Delaware (Highmark BCBS) has submitted its required annual rate filing to the Delaware Department of Insurance. After years of substantial increases, Delaware’s Marketplace has stabilized and premiums have decreased. Highmark BCBS, the only insurer continuing to offer insurance coverage in Delaware’s individual market, has proposed a 5.8% decrease for 2020. The proposed 2020 rate decrease will affect over 20,000 Delawareans.

The decrease comes after last year’s 3% rate increase and the Department’s decision to silver load. By applying the rate increase to silver level plans only, a practice known as ‘silver-loading,’ Delaware’s Marketplace received more federal subsidies, helping to assist in stabilizing the market and lowering premiums.

via University of Michigan Law Professor and all-around mensch Nicholas Bagley (this is all via Twitter...I've reformatted to clean it up a bit):

The Justice Department has filed its supplemental brief with the Fifth Circuit. In it, the Department clarifies that a case or controversy still exists because, "critically," the government "continues to enforce the ACA."

The Justice Department nonetheless thinks that neither the House of Representatives nor the blue states have standing. And if the Fifth Circuit dismisses the appeal, the Department says that O'Connor's opinion should *not* be vacated.

Significantly, the Justice Department now says that it will continue to enforce the ACA "pending a final judicial determination of the constitutionality of the individual mandate as well as the severability of the ACA's other provisions."

Huh. This is an interesting development...

Republican attorneys general suing to strike down the Affordable Care Act asked the 5th U.S. Circuit Court of Appeals to delay oral arguments in the case, which are set to take place on July 9.

The Republican states said they need more time to file a supplemental brief on whether the U.S. House of Representatives and the Democratic states that are defending the landmark healthcare law have standing to intervene in the case and if not, what that means for the appeal. The Republican attorneys general asked to extend the July 3 deadline to file the brief by 20 days and reschedule oral arguments for after that date.

...The Democratic states and the House urged the court to deny the request, arguing that moving ahead with the case would reduce uncertainty in the healthcare sector.

...except that the court has already responded with a big, fat bucket of Nope:

via the Washington Informer:

D.C. residents are among tens of thousands of Americans left uninsured by a health insurance scam that collected more than $100 million in premiums for junk plans.

A special enrollment period from now through Aug. 30, via the DC Health Benefits Exchange Authority, has been earmarked for residents who bought the junk plans from a Florida-based operation that was recently shut down by a federal court.

This Just In from the Indiana Insurance Dept...

INDIANA 2020 ACA FILINGS

The overall average rate increase for 2020 Indiana individual marketplace plans is 9.0%. CareSource and Celtic (MHS/Ambetter) have filed to participate in the 2020 Indiana Individual Marketplace. The Department of Insurance anticipates that all 92 counties in Indiana will be covered by both CareSource and Celtic (MHS/Ambetter).

Anthem has filed to offer a 2020 Off-Marketplace plan in Indiana. This plan is a catastrophic plan and is offered only in Benton, Jasper, Newton, Warren and White Counties.

Filing a rate does not guarantee it will be approved for use on the Marketplace, nor does the filed rate guarantee to be the final rate. Therefore, the Department of Insurance is not able to ascertain the amount of any final rates at this time. The state has until September 24, 2019 to review and submit dispositions to U.S. Department of Health and Human Services.

This Just In from the Montana Insurance Commissioner's office:

2020 Rate Filings and Rate Review

Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Montana State Auditor’s Department of Insurance for review and before plans can be sold to consumers.

What is rate review?

The rate review process, established by the Montana Legislature in 2013, does not give the Commissioner the authority to disapprove rates or prevent them from taking affect. It does give the commissioner the chance to review the factors insurance companies use in setting rates.

If the commissioner finds a rate increase to be excessive or unjustified, the insurer can voluntarily lower the rate increase. If the insurer decides to use the rate anyway, the commissioner will issue a public finding announcing that the rate is unjustified.

What does the department consider?

This Just In from the Kentucky Insurance Commissioner's office:

Proposed Insurance Rates Submitted to DOI for Review

Rates Subject to Review

Frankfort, Ky. (June 25, 2019) – Insurance Carriers have submitted proposed rates to the Department of Insurance (DOI) for Kentucky’s 2020 individual and small group markets. Anthem Health Plans of Kentucky, Inc. (Anthem) filed requests for 13 different plans to be offered on the Exchange with a proposed average rate increase of 12%. CareSource Kentucky Co. requested an average rate decrease of 4.5% for 12 different plans to be offered on the Exchange. This decrease follows the 19.4% rate increase approved last year for the 12 plans it offered. The submitted rates are subject to review by the Department.

After some last-minute drama in one state and a surprising lack of drama in another, both New Jersey and Pennsylvania have officially passed bills allowing them to each establish their own ACA exchanges and enrollment platforms, splitting off from the federal exchange and HealthCare.Gov:

New Jersey:

New Jersey Gov. Phil Murphy signed into law a bill establishing a state-based health care marketplace.

Murphy signed the legislation on Friday in a private ceremony.

Under current law, New Jersey uses a federal exchange, or marketplace, letting people shop for and enroll in coverage under the Affordable Care Act.

With all the fuss & bother being made over whether Democratic Presidential candidates support or don't support eliminating private insurance in favor of a universal, fully-mandatory "Medicare for All" single-payer healthcare system (especially after the first official debates over the past couple of days), I decided to attempt to put together a comprehensive table listing which healthcare expansion/overhaul bills each of the candidates actually support or oppose.

This may sound like a simple question: Senators Booker, Gillibrand, Harris, Sanders (obviously) and Warren are all cosponsors of Bernie Sanders' "Medicare for All" bill, S.1129, while Representatives Gabbard, Ryand and Swalwell have cosponsored the House version (H.R.1384). Pretty cut 'n dry, right?

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