Charles Gaba's blog

For weeks now, one of the rallying cries in Congressional and Senatorial Town Halls across the country has been "Care, not Chaos!". There's a whole website about it and everything. There's a bunch of different organizations dedicated to preserving the Affordable Care Act...but some of them are taking a different approach, by reasonably stating that if the GOP is absolutely dead-set on repealing the law, they should at least make sure there's a decent replacement plan ready to go the moment that the ACA is shredded:

Thirty million people will lose their health insurance. Insurance premiums will skyrocket. Hospitals will lose billions. And if the Medicaid program is cut, state and local governments could raise taxes on hardworking families to make up the difference.

We must work together to make healthcare better and more affordable for all. Our healthcare system is far from perfect, but repealing our healthcare without an immediate replacement plan that protects our care will put the health and financial security of millions of Americans at risk.


Via Vox, but also a whole mess of other outlets within the past hour:

In remarks at a press preview of his budget priorities on Monday, President Donald Trump teased the idea that, after working with his team and in consultation with Republican governors, he is nearly ready to unveil his plan to repeal and replace the Affordable Care Act.

“We have come up with a solution that’s really, really, I think very good,” he said, before proceeding to say nothing about what that solution looks like. One issue, according to Trump, is that health insurance policy is difficult. “It’s an unbelievably complex subject, nobody knew that health care could be so complicated.”

Needless to say, this is utter horseshit. Many, many people know just how complicated healthcare policy can be (and yes, I prefer to use the single word "healthcare" as opposed to "health care". Get over it).

However, until around October 2013, I was not one of them.

As I wrote just over a year ago:

So, this headline over at the Washington Examiner caught my eye this morning...

Obamascare: 60% of online Obamacare defenders 'paid to post' hits on critics

A majority of online and social media defenders of Obamacare are professionals who are "paid to post," according to a digital expert.

"Sixty percent of all the posts were made from 100 profiles, posting between the hours of 9 and 5 Pacific Time," said Michael Brown. "They were paid to post."

His shocking analysis was revealed on this weekend's Full Measure with Sharyl Attkisson, broadcast on Sinclair stations and streamed live Sunday at 9:30 a.m. Her upcoming show focuses on information wars and Brown was describing what happened when he had a problem with Obamacare and complained online.

Brown said that social media is used to manipulate opinion, proven in the last presidential election.

OK. First of all, "social media is used to manipulate opinion" isn't exactly a "shocking analysis".


This is sheer brilliance, especially the "thong" metaphor. Trust me; watch all 18 minutes.

The Center for American Progress has apparently sneaked a peek at the CBO's initial analysis of Paul Ryan and the House GOP's replacement plan for the ACA, and it's not pretty:

Last week, the House majority released an outline for repealing the Affordable Care Act, or ACA. Although the document provides no new details, it does provide enough information to evaluate the adequacy of financing, the likely policies needed to pay for new tax credits for health insurance, the likely effects on tax credit levels, and the political hurdles to such an approach. This analysis is based exclusively on numbers from the nonpartisan Congressional Budget Office, or CBO.

Here's CAP's main findings; in short, Ryan's repeal bill would....

When the ACA exchanges were first launched in October 2013, there were roughly 10.6 million people enrolled in pre-ACA individual market policies. These fell into two categories:

  • Those still enrolled in the same policy they had been as of March 2010 (when the ACA was signed into law)
  • Those who enrolled in policies between April 2010 - September 2013

Those in the first category were allowed to hold onto their existing policies for as long as they wished (or at least until they died or their carrier voluntarily chose to discontinue them). These policies were "grandfathered" in pretty much forever.

Pew Research just released another new survey about the Affordable Care Act, and like several other recent ones, the turnaround regarding public opinion on the ACA has shifted dramatically...just in time for it to (supposedly) be repealed (maybe):

Republicans divided on whether GOP leaders should modify health care law or scrap it entirely

As I noted earlier, much of this falls into the category of "You don't know what you've got 'til it's gone". Fully 85% of Democrats and 53% of Independents now "approve" of the ACA, with only 2% and 15% wanting to scrap it. Meanwhile, while Republicans still don't like Obamacare as it stands now much at all (only 10% want to keep it), only 44% of them now want it fully repealed.

Welp (via Politico):

Boehner: Republicans won't repeal and replace Obamacare

Former House Speaker John Boehner predicted on Thursday that a full repeal and replace of Obamacare is “not going to happen.”

Boehner, who retired in 2015 amid unrest among conservatives, said at an Orlando healthcare conference that the idea that a repeal-and-replace plan would blitz through Congress was just “happy talk.”

Instead, he said changes to former President Barack Obama’s signature legislative achievement would likely be relatively modest.

...“I started laughing,” he said. “Republicans never ever agree on health care.”

In the end, “Most of the framework of the Affordable Care Act … that’s going to be there,” he concluded.

Over the past few weeks, a whole bunch of polls have come out showing that support for Obamacare has miraculously shot up substantially now that there's a very strong possibility that it will actually be repealed for real. Obviously there's a lot of "You don't know what you've got 'til it's gone" stuff going on here.

For all the arguing and debate about the benefits and downsides of the ACA, however, there's one major positive which received some attention when it first passed but hasn't been talked about much of late: Rescission.

Rescission, as you may recall, was an ugly little gimmick that insurance companies used to use in order to utterly screw over people who had been paying them premiums for years or even decades. Here's how it would work:

Massachusetts is, in many ways, the birthplace of the Affordable Care Act (Obamacare), which was largely based on "RomneyCare"...the healthcare reform system established by GOP Governor Mitt Romney back in 2006. It is therefore either completely fitting or highly ironic that Massachusetts is also the last state that I've analyzed to figure out just how many people would likely lose healthcare coverage if and when the ACA is indeed fully repealed without a reasonable replacement policy immediately in place.

Nevada's Medicaid expansion data has been tricky to track down; the most recent hard number I had until now was 187,000 people statewide, and that was as of September 2015. According to this January 2017 article in the Las Vegas Review-Journal, however, that number has since grown to around 320,000 Nevadans.

In Nevada, , 89,000 people enrolled in exchange policies as of the end of January. Of these, I estimate around 62,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus the additional 320,000 enrolled in Medicaid expansion, for a total of 382,000 Nevadans kicked to the curb.

The last official ACA Medicaid expansion enrollment number I have recorded for Indiana (via their modified "Healthy Indiana 2.0" program) was 290,000 people way back in July 2015. At the time, the maximum potential HIP 2.0 enrollment total was 680,000 Hoosiers, made up of 350,000 newly covered plus another 330,000 being transferred over from the HIP 1.0 program.

This NPR article from a couple of weeks ago states that as of January, "the Healthy Indiana Plan that he established in 2015 as the state's governor has brought Medicaid coverage to more than 350,000 people." However, that number is a bit confusing given that they were also supposedly transferring the other 330K over from the other program as well. I'm not sure if 350K refers to total HIP 2.0 enrollment or only those who were previously uninsured.

UPDATED 2/19/17 with more recent data (final OE4 exchange enrollment data & February 2017 Medicaid expansion data):

Louisiana just expanded Medicaid via the Affordable Care Act last July, and as of Februay 16th had over 400,000 residents enrolled in the expansion program. All of those people would be kicked right back off of that coverage again if the ACA is repealed. In just 7 1/2 months...

  • 58,713​ Adults have received preventive healthcare or new patient services

In Connecticut111,541 people selected Qualified Health Plans during the 2017 Open Enrollment Period. Of these, 76% are receiving financial assistance; of those, I estimate around 69,000 will actually pay their premiums and receive significant tax credits. In addition, the CT Dept. of Social Services just confirmed 213,000 CT residents enrolled in Medicaid via ACA expansion. That's a total of 282,000 CT residents who would likely lose coverage if the ACA is fully repealed without a reasonable replacement on hand.

For the individual market, my standard methodology applies:

Yesterday was supposed to be a Big Day for Congressional Republicans, as they were set to finally reveal their Master Plan to replace the Affordable Care Act. Speaker of the House Paul Ryan held a press conference about it, and they even released a 19-page "Policy Brief" which purported to explain it to everyone. Hooray! They were hoping that the entire news universe would be singing their praises all day long.

That didn't happen, however, for two reasons. FIrst, because Donald Trump's bizarre, surreal press conference, complete with racist and anti-semetic incidents, pretty much sucked all the oxygen out of the news cycle. The other reason is that their "policy brief" didn't really include much that we hadn't seen before. As Jeffrey Young of the Huffington Post put it:

It was basically the same as what Ryan and the leadership outlined over the summer with “A Better Way” proposal.