Charles Gaba's blog

2018 MIDTERM ELECTION

Time: D H M S

My apologies. Between a death in the family and some other personal issues, I'm way behind the eight ball this week. As a result, I'm just now getting around to writing about not one, not two, not three, but FOUR major GOP attacks on the ACA and healthcare in general which either happened or had major developments this week.

Instead of getting even further behind by trying to do a full, detailed take on each of them, I'm going to crib like crazy from other healthcare reporters/articles to cover the gist of each.

2: House GOP 2019 budget calls for deep Medicare, Medicaid spending cuts

Big shocker, I know...yeah, that's the actual headline of the Hill article, in which the GOP also proposes simply stripping out all funding for the ACA while they're at it:

Last year, Iowa's already-ugly individual market was rocked further yet by Big Kahuna Wellmark announcing that after finally entering the ACA exchange market in 2017, they were dropping back out again this year, leaving Medica as the only carrier offering ACA-compliant policies throughout the whole state. In response, Medica raised their 2018 ACA rates by a whopping 57% this year. This, in turn, led to the state legislature passing a law which stripped away pretty much any type of restriction or regulation of "Farm Bureau" plans, exacerbating the risk pool problem further yet.

My apologies. Between a death in the family and some other personal issues, I'm way behind the eight ball this week. As a result, I'm just now getting around to writing about not one, not two, not three, but FOUR major GOP attacks on the ACA and healthcare in general which either happened or had major developments this week.

Instead of getting even further behind by trying to do a full, detailed take on each of them, I'm going to crib like crazy from other healthcare reporters/articles to cover the gist of each.

#1: GRAHAM-CASSIDY 2.0 (via ThinkProgress):

Republicans renew attempts to repeal Obamacare

A group of Republicans and Washington D.C. think tanks released a proposal Tuesday that aims to resurrect Obamacare repeal. The consistent chatter around the proposal has drawn ire from the White House and GOP leadership, as the midterms are just months away, and repeal efforts haven’t proved to be winning strategies.

I'm addressing this Open Letter to Florida-based Politico reporter Marc A. Caputo, but the truth is there are hundreds of journalists out there who it could apply to as well. I know parts of it seem like a run-of-the-mill flame war between two people on Twitter, but I think there's a much deeper and more disturbing point here given Caputo's profession and status as a reasonably respected journalist.

Dear Marc:

First, let me say that I've followed your political reporting out of Florida for several years, so I know that you're a skilled, capable journalist.

That actually makes everything else in this letter more disturbing, because it proves that even intelligent, well-educated people can suffer from incredibly dangerous blind spots.

UPDATED 6/22/18: Added Indiana and Iowa to the table.
UPDATED 6/25/18: Added Florida, Kentucky, Ohio and Texas* to the table
*(Texas only has about 1/3 of the total ACA individual market accounted for, so it could easily change)
UPDATED 7/3/18: Added Montana and Georgia to the table
UPDATED 7/13/18: Added Tennessee, updated Texas to add BCBSTX
UPDATED 7/16/18: Added Colorado
UPDATED 7/17/18: Added Nevada
UPDATED 7/19/18: Added California
UPDATED 7/20/18: Added Connecticut

Well this is a nice surprise! Yesterday the Minnesota ACA exchange, MNsure, issued a press release a day ahead of the public posting of requested 2019 individual market insurance rate changes, advising people of the various ways they have to keep their premiums down via ACA tax credits, shopping around and so forth. I was immediately concerned that they might know something I didn't...perhaps they were expecting a batch of double-digit rate hikes as has happened in so many other states the past few years?

Well, today the Minnesota Commerce Dept. did release the preliminary 2019 rate requests, and I'm pleasantly surprised to report that for the second year in a row, Minnesota carriers are actually asking for rate decreases:

NOTE: I originally missed two carriers (McLaren and Molina); thanks to Louise Norris for calling attention to my error. The entire post, along with the table, has been updated to reflect the updated numbers including all 11 carriers.

Also note that while the headline originally reflected what the average rate change would be without the CSR load sabotage factor introduced in 2017, I've decided to be consistent with other states and only include 2018 sabotage impact.

My home state of Michigan just posted their preliminary requested rate changes for the 2019 Open Enrollment Period, and unlike most of the other states which have released their early requests so far, Michigan is a pleasant surprise: An overall average requested premium increase of just 1.7%!

Also noteworthy: According to the filings, eight of the carriers are specifically projecting exactly a 5% mandate repeal factor, which is remarkably consistent (usually the projections are all over the place). HAP is slightly lower (4.4%) while Molina is higher (7.2%). Priority Health didn't mention this at all, but it's safe to assume it'd be roughly 5% for them as well.

So, I just received the following press release from MNsure (Minnesota's ACA exchange)...

Tax Credits Through MNsure Can Help Lower Proposed Premiums for 2019
June 14, 2018

DULUTH, Minn.—Preliminary health insurance rates proposed by Minnesota health insurance companies will be available on the Minnesota Department of Commerce website on Friday, June 15.

Private insurance companies set premium prices, and the Minnesota Department of Commerce regulates those companies. Final, approved 2019 premium rates will be available by October 2, and the 2019 open enrollment period begins on November 1. Minnesotans shopping for health insurance through the individual market may be able to reduce premium costs in three ways:

1. See if you are eligible for tax credits only available through MNsure

Well this is rather unexpected.

Let's fire up the Wayback Machine, Sherman, and go back to 3 years ago, when the Risk Corridor Massacre first reared its ugly head.

The simplest explanation of how Risk Corridors worked is this:

  • The ACA made dramatic changes to how the individual insurance policy market worked.
  • Since it was so disruptive, it included several provisions to help stabilize the market.
  • One of these programs, called "Risk Corridors", was a temporary (3 year) program which acted as sort of an insurance policy for insurance carriers.
  • In a nutshell: Carriers which earned excessive profits on ACA policies had to place a chunk of those profits into a pool of money. Carriers which took excessive losses on ACA policies were supposed to be reimbursed for a chunk of those losses.
  • If the profits exceeded the losses, the government got to keep the difference, so it was theoretically possible they'd actually profit off the system.
  • If, however, the losses exceeded the profits, the government was supposed to pay out the difference.

(As an aside: For those claiming "government bailout! picking winners and losers!" etc etc, the ACA's risk corridor program is actually very similar in many ways to the permanent Medicare Part D risk corridor program, although there are some key differences between the two).

Rick Scott is the Republican Governor of Florida, coming up on the end of his 2nd term in office.

Rick Scott is also running to become the next U.S. Senator from Florida, against incumbent Democrat Bill Nelson.

Prior to being elected Governor of Florida, Rick Scott was the CEO of Columbia/HCA, aka Hospital Corporation of America.

Under Rick Scott's leadership, Columbia/HCA was behind the largest Medicare fraud in history at the time:

Scott started what was first Columbia in 1987, purchasing two El Paso, Texas, hospitals. Over the next decade he would add hundreds of hospitals, surgery centers and home health locations. In 1994, Scott’s Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies.

As usual, Louise Norris has the skinny:

Rate filings were due in New Mexico by June 10, 2018, for insurers that wish to offer individual market plans in 2019. Insurers that offer on-exchange coverage have been instructed by the New Mexico Office of the Superintendent of Insurance (NMOSI) to add the cost of cost-sharing reductions (CSR) only to on-exchange silver plans and the identical versions of those plans offered off-exchange (different silver plans offered only off-exchange will not have the cost of CSR added to their premiums).

Presented without comment:

AHIP Issues Statement Regarding TX v. United States of America

WASHINGTON, D.C. – America’s Health Insurance Plans (AHIP) issued the following statement regarding the latest developments in TX v. United States of America:

“Millions of Americans rely on the individual market for their coverage and care, and they deserve affordable choices that deliver the value they expect. Initial filings for 2019 plans have shown that, while rates are higher due to the zeroing out of the individual mandate penalty, the market is more steady for most consumers than in previous years, with insurance providers stepping in to serve more consumers in more states.

Last Thursday, in my initial alarm-sounding post about the federal #TexasFoldEm lawsuit against the ACA, I used this headline:

ACA about to be torpedoed by a lawsuit even more idiotic than King vs. Burwell???

Law Professor and ACA expert Nicholas Bagley blasted both the case itself and the Dept. of Justice's response in an epic post which also coined the #TexasFoldEm moniker for this travesty:

For those of you just coming to the case, this is from my earlier recap:

In their complaint, the states [including Texas and other red states] point out (rightly) that the Supreme Court upheld the ACA in NFIB v. Sebelius only because the individual mandate was a tax and (rightly) that Congress has now repealed the penalty for going without insurance. As the states see it, the freestanding requirement to get insurance, which is still on the books, is therefore unconstitutional. Because it’s unconstitutional, the courts must invalidate the entire ACA—lock, stock, and barrel.

Welp. The idiotic #TexasFoldEm lawsuit against the ACA...or more specifically, the Trump Administration's decision to lay down and even join the lawsuit against it--appears to be doing even more damage to the U.S. Justice Department than I had thought:

In addition to three nonpartisan Justice Department attorneys withdrawing from the case just minutes before the government's brief in the case was formally filed (presumably in protest of the decision by their boss), a highly-respected senior attorney with the Department has also resigned in protest:

A highly respected career lawyer at the Justice Department has decided to resign just days after the Trump administration backed a controversial lawsuit that would wreck part of the Affordable Care Act.

About 90% of my focus here at ACASignups.net is on the two biggest sections of the ACA: The Individual Market (3-legged stool, exchanges, subsidies, etc.) and Medicaid expansion. I tend not to write much about Medicare, "traditional" Medicaid or the Employer-Sponsored Insurance (ESI) market, which mainly consists of the Large Group Market (companies with 50 employees or more) and the Small Group Market (companies with fewer than 50 employees). As it happens, the ESI market covers nearly half the U.S. population (roughly 155 million Americans, give or take).

Under the ACA, individual market policies have to include the following "Blue Leg" provisions to be considered ACA-compliant:

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