2018 MIDTERM ELECTION

Time: D H M S

In case you needed more evidence that Donald Trump doesn't give a rat's ass about actual policy as long as it means people lavish praise on him at any given moment:

Washington (CNN)President Donald Trump told Republican senators lunching at the White House Tuesday the House-passed health care reform bill he celebrated earlier this year was "mean," a source told CNN.

Trump made clear multiple times that he was pleased that the Senate negotiations appeared to be moving away from where the House version of the repeal and replace effort ended up, according to three sources familiar with the meeting.

Trump told the lawmakers that the House bill didn't go far enough in protecting individuals in the marketplace -- and appeared to use that as his rationale for why he has ambiguously called twice for the Senate to "add more money" to the bill.

...But the comment belies the celebratory Rose Garden ceremony Trump hosted earlier this year when the House passed the bill and the President championed it as "incredibly well crafted."

Normally I don't post my Rate Hike Project analysis for a state until I have rate filing data available for all (or nearly all) of the individual market enrollees on hand.

I'm making an exception in the case of Michigan, however, because a) it's my home state, and b) My wife, son and I happen to be enrolled in an ACA exchange policy ourselves, via Blue Care Network (the HMO division of Blue Cross Blue Shield of Michigan).

Unfortunately, as of today (6/13) only one carrier has submitted their 2018 rate filing for the ACA-compliant individual market...and it's BCBSMI itself. That is, the PPO division of Blue Cross, not the HMO division.

Every summer for the past few years, the CMS division of the HHS Dept. has released a quarterly report stating how many ACA exchange enrollees are still enrolled in effectuated policies as of March 31st of that year.

The precise wording of this is important, because (as Republicans and other ACA detractors have been shouting about since day one), just because someone signus up for a healthcare policy doesn't mean that they actually pay their first month's premium to be enrolled...and even if they do, some of them will then drop their policy a few months later for any number of reasons (new job with benefits, moving to a different state, turning 65 and moving to Medicare, falling on hard times and qualifying for Medicaid or, in some cases...dying).

The first year of ACA Open Enrollment, running from 10/1/13 - 3/31/14, was a bit of a mess, due not only to the technical meltdown at launch but also the whole system being brand-new to everyone on the individual market. A full six months was given for the enrollment period, and even then there was so much pent-up demand at the end of March that an extra 2 weeks was tacked onto the end, for a total Open Enrollment period of 197 days.

via Caitlin Owens, Axios (limiting the quote to fair use levels is tricky since the article itself is so short anyway):

Senate GOP won't release draft health care bill

Senate Republicans are on track to finish writing their draft health care bill this evening, but have no plans to publicly release the bill, according to two senior Senate GOP aides.

"We aren't stupid," said one of the aides. One issue is that Senate Republicans plan to keep talking about it after the draft is done: "We are still in discussions about what will be in the final product so it is premature to release any draft absent further member conversations and consensus."

...Democratic senators are already slamming Republicans for the secrecy of their bill writing process, and this isn't going to help. Republicans are sure to release the bill at some point, but it's unclear when — and they want to vote on it in the next three weeks, before the July 4 recess.

"We aren't stupid."

Laura Packard is a friend of mine. We first met about 10 years ago at a state convention in Detroit. She's an all-around awesome person, and one of the most accomplished people I know. Here's just a sampling:

I'm a partner at PowerThru Consulting, a growing national progressive digital consulting shop. At PowerThru we help nonprofits and Democratic campaigns use technology to spread their message and organize and activate their supporters online, to create change offline. We have staff in several states, and work with non-profits of all kinds and on progressive state and federal issues, campaigns and elections of all kinds. We've won four Reed awards and three Pollies for our work to date (including Best Congressional Website in both, Best State/Local Organization Website, Best County/Local/Judicial Website).

I'm a regular contributor to Campaigns & Elections magazine, Huffington Post, and Epolitics.

As I've written about more times than I can remember, for all the very real and highly damaging GOP sabotage of the ACA over the years, there are some problems which were, quite frankly, inherent in the law as passed itself. This should be no great revelation, since it is a major piece of legislation which impacts nearly 1/5th of the entire economy is always going to have some problems to deal with, just as the 1.0 version of any piece of software will always have to have updates and patches applied. If this wasn't the case, there wouldn't be any amendments to the U.S. Constitution (not even the 2nd, so beloved by the GOP).

In any event, one of the biggest flaws with the ACA itself is that the formula and rules for individual market tax credit eligibility are, quite simply, too stingy. They only apply to those falling within 100-400% of the Federal Poverty Level (roughly $12,000 - $48,000 for a single adult, or $24,000 - $96,000 for a family of 4), Within that income range, subsidies drop off on a sliding scale, based on what percentage of household income the benchmark Silver policy costs. Here's the official chart:

This is rather amazing, really. With all the dramatic twists and turns that the Trumpcare/AHCA debacle has taken in the 3 months since it was slapped together by Paul Ryan & Co., you'd think that there would be some movement of the approval numbers, wouldn't you?

Well, technically there has been: It went from 17% approval in March to 21% approval in May...

...and as of last week, had dropped right back down again to the same 17% it started out with:

American voters disapprove 62 - 17 percent of the Republican health care plan, compared to a 57 - 20 percent disapproval in a May 25 Quinnipiac University poll. Today, Republicans approve of the health care plan 42 - 25 percent, as every other listed party, gender, education, age or racial group disapproves by wide margins. 

(sigh) OK, this is getting very confusing now.

The good news for me out of Maine is that they've released the filings for all three individual market carriers for 2018 (Aetna has around 1,000 enrollees but they're leaving the individual market entirely), and all three include the exact number of current enrollees, making the average rate hike request simple enough on the surface: 21.2% for Anthem, 39.7% for Harvard Pilgrim (HPHC) and 19.6% for Maine Community Health Options (one of the few remaining ACA-created CO-OPs*), for a weighted average unsubsidized increase request of 25.2%.

*UPDATE: My mistake! I accidentally confused MCHO with Evergreen Heatlh of Maryland, which is in the process of converting itself from a Co-Op into a private carrier! Thanks to Louise Norris for the catch!

UPDATE: Some people are crediting me with creating the "3-legged stool" metaphor, which simply isn't the case; that credit goes to (I believe) MIT Economics Professor Jonathan Gruber, who came up with the metaphor back in 2006 while helping develop Mitt Romney's "RomneyCare" model for Massachusetts, which was the basis for the ACA's exchange model for the individual insurance market.

I'm simply expanding on the metaphor to explain some of the terms and concepts which are swirling around these days during the repeal/replace brouhaha.

This just in from the Washington State insurance commissioner's office...

Eleven health insurers file for 2018 individual market in 37 counties, leaving two with no coverage
Kreidler: Trump administration’s actions fuel insurers’ uncertainty, harm consumers

Eleven health insurers have filed 71 plans for Washington state’s 2018 individual health insurance market:

  • Six insurers inside the Exchange, Washington Healthplanfinder.
  • Eight insurers outside the Exchange.
  • Two insurers selling both inside and outside the Exchange.
  • Currently, no insurer has filed plans in two counties – Klickitat and Grays Harbor.

Two insurers, Community Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, announced earlier this year that they will not participate in the 2018 individual health insurance market.

Thanks to Bill Hammond of the Empire Center for the heads up.

Like Pennsylvania, the New York Dept. of Financial Services made it very easy for me this year:

This chart sets forth the average premium rate adjustments that health insurers have requested from the New York State Department of Financial Services (DFS). There are 16 insurers that have submitted individual rates and 20 insurers that have submitted small group rates for 2018. These are the rates insurers have requested and are not the final premium rates DFS will approve. Under the Insurance Law, the Superintendent may deny or modify the requested rates if she finds that the insurer's request is unreasonable, excessive, discriminatory or inadequate based on sound actuarial assumptions and methods (Insurance Law §§ 3231(e)(1), 4308(c)). From the date DFS posts insurer rate applications on the DFS website, the public will have 30 days to submit comments to DFS on the proposed rates. The total percentage requested rate increase for individual and for small group on the chart below represent a weighted average that accounts for the relative share of overall enrollment for each insurer.

So, I got back from my trip to the NIHCM awards dinner in DC late last night, and am groggily attempting to bone up on all the healthcare stuff which happened while I was gone (ironic, of course, given that I was attending a healthcare-related event filled with other healthcare wonks/reporters).

In the past 2 days...

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA).

It's early June now, so I checked in once more, and the numbers have continued to grow. I have the direct links for 5 states now (including New Hampshire)...

Between updating the "Who could lose coverage" graphics, prepping for my town hall thing last night and updating the 2018 Rate Hike project, I've gotten way behind on my "Who's saying 'screw rate hikes, I'm just gonna bail completely next year' updates. Let's take care of that now, OK? The first three updates are courtesy of Louise Norris writing for healthinsurance.org; the fourth is vai Kimberly Leonard for the Washington Examiner:

IDAHO: BridgeSpan is out, 4 carriers staying put:

Insurers in Idaho had to submit forms for 2018 plans by May 15, but they have until June 2 to file rates. Mountain Health CO-OP, SelectHealth, PacificSource and Blue Cross of Idaho all filed forms to continue to offer Your Health Idaho plans in 2018.

I've been warning for months now that the Trump administration is doing everything possible to disrupt, undermine and otherwise sabotage the ACA exchanges as much as possible. Yes, the GOP in general has been doing so for 7 years now, but they've really shifted it into overdrive now that they hold all the cards.

In the past, some of those sabotage efforts were obvious and had a direct impact on the exchanges (the Risk Corridor Massacre, for instance) while others were smaller, less obvious and harder to pinpoint a precise cause/effect relationship (red states attempting to obstruct ACA navigators, for example). Donald Trump and his rogue's gallery of cretins are not exactly known for their subtlety, however, so his obstruction/sabotage efforts have been pretty blatant, including:

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