Time: D H M S

*(OK, much of it is already here, actually)

Former CMS representative and current healthcare policy advisor for Sen. Brian Schatz, Aisling McDonough, made an important point last night:

If you have a pre-existing condition and live in a rural area, especially in VA, TN, OH, IN, MO, IA, or NV, then I'm worried there might not be a plan available for you next year.

(I pulled those states from this KFF brief: https://t.co/WgCWO16wOa)

— Aisling McDonough (@AislingMcDL) March 12, 2018

People should be worried about bare ACA counties in 2019 b/c of GOP sabotage.

Between mandate repeal, short-term plans, health ministries, farm bureaus, etc, the guaranteed $ for the lone ACA insurer is getting smaller. It's not the same calculus as it was in 2017 & 2018.

— Aisling McDonough (@AislingMcDL) March 12, 2018

h/t to Annette Prentice for the heads up on this. Via Michigan Public Radio:

State Senate introduces bill to add work requirements to Medicaid

The bill would require able-bodied adults to work or be in school for 30 hours a week in order to receive Medicaid.

Some lawmakers in Lansing want people to work to get Medicaid. The Senate introduced a bill Thursday. It would add work requirements to the Medical Assistance Program, or Medicaid.

...If passed, able-bodied adults would be required to work or continue school for 30 hours per week as a condition of receiving medical assistance.

There’s a similar bill in the state House. It’s been waiting for a committee hearing since December.

Opponents say there shouldn’t be more restrictions on health care – which they say is a human right.

In a way I guess this was the next "logical" step (via Jesse Cross-Call of CBPP):

Alabama, which has refused to expand Medicaid for low-income adults under the Affordable Care Act (ACA), is now proposing to make work a condition of Medicaid eligibility for very low-income parents, stating that it wants to encourage work. Its proposal, however, actually would penalize work: because Alabama hasn’t expanded its program, those who comply with the new requirements by working more hours or finding a job will raise their income above the state’s stringent Medicaid income limits, thereby losing their Medicaid coverage and likely becoming uninsured.

Five weeks ago, when Idaho Governor "Butch" Otter announced that Idaho had decided to basically just blow off federal law altogether and start offering non-ACA compliant health insurance policies on the individual market alongside the compliant versions, I wrote:

To be honest, I'm not entirely sure I understand why Idaho would do this. Yes, of course the deep red state government opposes the ACA in general and sure, they want to "lower premiums" on the individual market, but Trump's recent "ShortAss Plan" executive order would do pretty much the same thing (allowing non-ACA compliant off-exchange "Short Term/Association Plans" which amount to the same thing...without putting GOP Gov. Butch Otter's fingerprints all over the ugly stories which would soon follow if/when people started actually enrolling in these types of policies. Besides, as much as Idaho claims to hate the ACA, they seem to be quite proud (and rightly so) of their own state-based ACA exchange, Your Health Idaho.

Well, it sounds like CMS Administrator Seema Verma was thinking along the same lines, because this unexpected story broke a few hours ago: Verma sent a letter to Otter and his state Insurance Commissioner shooting down their "state-based plans" idea as being flat-out illegal.


(sigh) They. Will. Never. Let. It. Go. Via Kimberly Leonard of the Washington Examiner:

Top Republican looks to codify move to short-term healthcare plans

Sen. John Barrasso, R-Wyo., introduced legislation Wednesday that would let more people enroll in short-term health insurance plans, an idea that builds off a Trump administration proposal issued last month.

The Improving Choices in Health Care Coverage Act would allow people to stay on less expensive, short-term medical plans for as long as 364 days and allow them to renew for subsequent years.

Yes, that's right: "Improving Choices in Health Care Coverage Act", or ICHCCA. I'm going with #IckyJunkPlan instead, it rolls off the tongue better.

In other words, this would codify Donald Trump's executive order into federal law. It might even trump (no pun intended) state laws against #ShortAssPlans, although perhaps not.

Today, Covered California issued a new study about the projected impact of Donald Trump and Congressional Republican efforts to undermine and sabotage the Affordable Care Act not just in 2019, but over the next 3 years. They main focus is on two sabotage moves which have already happened (repeal of the individual mandate and the shortened/underfunded marketing of the open enrollment period on the federal exchange) and one which is on the verge of happening (Trump's "Short Term and Association Plan" executive order, aka #ShortAssPlans).

Here's what they concluded:

*(except people who are actually sick, that is) --h/t Anne Paulson

I've written a lot about Idaho's decision to simply ignore ACA regulations by allowing non-ACA compliant healthcare policies which would destabilize the individual healthcare market even worse than it already is today.

A couple of weeks ago, University of Michigan law professor and ACA expert Nicholas Bagley explained how the bigger danger here is that if this move is allowed to stand, it won't be limited to just Idaho:

But it would be a mistake to ignore what Idaho is up to. If the Trump administration doesn’t intervene, other red states will surely follow in its footsteps. The result will be widespread disregard of the law and the rise of state-to-state inequalities in the private market similar to those that already exist in Medicaid.

Every day I'm overwhelmed with so many important healthcare policy stories that I don't have time to do a full write-up on them all. Usually I just skip past most, but once in awhile I like to do quick posts on a bunch at a time.

STAT News: One of many problems with short-term insurance plans: Consumers can’t understand them

Most people try to avoid reading their health insurance policies — that’s what employers and insurance agents are for. Anyone who plans to buy short-term health insurance, though, will need to read the policy carefully.

The Trump administration recently announced plans to allow consumers to buy short-term health insurance plans that last for up to a year. They are currently capped at 90 days.

Thanks to Twitter follower "@tweetmix" for bringing this to my attention.

Back in late January, I noted that while the ACA's Shared Responsibility Penalty (aka the Individual Mandate) was repealed by Congressional Republicans back in December, ithe repeal doesn't actually go into effect until spring 2020 (for lacking coverage in 2019). For 2017 and 2018, it's still on the books...and the IRS has stated point-blank that they will be rejecting tax returns that don't include a statement of ACA-compliant coverage. This, I noted, is going to piss off a whole bunch of confused people who are under the assumption tthat the mandate penalty has already been repealed. My suspicions were confirmed by last week's Kaiser Family Foundation survey, which found that sure enough, at least 21% of the country incorrectly thinks that they don't have to pay a fine for not having compliant coverage this year.

In a move which should surprise exactly no one, Congressional Republicans are attempting to defund Planned Parenthood AGAIN:

House Republicans are demanding a series of controversial abortion and health care policies in the annual health spending bill, setting up a showdown with Democrats and threatening passage of an omnibus spending package to keep the government open.

Democrats are vowing to block the slew of long-sought conservative priorities. The riders would cut off federal funding to Planned Parenthood, eliminate a federal family planning program and ax the Teen Pregnancy Prevention Program, according to sources on Capitol Hill. Republicans also want to insert a new prohibition on funding research that uses human fetal tissue obtained after an abortion.

Nearly three years ago, there was a big report about a bunch of Republican Governors of states which hadn't expanded Medicaid under the Affordable Care Act who claimed that they were willing to do so, but only if a work requirement was part of the deal:

In nearly a dozen Republican-dominated states, either the governor or conservative legislators are seeking to add work requirements to Obamacare Medicaid expansion, much like an earlier generation pushed for welfare to work.

The move presents a politically acceptable way for conservative states to accept the billions of federal dollars available under Obamacare, bringing health care coverage to millions of low-income people. But to the Obama administration, a work requirement is a non-starter, an unacceptable ideological shift in the 50-year-old Medicaid program and a break with the Affordable Care Act’s mission of expanding health care coverage to all Americans. The Health and Human Services Department has rejected all requests by states to tie Medicaid to work.


Yesterday the House Democrats laid out a completely rational, reasonable, responsible list of serious improvements to the Affordable Care Act.

Today, the Trump White House responded with...this hot mess of pig vomit:

The White House is seeking a package of conservative policy concessions — some of which are certain to antagonize Democrats — in return for backing a legislative package bolstering Obamacare markets, according to a document obtained by POLITICO.

The document indicates the administration will support congressional efforts to prop up the wobbly marketplaces, in exchange for significantly expanding short-term health plans and loosening other insurance regulations.

Washington State Insurance Commissioner Mike Kreidler has decided to shut down Donald Trump's #ShortAssPlans executive order before it starts infecting the Evergreen State (yes, that's their official nickname...I looked it up):

Kreidler announces intention to being rulemaking on short-term medical plans

March 6, 2018

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler announced his intention today to begin rule-making to create protections for Washington consumers who buy short-term medical plans. He is taking this action in response to the recent rules the Trump administration proposed to increase the duration of short-term medical plans from 90 days to up to 364 days.

In a statement last week, Kreidler shared his concerns about short-term medical plans:

I don't write much about Rhode Island outside of the actual Open Enrollment Period each year, and I almost never write about the ACA's "SHOP" (Small Business Health Options Program...which should really be labelled SB-HOP) these days (the program has never enrolled more than perhaps 200,000 people nationally at most)...but both the state and the program could use a little love, so what the heck:

HealthSource RI for Employers enrolls its 700th small business

RUMFORD, RI (March 6, 2018) – HealthSource RI for Employers today announced it has hit a major milestone. The health insurance marketplace for small employers has now enrolled its 700th small business. These 700 local businesses reflect over 5,200 Rhode Islanders.


With the 2018 Open Enrollment Period coming up just 5 days from now, it's time to put this to bed: After 6 months of painstaking research and analysis, I've compiled a comprehensive analysis of the weighted average rate changes for unsubsidized ACA-compliant individual market policies in 2018, including both the on- and off-exchange markets. It's already been confirmed by a different analysis by healthcare consulting firm Avalere Health, which used a completely different methodology to arrive at the exact same conclusion: The national average increase is between 29-30%, ranging from as low as a 22% average premium drop in Alaska (thanks to their successful reinsurance program) to as high as a painful 58% increase in Virginia.