2018 MIDTERM ELECTION

Time: D H M S

A reader forwarded this to me; I ran a search for the organization they referred to and sure enough, it's legit:

Email today from Texas Well and Healthy that might suggest another one of those "we have to craft a uniquely TX solution for a uniquely TX problem because Obamacare sucks" deal. Copy follows...

County Leaders Call for Insurance Solution as Texas Senate Commitee Discusses Alternatives to Medicaid Expansion

Our state leaders may be moving slow on health care, but local leaders are giving them a nudge in the right direction.

Leaders of six of the state's largest counties -- ranging from Harris County's Republican Judge Emmett to Dallas County's Democratic Judge Jenkins -- have joined together to call on the legislature to find a "uniquely Texas solution" to covering uninsured low-wage workers.

The county leaders wrote to the legislature as the Senate Health and Human Services Committee met to discuss Texas alternatives to Medicaid expansion.

Last October, at the height of the botched HC.gov rollout, I repeatedly commented over at Daily Kos:

 I still don't know why they didn't roll it out one state per day; if they'd gone alphabetically, they would have had a solid week to work the kinks out with a (relatively) low volume before hitting a big state:

  • Alabama, Alaska, Arizona and Arkansas are all relatively low-population.
  • California, Colorado, Connecticut and Delaware* are all state-run exchanges.
  • That means they wouldn't have hit Florida on the federal site until tomorrow.

I know that the system still would have had serious software issues, but at least they wouldn't have to deal with the massive overload of traffic at the same time that they were trying to fix the issues.

*(Obviously I was mistaken at the time about Delaware running their own exchange, but it's still a low-population state so my point was still valid...and of course the District of Columbia does run their own exchange).

Well, obviously it was too late for that at the time, and they've since scrambled to get their act together on the individual exchange side.

So, the big news this morning is that the Kaiser Family Foundation has determined that the "benchmark silver plan" premiums in 16 major U.S. cities are expected to drop by 0.8% on average next year. Not a huge number, but the fact that they're dropping at all is astonishing given the "OMG!!! DOUBLE-DIGIT RATE HIKES!!" freakout which have dominated the most recent ACA critical attacks.

Of course, as has already been shown repeatedly, 1) premiums were already going up by 10-11% per year prior to the ACA exchanges launching anyway, and 2) many states have already reported in on their 2015 rates, and for the most part they're going up by...well, not much (and in some cases actually dropping):

Just two weeks ago, Sen. Mark Pryor (D-Ark.) surprised much of the political world with a powerful television ad. Though the conventional wisdom was that Pryor, facing a tough re-election fight, would avoid talking about the Affordable Care Act, but the senator neverthelessdid the opposite, boasting about the benefits he’s delivered for Arkansans through the ACA.
 
...Would Pryor back down? As it turns out, no. MaddowBlog received an exclusive first look at the Pryor campaign’s new campaign ad, which is the second spot in which the Arkansas senator boasts about ACA benefits.

BLAM! The infamous "$700B cut from Medicare!!" lie has been festering since well before the 2012 presidential election. The $700 billion in question refers to savings from cutting waste, fraud and abuse from the Medicare system (this is a good thing, folks).

Kudos to Sen. Pryor for debunking this garbage head on.

Greg Sargent has more:

Me, July 17th, re. Rhode Island's 2015 rate report:

The preliminary rate requests are just that: Preliminary. You can REQUEST anything; that doesn't mean you'll get it.

Me, July 22nd, re. New York's 2015 rate request report:

...as I noted last week, there's a huge difference between what the insurance companies are asking for and what they actually get approved. As noted in the article CNY article:

Last year, insurers requested 9.5 percent increases in premiums for their individual plans, but the state Department of Financial Services, which regulates insurers, approved, on average, only a 4.5 percent increase. 

Well, guess what?

This Just In from Ian Millhiser at Think Progress:

In July, two Republican judges on the United States Court of Appeals for the District of Columbia Circuit handed down a decision defunding much of the Affordable Care Act (ACA). This effort to implement Sen. Ted Cruz’s (R-TX) top policy priority from the bench was withdrawn on Thursday by the DC Circuit, and the case will be reheard by the full court — a panel that will most likely include 13 judges. In practical terms, this means that July’s judgment cutting off subsidies to consumers who buy insurance plans in federally-operated health exchanges is no more. It has ceased to be. It is, in fact, an ex-judgment.

(Bonus points to Millhiser for the Monty Python nod.)

OK, so this means that the case will simply get bumped up to the SCOTUS, right? Well, not necessarily:

If it seems like I keep posting Minnesota's latest every few days, that's because...well, frankly, I am, for two reasons: First, they're updating it every few days (almost odometer-like); and second, MNsure is pretty much the only one posting updates on a regular basis (again, Oregon is now the only one doing so more frequently than once a month).

On the up side, those MN numbers keep increasing at a pretty impressive rate, with another 294 QHPs added and 5,848 more added to Medicaid/CHIP in just the past 6 days:

latest enrollment numbers

September 2, 2014

Health Coverage Type Total Enrollments
Medical Assistance 191,568
MinnesotaCare 69,671
Qualified Health Plan (QHP) 54,354
TOTAL 315,593

For some perspective, this means that Minnesota's total ACA exchange enrollments have gone up over 5.1% in just the past 12 days.

Larry Levitt of the Kaiser Family Foundation tweets:

CMS actuaries are now projecting that health spending will be $529 billion lower in 2019 than they thought four years ago.

— Larry Levitt (@larry_levitt) September 3, 2014

I'm pretty sure this is related to this story:

In a historical aberration, out-of-pocket spending on health care is expected to decrease in 2014, according to a new report from the Centers for Medicare and Medicaid Services, because of expanded insurance coverage under Obamacare.

CMS actuaries, writing in Health Affairs, projected that Americans' out-of-pocket spending would decrease by 0.2 percent. While that's a small drop, it's a big change from the historical trend of steadily increasing out-of-pocket spending. Out-of-pocket spending increased by 3.2 percent in 2013. According to the Kaiser Family Foundation's Larry Levitt, such spending has only decreased in 1967 (Medicare and Medicaid took effect) and in 1994 and 2009 under slowing economies.

(Note: I said Anthem may stink. Then again, maybe they don't. That's kind of the point of this entry)

The following letter to the editor appeared in yesterday's Fresno Bee, supposedly written by a "William Haskel of Fresno, California":

I signed up for Anthem Blue Cross to meet the May deadline. My previous employer also was Anthem Blue Cross, with prescription drug benefits. As I am starting a new business, I chose to go with Covered California through Anthem Blue Cross. The same company, without the drug coverage — or so I thought. Here's what I got:

Cost $845 a month, $5,000 deductible.

Family physician doesn't take the plan.

Wife's gynecologist doesn't take the plan.

Dermatologist doesn't take the plan.

Dentist doesn't take the Covered California dental plan.

So for $10,140 in annual premiums and $5,000 deductible, I am now searching for new doctors for my family.

This Just In...3 out of the 5 insurers operating on the New Mexico ACA exchange are dropping their 2015 premium rates. A fourth is increasing theirs, and the fifth one is new. The overall average is a 1-2% drop, although I can't tell whether that's a weighted or unweighted average (neither the enrollee breakdown nor the actual % change for the individual companies is included in the article):

Individual health insurance premiums in New Mexico will drop by an average of 1 to 2 percent in 2015 for those who buy on the state’s health insurance exchange, New Mexico Superintendent of Insurance John Franchini said Wednesday.

Franchini’s office released the new individual rates from the five insurers that will be selling on the exchange. Three of those insurers – New Mexico Health Connections, Blue Cross and Blue Shield of New Mexico and Molina Healthcare of New Mexico – saw some decreases in their overall rates from this year, said Aaron Ezekiel, head of Affordable Care Implementation for the Office of the Superintendent of Insurance.

Presbyterian Health Plan had some increases, Ezekiel said. CHRISTUS Health Plan is new to the exchange.

Another ancillary benefit of the Affordable Care Act: It's helping influence healthy changes in industries not directly impacted by the law:

As of midnight on Tuesday, all 7,700 CVS locations nationwide will no longer sell tobacco products, fulfilling a pledge the company made in February, as it seeks to reposition itself as a health care destination.

The rebranding even comes with a new name: CVS Health.

The decision to stop selling cigarettes is a strategic move as pharmacies across the country jockey for a piece of the growing health care industry. Rebranding itself as a company focused on health could prove lucrative for the drugstore as it seeks to appeal to medical partners that can help it bridge the gap between customers and their doctors.

The New York Times has an story this morning about the challenges facing the ACA exchanges as they head into Year Two of Open Enrollment. For the most part it's pretty good, but there's one bit of flawed reasoning which caught my eye. I was planning on writing an extensive response, but Xpostfactoid (whom anyone who visits this site regularly should also be reading) beat me to the punch:

No one can or will try to ensure eight million renewals, because a very large proportion of 2014's enrollees -- perhaps half or more -- will not need to renew their coverage. They will be covered by new employers, or new spouses, or newly employed old spouses, or they will lose income and become eligible for Medicaid, or they will go on disability, or die, or, or, or...

Read his whole piece. I'm only posting anything here in the hopes of gaining some exposure for his analysis.

This Just In...

Thanks to Rachana D. Pradhan for the heads up. The HHS Department has just posted a 50-page PDF which lays out the regulations for insurers participating on the 2015 Federal ACA exchange.

I haven't read it yet (it literally went live just moments ago, and a lot of it is likely over my head anyway), but have at it...lemme know if you find anything noteworthy in it:

DEPARTMENT OF HEALTH AND HUMAN SERVICES
45 CFR Parts 146, 147, 148, 155, and 156
[CMS-9941-F]
RIN 0938-AS32
Patient Protection and Affordable Care Act; Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs; Health Insurance Issuer Standards under the Affordable Care Act, Including Standards Related to Exchanges

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule.

(sigh) Here we go again. Over at Forbes, Avik Roy has decided that his contribution to celebrating the labor movement should be to trash the Affordable Care Act again, even though it's based primarily on his old boss's policy in Massachusetts.

There are some areas of his latest which I'm not equipped to address, but there are two points which jump out at me:

First, he brings up 2 surveys from the Federal Reserve Bank of New York about how business owners feel about the impact of the ACA on their expenses and employment.

I should first note that Roy refuses to refer to the healthcare law by anything close to its actual name. He doesn't call it the "Patient Protection & Affordable Care Act". He doesn't call it "the Affordable Care Act". He doesn't even call it "the ACA", which would make the most sense...not even once.

Nope, he refers to it as "Obamacare". Not just in the headline, not just once or twice in the article, but twenty-five times. I counted.

Now, I don't happen to have a problem with the "Obamacare" moniker. I think in the long run the GOP will regret tying the law to Barack Obama's name so closely. But THEY think it's an insult, and keep throwing it around as often as possible.

Thanks to the Kaiser Family Foundation's Larry Levitt, who linked to a PDF from the Florida Health Insurance Advisory Board. This report has data which has made the news twice already: First, because of the 13.2% "weighted average" premium increase for the state (which has come under fire for "weighting" based on projected membership instead of current membership), and secondly because of the exchange QHP enrollment number in June, which is 22.5% lower than the 4/19 total (but which, as I've already shown, isn't nearly as bad as right-wing outlets like the Daily Caller are claiming).

Levitt has noted a third interesting data point in this report:

Two-thirds of those buying their own insurance in Florida are now in ACA-compliant plans. http://t.co/JYVo1UXkvf

— Larry Levitt (@larry_levitt) September 2, 2014

I took a look to see what he's referring to, and it's interesting indeed:

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