I haven't written about "Healthcare Sharing Ministries" as much as I should have. This is from my only substantive blog post about them 3 years ago:

A health care sharing ministry is an organization that facilitates sharing of health care costs between individual members who have common ethical or religious beliefs in the United States. A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance polices on behalf of its members.

Members of health care sharing ministries are exempt from the individual responsibility requirements of the Patient Protection and Affordable Care Act, often referred to as Obamacare. This means members of health care sharing ministries are not required to have insurance as outlined in the individual mandate.

Earlier today I once again dusted off my ACA Individual Market Rate Change project for the 5th year, as the state of Maryland has issued their preliminary 2020 premium rate filings. With that in mind, I decided to go back and look at my personal projections for average 2019 premiums (from June - October of 2018) and compare them against the actual average 2019 premiums as reported by the Centers for Medicare & Medicaid 2019 Open Enrollment Period Public Use Files.

Bottom line: I was pretty damned close, coming within 2% of the actual average premium in 27 states and within 5% in 42 states. Nationally, I was off by 2.0%, projecting an average monthly premium of $611 vs. the $599 actual average.

The outliers were:

Every year for 4 years running, I've spent the entire spring/summer/early fall painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

The actual work is difficult due to the ever-changing landscape as carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it next to impossible to find the specific data I need.

The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

Back in January, I noted that California Governor Gavin Newsom was proposing a stripped-down version of one of the most important ACA 2.0 provisions I've been pushing for years now: Raising the ACA's APTC subsidy income eligibility cap and beefing up the underlying subsidy formula.

At the time, he was

Well, the latest official revision to the proposed CA 2019 - 2020 state budget has been released, and not only are both the mandate reinstatement and the enhanced subsidies included, the subsidies have actually been increased a bit more than Newsom was originally proposing:

EXPANDED SUBSIDIES TO PROMOTE AFFORDABLE COVERAGE

To improve affordability and access to health care, the Governor's Budget proposed subsidies to help more low and middle class Californians afford health coverage through Covered California.

About three weeks ago I noted that the Nevada state Senate had passed a bill which locks in many of the ACA's patient protections at the state level, just in case the idiotic #TexasFoldEm lawsuit prevails and the ACA is repealed after all.

Yesterday, the Nevada state House followed through as well:

Nevada stands to become the fifth state to fully incorporate the federal Affordable Care Act’s protections for patients with pre-existing conditions into state law after unanimous passage of a bill Tuesday in the state Senate.

"Fully incorporate" isn't quite accurate; as I noted with the Senate version, it looks like the three most important ones are covered (Guaranteed Issue, Community Rating and the ACA's 10 Essential Health Benefits), along with a pre-ACA law letting young adults stay on their parents plan until age 24 (but only if they're unmarried and enrolled in school).

A few days ago I noted that North Dakota had jumped onto the ACA reinsurance train; now it looks like Montana is onboard as well:

Governor Signs Bill Meant to Lower Some Insurance Premiums

HELENA — Gov. Steve Bullock has signed legislation meant to lower premiums for Montana customers who receive health insurance through the Affordable Care Act’s individual marketplace.

Bullock signed the bill Tuesday creating a reinsurance program to help reimburse insurers for high-cost claims so those costs aren’t included in determining individual marketplace premiums for the following year.

U.S. health officials also must approve the plan, which is estimated to offset 2020 premium increases by 10% to 20%.

UPDATE 11/29/19: This horrific and batshit insane Ohio bill is making the news again six month later thanks to a new Guardian article about it.

The only silver lining I can find here is that the bill doesn't appear to have made any further progress in that time--according to the official Ohio Legislature website, so far it's only been "introduced" and "referred to committee", and those happened back in April. The Guardian article has the number of co-sponsors the same as it was in May as well (19, plus the primary sponsor of the bill).

UPDATE: It's been pointed out that the Supreme Court has ruled that minors can't receive the death penalty, so I guess that means "only" life in prison for them. If they're 18 or older, however...

On the other hand, several people have noted that an 11-year old pelvis isn't generally developed enough to even deliver a baby safely, along with other health risks, so it could very well be a death sentence regardless, so I'm leaving the headline as is.

Georgia's "pro-life" Republicans have passed a law that would subject a woman who self-terminates after six weeks to life imprisonment or capital punishment. https://t.co/vbBpfRzIgj @Slate pic.twitter.com/Djqn0LbLf6

— Mark Joseph Stern (@mjs_DC) May 7, 2019

 

IMPORTANT: SUBMIT COMMENTS TO THE OMB REGARDING THIS ATTEMPT TO HURT POOR PEOPLE AT THIS LINK BY MIDNIGHT ON FRIDAY, JUNE 21st.

In the far simpler days of 2001, when the President of the United States didn't suck up to genocidal dictators and thank Russia for helping him win the Electoral College, an episode of The West Wing aired entitled "The Indians in the Lobby".

I was instantly reminded of the scene above* (in reverse) when I read this story by Justin Sink at Bloomberg News:

The Trump administration may alter the way it determines the national poverty threshold, putting Americans living on the margins at risk of losing access to welfare programs.

For years, Michigan, the state which put America on the road, has held the dubious honor of having the highest auto insurance premiums in the nation:

Michigan is the most expensive state for car insurance for the sixth consecutive year.

The Wolverine State is in a league of its own when it comes to car insurance with an average annual premium that is $313 higher than that of Louisiana, which ranked second. A Michigan car insurance policy averages $2,611, which is almost 80 percent higher than the national average of $1,457.

Louisiana remained in second place for the third year in a row, while Florida secured third place. Oklahoma and Washington D.C. rounded out the top five.

In most cases, a high number of uninsured drivers combined with less than stellar weather and high population density led these states onto the most expensive states for car insurance list.

There's several reasons for this, but one stands out above all others:

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