2018 MIDTERM ELECTION

Time: D H M S

Pennsylvania is way too easy for me this year; I don't even have to plug numbers into a spreadsheet to figure out the statewide average rate hikes.

Why? Because the state insurance commissioner has already done the math for me...and then some:

Insurance Commissioner Announces Single-Digit Aggregate 2018 Individual and Small Group Market Rate Requests, Confirming Move Toward Stability Unless Congress or the Trump Administration Act to Disrupt Individual Market

Last week Donald Trump's new Assistant Secretary for Planning & Evaluation, Stephen Parente (an avowed and open opponent of Obamacare) issued a hit piece on the ACA just one day ahead of the Congressional Budget Office's devastating report on the GOP's AHCA "replacement" healthcare plan.

The ASPE report made a simple claim: That average individual market premiums have more than doubled since ACA-compliant policies were launched in 2014. It plugged in the average individual market premiums for this year and compared them against the average indy market premiums for 2013 (the last year before all newly-enrolled policies had to be ACA compliant). It only included the 39 states maintained by the federal exchange, HealthCare.Gov, and concluded that on average, monthly premiums had increased from $224 in 2013 to $476 in 2017...a 105% increase over 4 years.

For 2017, North Carolina's unsubsidized, weighted average individual market rate hikes came in at around 24.2%. With carriers like Aetna, United Healthcare, Humana and Celtic all dropping out of the NC exchange market, there wasn't much math to do in order to find a weighted average: The only individual market carriers left were Blue Cross Blue Shield of NC, Cigna and "National Foundation Life Insurance", which is basically a non-entity shell company related to "Freedom Life", the less said about the better. Since Cigna only had around 1,200 indy market enrollees at the time (less than 0.5% of the total market share), that pretty much left BCBSNC as the only game in town, so their 24.3% hike was the whole shebang for the state.

On Tuesday, the HHS Dept., knowing that the CBO score of the passed version of the AHCA was imminent (and that it would likely be devastating), released a report which they hoped would take attention away from the CBO score: A comparison, they said, of how much individual market healthcare policy premiums have increased since the Affordable Care Act regulations were fully implemented. To do this, they compared the average monthly premiums for individual market policies in 2017 against average monthly premiums in 2013...the final year before every newly-enrolled individual market policy had to be fully ACA-compliant.

Their conclusion was that, across the 39 states covered by the federal exchange (HealthCare.Gov), average premiums have more than doubled, from $224/month in 2013 to $476/month in 2017...a 105% increase overall.

(this is Part Two of my analysis of the CBO score of AHCA 2.0 (the version which actually passed the House 3 weeks ago). Part One is here.

OK, digging into the PDF itself, let's see what else there is of interest... (this is a blog post in progress...check back for frequent updates...)

Here's a list of what HASN'T changed from the "1.0" version of the AHCA:

In this cost estimate, as in the preceding estimates, the budgetary effects related to health insurance coverage would stem primarily from the following provisions:

  • Reducing the federal matching rate for adults made eligible for Medicaid by the ACA to equal the rate for other enrollees in the state, beginning in 2020.

Goodbye 90% Federal funding! States would have to pony up anywhere from 25-50% of the funding if they wanted to keep those folks covered.

From Gelf Magazine, January 2, 2009:

The critic blurb is a staple of arts advertising. Yet if you look behind some blurbs, you'll find quotes out of context, quote whores, and other questionable ad practices. Blurb Racket exposes the truth behind critics blurbs in movie ads from the New York Times.

For the second straight year, Gelf is unveiling its favorite blurbs of the year (see our favorites from 2007). Each one exemplifies a deceptive practice that is near the top of the blurb writer's toolbox. Don't like a review? Rearrange it, or cut out the negativity, or change a word entirely. Or even better, find a non-critic associated with a reputable publication who raved, and use that.

Examples from the article (and the version from a year earlier):

 

UPDATE 4:30PM: SCROLL DOWN FOR THE ANALYSIS OF THE CBO SCORE.

Yes, this is it, kids...the Big Day all healthcare wonks have been waiting for: The Congressional Budget Office is releasing their score of the final version of the AHCA (that is to say, the version which was actually voted on and passed by a whisker 3 weeks ago) later on today.

Remember, Paul Ryan and the House GOP insisted on ramming the vote through before the CBO score came out, which means that due to the way Congressional budget rules work, depending on how much the CBO think the final changes to the bill impact the budget, they may have to go back and make more changes which would require another vote in the House...and that's all before it moves onto the Senate, where the GOP Senators have already said they plan on starting from scratch anyway. Fun times!

(title changed to reflect first update below)

The HHS Dept. has issued a new report via the Assistant Secretary for Planning & Evaluation which concludes that...

  • Premiums for individual market coverage have increased significantly since the Affordable Care Act’s key provisions have taken effect, but most estimates have focused on annual increases and have not captured the comprehensive increase in premiums since 2013, and thus do not accurately capture the ACA’s true effect.
  • Comparing the average premiums found in 2013 MLR data and 2017 CMS MIDAS data shows average exchange premiums were 105% higher in the 39 states using Healthcare.gov in 2017 than average individual market premiums in 2013. Average monthly premiums increased from $224 in 2013 to $476 in 2017, and 62% of those states had 2017 exchange premiums at least double the 2013 average.

The big headline, of course, is that according to the ASPE report, individual market premiums more than doubled on average between 2013 (the last year before all newly-enrolled-in healthcare policies had to conform to full ACA regulations) and 2017.

To which I respond: Yes, I'm sure you're correct...and your point is?

via Bob Herman of Axios:

Health Care Service Corp. — the parent company of the Blue Cross and Blue Shield affiliates in Illinois, Montana, New Mexico, Oklahoma and Texas — recorded an $869 million profit in the first quarter of 2017, according to the company's latest financial documents. That was a $1.3 billion turnaround after HCSC lost $442 million in the first quarter of 2016.

How to interpret this: The Affordable Care Act exchanges in some areas are hurting, but overall are not imploding. Many insurance companies continue to do well (like Florida Blue) or are turning things around (like HCSC). And HCSC carries a lot of weight, since it covers nearly 1.1 million people in ACA plans and is the largest Blue Cross and Blue Shield company after Anthem.

Something to consider:

Note: Given the time constraint--today is the deadline for submitting a letter--I've stolen some of the following from Andrew Sprung:

Topher Spiro of the Center for American Progress acquired a letter from Senate Finance Committee Chair Orrin Hatch to healthcare "stakeholders," inviting their input by May 23 on Republican senators' efforts to write an ACA repeal bill. Hatch asked that letters be sent to HealthReform@Finance.Senate.gov.

Since the Republican senators' bill-writing process is as secretive and rushed as the House's, Spiro seized the opportunity to encourage non-privileged "stakeholders" -- all of us -- to send their two cents to the email address provided. He has offered to tweet any letters tweeted at him, with a screenshot.

Here's mine:

Dear Members of the Senate Finance Committee:

via Kayla Tausche of CNBC:

The House of Representatives and Department of Justice plan to ask the DC federal appeals court to keep on hold for another 90 days a lawsuit that questions the legality of cost-sharing subsidies in the Affordable Care Act, according to four people familiar with the matter.

The White House, during that time, will continue to make payments to insurers, according to a senior administration official.

OK, assuming they do indeed ask for this, and assuming the court grants a third 90-day extension, this means that CSR reimbursement payments can continue for another 3 months. That's the good news.

Insurers planning to offer plans on the exchanges in 2018 must submit their pricing in the coming days and weeks.

This is the actual headline of an actual article posted on Breitbart.com right now:

I'm loathe to link to the article itself (I did include one somewhere on this page, feel free to look for it), but a Google search will bring it up. Even more remarkably for Breitbart, much of it is actually pretty darned accurate:

Obamacare will go into a death spiral on May 22 if the Trump administration chooses not to continue fighting in court to preserve cost-premium subsidies that were ruled illegal last year.

On May 12, 2016, U.S. District Court Judge Rosemary M. Collyer ruled House v. Burwell that the Obama Administration’s payment of cost-sharing subsidies without congressional approval was a violation of the Constitution’s Appropriations Clause.

 

About 5 weeks ago I noted that organizations representing pretty much the entire healthcare industry sent urgent letters to Donald Trump, HHS Secretary Tom Price, Treasury Secretary Steven Mnuchin, OMB Director Mick Mulveney and current CMS Administrator Seema Verma...basically, every major healthcare-related administration figure...practically begging them to fund the goddamned Cost Sharing Reduction reimbursements.

They made it crystal clear how vitally important doing this was, and Trump grudgingly went ahead and made the April payment, then later indicated that he was "probably" going to keep reimbursing carriers for the CSR funds legally owed to them on an ongoing basis, at least until the House vs. Price (formerly House vs. Burwell) lawsuit appeal process was completed.

The District of Columbia is the 6th state (OK, it's not a state but it's considered one legislatively for purposes of the ACA) to post their initial 2018 rate filings (h/t to Louise Norris for the heads up). For 2017, the weighted average rate increase for the individual market was a mere 7.3%, highly unusual for this year, while the small group market increase was almost non-existent: Just 0.4% overall.

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