START OF 2018 OPEN ENROLLMENT PERIOD

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At this point, the Trump Administration's ongoing efforts to sabotage the Affordable Care Act in general and this fall's Open Enrollment Period in particular are so offensive and ham-handed they should be dating Miss Piggy.

Trump administration abruptly drops out of Obamacare events in Mississippi
“It’s clearly sabotage.”

For the past three years, the US Health and Human Services Department has partnered with a health advocacy group in Mississippi on an education tour before Obamacare enrollment started. They would meet around the states with groups that sign people up for coverage — state officials, health centers, insurance brokers, and the like — to prepare for open enrollment.

Up until Monday, Roy Mitchell, executive director of the Mississippi Health Advocacy Program, thought these events were going forward in the coming weeks as planned. He had even asked HHS just last week for biographies of the officials they’d be sending.

Me, 8 days ago:

More to the point, however: What other significance does not including CSR funding have?

...That means that even if there's a last minute change to the bill, at this point, CSR payments are virtually certain not be guaranteed next year.

...I wouldn't be at all surprised to see more 11th-hour drop-outs next week. Donald Trump and the Republican Party's open sabotage of the ACA will likely bear even more fruit.

Today, literally 11 hours before the contract signing deadline:

Anthem leaving Maine ACA marketplace, citing uncertainty

Anthem Blue Cross Blue Shield has withdrawn nearly all of its offerings from Maine’s Affordable Care Act health insurance marketplace, and the insurer is citing market uncertainty and volatility as the reasons.

Presented with minimal comment:

Individual Segment Findings

There's no denying the Individual health insurance market has endured its fair share of challenges. In order for this segment to be sustainable there must be adequate membership and a balanced risk pool, slow growth in healthcare spending while maintaining quality of care and enough health insurer participation and plan offerings to bolster consumer choice. The volatility of the Affordable Care Act's (ACAs) exchange program forced many insurers to significantly raise premiums to make up for financial losses due to imbalanced risk pools, or withdraw from the exchanges altogether. In 2016, insurance premiums exceeded medical care costs for many insurers; however, segment profitability was still elusive to most plans. MFA's assessment of mid-year 2017 profitability for the Individual market indicates improved overall results.

HE'S OUT. SEE UPDATE AT BOTTOM.

So this morning I read this story at Politico by Dan Diamond and Rachana Pardhan:

Price’s private-jet travels included visits with colleagues, lunch with son

Health and Human Services Secretary Tom Price took a government-funded private jet in August to get to St. Simons Island, an exclusive Georgia resort where he and his wife own land, a day and a half before he addressed a group of local doctors at a medical conference that he and his wife have long attended.

The St. Simons Island trip was one of two taxpayer-funded flights on private jets in which Price traveled to places where he owns property, and paired official visits with meetings with longtime colleagues and family members. On June 6, HHS chartered a jet to fly Price to Nashville, Tennessee, where he owns a condominium and where his son resides. Price toured a medicine dispensary and spoke to a local health summit organized by a longtime friend. He also had lunch with his son, an HHS official confirmed.

...and the immediate fallout as summarized below...

I've spent the past two weeks posting about almost nothing besides the Graham-Cassidy debacle, so haven't had a chance to keep on top of the approved 2018 rate changes as I usually do. Fortunately, Louise Norris of healthinsurance.org has stayed on the rate hike job, and reports the final numbers out of Washington State:

2018 rates: 24% approved rate increase, due in large part to federal uncertainty — and higher backup rates will be implemented if CSR funding is cut mid-year

Insurers in Washington had to file rates and plans for 2018 by June 7, 2017. On June 8, Kreidler’s office published a summary of what had been filed (rate filings are available here, and that page will show final rate changes for the individual market once they’re approved), and publicized the filing details on June 19. The average proposed rate increase in Washington, before any subsidies are applied, was 22.3 percent.

Back in August it looked as though Florida carriers were looking at either 15.5% unsubsidized rate increases on the individual market if CSR reimbursement payments were guaranteed next year, or around 35.5% if they weren't. Well, the official rates have been released by the Florida Dept. of Insurance, and it's even uglier than that for unsubsidized enrollees:

Office Announces Submission of Proposed Rates for 2018 Federal PPACA Health Insurance Plans

 

As you've probably heard fby now, Mitch McConnell has formally/officially pulled the latest incarnation of Trumpcare, aka "Graham-Cassidy" (or "Graham-Cassidy-Heller-Johnson" for those who love hyphens) from being voted on this week before the September 30th reconciliation deadline:

Republican leaders have decided not to vote on Obamacare repeal legislation this week, effectively ending the party’s latest effort to wipe away the 2010 health care law.

When, and whether, they will try again remains to be seen. But for now, a defining cause of the Republican Party, including President Donald Trump, lies in tatters.

And at least for the moment, insurance coverage for many millions of Americans who rely on Medicaid or the Affordable Care Act’s federal subsidies remains intact ― although insurance markets in some states remain unstable, and the Trump administration’s willingness to manage the program remains unclear.

(sigh) When I last checked in on Virginia, things were looking up a bit (relatively speaking), as Anthem Blue Cross Blue Shield (aka "HealthKeepers") had announced that they were jumping back into the state in order to cover the 60-odd counties which would otherwise be left bare by Optima Health Insurance dropping out of half the state a week or so earlier.

Unfortunately, while this did resolve the "bare county" problem for VA, it didn't resolve the other big problem: Major rate hikes for unsubsidized individual market enrollees:

As many see their options for health plans dwindle down to one insurer, premiums are simultaneously set to rise by an average of 57.7 percent next year in Virginia’s individual marketplace.

The increase is “unquestionably the highest we’ve ever seen,” David Shea, health actuary with Virginia’s Bureau of Insurance, told lawmakers Monday.

Yesterday was a Graham-Cassidy (or "Grassidy", as former CMS Administrator Andy Slavitt keeps trying to push) Fest, with all sorts of Grassidy-centric happenings, including the one-and-only Senate hearing on the bill; the Congressional Budget Office releasing their preliminary/partial score of G-C (the prior version, not the later version); Senator Susan Collins releasing her statement opposing the bill; and last night's CNN healthcare debate between Senators Graham & Cassidy vs. Senators Sanders and Klobucher. I might write something about these items later today, but right now I want to look at another development.

Last week I broke the story (later picked up by Axios, NY Magazine and Vox.com) that the Graham-Cassidy bill would make thousands of current insurance policies illegal starting on January 1, 2018...just 98 days from now.

Why? Because, as noted at the link, while the current ACA structure (exchanges, tax credits, etc) would stay mostly in place for 2 more years, some provisions would be repealed immediately...including a nationwide ban on any exchange policy offering abortion coverage.

This morning JP Massar (who called my attention to the 1/1/18 effective date the first time) inquired as to whether that had changed with the new version of G-C. As you can see on pages 2 & 3 of the new bill...nope. It’s still in place.

 

Late Sunday night, Axios managed to get ahold of a copy of the revised version of the Graham-Cassidy bill...and it's a complete and utter travesty.

Here's direct links to the bill itself and to the GOP's table showing what they claim would be the net federal funding changes from 2020-2026 for each state relative to current law...but they pulled one hell of a fast one.

Here's the original table...

 

it's pretty rare for the entire medical, hospital and insurance industry to agree on just about anything...and yet here we are (emphasis in the original):

The following statement was jointly released on September 23, 2017 by the American Medical Association, American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, America's Health Insurance Plans and the BlueCross BlueShield Association regarding the Graham-Cassidy-Heller-Johnson legislation.

We represent the nation's doctors, hospitals and health plans. Collectively, our organizations include hundreds of thousands of individual physicians, thousands of hospitals, and hundreds of health plans that serve tens of millions of American patients, consumers and employers every day across the United States.

Anyone who's followed me either here at ACASignups.net or over at Twitter over the past eight months knows that no one has been sounding the alarm louder or more frequently than me about both the real and potential sabotage of the ACA being carried out (or at least attempted) by the GOP in general and Donald Trump/Tom Price specifically. Hell, back in July, I even warned of a half-dozen things to look out for, several of which have since already been proven true:

This brings me to the main point of this entry: This is likely just the beginning. I'm not going to say that any or all of the following will happen--it's possible that Trump/Price/Verma will show some level of restraint--but I wouldn't be at all surprised to see any or all of these happen during this fall's Open Enrollment Period (which runs from Nov. 1st - Dec. 15th, by the way):

The past few weeks, while trying to push the Godawful "Graham-Cassidy" ACA repeal bill, Louisiana Republican Senator Bill Cassidy has used the following as one of his standard talking points:

.@BillCassidy shares the story of a Louisiana man paying more than $40,000 for his special needs son’s health care under Obamacare. pic.twitter.com/AaZ0IQIfF7

— GOP (@GOP) September 21, 2017

He's posted several variants of the "$40,000 premium" tweet of late.

The tweet above includes an embedded Twitter video, which I've reposted to YouTube:

 

Credit where due. Last time around McCain made everyone hold their breath in suspense (then again, in his defense, he had just been diagnosed with a brain tumor and had to schlep all the way back from Arizona to DC for the vote a day or so earlier).

This time around he’s being more clear and up front about it: He says he likes the idea of the bill in general, and would be influenced by AZ Gov. Ducey’s support of it, but the process has stunk and continues to stink from top to bottom:

!!! McCain is a NO on Cassidy-Graham pic.twitter.com/a9gC2Li7TZ

— Jennifer Bendery (@jbendery) September 22, 2017

Seriously, good for him. He’s being quite clear about not just his decisions but his reasons...and while it would be nice if he opposed the bill on the merits (it stinks), his actual reasons make perfect sense as well.

Here’s his full statement:

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