2018 MIDTERM ELECTION

Time: D H M S

The Indiana Insurance Dept. has released the preliminary rate requests for 2019 insurance policies on the ACA individual and small group markets.

Like last year, there's only three carriers participating in Indiana's individual market: CareSource and Celtic (aka Ambetter) will again be available both on and off the ACA exchange, while Anthem will only be offering a single Catastrophic plan on the off-exchange market in just five counties:

The overall average rate increase for 2019 Indiana individual marketplace plans is 5.1%. CareSource and Celtic (MHS/Ambetter) have filed to participate in the 2019 Indiana Individual Marketplace. The Department of Insurance anticipates that all 92 counties in Indiana will be covered by one or more insurance company. CareSource plans to cover 79 counties. Celtic (MHS/Ambetter) plans to increase its coverage from 43 counties in 2018 to all 92 counties in 2019.

Anthem has filed to offer a 2019 Off-Marketplace plan in Indiana. This plan is a catastrophic plan and is offered only in Benton, Jasper, Newton, Warren and White Counties.

HHS just blocked us from entering its facility in Homestead, Florida to check on the welfare of the children being held here. They are obviously hiding something, and we are going to get to the bottom of this. pic.twitter.com/q4m6Zd0ck2

— Senator Bill Nelson (@SenBillNelson) June 19, 2018

An HHS official tells @weijia that there will NOT be special efforts made to reunite children who have already been separated from their families bc of the Zero Tolerance Policy, despite Trumps EO. Process will proceed for minors currently in the unaccompanied children program.

— Jacqueline Alemany (@JaxAlemany) June 20, 2018

My apologies. Between a death in the family and some other personal issues, I'm way behind the eight ball this week. As a result, I'm just now getting around to writing about not one, not two, not three, but FOUR major GOP attacks on the ACA and healthcare in general which either happened or had major developments this week.

Instead of getting even further behind by trying to do a full, detailed take on each of them, I'm going to crib like crazy from other healthcare reporters/articles to cover the gist of each.

3: Senate rejects Trump plan to claw back spending

via The Hill:

The Senate on Wednesday narrowly rejected President Trump's plan to claw back roughly $15 billion in spending approved by Congress earlier this year.

(Note: It was approved by Republicans in Congress earlier this year.)

In a 48-50 vote, senators failed to discharge the measure from committee. A majority vote was needed.

My apologies. Between a death in the family and some other personal issues, I'm way behind the eight ball this week. As a result, I'm just now getting around to writing about not one, not two, not three, but FOUR major GOP attacks on the ACA and healthcare in general which either happened or had major developments this week.

Instead of getting even further behind by trying to do a full, detailed take on each of them, I'm going to crib like crazy from other healthcare reporters/articles to cover the gist of each.

2: House GOP 2019 budget calls for deep Medicare, Medicaid spending cuts

Big shocker, I know...yeah, that's the actual headline of the Hill article, in which the GOP also proposes simply stripping out all funding for the ACA while they're at it:

Last year, Iowa's already-ugly individual market was rocked further yet by Big Kahuna Wellmark announcing that after finally entering the ACA exchange market in 2017, they were dropping back out again this year, leaving Medica as the only carrier offering ACA-compliant policies throughout the whole state. In response, Medica raised their 2018 ACA rates by a whopping 57% this year. This, in turn, led to the state legislature passing a law which stripped away pretty much any type of restriction or regulation of "Farm Bureau" plans, exacerbating the risk pool problem further yet.

My apologies. Between a death in the family and some other personal issues, I'm way behind the eight ball this week. As a result, I'm just now getting around to writing about not one, not two, not three, but FOUR major GOP attacks on the ACA and healthcare in general which either happened or had major developments this week.

Instead of getting even further behind by trying to do a full, detailed take on each of them, I'm going to crib like crazy from other healthcare reporters/articles to cover the gist of each.

#1: GRAHAM-CASSIDY 2.0 (via ThinkProgress):

Republicans renew attempts to repeal Obamacare

A group of Republicans and Washington D.C. think tanks released a proposal Tuesday that aims to resurrect Obamacare repeal. The consistent chatter around the proposal has drawn ire from the White House and GOP leadership, as the midterms are just months away, and repeal efforts haven’t proved to be winning strategies.

I'm addressing this Open Letter to Florida-based Politico reporter Marc A. Caputo, but the truth is there are hundreds of journalists out there who it could apply to as well. I know parts of it seem like a run-of-the-mill flame war between two people on Twitter, but I think there's a much deeper and more disturbing point here given Caputo's profession and status as a reasonably respected journalist.

Dear Marc:

First, let me say that I've followed your political reporting out of Florida for several years, so I know that you're a skilled, capable journalist.

That actually makes everything else in this letter more disturbing, because it proves that even intelligent, well-educated people can suffer from incredibly dangerous blind spots.

Well this is a nice surprise! Yesterday the Minnesota ACA exchange, MNsure, issued a press release a day ahead of the public posting of requested 2019 individual market insurance rate changes, advising people of the various ways they have to keep their premiums down via ACA tax credits, shopping around and so forth. I was immediately concerned that they might know something I didn't...perhaps they were expecting a batch of double-digit rate hikes as has happened in so many other states the past few years?

Well, today the Minnesota Commerce Dept. did release the preliminary 2019 rate requests, and I'm pleasantly surprised to report that for the second year in a row, Minnesota carriers are actually asking for rate decreases:

NOTE: I originally missed two carriers (McLaren and Molina); thanks to Louise Norris for calling attention to my error. The entire post, along with the table, has been updated to reflect the updated numbers including all 11 carriers.

Also note that while the headline originally reflected what the average rate change would be without the CSR load sabotage factor introduced in 2017, I've decided to be consistent with other states and only include 2018 sabotage impact.

My home state of Michigan just posted their preliminary requested rate changes for the 2019 Open Enrollment Period, and unlike most of the other states which have released their early requests so far, Michigan is a pleasant surprise: An overall average requested premium increase of just 1.7%!

Also noteworthy: According to the filings, eight of the carriers are specifically projecting exactly a 5% mandate repeal factor, which is remarkably consistent (usually the projections are all over the place). HAP is slightly lower (4.4%) while Molina is higher (7.2%). Priority Health didn't mention this at all, but it's safe to assume it'd be roughly 5% for them as well.

So, I just received the following press release from MNsure (Minnesota's ACA exchange)...

Tax Credits Through MNsure Can Help Lower Proposed Premiums for 2019
June 14, 2018

DULUTH, Minn.—Preliminary health insurance rates proposed by Minnesota health insurance companies will be available on the Minnesota Department of Commerce website on Friday, June 15.

Private insurance companies set premium prices, and the Minnesota Department of Commerce regulates those companies. Final, approved 2019 premium rates will be available by October 2, and the 2019 open enrollment period begins on November 1. Minnesotans shopping for health insurance through the individual market may be able to reduce premium costs in three ways:

1. See if you are eligible for tax credits only available through MNsure

Well this is rather unexpected.

Let's fire up the Wayback Machine, Sherman, and go back to 3 years ago, when the Risk Corridor Massacre first reared its ugly head.

The simplest explanation of how Risk Corridors worked is this:

  • The ACA made dramatic changes to how the individual insurance policy market worked.
  • Since it was so disruptive, it included several provisions to help stabilize the market.
  • One of these programs, called "Risk Corridors", was a temporary (3 year) program which acted as sort of an insurance policy for insurance carriers.
  • In a nutshell: Carriers which earned excessive profits on ACA policies had to place a chunk of those profits into a pool of money. Carriers which took excessive losses on ACA policies were supposed to be reimbursed for a chunk of those losses.
  • If the profits exceeded the losses, the government got to keep the difference, so it was theoretically possible they'd actually profit off the system.
  • If, however, the losses exceeded the profits, the government was supposed to pay out the difference.

(As an aside: For those claiming "government bailout! picking winners and losers!" etc etc, the ACA's risk corridor program is actually very similar in many ways to the permanent Medicare Part D risk corridor program, although there are some key differences between the two).

Rick Scott is the Republican Governor of Florida, coming up on the end of his 2nd term in office.

Rick Scott is also running to become the next U.S. Senator from Florida, against incumbent Democrat Bill Nelson.

Prior to being elected Governor of Florida, Rick Scott was the CEO of Columbia/HCA, aka Hospital Corporation of America.

Under Rick Scott's leadership, Columbia/HCA was behind the largest Medicare fraud in history at the time:

Scott started what was first Columbia in 1987, purchasing two El Paso, Texas, hospitals. Over the next decade he would add hundreds of hospitals, surgery centers and home health locations. In 1994, Scott’s Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies.

As usual, Louise Norris has the skinny:

Rate filings were due in New Mexico by June 10, 2018, for insurers that wish to offer individual market plans in 2019. Insurers that offer on-exchange coverage have been instructed by the New Mexico Office of the Superintendent of Insurance (NMOSI) to add the cost of cost-sharing reductions (CSR) only to on-exchange silver plans and the identical versions of those plans offered off-exchange (different silver plans offered only off-exchange will not have the cost of CSR added to their premiums).

Presented without comment:

AHIP Issues Statement Regarding TX v. United States of America

WASHINGTON, D.C. – America’s Health Insurance Plans (AHIP) issued the following statement regarding the latest developments in TX v. United States of America:

“Millions of Americans rely on the individual market for their coverage and care, and they deserve affordable choices that deliver the value they expect. Initial filings for 2019 plans have shown that, while rates are higher due to the zeroing out of the individual mandate penalty, the market is more steady for most consumers than in previous years, with insurance providers stepping in to serve more consumers in more states.

Last Thursday, in my initial alarm-sounding post about the federal #TexasFoldEm lawsuit against the ACA, I used this headline:

ACA about to be torpedoed by a lawsuit even more idiotic than King vs. Burwell???

Law Professor and ACA expert Nicholas Bagley blasted both the case itself and the Dept. of Justice's response in an epic post which also coined the #TexasFoldEm moniker for this travesty:

For those of you just coming to the case, this is from my earlier recap:

In their complaint, the states [including Texas and other red states] point out (rightly) that the Supreme Court upheld the ACA in NFIB v. Sebelius only because the individual mandate was a tax and (rightly) that Congress has now repealed the penalty for going without insurance. As the states see it, the freestanding requirement to get insurance, which is still on the books, is therefore unconstitutional. Because it’s unconstitutional, the courts must invalidate the entire ACA—lock, stock, and barrel.

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