A month ago I noted that along with a whole mess of other crap, Congressional Republicans were attempting to effectively starve the ACA out by simply cutting off funding of the law via the recent "must pass" omnibus spending bill:

Republicans also want to use the funding bill to go after Obamacare. They would prohibit funding for administering or enforcing the health care law, prohibit the administration from collecting a fee from insurance companies to run the insurance exchanges and eliminate more than half a billion dollars in funding for managing the program at the Centers for Medicare and Medicaid Services.

(sigh) I'm not quite sure how "prohibiting funding for administration" differs from "eliminating funding for managing the program", but it amounts to the same thing: They're trying to shut down CMS's ability to actually run the ACA.

The good news is that none of that ended up making it into the omnibus bill.

Regular readers know that I've developed a tradition over the past three years of tracking the average unsubsidized premium rate increases for the ACA-compliant individual market, painstakingly poring over the rate filings for every carrier in every state and running a weighted average by their market share.

Every year there are numerous challenges and headaches which get in the way, including things as obvious as "not every carrier publishes the number of enrollees they have covered" to complex situations like "carrier X is dropping out of the on-exchange market in half the counties of the state but is sticking around in the off-exchange market". In addition, many carriers submit an initial rate request...followed a few months later by a revised one...neither of which might end up matching the final premium changes approved by state regulators. Sometimes there may be 2-3 more revised filings along the way which muddy the waters even further.

Over the past few weeks, in the midst of the failed Republican-sponsored "ACA stabilization bill" known as Alexander-Collins (which laughably included "Bipartisan" in the title evne though it had changed dramatically from the actual bipartisan bills which Senators Patty Murray and Bill Nelson had worked with Lamar Alexander and Susan Collins on last fall), Democrats in both the House and Senate introduced real ACA stabilization/improvement bills of their own.

The official names of these bills are the "Undo Sabotage and Expand Affordability of Health Insurance Act of 2018" (USEAHIA) and the "Consumer Health Insurance Protection Act" (CHIPA) respectively, but for pretty obvious reasons I'm shortening each of them to simply "ACA 2.0".

Reagan Bush

 

Whenever the discussion of what the next Big Move for healthcare policy should be comes up in Democratic/progressive circles, the incredibly difficult path which had to be paved to get the Affordable Care Act passed in 2009-2010 is often brought up as an example of how difficult it is to make even minor changes, much less major ones.

That gets a bit repetitive after awhile, however, so here's another excellent case study from 20 years earlier: The Medicare Catastrophic Coverage Act of 1988.

Thanks to Amy Lotven for this trip down memory lane via the New York Times:

Retreat in Congress; The Catastrophic-Care Debacle - A special report.; How the New Medicare Law Fell on Hard Times in a Hurry

With the benefit of hindsight, legislators and policy makers in both parties now agree that the seeds of disaster for the Medicare Catastrophic Coverage Act were sown well before it became law barely a year ago.

OK, it's taken me way too long to get around to doing this, but I'm finally going to do livestreaming via Periscope.

You can follow public streams via Twitter, of course (which I may do from time to time), but in order to receive notices of scheduled livestreams, you have to follow me on Periscope itself:

1. Download the Periscope App to your iOS/Android device, of course.

2. Launch Periscope and tap the "People" tab.

3. Run a search for my username: @charles_gaba

4. Tap the + icon to follow me.

Then shoot me a message to let me know you're following me. There's supposed to be a notification tool for announcing when you're going live.

It's my intent to have two types of livestreams: Some will be open to anyone and may be done randomly; others will be scheduled and restricted to certain Patreon supporters.

I'm still working out the details on the distinction between the two, but one way or the other will be having the first one next week.

Well this could suck. The Times-Picayune reports that up to 60,000 Louisiana residents enrolled in traditional (ie, non-expansion) Medicaid might end up being kicked off the program starting in July:

Louisiana officials will have to notify around 60,000 people who are elderly or disabled in early May that they are slated to lose their Medicaid benefits in July as a result of the Legislature's stalemate over the state budget and taxes.

Gov. John Bel Edwards has proposed eliminating some Medicaid programs that provide long-term care in order to cope with a $994 million budget deficit. The governor said he doesn't want to put forward such cuts, but he doesn't have much of a choice given the state's financial restrictions starting July 1, when the new budget year begins. 

The Louisiana Department of Health is legally obligated to warn people about what might cuts be coming in July two months ahead of time, even if the programs are ultimately spared. 

Over at LinkedIn, George Kalogeropoulos has and Shandon Fowler have a fascinating piece about employer-based coverage and the relationship it has to public healthcare coverage:

Here is our call to action for employers: Guide employees of any eligibility status to health coverage, whether employer-sponsored or government-supported, because it will benefit both employees and your company.

The main thrust of the article is that while most employers offer some sort of healthcare coverage option to their employees (in fact, most did so before the ACA mandated it), most of them don't appear to make a whole lot of effort to actually get the employees to enroll in that coverage...and even fewer make any sort of effort to encourage their staff to enroll in other types of healthcare coverage outside of the employer plan.

They include several charts and graphs, but this is the key one to me:

via the Salt Lake Tribune:

Gov. Gary Herbert signed a measure Tuesday to give more than 70,000 needy Utahns access to government health coverage, ending years of failed attempts on Capitol Hill to expand Medicaid in the state.

But whether House Bill 472 ever takes effect still remains uncertain. Under President Obama’s signature Affordable Care Act (ACA), the Utah law needs approval by the federal Centers for Medicare and Medicaid Services (CMS), which has sent mixed signals on whether it will fully sign off.

Even if CMS does approve HB472, it will likely be about a year — even on an aggressive schedule — before the state can begin enrolling people for coverage. Meanwhile, a competing Utah citizens initiative that would expand Medicaid coverage more widely than HB472 also continues to gather signatures for a spot on November’s ballot.

A couple of weeks ago, I noted that Iowa had come up with an ingenious plan to resolve their troubled individual health insurance market: Start offering junk plans for everyone and damn the consequences:

Well, sure enough, just yesterday the Iowa state Senate voted to allow unregulated junk plans to be sold to...pretty much anyone in the state:

The Iowa Senate voted Wednesday to let the Iowa Farm Bureau Federation and Wellmark Blue Cross & Blue Shield sell health insurance plans that don't comply with the federal Affordable Care Act.

The new coverage could offer relatively low premiums for young and healthy consumers, but people with pre-existing health problems could once again be charged more or denied coverage.

Christina Lechner Goe has written up a detailed explainer going over the various types of NON-ACA-Compliant healthcare policies available and how each of them impacts the individual and small group markets. The report was commissionerd by consumer representatives of the National Association of Insurance Commissioners (NAIC):

Pages

Advertisement