Wyoming

Not the highest-profile ACA/healthcare story in the world, but Wyoming almost never makes the news, and this is especially noteworthy given the state, the Governor and the GOP having total control over the federal government:

As health care debate simmers, Mead laments lack of Medicaid expansion in Wyoming

Gov. Matt Mead lamented the $100 million that Wyoming left on the table by choosing not to expand Medicaid, and he expressed concern for the state’s hospitals while discussing health care with the Star-Tribune recently.

Mead echoed some of the fears that many Wyoming hospital officials have expressed for months: that congressional proposals to overhaul the health care system may have negative effects on facilities here and that the state has suffered because it chose not to allow more people to qualify for Medicaid.

“The idea that we did not accept Medicaid expansion and things are going to be good just hasn’t turned out,” he said.

The following letter was just sent to GOP U.S. Senator Lamar Alexander and Dem U.S. Senator Patty Murray of the HELP (Health, Education, Labor & Pensions) Senate Committee:

Dear Chairman Alexander and Ranking Member Murray:

Thank you and members of the Senate Health Education Labor and Pensions Committee for your commitment to hold September hearings on actions that Congress should take to stabilize and strengthen the individual health insurance market. The State Health Exchange Leadership Network, an association of state leaders dedicated to the implementation and operation of the state-based health insurance marketplaces, appreciates this opportunity to submit testimony.

On Sunday, HHS Secretary Tom Price officially called it in Texas:

Health and Human Services Secretary Tom Price, MD, declared a public health emergency in Texas on Saturday as Hurricane Harvey was pounding the state's coast.

Harvey made landfall late Friday night with winds topping 130 mph. Forecasts called for the storm to hover over the state for 5 days or more, possibly drenching some areas with as much as 50 inches of rain. Hundreds of thousands were without power and the National Weather Service said parts of Texas could be "uninhabitable for weeks or months."

"Many Medicare beneficiaries have been evacuated to neighboring communities where receiving hospitals and nursing homes may have no health care records, information on current health status or even verification of the person's status as a Medicare beneficiary. Due to the emergency declaration and other actions taken by HHS, CMS is able to waive certain documentation requirements to help ensure facilities can deliver care," an HHS statement read.

According to several sources, Bernie Sanders plans on releasing a new "Medicare for All" plan in the next week or two.

In light of this, I thought it might be a good idea to remember his last such plan, introduced back on January 18, 2016 in the midst of his heated primary battle with Hillary Clinton.

If you visit BernieSanders.com and click on the "Issues" tab today, you can still find his official 2016 campaign "Medicare for All" plan, without a single word changed.

It's important to note that while Bernie's plan as presented on his website was not actual legislative text, it was, in his own words, the "FULL plan"...that is, this wasn't supposed to be a "summarized" version or an "overview", but literally "the FULL PLAN", as the link leading to it clearly states twice:

Note: This entry is in response to Kimberly Leonard's article at the Washington Examiner in which she interviews unsubsidized individual market enrollees.

Amidst all the discussion and debate about how to fix/improve/strengthen/expand the Affordable Care Act, one thing I've written about as much as anyone else (and far more than many others) is people enrolled in the unsubsidized individual market. To recap: Around 18 million people are enrolled in individual market policies, of which around half (9 million) receive tax credits to help cover a chunk of the premiums. Of those, around 7 million also receive CSR assistance to help cover deductibles and co-pays. The amount/portion of their expenses which are covered varies from high to low based on a sliding income scale, and it's frankly too skimpy at the upper end of that range, but at least these folks receive some assistance.

File this one under "Be Careful What You Wish For".

Just a couple of days ago I reported that the New York Dept. of Financial Services had issued their approved 2018 rate changes for the 15 insurance carriers participating in the state's individual and small group markets...and, in some welcome news, they whittled down the rate increases by a bit, from 17.7% on average to 14.5% on average in the individual market, and from 11.7% to 9.3% in the small group market.

Then, the very next day, Zach Tracer of Bloomberg News broke this story:

New York State’s biggest hospital system plans to stop selling Obamacare plans, blaming a costly plank of the law and uncertain prospects for a fix amid a wider Washington brawl over health care.

Hey Michigan Residents! Do you live in the Clinton Township area?

If so, come on out on Sunday, August 27th, and join Congressman Sander Levin, State Representative Henry Yanez and myself as we explain what the latest craziness is regarding the ACA, the GOP attempts to repeal and/or sabotage it and healthcare policy in general from 2:00pm - 4:00pm at the Clinton Macomb Public Library:

Hey Michigan Residents! Do you live in the Marquette area?

If so, come on out on Saturday, August 26th, and join State Representatives Christine Greig (in person) and myself (via Skype) as we explain what the latest craziness is regarding the ACA, the GOP attempts to repeal and/or sabotage it and healthcare policy in general from 11:30am - 12:30pm at the University Center of Northern Michigan University:

Over at Balloon Juice, David Anderson has whipped up a nifty little graph which attempts to break out just which ACA exchange enrollees would be positively or negatively impacted by the CSR reimbursement brouhaha under different scenarios.

As I noted last month with my "Silver Switcharoo" explainer, for carriers which remain in the ACA exchanges next year, there's three potential scenarios which could happen (well, four, actually, if you include "Congress manages to sneak a full CSR appropriation bill into law just under the wire", although that seems pretty unlikely at this point given the time crunch and the fact that it'd need a 2/3 majority in both the House and Senate to avoid being vetoed by Trump anyway):

Quick recap: As of 2013, the pre-ACA individual market consisted of around 10.7 million people. The vast majority of the policies these folks were enrolled in were not ACA-compliant for one reason or another, including not covering one or more of the 10 Essential Health Benefits (EHBs) required by the ACA, having annual/lifetime caps on benefits or any number of other reasons.

Under ACA regulations, non-compliant policies which people were enrolled in prior to March 2010 (when President Obama signed the ACA into law) were grandfathered in...that is, insurance carriers could continue to offer them to existing enrollees for as long as they wanted to, and existing enrollees could stay on them for as long as they wished, but they couldn't be offered to anyone else, and once a current enrollee dropped out of a grandfathered plan they aren't allowed to rejoin it later on. The number of "grandfathered" enrollees has gradually declined since 2013, of course, as people either move to other coverage, die off (hey, it happens) or the carriers decide to discontinue the policies altogether.

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