2018 MIDTERM ELECTION

Time: D H M S

Way back in February, the board of directors of the DC ACA exchange board unanimously recommended that the District reinstate the individual mandate penalty, as well as putting strict restrictions back onto short-term plans. This recommendation was later agreed to by the DC Council in their proposed 2019 budget. In July, Congressional Republicans made an effort to quash DC bringing the mandate penalty back, but fortunately, it sounds like their effort failed:

Normally at this point in the year I only do full rate hike write-ups for states when their approved rate changes are made public by insurance regulators. I'm making an exception for Texas, however, because my preliminary analysis of the statewide average premium changes back in June was missing a huge portion of the market--I only had around half the ACA individual market accounted for, and I repeatedly warned that the missing enrollment and rate change data could easily skew the statewide average higher or lower.

Well, it's early September now, and not only do I have access to pretty much all of the missing data now, some of the rate filings have changed significantly as well. At the time, I estimated Texas carriers as requesting average rate increases of just 1.5% overall, with them dropping around 10.6% if not for the ACA's individual mandate being repealed and Trump's expansion of #ShortAssPlans.

I received a tip about this early this morning...which, unfortunately, I was unable to scoop anyone with due to being bogged down/caught up with the #TexasFoldEm drama.

As a result, it looks like Shelby Livingston of Modern Healthcare was first to post about it:

Montana insurer wins lawsuit against feds over unpaid cost-sharing reduction payments

Several health insurers have sued the U.S. government over its failure to make cost-sharing reduction payments that help lower healthcare costs for certain consumers. One just scored the first victory. The U.S. Court of Federal Claims ruled in favor of Montana Health Co-op, which sued the federal government for $5.3 million in unpaid cost-sharing reduction payments, finding that the government violated its obligation under the Affordable Care Act when it stopped paying the CSRs in October 2017."

The rest of the article is behind a paywall, but the gist of it is as follows:

 

Welp. This doesn't look good. As I noted earlier this afternoon, the insane #TexasFoldEm lawsuit held their oral arguments today, and as expected, the Republican-appointed judge in the case, Reed O'Connor, isn't exactly a fan of the ACA. Paul Demko lays out the bottom line in Politico:

U.S. District Court Judge Reed O'Connor, a George W. Bush appointee, vigorously questioned attorneys during the three-hour hearing but gave no indication when he would rule.

Lawyers for the Trump administration partially agreed with the red states' argument, concluding that the removal of Obamacare's individual mandate requires striking down the law's insurance provisions, including protections for people with preexisting medical conditions.

But the administration disagreed on the need for immediate action, arguing that any remedies should not be applied until next year.

I noted this back in June, and the numbers are virtually identical today:

In June 2018, President Trump’s administration announced – as part of a lawsuit known as Texas v. United States, brought by 20 Republican state attorneys general – it will no longer defend the ACA’s protections for people with pre-existing medical conditions.

Yes, this is the #TexasFoldEm case which has oral arguments happening even as I'm typing this.

U.S. Senator Tammy Baldwin (D-WI) recently introduced a new bill which, while it has zero chance of actually passing (or even being voted on) neatly tackles not one but two different types of Republican sabotage of the Affordable Care Act: The expansion of short-term plans being pushed hard by Donald Trump and the elimination of pre-existing condition protections being pushed hard by 20 GOP Attorneys General in the idiotic #TexasFoldEm case. Per Dylan Scott in Vox last week:

Senate Democrats are preparing a long-shot procedural maneuver to reverse new Trump administration regulations that they say would sabotage the Affordable Care Act by expanding “junk” insurance that isn’t obligated to cover preexisting conditions.

Rhode Island is kind of an interesting state this year. The smallest state geographically and one of the smallest population-wise, they only have two carriers offering individual market coverage: Blue Cross Blue Shield and Neighborhood Health Plan. Way back in May both carriers submitted their preliminary 2019 ACA policy rate increase requests, averaging around 9.7% overall. What's most noteworthy is that unlike most other states, both carriers are mostly blowing off 2018 ACA sabotage factors like mandate repeal and #ShortAssPlans. Blue Cross isn't adding anything to account for the negative risk pool impact, while Neighborhood (which holds slightly more than half of the market share) is only tacking on about 2% in response.

EVERYONE in the country should be either calling their Senator at (202) 224-3121 or watching this.

OK, a little more self-serving news...until last week I hadn't been interviewed, quoted or cited by other media outlets for awhile, but with both the #TexasFoldEm lawsuit, the Brent Kavanaugh SCOTUS hearings and the 2019 Open Enrollment Period all coming up fast, I've had one of each of the above happen over the past week:

INTERVIEW: If you want to hear me flap my gums explaining the #TexasFoldEm lawsuit and the implications of it for 40 minutes or so, check out last week's special episode of Hopping Mad podcast with Arliss Bunny and Will McLeod:

The Big News this week is all about the #TexasFoldEm court case (which could potentially destroy the Affordable Care Act as soon as January 2019) and the Brent Kavanaugh SCOTUS confirmation hearings (which could potentially destroy both the Affordable Care Act and the rest of United States as soon as, oh, let's call it within a year or so).

I hope neither of these things happens, of course...but regardless of how things play out, I also hope to still be around to document, analyze and explain the latest healthcare policy drama as it happens for years to come.

ACASignups.net has been kept alive for nearly five years thanks to two main sources: Individual supporters who donate either once or monthly, and banner ads, which are usually generic. Today I'm honored to announce that the Robert Wood Johnson Foundation, one of the most respected sources for healthcare knowledge and education, has also agreed to advertise on this site.

This shouldn't come as a surprise to anyone, of course, but it's actually good to have Vice President Pence state it point-blank:

Vice President Pence said Thursday that Republicans plan to give another try to repealing and replacing ObamaCare if they do well enough in November’s elections.

Pence made the remarks to reporters while in Wisconsin to campaign for GOP Senate candidate Leah Vukmir, saying that if she wins, it would help Republicans with their goal of eventually repealing the health-care law.

“We made an effort to fully repeal and replace ObamaCare and we'll continue, with Leah Vukmir in the Senate, we'll continue to go back to that,” Pence told reporters.

This comes on top of similarly unequivocal statements by several Republican Senators a day earlier:

Back in April, I started an ambitious project which set out to track every legislative or regulatory measure taken by every state to counter, cancel out or mitigate sabotage of the Affordable Care Act by the Trump Administration and Congressional Republicans. It resulted in this color-coded spreadsheet, which lists dozens of bills, proposals, amendments and so on at various stages of completion.

The bad news is that project has proven to be too large for me to keep up with--there's simply too many bills, too many stages and too much other stuff going on for me to keep track of it all.

The good news is that the Center for American Progress (which has slightly more resources than I do) has launched their own version of this project, and it's very slickly done:

Last year, Virginia residents experienced massive amounts of heartburn and ulcers as two major insurance carriers, Optima (Sentara Health) and Anthem (HealthKeepers) played musical chairs with both their 2018 rate filings and which areas of the state they offered plans on.

In May 2017, things didn't look too bad: Both Anthem and Optima were available in fairly large chunks of the state, and while Anthem wanted to raise rates an ugly 38% on average, Optima was only looking to increase rates by around 10-11%.

Hat tip to Louise Norris for the heads up about the Kentucky Dept. of Insurance issuing their final rulings for 2019 ACA individual market and small group policy premiums:

DOI Completes Review of Individual and Small-Group Health Insurance Rate Filings

The Kentucky Department of Insurance (DOI) announced today that it has completed its review of the individual and small-group insurance rates filed in the Kentucky market. The rates will be used to calculate insurance premiums in the 2019 benefit year.

Kentuckians in the individual market will once again experience changes in premiums and plan offerings. The rates that will be used reflect an average rate increase of 4.3 percent for Anthem Health Plans of Kentucky (Anthem) and 19.4 percent for CareSource. Since the actual premium charged will vary by individual and the plan level selected, some individuals may see a decrease in rates.

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