2018 MIDTERM ELECTION

Time: D H M S

Linda Qui is a NY Times Fact Checker, formerly of PolitiFact. She cited me as a fact-check source twice for PolitiFact: Once in October 2015 and again just before the election last fall (I can't find the link for that one). The first time around it was about Donald Trump's claim that premiums were skyrocketing (again, this was back in 2015, referring to 2016 rates increases). After a phone discussion, here's what I wrote her:

Yes, some people in some plans through some carriers in some states are, indeed, looking at rate hikes of “35 - 50%” if they stick with those plans in 2016. Alaska, Minnesota and Hawaii, for instance, are all looking at 30-40% average hikes, and individual plans (or individual carriers) in a few states are indeed jacking up rates by that much.

However, by my current estimates, here’s the state-by-state breakdown:

Back in January, I wrote a long rant about High Risk Pools. The general thrust was that in theory HRPs aren't necessarily a horrible idea; on paper they can be made to work...assuming the math adds up and they're properly funded on a permanent basis.

However, I also pointed out that due to the very nature of HRPs (i.e., segregating out a small, highly vulnerable group of people from the rest of society), it's incredibly easy for legislators not to properly fund or maintain them, especially after the initial funding comes up for renewal.

Wow. Thanks to Bob Herman of Axios for the heads up:

Molina Healthcare Announces Leadership Changes

CAO Joseph W. White Named Interim CEO and Appointed CFO
Board Initiates Permanent CEO Search

Dale B. Wolf Named Chairman of the Board

Pre-Releases First Quarter 2017 GAAP Net Income Per Share

 

No real analysis here, just some choice tweets from this morning on the latest insanity. I'll likely tack on a few more as the day progresses.

.@SteveScalise says the repeal bill has "layers of protection" for peeps w/pre-existing conditions. That's the new GOP talking point, guys

— Rachael Bade (@rachaelmbade) May 2, 2017

"Layers of protection." As Jeffery Young of the Huffington Post noted...

You always test out new talking points when you're winning. It's a sign of great confidence in the policy and politics of your situation. https://t.co/CTgnppDP01

— Jeffrey Young (@JeffYoung) May 2, 2017

Speaking of having tremendous confidence...

Ryan tells fellow Republicans behind closed doors to pray for the health vote they may be about to take this week.

The latest iteration of the AHCA is supposedly being scheduled for a vote (for real, this time) sometime this week. The pressure is high on both sides, the whip counts are bouncing around, the tension is palpable, etc etc.

The first time around, the biggest tug-of-war was over Medicaid expansion. This time, the major issue seems to be Pre-Existing Condition coverage...and along with it, Guaranteed Issue and Essential Health Benefits; the three have to be pretty much joined at the hip, since removing one effectively makes the other two pointless in practice. It doesn't do most people much good to be told that yes, they'll be covered even if they have cancer if that coverage is gonna cost them $50,000/month.

Anyway, people are furiously scrambling to call their member of Congress and lighting up social media spreading the word...while Donald Trump, MIke Pence and Paul Ryan are running around DC desperately trying to squeak out 216 "Yes" votes from the Republican caucus.

And then, Monday, four amazing things happened.

Regular visitors know that I write an occasional freelance piece for healthinsurance.org. The only problem is that both that site and mine have pretty narrow audiences, comprised mainly of those who are already actively seeking out analysis/opinion about health insurance matters, as opposed to the general public.

I also cross-post my diaries frequently over at Daily Kos, where the ACA Signups project originated, of course.

I'm therefore pleased to announce that this morning I've had my first publication on a non-healthcare or political-oriented website: Cracked.com.

I've attempted to fully explain how absurdly complex the U.S. healthcare system is (and thus why it's so difficult to make major changes to it) in a way which is easy for the average Joe to get (with a few poop jokes thrown in to keep within the Cracked tradition).

Anyway, I'm a long-time fan of Cracked, so I'm pretty geeked about this. Check it out!

CBS News. Face the Nation. This morning:

JOHN DICKERSON: Let me ask you about health care -- Tucker Carlson interviewed you about six weeks ago when you were in the middle of health care negotiations. And you agreed with him that the health care bill wasn't going to help your supporters. That those who lived in rural areas, the older, were going to get hurt by that bill. And you told him--

PRESIDENT DONALD TRUMP: Excuse me, the health care bill is going to help my supporters.

"F*ck anyone who didn't support me, though."

JOHN DICKERSON: Well, hold on. Let me just finish the question, if I may, sir--

PRESIDENT DONALD TRUMP: Otherwise, I'm not going to sign it. I'm not going to do it.

JOHN DICKERSON: Well, this is why I wanted to ask you. You said to Tucker, "We will take care of our people, or I am not signing it." You said you were going to negotiate.

PRESIDENT DONALD TRUMP: Well, that's what I just said.

JOHN DICKERSON: So tell me what in the bill you've been negotiating to get--

PRESIDENT DONALD TRUMP: But let me--

Here's yesterday's press release from Covered California referred to by Dan Mangan of CNBC a little while ago:

New Analysis Shows Potentially Significant Health Care Premium Increases and Drops in Coverage If Federal Policies Change

  • California’s premiums could rise by 28 to 49 percent in 2018, and up to 340,000 consumers could lose individual market coverage if changes are made to existing federal policies.
  • The potential rate increase would mean billions of dollars in additional federal spending. The 1.2 million consumers who do not receive subsidies would bear the entire brunt of these increases.
  • The potential decrease of 340,000 insured consumers would not only represent many individuals losing access to potentially life-saving care, but it would result in a sicker risk mix in the individual market and higher premiums for everyone.

SACRAMENTO, Calif. — A new analysis shows the dramatic consequences facing Californians if federal policies are changed from the current structure and there is no longer direct federal funding of cost-sharing reduction (CSR) reimbursements and the individual shared responsibility payment is not enforced when a consumer chooses not to purchase coverage.

The analysis found that Covered California health plan premiums could rise up to 49 percent if two key elements that have been in place for the past four years are changed: Cost-sharing reduction reimbursements are no longer directly funded as reimbursements to carriers, and the shared individual responsibility payment is not enforced.

 

I noted a week or so ago that according to David Anderson of Balloon Juice, rumor has it that many insurance carriers are making their actuaries work overtime to put together multiple rate filings for 2018 based on several different outlooks:

  • Trump/Price/GOP quit screwing around, officially fund CSR reimbursements, enforce the mandate penalty and generally implement the ACA in good faith.
  • Trump/Price/GOP cut off CSR funding but otherwise enforce the law somewhat reasonably
  • Trump/Price/GOP cut off CSR, don't enforce the mandate, keep mucking around with half-assed repeal/replacement bills
  • (etc, etc...several possible scenarios)

Today the California Insurance Commissioner, Dave Jones, made a formal announcement that this is exactly what CA insurance carriers will be allowed to do, and he isn't pussyfooting around with the reasons for the policy change either:

Ben Sasse is a Republican U.S. Senator from Nebraska. As you might imagine, he's not a fan of the ACA.

About an hour ago, he tweeted the following:

Just heard from small-biz owner--whose plan was cancelled by ObamaCare--that he's been forced into this:
$13k/yr deductible
$15k/yr premium

— Ben Sasse (@BenSasse) April 28, 2017

...which I thought would be the first tweet in a brief thread including some additional details, such as:

 

*(Disclaimer: No, that's not a direct quote from Dr. Molina, but it's a pretty damned spot-on paraphrase).

A couple of weeks ago I noted that a buttload of heavy players in the healthcare field sent a joint letter to Trump, Tom Price and everyone else under the sun making it pretty clear how vital resolving the CSR issue is, and what the consequences would be if Congress and Trump don't make good on them.

Today, Molina Healthcare, which has around 1 million ACA exchange enrollees at the moment (roughly 9% of all effectuated enrollees) lowered the boom even harder (via Bob Herman of Axios):

Molina will exit exchanges if ACA payments aren't made

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA). By the end of March, the numbers in these 4 states had gone up by another 19,300.

It's the end of April now, so I checked in once more, and sure enough, the numbers continue to grow:

UPDATE: Note that Anthem made these statements BEFORE Molina drew their line in the sand re. CSR payments. That could be a game changer.

I'll let Tami Luhby of CNN/Money take the floor:

Anthem says Obamacare business doing 'significantly better,' but still may exit some areas. https://t.co/ToFAvXj62t via @CNNMoney @luhby

— Tami Luhby (@Luhby) April 26, 2017

$antm CEO: "Individual business is doing markedly better than last year." But claims are slightly higher than expected.

— Tami Luhby (@Luhby) April 26, 2017

UPDATE: Important to note that this story broke BEFORE Molina drew a line in the sand re. the CSR issue. That could be a game changer.

via the Oregon Register-Guard:

Insurer Centene commits to shaky ACA exchanges for 2018

One health insurer is eager to dive back into the Affordable Care Act’s troubled insurance exchanges next year, even as competitors waver and President Trump tweets doom about the law’s future.

Centene Corp. said Tuesday that its exchange enrollment has swelled 74 percent since last year, up to nearly 1.2 million people.

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