Montana didn't expand Medicaid under the Affordable Care Act until January 2016, and when they did so, the legislation was written with an automatic sunset date of June 30, 2019 unless it's expanded beyond that. Unfortunately, the ballot proposal to make Medicaid expansion permanent failed last November, which put the issue back in the hands of state lawmakers.

The good news is that the Montana state legislature did indeed finally vote to extend the program, which covers around 96,000 people, this week. The bad news is...well:

The bill to continue Medicaid expansion in Montana passed out of the state Senate Tuesday after teetering on the edge of a deadline for end of session negations.

via the Lexington Herald-Leader:

Colorado's Senate advanced another piece of Democratic Gov. Jared Polis' health care agenda on Tuesday by tentatively endorsing a study on creating a state-run health insurance option.

The bill would direct state agencies to recommend a plan that would compete with existing private insurance plans and those offered on Colorado's health care exchange. Another Senate vote sends the study bill to the governor. It's already cleared the House on a bipartisan 46-17 vote.

On the surface, this sounds pretty much like the state-level Public Option bill which has quietly been rushed through the Washington State legislature over the past few weeks. Unlike the Washington bill, however, it looks like the Colorado legislature is covering a few more bases...particularly funding:

I've written several times over the past few months about the confusion regarding how much of an impact on the private insurance industry the move to a universal, 100% publicly-financed single payer healthcare system would have.

Most recently I noted that not only would the latest versions of the House and Senate "MFA" bills expand their reach even further by adding in Long-Term Services & Support (thus legally denying private insurers yet another range of services that they'd be legally allowed to duplicate), but in an interview ahead of the rollout, Bernie Sanders himself stated point-blank that private health insurance companies would be "reduced to nose jobs" and the like (which is of course the whole point).

Back in January, 2nd-term Washington Governor and Democratic Presidential candidate Jay Inslee jumped fully onboard the Public Option train:

Inslee proposes ‘public option’ health-insurance plan for Washington

The proposal, which Inslee said is the first step toward universal health care, is geared in part to help stabilize the exchange, which has wrestled with double-digit premium increases and attempts by Republicans in Congress and President Donald Trump to dismantle the Affordable Care Act.

...The proposal would have the state Health Care Authority contract with at least one health-insurance carrier to offer qualified health coverage on the Washington Health Benefit Exchange, according to a summary of the proposal.

The tagline for ACASignups.net is "healthcare policy data, analysis & snark", so naturally many of my blog posts have tongue-in-cheek, sarcastic headlines.

This is not one of those times. The headline above is absolutely, sickeningly true.

On a couple of days ago, both houses of the Ohio state legislature--the House and Senate alike--voted to ban abortion outright six weeks after conception. There's no exception for rape. There's no exception for incest. There is an exception for the life of the mother (not her health, mind you...just her actual ability to keep breathing)...but that's it. Yesterday this bill was signed into law by GOP Governor Mike DeWine.

The six-week abortion ban known as the "heartbeat bill" is now law in Ohio. That makes Ohio the sixth state in the nation to attempt to outlaw abortions at the point a fetal heartbeat can be detected.

I'm lumping together three Tennessee-based stories here from the past month or so, but they're perfectly connected to each other:

March 7th, 2019:

The Tennessee House of Representatives passed a bill on Thursday that would ban abortion after a fetal heartbeat is detected, mimicking laws in other states that have been struck down by the courts and drawing the criticism of both advocates and opponents of abortion rights.

The measure, House Bill 77, would tightly restrict the window of time within which a woman could seek an abortion, because a fetal heartbeat can be detected as early as six weeks into a pregnancy. That is before many women even realize they are pregnant.

 

Over the past month or two, I've written a couple of pieces which explored the whole "MFA would eliminate private health insurance" issue.

My main point was that while most MFA activists have long insisted that eliminating (or virtually eliminating) private health insurance companies is not only a feature but the entire point of moving to single payer, ever since Kamala Harris walked back her “get rid of all that!” comment in a CNN Town Hall the next day, I’ve seen some MFA activists fall all over themselves to suddenly insist that “no, no...there’d still be plenty of room for private insurance, really!”

From last August:

The #TexasFoldEm case uses the World's Flimsiest Excuse to try and eliminate the Affordable Care Act's critical health insurance coverage protections for the 130 million Americans who have pre-existing conditions.

In response, Republican Senators Tillis, Alexander, Grassley, Ernst, Murkowski, Cassidy, Wicker, Graham, Heller and Barrasso have introduced a new bill which they claim would ensure pre-existing coverage protections. Unfortunately, it...doesn't.

I've been out and about all day and will also be unable to update the blog all day Saturday, so I'll keep this one short. Besides, several others, including Jeffrey Young of the Huffington Post have already written up good overviews of this garbage:

A week or so ago there was an important ruling by a federal judge which shot down Medicaid expansion work requirements in two states (Arkansas and Kentucky) while also having a ripple effect in two more (Idaho and Iowa):

The [Idaho] Senate Health and Welfare Committee voted 7-2 to hold in committee a House bill that would create a work requirement for Medicaid expansion beneficiaries — after lawmakers found out during the hearing that a federal judge had just struck down Medicaid work requirements in Kentucky and Arkansas.

Meanwhile, a Senate bill that would create a voluntary job training requirement for Medicaid expansion beneficiaries is still in that chamber’s amending order and could come up soon. The Medicaid budget for 2019-2020 is still being held in the full House. And Gov. Brad Little has said he won’t let lawmakers adjourn for the year until Medicaid expansion and funding is resolved.

This Just In from the Washington State Insurance Commissioner's office...

Kreidler's bill to protect consumers from surprise billing passes Senate
April 10, 2019

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler’s proposal to end the harmful practice of surprise medical billing passed the Senate today on a vote of 47 to 0. It now goes back to the House of Representatives for a concurrence vote before heading to the governor’s desk.

Second Substitute House Bill 1065 (www.leg.wa.gov) prevents consumers from getting a surprise bill when they seek either emergency treatment at an out-of-network emergency room or medical services at an in-network hospital or facility but are treated by an out-of-network provider.

In September 2017, Sen. Bernie Sanders introduced his "official" Medicare for All, universal single payer bill to much fanfare. At the time, it garnered a lot of attention, but it also had some gaping holes...most notably the lack of any actual funding mechanism or specifics, as well as a big coverage gap which could be found in both the "Medicare for America" bill which I'm a big fan of as well as the House MFA version.

Today, Sanders launched a revised version of the bill which supposedly addresses both of those issues along with others. Let's take a look.

First of all, who's co-sponsoring it? In 2017, it was cosponsored by 16 Democratic Senators:

Mr. Sanders (for himself, Ms. Baldwin, Mr. Blumenthal, Mr. Booker, Mr. Franken, Mrs. Gillibrand, Ms. Harris, Mr. Heinrich, Ms. Hirono, Mr. Leahy, Mr. Markey, Mr. Merkley, Mr.Schatz, Mrs. Shaheen, Mr. Udall, Ms. Warren, and Mr. Whitehouse) introduced the following bill; which was read twice and referred to the Committee on Finance

 

Sorry, I'm a little behind the 8-ball today...a few hours ago, the House Education & Labor Committee voted on and approved H.R.1010, which would reverse the Trump Administration's executive order which removed restrictions placed on so-called "short-term, limited duration" (STLD) healthcare policies, commonly known as "junk plans" since most ACA regulations/requirements don't apply.

Again, the short version (no pun intended) is this: Under the Obama Administration, STLDs were restricted to no more than 3 months at a time, and forbid them from being renewed within the same calendar year. They were always intended to be just that: Short-term only, and of limited duration, for certain people in special circumstances only.

h/t to Rachel Schwab for the heads up!

A couple of weeks ago I reported that the Colorado legislature was moving on an ACA reinsurance bill which, on the surface would seem to be similar to other reinsurance programs implemented in over a half-dozen other states to cut down on individual market premiums. The Colorado bill, however, had an unusual funding mechanism:

While similar programs have gone into effect in a number of states, Colorado’s funding mechanism for reinsurance would be an innovative approach. This mechanism utilizes Medicare reference-based pricing to bring down health care costs (what is paid to hospitals and doctors). Medicare-reference-based pricing means that the hospitals, doctors and other healthcare providers would be paid a percentage of what Medicare would pay. For example, the program may pay 150 percent (or 1.5 times) of what Medicare would pay for services, which would be less than what is currently paid to healthcare providers. That savings is then passed on to consumers in the form of lower premiums.

via the Hopping Mad podcast:

8 April 2018 – We have hopped and moved the show we planned to have this week back to next week in order to have the ACA expert, Charles Gaba (ACASignups.net, @Charles_Gaba) on to update everyone on the latest chaos surrounding the ACA.

Because of the recent ruling by a Federal judge in the Northern District of Texas, the ACA is back on uncertain ground. No one is surprised. Trump is swerving all over the place first into the total, immediate destruction of the ACA and then veering back to say that his incredible new plan will come out right after he is re-elected. Even McConnell isn’t humoring Trump this time, which should be your first clue. But don’t worry, “preexisting conditions will be covered.” Of course, insurance companies will be able to charge whatever they feel like in order to issue the coverage but Trump is positive that will work for everyone. Well, at least all the billionaires. The rest of us can just use the hospital emergency room, right?

Meet the Press a few hours ago:

CHUCK TODD: Let me move to health care because to me, it's an even more trickier situation, given that you won re-election I believe, excuse me, you won election in Utah on the same ballot that a majority of -- of your constituents wanted to see Medicaid expanded. So what would you do now with health care? Would you scrap the system we have and build from scratch? Or do you take the Obamacare infrastructure, which many will note was modeled in some ways off of what you did in Massachusetts, and try to reform from there?

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