Arthur Childs, DO, FACOI is an internist specializing in critical care medicine in Cape May Court House*, New Jersey. About a year ago, as part of a project for the Jefferson School of Population Health, he put together his own Strategic Roadmap for Healthcare Delivery in the United States as a potential alternative to the various universal coverage proposals being tossed around on the left side of the aisle these days. He asked me to read it over and wanted my feedback.

I've done so, and while I'm still a strong proponent of going the Medicare for America route, he makes a lot of useful points and provides much food for thought. It's also very well-researched and cited, and I felt it deserved a wider audience. And so, with the permission of both him and the Jefferson School of Population Health, I'm presenting his full paper with a few of my own thoughts interspersed.

*(yes, that's the actual name of the municipality)

Back in January I reported that the state of Colorado is joining several other states in cracking down on non-ACA compliant so-called "Short-Term, Limited Duration" healthcare policies. As of April 1st, STLDs:

  • Can last no longer than 6 months/year (still longer than the 3-mo limit under Obama)
  • Have to stick to the ACA's 3:1 age band limit on premiums
  • Must be guaranteed issue (no more medical underwriting)
  • They can still exclude coverage of pre-existing conditions, but there's a limit of 12 months on the lookback timeframe
  • Must cover all 10 of the ACA's Essential Health Benefits
  • Must follow other ACA community rating requirements (limiting variances to age, tobacco use and geographic area)
  • A minimum Medical Loss Ratio of 80% to match the ACA's MLR (currently CO only requires a 60% MLF)

In other words, Colorado just made STLDs follow most of the same rules as ACA-compliant policies.

Governor Mills Announces Federal Approval of Medicaid Expansion

Governor Janet Mills announced today that the U.S. Centers for Medicare and Medicaid Services (CMS) has approved Maine’s State Plan Amendments to expand Medicaid (MaineCare) under the Affordable Care Act. CMS notified the Maine Department of Health and Human Services (DHHS) of the approval today.

CMS approved the state’s plan retroactive to July 2, 2018, which was the date indicated in the 2017 ballot initiative supported by nearly 60 percent of Maine voters. MaineCare expansion is projected to provide coverage to approximately 70,000 people throughout the state. With today’s approval, the federal government will finance more than $800 million in estimated costs for those who enroll under expansion from July 2, 2018 through state fiscal year 2021. Maine is among 36 states plus the District of Columbia that have expanded Medicaid.

Last week I noted that the House Energy & Commerce Committee held all-day hearings a dozen healthcare-related bills, half of which are related to prescription drug regulation & pricing, the other half of which cover about half of the provisions of the larger ACA 2.0 bill also rolled out by the House Dems last week.

Late last night, the E&C committee was burning the midnight oil (seriously...they were working on it past midnight) during the "markup langage" part of the process...and ended up voting to approve all 12 bills:

E&C CHAIRMAN PALLONE ON PASSAGE OF 12 BILLS TO LOWER HEALTH CARE AND PRESCRIPTION DRUG COSTS FOR CONSUMERS
Apr 4, 2019

Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ) released the following statement today after 12 bills to lower health care and prescription drug costs for consumers were favorably reported to the full House of Representatives:

Last week, after Donald Trump dropped another massive turd in the punchbowl by telling his Justice Dept. to ask for the entire ACA to be ruled unconstitutional (as opposed to "only" the pre-existing condition protection provisions, as if that wasn't bad enough), Congressional Republicans were caught completely blindsided and at first, couldn't distance themselves from him fast enough:

Senate Majority Leader Mitch McConnell (R-Ky.) told President Trump in a conversation Monday that the Senate will not be moving comprehensive health care legislation before the 2020 election, despite the president asking Senate Republicans to do that in a meeting last week.

McConnell said he made clear to the president that Senate Republicans will work on bills to keep down the cost of health care, but that they will not work on a comprehensive package to replace the Affordable Care Act, which the Trump administration is trying to strike down in court.

NOTE: CLICK THE IMAGES FOR HIG-RES VERSIONS.

The Centers for Medicare and Medicaid released the official 2019 Open Enrollment Period report over a week ago. Normally I pounce all over these reports and spend a couple of days analyzing every last data point, seeing how that's the core of what I do here at ACASignups.net.

However, this report was released amidst a gusher of other major ACA/healthcare news stories over the course of the week, and I never really got around to a deep dive. I'm still swamped, but I figured I should at least go back and do a little more analysis today.

OK, first of all, I need to clean up the discrepancies between the OE6 enrollment data I had and what's in the official CMS report. Every year there are always slight variations in a few states, usually when it comes to the state-based exchanges, and this year is no exception. There were differences reported in six states; in five of them, CMS reported lower enrollment numbers; in one the CMS tally is higher:

(sigh) Here we go again:

Everybody agrees that ObamaCare doesn’t work. Premiums & deductibles are far too high - Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance. The Republicans.....

— Donald J. Trump (@realDonaldTrump) April 2, 2019

Yes, I'm still fiddling around with the 3-Legged Stool metaphor. I wasn't gonna mess with it any further, but gvien that Donald Trump has decided that making healthcare the biggest topic of the 2020 election cycle (again) is a brilliant strategy for the Republican Party, I figured it was time for an update.

The version below includes a bunch of changes; some are corrections; others are enhancements:

  • Moved "Maximum Out-of-Pocket Costs" to the Blue Leg, since that's really a carrier covrerage requirement.
  • Added "Stay on Parents Plan until Age 26" to the Blue Leg. I never had it listed before, not sure why.
  • Added "Health Insurance Exchanges" to the Green Leg. I never had them actually listed on the graphic, but they're an important Government Responsibility, after all.

A big news story out of New York State today is about Governor Andrew Cuomo reaching a budget deal with the state legislature:

Governor Andrew M. Cuomo, Senate Majority Leader Andrea Stewart-Cousins and Assembly Speaker Carl Heastie today announced an agreement on the FY 2020 Budget. The Budget holds spending growth at 2%for the ninth consecutive year and cuts taxes for the middle class.

The Budget includes several landmark policies that will bring sweeping transformation and social justice reform to the state with the passage of the permanent 2% property tax cap that has already saved New Yorkers $25 billion since it was first implemented in 2012; a strategic MTA reform plan and steady revenue stream to fund the next capital plan through Central Business District Tolling; an additional $1 billion to support education, bringing total education funding to $27.9 billion; and landmark criminal justice reforms, including reforming the cash bail system, speedy trial, and the discovery process for a more fair and just New York for all.

I swear to God, Thanos must have invoked the Time Stone, because we’re right back to two years ago with this crap. I could just re-promote old blog entries from April 2017 and no one would know the difference:

White House working on secret healthcare plan with three conservative think tanks https://t.co/I6Uutj1CVT

— Kimberly Leonard (@leonardkl) April 1, 2019

The White House is quietly working on a healthcare policy proposal to replace the Affordable Care Act, according to multiple sources with knowledge of the matter.

...The analyst said the administration has been “having conversations” on healthcare policy and has reached out to numerous think tanks, including the Heritage Foundation, the Mercatus Center, and the Hoover Institute.

There's over a half a dozen major healthcare reform bills swirling around the Democratic side of the aisle these days. The two biggest contenders at the moment are the universal, 100% mandatory single payer "Medicare for All" bill being pushed by the Progressive Caucus in the House (led by Pramila Jayapal) and, of course Bernie Sanders in the Senate; and the universal, 50% mandatory (over time) "Medicare for America" being championed by Reps. Rosa Delauro and Jan Schakowsky in the House and Presidential contender Beto O'Rourke.

Regular ACA Signups readers know that I'm a huge fan of the Medicare for America approach (although I think we also need a robust ACA 2.0 upgrade to tide things over until Med4Am can be ramped up). However, there are still a bunch of other proposals out there, and there's nothing wrong with any of them; it's mostly a question of how far you want to set your marker.

Virginia Governor Ralph Northam has been out of the national news for the past month or so, keeping a low profile since the media frenzy over the "med school blackface photo" debacle subsided. Rightly or wrongly, in the end, in spite of pretty much everyone under the sun demanding that he resign, he stuck it out and outlasted the scandal by simply...not.

He isn't up for reelection (and in fact under Virginia law he can't run again anyway), he didn't actually commit any crimes or anything else impeachable, so it sounds like the state has pretty much just sort of accepted that he's gonna stick it out for another couple of years. In fact, according to this article in the Virginian-Pilot, he seems to have regained some of his pre-scandal stature:

Two months after a blackface photo in an old yearbook nearly ended the political career of Virginia Gov. Ralph Northam, his life seems mostly back to normal.

Over the past week or so, I've written several posts explaining how the new ACA 2.0 bill rolled out by the House Democrats would improve the law. So far I've mainly focused on the impact on health insurance policy premiums, since that's the single most obvious improvement.

In particular, I posted an extensive explainer, with colorful graphs and tables, showing how single adults at various ages would fare under ACA 2.0 compared to current law (households with more than one person would follow a similar patter, with the dollar amounts simply being higher across the board).

However, it's probably a good idea for people to also understand how age bands work. The age band is the reason an (unsubsidized) 64-year old pays so much more than a 21-year old.

From February:

The full expansion initiative passed last fall, of course, is supposed to cover Utah residents earning up to 138% of the poverty line, or around 150,000 people...without any work requirements.

The bill barreling through the Utah Legislature was “an effort to override the will of the people,” said Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit group that supported the full expansion of Medicaid.

Utah lawmakers, worried that the sales tax increase might not fully cover the costs, are rushing through a bill that would limit the expansion of Medicaid to people with incomes less than or equal to the poverty level, about $12,140 for an individual.

State officials say that the bill, which is estimated to cover 90,000 people, could be on the desk of Gov. Gary R. Herbert, a Republican, in a week or two.

In an excellent scoop by Dan Diamond and Adam Cancryn this morning, Politico reports that CMS Administrator Seema Verma--the woman in charge of Medicare and Medicaid who takes great joy in trashing Medicare and Medicaid--has spent millions of dollars on partisan consulting firms to boost her own image:

The Trump appointee who oversees Medicare, Medicaid and Obamacare quietly directed millions of taxpayer dollars in contracts to Republican communications consultants during her tenure atop the agency — including hiring one well-connected GOP media adviser to bolster her public profile.

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