ACA Sabotage

2018 MIDTERM ELECTION

Time: D H M S

 

5/16/18: IMPORTANT UPDATE BELOW.

(sigh) Stop me if you've heard this one before...this is an Op-Ed in the Washington Examiner from a columnist and failed Republican Congressional candidate:

Time and opportunity still exist to replace Obamacare.

...I reported in January that a number of conservative groups, under the leadership of former Sen. Rick Santorum, was working hard to craft a new Obamacare replacement...Behind the scenes, those groups...have continued to meet and tweak their plan, and they seem just a few weeks away from being able to unveil it.

...I listened in on a March 21 conference call among numerous interested parties, and received further updates within the past week from Santorum.

Last month I noted that New Jersey is taking a leading role regarding protecting and improving the Affordable Care Act; the state legislature has passed bills which would:

  • Reinstate the ACA's individual mandate penalty,
  • Establish a robust reinsurance program to significantly lower insurance premiums for individual market enrollees,
  • Protect people from out-of-network "balance billing", and
  • Cancel out Trump's expansion of "Association Health Plans"

(New Jersey actually already had several other "ACA protection" laws on the books in the first place, including protections against short-term plans and "surprise billing".)

In addition, new Governor Phil Murphy had alread proven that he understands and supports the ACA; within days of taking office he had already issued an executive order telling all state agencies to do everything they reasonably can to inform the public about how to enroll during Open Enrollment and so forth.

Sadly, this is pretty much exactly what I've been expecting:

Sen. Mike SHIRKEY (R-ClarkLake) said today he's hammered out an agreement with the administration and the House on creating work requirements for Medicaid recipients.

Speaking during a taping of "Off The Record," Shirkey said, "We have a deal." All sides have signed off on the exemptions to the work requirement, but he didn't get into all fo them pending a formal announcement coming as soon as later this week.

From the wording of this, it sounds an awful lot like "all sides" appears to refer to Republican Senator Shirkey, the rest of the Republican State Senate, the Republican State House and the Republican Governor.

Shirkey confirmed that the 29-hour job requirement in the Senate bill has been pared back to 20 to which he says, "I was hoping Michigan could take a leadership position and set a new standard for that." But rather than jeopardize the entire package, he compromised.

Just an hour or so ago I posted about a vice president of the Blue Cross Blue Shield Association stating point-blank what I and every other healthcare wonk under the sun has been warning for months (or years, really, if you include the original justification for the Individual Mandate under RomneyCare):

Kris Haltmeyer, a vice president at the Blue Cross Blue Shield Association, told reporters that the premium increases were in part due to the repeal of ObamaCare’s individual mandate in the Republican tax reform bill in December...“With the repeal of the individual mandate and the failure of Congress to enact stabilization legislation, we are expecting premiums to go up substantially,” Haltmeyer said.

...He said the premium increases are “related to the loss of the mandate and then underlying medical costs.”

“Those two things have the most impact on the rate increases,” he added.

...Oh, and what comes after mandate repeal and underlying medical costs? You guessed it: #ShortAssPlans

One of the things Ford had always found hardest to understand about humans was their habit of continually stating and repeating the very very obvious, as in ‘It’s a nice day’, 'You’re very tall’, or 'You seem to have fallen down a thirty-foot well, are you alright?’

--Douglas Adams, The Hitchhiker's Guide to the Galaxy

via Peter Sullivan, The Hill:

A top insurance industry official said Wednesday that he expects “substantial” ObamaCare premium increases for 2019.

Kris Haltmeyer, a vice president at the Blue Cross Blue Shield Association, told reporters that the premium increases were in part due to the repeal of ObamaCare’s individual mandate in the Republican tax reform bill in December. He also cited lawmakers’ failure to pass a bill aimed at lowering premiums, which fell apart earlier this year amid a partisan dispute over abortion restrictions.

Two big developments (or in one case, a lack of development) out of Virginia this evening.

First: Just yesterday I was noting that it looked as though after 8 years, Virginia's state legislature might finally be going ahead and expanding Medicaid under the ACA as soon as today:

The stage is set for a showdown in the Virginia Senate on Tuesday over a budget compromise negotiated by Senate Finance Co-Chairman Emmett Hanger, R-Augusta, and House Appropriations Chairman Chris Jones, R-Suffolk, to expand the state’s Medicaid program and pay for the state’s share through a new tax on hospital revenues that also would boost Medicaid payments for inpatient provider care.

Unfortunately...that didn't happen:

Governor Northam Statement on Virginia Senate Budget Process

This evening brought three major pieces of ACA-related news out of three different states:

First, in California, the State Senate passed SB-910, which wouldn't just limit short-term plans, but would outright prohibit them altogether. To my knowledge, CA would be the only state* where STPs wouldn't be allowed at all:

(*Correction: It turns out that New York, New Jersey and Massachusetts also ban Short-Term Plans as well, although according to Dania Palanker of the Center on Health Insurance Reforms at Georgetown University, California would be the first state to explicitly outlaw short-term plans as opposed to simply stating that all policies have to meet certain standards.)

SACRAMENTO – Today, the State Senate approved passage of Senate Bill 910, which prohibits the sale of short term limited duration health insurance in California.

*(To be honest, all of these types of bills--work requirements for Medicaid, drug testing for welfare benefits, photo ID for voting--have at least a tinge of racism to them no matter what, but at least this one isn't blatantly racist anymore).

This just in off the AP newswire...

LANSING, Mich. (AP) — The sponsor of proposed Medicaid work requirements said Monday that lawmakers are removing a provision to exempt recipients who live in Michigan counties with high unemployment, saying it would have been too difficult to administer and denying allegations of racism.

Republican Sen. Mike Shirkey of Clarklake also told The Associated Press that the proposed 29-hour-a week workforce engagement requirement for able-bodied adults is being lowered to “very close” to 20 weeks. That is in line with the three states that have enacted Medicaid work laws and with Michigan’s work requirement for food assistance beneficiaries.

Having a doctor holding elected office is kind of hit or miss (former HHS Secretary Tom "Fly Me!" Price was an orthopedic surgeon, for instance, while Rand "Kneel before Aqua Buddha!" Paul is supposedly a "self-certified" opthamologist), but once in awhile it can be a very good thing.

Case in point: Ralph Northam, the new Governor of Virginia, a former Army doctor and pediatric neurologist, who just formally vetoed not one, not two, but four different GOP-passed healthcare bills, each of which would have further weakened and damaged the ACA individual market risk pool:

RICHMOND—Governor Ralph Northam today vetoed Senate Bills 844, 934, 935, and 964, which would put Virginians at risk of being underinsured, result in rapidly increasing Marketplace premiums, and undermine key protections in the Affordable Care Act. Governor Northam remains committed to expanding health care for nearly 400,000 uninsured Virginians, return millions to the state budget, and reduce Marketplace premiums. The Governor’s full veto statements are below.

I've written quite a few entries bashing the Short-Term Plan portion of Donald Trump's executive order opening up the floodgates on non-ACA compliant policies. However, I've written far less about the other shoe he's dropping: Association Health Plans, or AHPs. In fact, while I discussed AHPs briefly in Part Two of my Risk Pool video, the only blog post I've written to date which specifically focuses on them just quoted from this Avalere Health article:

Association Health Plans (AHPs) are health insurance arrangements sponsored by an industry, trade, or professional association that provide health coverage to their members—typically small businesses and their employees. Health insurance coverage offered through AHPs aims to make coverage available and affordable for small groups and individual employees. Importantly, these arrangements are currently governed by state and federal requirements and are subject to state oversight, including standards related to premiums and benefit requirements.

Via press release from "Protect Our Care":

Polls in 6 Battleground States Show Voters Blame Republicans for Rate Hikes

Six new Public Policy Polling surveys in battleground states find voters will blame Republicans for the expected health care premium increases this summer by approximately 30 points and voters believe Republicans and President Trump have been actively undermining and sabotaging the Affordable Care Act.

ARIZONA Voters say they will blame Republicans if health care premiums increase this summer. 55% say they will hold Republicans in Washington responsible if rates increase, compared to just 29% who said they would not. A plurality of voters (49%) say they believe Washington Republicans and President Trump have been trying to undermine and sabotage the Affordable Care Act – and a majority of independent voters (57%) also say they agree with that statement.

OK, this doesn't technically count as an official 2019 Rate Hike analysis since none of it comes from actual carrier rate filings, but Covered California, the largest state-based ACA exchange, just released their proposed 2018-2019 annual budget, and it includes detailed projections regarding expected premium increases and enrollment impact over the next few years due specifically to the GOP's repeal of the ACA's Individual Mandate. Oddly, while they mention short-term plan expansion as another potential threat to enrollment/premiums, they do so passingly, and they don't mention association plans at all:

Since 2014, nearly 5 million people have enrolled in Medi-Cal due to the Affordable Care Act expansion, and more than 3.5 million have been insured for some period of time through Covered California. Together, the gains cut the rate of the uninsured in California from 17 percent in 2013 to a historic low of 6.8 percent as of June 2017.

Last month, after much painstaking research and analysis, I concluded that unsubsidized ACA-compliant individual market enrollees (both on & off the exchanges) are paying an average of around $960 this year (~$80/month) more in healthcare premiums nationally in 2018 than they otherwise would be if not for the various forms of ACA sabotage carried out by Donald Trump and Congressional Republicans last year.

Again, it's important to clarify that this is $960 more (around 17% more) in addition to non-sabotage-related factors such as normal medical expense inflation (around 7%), the reinstatement of the ACA carrier tax (about 2%) and other various/sundry factors (around 2%).

Back in mid-April, I crunched a bunch of numbers and concluded that around 6.5 million people enrolled in unsubsidized ACA-compliant individual market policies are, on average, paying an additional $960/year ($80/month) for their policies this year due specifically to last year's sabotage efforts by Donald Trump and Congressional Republicans. This is separate from other factors such as medical trend and the reinstatement of the ACA carrier tax. The actual 2018 "Trump Tax" ranges from as little as almost nothing at all in Vermont and North Dakota to as high as $1,500 per enrollee in Mississippi and Pennsylvania.

The 2018 sabotage impact was mainly due to 1) CSR reimbursement funding being cut off; 2) uncertainty over individual mandate enforcement; and 3) a mish-mash of Open Enrollment changes including cutting the time window in half, slashing marketing/assistance budgets by 90% and 40% respectively and so forth.

 

The Kaiser Family Foundation just released an important new study which proves everything I've been saying for the past year and a half: After years of turmoil, the ACA-compliant individual market had finally quieted down and reached equilibrium last year...right up until Donald Trump, combined with total GOP control of the federal government, deliberately came in like a wrecking ball and messed everything up again:

Concerns about the stability of the individual insurance market under the Affordable Care Act (ACA) have been raised in the past year following exits of several insurers from the exchange markets for 2017, and again last year during the debate over repeal of the health law.

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