Former CMS representative and current healthcare policy advisor for Sen. Brian Schatz, Aisling McDonough, made an important point last night:
If you have a pre-existing condition and live in a rural area, especially in VA, TN, OH, IN, MO, IA, or NV, then I'm worried there might not be a plan available for you next year.
People should be worried about bare ACA counties in 2019 b/c of GOP sabotage.
Between mandate repeal, short-term plans, health ministries, farm bureaus, etc, the guaranteed $ for the lone ACA insurer is getting smaller. It's not the same calculus as it was in 2017 & 2018.
UPDATE 4/11/18: I posted this piece about a month ago; I don't have any specifics, but I have reason to believe that the Michigan state legislature could be moving on this any day now. If you live in Michigan, CALL YOUR STATE SENATOR OR REPRESNTATIVE AND TELL THEM *NOT* TO IMPOSE WORK REQUIREMENTS ON "HEALTHY MICHIGAN" ENROLLEES!
State Senate introduces bill to add work requirements to Medicaid
The bill would require able-bodied adults to work or be in school for 30 hours a week in order to receive Medicaid.
Some lawmakers in Lansing want people to work to get Medicaid. The Senate introduced a bill Thursday. It would add work requirements to the Medical Assistance Program, or Medicaid.
...If passed, able-bodied adults would be required to work or continue school for 30 hours per week as a condition of receiving medical assistance.
Top Republican looks to codify move to short-term healthcare plans
Sen. John Barrasso, R-Wyo., introduced legislation Wednesday that would let more people enroll in short-term health insurance plans, an idea that builds off a Trump administration proposal issued last month.
The Improving Choices in Health Care Coverage Act would allow people to stay on less expensive, short-term medical plans for as long as 364 days and allow them to renew for subsequent years.
Yes, that's right: "Improving Choices in Health Care Coverage Act", or ICHCCA. I'm going with #IckyJunkPlan instead, it rolls off the tongue better.
In other words, this would codify Donald Trump's executive order into federal law. It might even trump (no pun intended) state laws against #ShortAssPlans, although perhaps not.
*(except people who are actually sick, that is) --h/t Anne Paulson
I've written a lot about Idaho's decision to simply ignore ACA regulations by allowing non-ACA compliant healthcare policies which would destabilize the individual healthcare market even worse than it already is today.
But it would be a mistake to ignore what Idaho is up to. If the Trump administration doesn’t intervene, other red states will surely follow in its footsteps. The result will be widespread disregard of the law and the rise of state-to-state inequalities in the private market similar to those that already exist in Medicaid.
House Republicans are demanding a series of controversial abortion and health care policies in the annual health spending bill, setting up a showdown with Democrats and threatening passage of an omnibus spending package to keep the government open.
Democrats are vowing to block the slew of long-sought conservative priorities. The riders would cut off federal funding to Planned Parenthood, eliminate a federal family planning program and ax the Teen Pregnancy Prevention Program, according to sources on Capitol Hill. Republicans also want to insert a new prohibition on funding research that uses human fetal tissue obtained after an abortion.
In 2018, unsubsidized premiums for ACA-compliant individual healthcare policies have shot up by around 30% on average nationally. Around 18 points of this (60% of the total) is due specifically to policy decisions by the Trump Administration and Congressional Republicans, primarily the cut-off of Cost Sharing Reduction reimbursement payments and the (accurate, as it would later develop) anticipation, by some carriers, of the ACA's individual mandate being repealed.
What about 2019, however? The 2-3 points tacked on out of concern for the mandate being repealed was only a small portion of the full impact insurance carriers expect it to have, and of course there's the further undermining of the ACA via Donald Trump's "Short Term" and "Association Plan" executive orders. Finally, there's the impact of what is assumed to be another year of the advertising/outreach budget being starved by the Centers for Medicare & Medicaid.
Back in June 2016, the Obama Administration rightly clamped down on "Short-Term Plans", limiting them to, you know, a "short term"...no more than 3 months out of the year, while also making them non-renewable; that is, you couldn't get around the 3-month limit by simply renewing the policy every three months:
From the Cabinet Meeting scene in the comedy "Dave":
DAVE: Now the Commerce Department..,
SECRETARY OF COMMERCE (sitting erect): Yes, Mr. President?
DAVE (from a card): You're spending forty-seven million dollars on an ad campaign to... (reading) 'Boost consumer confidence in the American auto industry.'
SECRETARY OF COMMERCE: Um...yes, sir...it's designed to bolster individual confidence in a previous domestic automotive purchase.
DAVE: So we're spending forty-seven million dollars so someone can feel better about a car they've already bought?
SECRETARY OF COMMERCE: Yes, sir, but I wouldn't characterize it that way...
DAVE (indignant): Well I'm sure that's really important, but I don't want to tell some eight- year-old kid he's got to sleep in the street because we want people to feel better about their cars. (beat) Do you want to tell him that?
SECRETARY OF COMMERCE (quietly): No sir...(looks at TV cameras)...no sir, I sure don't.
President Trump’s budget plan released Monday endorsed an Obamacare repeal and replace bill that gives funding to states and makes cuts to Medicaid.
...Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., are behind the legislation that takes Obamacare’s funding for the Medicaid expansion and tax subsidies for lower premiums and gives it to states through block grants. The senators introduced the bill in September along with Sens. Ron Johnson, R-Wis., and Dean Heller, R-Nev.
The bill would end the Medicaid expansion under Obamacare but supporters say states can implement it individually if they want. However, the bill makes cuts to Medicaid overall by capping federal funding per beneficiary.
The bill failed to get enough support in Congress in September, as some senators from expansion states worried about Medicaid cuts and protections for people with pre-existing conditions.
Last year, in my "If I Ran the Zoo" piece, I stuck my neck out and noted that the single biggest problem with the Individual Mandate isn't that it exists, but that it's not strong enough (conservative healthcare writer Michael Bertaut, who I disagree with on most issues but respect on this topic, also argues that the mandate has never been enforced strongly enough either). Here's what I said at the time:
The reality is that as much as everyone complains about the $695 or 2.5% income individual mandate penalty for NOT having qualifying healthcare coverage, the penalty should really be increased. There, I said it. The problem is that if the penalty is significantly less than the amount that the premiums would be, some people will still decide to eat the tax instead of signing up.
OPEN ENROLLMENT EXTENDED UNTIL DEC. 22
ONE WEEK ADDED TO ENROLL IN 2018 HEALTH, DENTAL COVERAGE
BALTIMORE (DEC. 13, 2017) – Open enrollment through Maryland Health Connection has been extended until Friday, Dec. 22 to choose a plan for health coverage to begin Jan. 1, 2018, with expanded call center hours through next week.
Individuals can apply at MarylandHealthConnection.gov or through the “Enroll MHC” mobile app available free in the App Store (iOS) and the Google Play Store (Android).
Also, hundreds of insurance brokers and navigators around the state can help Marylanders apply for financial help and enroll in a plan. Their locations and contact information are available at MarylandHealthConnection.gov or through a GPS-enabled locator tool on the app.
Collins' bill with Nelson would set aside $4.5 billion over two years to help states establish reinsurance programs. Reinsurance directly compensates insurance carriers for their most expensive customers.
To the best of my knowledge, that's...pretty much all it does: $2.25 billion per year for two years, and then...that's it. If there's more to the bill than that, I'll revise this post, but in the meantime, that seems to be the whole bill.
I've said before that there are a few areas of the ACA which I simply don't consider myself knowledgable enough about to try and explain to others in depth. One of these is the so-called "Cadillac Tax" on high-end employer sponsored insurance policies. The other (well 3 others, really) are the "3R" programs which were set up to try and smooth out the transition period for insurance carriers for the first few years. The "3 R's" are "Risk Adjustment", "Reinsurrance" and "Risk Corridors".
Risk adjustment is a process that deters insurance plans from trying to attract healthy enrollees (“cherry picking”), and protects companies that may—by chance or because of their particular benefits—attract sicker than average customers (“adverse risk selection”). Though the Affordable Care Act bans carriers from turning people down or charging them more based on their health, the incentive to attract healthier enrollees remains because healthier customers increase profits by reducing companies’ payouts.
