ACA Sabotage

IMORTANT UPDATE: As I suspected, it turns out that the stray rate filing posted to the California Insurance Dept. website a few days ago was posted prematurely, doesn't reflect the carrier's final* rate filing, and has since been pulled from the California Insurance Dept. website.

I've been asked to remove the filing data, and seeing how there's nothing nefarious about it (I wasn't "whistleblowing" evidence of anything criminal/unethical), I'm complying with that request. Since everything in the post related to that data, there wasn't much point in keeping the rest of it either.

*(Yes, I'm aware that none of these early filings are "final" since they tend to be revised/resubmitted throughout the summer/fall, but you know what I mean.)

...and to absolutely no one's surprise, GOP sabotage of the ACA will be directly responsible for a significant chunk of the individual market premium increases.

Every year for 3 years running, I've spent the entire spring/summer/early fall painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are going to increase (or, in a few rare instances, actually decrease).

The actual work is difficult due to the ever-changing landscape as carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it easy to find the specific data I need and sometimes make it next to impossible.

NOTE: Just to clarify, here's where the headline comes from:

...Sponsoring Sen. Mike Shirkey, R-Clarklake, created exemptions in the Michigan legislation that would waive the work requirement for parents with young children, pregnant women or caretakers for disabled family members. But asked about people like Maitre who could still lose health care, he told reporters the social safety net “by definition, has a lot of holes in it.”

“The best safety net ever invented by God is family,” Shirkey said, “but I’m not sure that government is supposed to supplement that process.”

Well, here we go:

#BREAKING tomorrow morning the House Appropriations Committee is taking up SB 897. Another Republican attempt to take away healthcare from Michigan families https://t.co/WsUhyntINj

— MI House Democrats (@MIHouseDems) May 2, 2018

 

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.

Covered California Analysis Shows Major Declines in New Enrollment Nationally and Identifies Policies That Could Lower Premiums in 2019

  • Enrollment in the federally facilitated marketplace has dropped 9 percent over the past two years, with a nearly 40 percent drop in new enrollment, while enrollment in state-based marketplaces remained steady during the same period.

Nothing new under the sun here; this is the core of what I do at ACASignups.net. In fact, this press release underplays the point slightly: The official enrollment tallies are down 10% on the federal exchange since 2016 and up 1.5%, although the discrepancy might be partly due to Kentucky shifting from state-based status to federal status in 2017.

 

Former Acting CMS Administrator Andy Slavitt and Huffington Post healthcare reporter Jeff Young have each written up a fairly comprehensive list of the various types of ACA/healthcare sabotage which the Trump Administration and/or other Republicans in Congress or at the state level have attempted (or are in the process of attempting today).

Young posted an excellent roundup under a nice headline which says it all:

The GOP Has One Big Idea For Health Care Reform: Crappier Insurance

So, about a week ago I tweeted this out:

(sigh) OK, gather 'round children, and let me tell you the story of how Cost Sharing Reductions went from being a thorn in the side of the Obama Administration to becoming a massive tree branch jammed into the kidney of Congressional Republicans. The following is an updated version of a lengthy post of mine from about six months ago.

The Cost Sharing Reduction (CSR) payment controversy has only really been sucking up a huge amount of political and policy oxygen for the past year and a half, since Donald Trump took office, but actually started long before then. Why? Because the whole reason the CSR payments were discontinued in the first place is a federal lawsuit filed by John Boehner on behalf of the House Republican Caucus back in 2014.

(sigh) Dammit, sure enough, as I expected, the full Michigan state Senate has gone ahead and passed the state Senator Mike Shirkey's "God's Safety Net" bill which would impose 29-hour-plus work requirements on 680,000 low-income Medicaid enrollees even though the vast majority of them already work, go to school, are medically fragile, take care of other medical fragile family members, elderly relatives or children and so forth. It was, as you'd expect, a party-line vote:

Able-bodied Medicaid recipients in Michigan may soon have to choose between finding a job or losing health insurance.

...Democrats condemned the proposal as harmful to thousands of Medicaid recipients who would not meet the several exemptions spelled out in SB 897 and said such a move is also illegal. Majority Republicans brushed aside those objections, and the bill passed 26-11.

The bill now heads to the House.

I was originally just planning on comparing the various provisions of the House and Senate Democratic versions of their "ACA 2.0" bills against my own, year-old "If I Ran the Zoo" wish list.

Then I wrote a post about a whole bunch of stand-alone bills in California which Louise Norris alerted me to and decided to throw those into the comparison table as well.

And now, with quick state-level action in both Maryland and New Jersey in recent days, I decided to expand this project across every state. I've started color-coding the status of each bill and am even adding some recent/past bills and/or waivers which have failed as I go (i.e., the failed/delayed mandate penalty restoration efforts in Connecticut and Maryland).

This is a work in progress, so the table is probably pretty incomplete for now and will likely be changing constantly as various bills are introduced, moved to committee, voted on, pass/fail, signed/vetoed by governors and actually implemented (or legally challenged).

UPDATE 4/20/18: Whew! OK, I've incorporated a bunch of Louise Norris' links for several states and have moved it to a full Google Docs spreadsheet. Be warned, it's pretty big now...

As I noted last month, the Republican-controlled Michigan State Senate is planning on jumping on board the pointless, wasteful, cruel "work requirement" bandwagon which is all the rage among the GOP types these days.

Sure enough, they're planning on ramming it through within the next week: The Michigan Senate’s Competitiveness Committee is expected to hold a hearing on SB 897, a bill that would impose a work requirement on over 670,000 adult Michiganders with Medicaid health coverage...or nearly 7% of the state population.

The committee chair and the bill’s sponsor, Senator Mike Shirkey (SD-16) is planning on pushing the committee vote through ASAP and then kicking it over to the full state Senate right away.

A few weeks ago I posted an entry title, "Will Trump's HHS Dept. do the stupidest thing possible? Reply Hazy; Try Again Later."

The "stupidest thing possible" being referred to was whether or not CMS Administrator Seema Verma is planning on putting the kibosh on Silver Loading and the Silver Switcharoo starting in 2019:

The head of the Centers for Medicare and Medicaid Services would not say Thursday if the Trump administration is considering setting limits on how insurers that sell Obamacare plans structure subsidies for their customers.

"I'm not going to comment on the agency's deliberations," CMS Administrator Seema Verma said when asked by the Washington Examiner about rumors that had circulated about the issue. When pressed about whether any conversations had occurred, Verma said, "I'm just going to leave it at that."

 

WARNING: LOTS OF WONKY NUMBER-CRUNCHY STUFF BELOW.

Skip to the end if you just want to see my findings for every state, but be warned that there's a bunch of caveats/disclaimers involved.

UPDATE: To clarify, you're looking for the VERY LAST TABLE. Not that one...no, not that one either...the one at the very bottom of the post. I've added a highlighted note right above it.

A month ago I noted that along with a whole mess of other crap, Congressional Republicans were attempting to effectively starve the ACA out by simply cutting off funding of the law via the recent "must pass" omnibus spending bill:

Republicans also want to use the funding bill to go after Obamacare. They would prohibit funding for administering or enforcing the health care law, prohibit the administration from collecting a fee from insurance companies to run the insurance exchanges and eliminate more than half a billion dollars in funding for managing the program at the Centers for Medicare and Medicaid Services.

(sigh) I'm not quite sure how "prohibiting funding for administration" differs from "eliminating funding for managing the program", but it amounts to the same thing: They're trying to shut down CMS's ability to actually run the ACA.

The good news is that none of that ended up making it into the omnibus bill.

Regular readers know that I've developed a tradition over the past three years of tracking the average unsubsidized premium rate increases for the ACA-compliant individual market, painstakingly poring over the rate filings for every carrier in every state and running a weighted average by their market share.

Every year there are numerous challenges and headaches which get in the way, including things as obvious as "not every carrier publishes the number of enrollees they have covered" to complex situations like "carrier X is dropping out of the on-exchange market in half the counties of the state but is sticking around in the off-exchange market". In addition, many carriers submit an initial rate request...followed a few months later by a revised one...neither of which might end up matching the final premium changes approved by state regulators. Sometimes there may be 2-3 more revised filings along the way which muddy the waters even further.

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