END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

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BCRAP

(sigh) I'm not really sure what the point of even writing about this is since it doesn't include the Cruz-Lee amendment which is supposedly the only thing keeping the ultra-conservative wing of the GOP Senate on board with BCRAP in the first place, but whatever:

CBO and the staff of the Joint Committee on Taxation (JCT) have prepared an estimate of the direct spending and revenue effects of the version of H.R. 1628, the Better Care Reconciliation Act, posted today on the Senate Budget Committee’s website.

By the agencies’ estimates, this legislation would lower the federal budget deficit by reducing spending for Medicaid and subsidies for nongroup health insurance. Those effects would be partially offset by the effects of provisions not directly related to health insurance coverage (mainly reductions in taxes), the repeal of penalties on employers that do not offer insurance and on people who do not purchase insurance, and spending to reduce premiums and for other purposes.

 

Flashback to November 2016:

But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.

 

(sigh) OK, is this the 3rd or 4th time I've used the exact same clip from "Dead Again"?

My colleague @SenMikeLee and I will not support the MTP to this version of BCRA. #HealthcareBill

— Jerry Moran (@JerryMoran) July 18, 2017

My colleague @JerryMoran and I will not support the MTP to this version of BCRA #HealthcareBill

— Mike Lee (@SenMikeLee) July 18, 2017

Here's Jonathan Cohn with the skinny:

Senate Republicans Just Killed Their Health Care Bill Again
But it could come back in another form. Like a zombie.

Yesterday, HHS Secretary Tom Price lied his ass off on the Sunday morning talk shows:

Health and Human Services Secretary Tom Price on Sunday made a bold and questionable prediction about the Senate GOP bill to repeal and replace Obamacare: He argued that the legislation could actually provide health insurance to more individuals than the Affordable Care Act, a claim undermined by the Congressional Budget Office’s analysis of the bill.

Price made the comment while discussing how the Senate bill closes a gap that existed in certain states that chose not to expand Medicaid under Obamacare. In those states, there is a section of the population that does not qualify for traditional Medicaid, but makes too little to qualify for subsidies on the exchanges since Obamacare intended to cover it through Medicaid expansion. The Senate bill closes this gap, and Price used that provision to argue that more people would be covered under the new legislation.

Larry Levitt of the Kaiser Family Foundation noticed this within minutes of the latest "Cruz-Lee" version of BCRAP being released last week...

Non-compliant plans don't count as continuous coverage. So, people in them would face a 6-month waiting period to enroll in compliant plans.

— Larry Levitt (@larry_levitt) July 13, 2017

...and Topher Spiro of the Center for American Progress points out the relevant text here:

Here's the part of the Senate bill that admits Cruz subprime junk insurance is not health insurance at all. Oops! pic.twitter.com/EZ3t5hObYl

— Topher Spiro (@TopherSpiro) July 17, 2017

Right on top of the American Academy of Actuaries' open letter explaining the extreme danger of the GOP passing their BCRAP bill (particularly the Godawful Cruz-Lee amendment) comes this joint letter sent to GOP Senate Majority Leader Mitch McConnell (well...and Chuck Schumer, since he is the Senate Minority Leader) from both America's Health Insurance Plans and the Blue Cross Blue Shield Association (h/t to Sahil Kapur and Topher Spiro...not sure who posted it on Twitter first):

 

Yes, that's GOP Speaker of the House of Representatives, 2nd in line to the Presidency, utterly clueless about the basic concept of how health insurance (or any type of insurance, really) works.

The American Academy of Actuaries has chimed in on the GOP Senate's #BCRAP Obamacare replacement bill, and I have to imagine that they had to bite their tongues clean through while composing this primer explaining the most rudimentary concepts behind "insurance", "risk pools" and "adverse selection" to Paul Ryan, Ted Cruz, Mike Lee and Mitch McConnell:

Risk Pooling: How Health Insurance in the Individual Market Works

What is risk pooling?

 

So the latest #BCRAP b-crap being pulled by the Senate GOP is that they supposedly "forgot" to include the Cruz-Lee Amendment with the rest of the revised BCRAP bill that they sent over to the Congressional Budget Office to score next week. Topher Spiro of the Center for American Progress posted a twitter thread this morning which started off like so...

1: Senate Republicans are about to do something unprecedented that will break the Senate.

2: They claim they forgot to send the Cruz amendment to CBO on time. I think it was purposeful.

Now, this raised my eyebrows because I hadn't heard about this tidbit; when I asked for clarification, Spiro responded:

there was some mixup - McConnell staff blaming Cruz staff and vice versa. All staged.

Here it is in all it's glory gory...

Note: The following notes are mostly cribbed from Larry Levitt of the Kaiser Family Foundation via Twitter, plus a few from other folks or tidbits I dig up myself...

  • Still cuts off tax credits at 350% FPL instead of the ACA's 400% FPL. Pass.
  • Still bases tax credits on a 58% AV Bronze plan instead of the ACA's 70% AV Silver plan. Pass.
  • Throws another $70 billion onto the "state stabilization fund" pile for a total of $132 billion
  • Throws another $70 billion on to "offset costs for high-risk patients" (I presume this means reinsurance?)
  • Yes, it includes the Cruz/Lee "Separate but Unequal" amendment; carriers could indeed go back to offering unregulated plans: No guaranteed issue, no community rating, no essential benefits, as long as they also offer a fully ACA-compliant plan
  • Tax credits couldn't be used for the unregulated plans, nor would they be attached to the risk adjustment program. In other words: Segregated risk pools
  • Catastrophic plans would be "counted" the same as other plans (ie, tax credits could be used for them), but they'd amount to the same as Bronze plans now anyway
  • It includes a #BakedAlaska giveaway to win over Lisa Murkowski...1% of funds have to go to "any state where premiums are 75% higher than average" (i.e., Alaska)

Last week, and then earlier today, I crunched some more numbers (with a big assist from the Kaiser Family Foundation) to figure out just what the impact of Ted Cruz's "Consumer Choice" #BCRAP amendment would be on the individual market, and the results weren't pretty. Here's what it boiled down to (rough estimates for all numbers):

n other words, Kaiser estimates the breakout of the individual market as something like this:

Last week I noted that Ted Cruz's proposed amendment to the GOP Senate's BCRAP bill is a big pile of crap all by itself, since it would effectively turn the ACA-compliant market into a massively underfunded High Risk Pool, while likely turning the non-compliant individual market into a wasteland of subprime junk insurance (or at best, plans which are reasonable right up until you get truly sick, in which case you're screwed).

To help explain how this would happen, I used this bar graph from the Kaiser Family Foundation to show how medical expenses are actually split up by different subsets of the population:

Based on these averages, I put together several scenarios showing what typical premiums might be for "ACA Enrollees" and "Cruz Enrollees" depending on how the market was split up:

So the Big News this week is that Ted Cruz has come up with what he thinks is a brilliant solution to the GOP Senate's BCRAP problem:

His proposal, which he’s circulating to his colleagues on typed handouts, wouldn’t explicitly create and fund the special insurance markets, as the House bill did. Instead, insurance experts said, it would create a sort of de facto high risk pool, by encouraging customers with health problems to buy insurance in one market and those without illnesses to buy it in another.

...There is no public legislative language yet, but here’s how Mr. Cruz’s plan appears to work, based on his handout and statements: Any company that wanted to sell health insurance would be required to offer one plan that adhered to all the Obamacare rules, including its requirement that every customer be charged the same price. People would be eligible for government subsidies to help buy such plans, up to a certain level of income. But the companies would also be free to offer any other type of insurance they wanted, freed from Obamacare’s rules.

Several regular commenters here at ACA Signups have been wondering why the Congressional Budget Office keeps using March 2016 as the "baseline" for projecting the net impact on healthcare coverage numbers under the GOP's Trumpcare bills (the House's AHCA and the Senate's BCRAP), as opposed to the more recent January 2017 baseline. After all, according to the March 2016 baseline, the CBO was projecting that under the ACA, the total individual market would have 25 million people as of 2026 (18 million on the exchanges plus another 7 million off-exchange), whereas under the January 2017 baseline, their projections are for the individual market to only be 20 million as of 2027 (13 million on the exchanges plus 7 million off-exchange). Taken at face value, this would seem to suggest a 5 million enrollee discrepancy. This drumbeat has been taken up more recently by GOP Senators, particularly Wisconsin Senator Ron Johnson.

UPDATE 7/18/17 1:30pm: Well, that didn't last long...

Three GOP senators — Shelley Moore Capito, Susan Collins, and now Lisa Murkowski — all will vote "no" on the new plan to repeal and then replace the Affordable Care Act.

Why it matters: This guarantees what was already widely expected: that Senate Republicans wouldn't be any more successful with a straight repeal plan, without a replacement, than they were with the repeal-and-replace legislation that stalled yesterday. Republicans could only lose two votes.

What's next: Senate Republicans are still likely to schedule the vote — even if it fails — because they have to prove to conservative groups (and President Trump) that they've tried everything.

Then again, who the hell knows...

UPDATE 7/18/17: REPOSTING since Mitch McConnell is now back to a "repeal with a 2-year delay" strategy:

Gee, this all seems awfully familiar...

UPDATE 7/20/17: The CBO score of BCRAP 2.0 has just been released, and while there are some tweaks/changes to their conclusions here and there, they still project about 22 million people to lose coverage by 2026 if BCRAP 2.0 is signed into law. They still expect about 15 million Medicaid enrollees to lose coverage by 2026. The only significant change on the "net loss of coverage" front is that they estimate that instead of 7 million people losing individual market coverage, they now project a net indy market reduction of 5 million...but also now expect about 2 million people with employer-based coverage to lose that, resulting in a net loss of...22 million.

I don't know if CAP plans on recrunching their numbers, since the BCRAP 2.0 bill still doesn't include the Cruz amendment which is supposedly going to be part of the final version voted on, but in the meantime, I'd imagine all numbers below could be updated by simply lowering all Individual Market column numbers by 29%...and just adding those numbers over to a new, Employer Coverage column.

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