2018 MIDTERM ELECTION

Time: D H M S

Michigan

UPDATE: It turns out that Humana is not dropping out of Michigan entirely; they're only dropping their PPO plans, not their HMOs.

I noted last month that like UnitedHealthcare, Humana is pulling out of the individual market in multiple states next year. Unlike United, however, both the number of states and the number of enrollees impacted by Humana's withdrawl is fairly nominal; at the time I counted 5 states and around 25,000 total enrollees. Since then, Humana has confirmed that they're also dropping out of Colorado (9,914 enrollees), for a total of roughly 35,400 people nationally.

Today, I've confirmed that Michigan can be added to the list, impacting 1,717 people enrolled in off-exchange PPO plans. This brings the total to around 37,000 nationally:

Hmmmm...I'm still waiting for the Michigan Dept. of Insurance to publicly post the 2017 requested rate hikes (they aren't due until June 20th, apparently), but in the meantime, Blue Cross Blue Shield of Michigan (the largest insurer in the state) decided to issue a press release patting themselves on the back for keeping their small business average rate hike down to 2.9%:

DETROIT, June 8, 2016 /PRNewswire-USNewswire/ -- In contrast to national trends, Blue Cross Blue Shield of Michigan today announced a comparatively small statewide average rate increase of 2.9 percent for small group employers in 2017, pending state regulatory approval. This follows rate reductions that Blue Cross delivered to small employer group customers that renewed during the second half of 2015.

When UnitedHealthcare announced last month that they were making good on their threat last fall to pull out of the individual market in over two dozen states next year, it caused shockwaves across the health insurance industry. It is an important development, as around 800,000 people will be impacted.

When Humana announced last week that they plan on pulling out of the individual market in at least 5 states next year, it was interesting and a bit of a bummer, but not nearly as earthshattering, because only about 25,000 people will have to shop around and find a new carrier.

Today, it is my duty to announce that Celtic insurance has also decided to pull out of the entire individual insurance market (both on and off-exchange) across at least 6 states, including:

After a year and a half of allowing the residents of Flint, Michigan to be poisoned, GOP Governor Rick Snyder, in response to growing public pressure, finally decided to do something decent for once:

Gov. Rick Snyder said Tuesday he will seek permission from the Obama administration to allow all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.

...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.

Even then, he wasn't exactly in a big hurry to do so; he waited another 3 weeks to get around to actually submitting his request:

Over the past week or so, UnitedHealthcare started making good on their threat last fall to drop out of the ACA exchanges in at least some of the 33 states that they offer individual market policies in. On April 8th they said they were pulling up stakes in Arkansas and Georgia (although they're keeping a small presence in Atlanta via their experimental "Harken Health" division). Then, last Friday, they said they were dropping off the Michigan exchange as well...and just today, Adam Cancryn noted that they're pulling the plug on Oklahoma, while Zachary Tracer says they're pulling out of Louisiana. Ugh.

Zachery Tracer of Bloomberg News reports some unfortunate but not unexpected news:

UnitedHealth Group Inc. plans to exit a third state Obamacare market as the insurer works to stem losses from its struggling Affordable Care Act business.

The insurer won’t sell policies through Michigan’s ACA exchange for next year, according to Andrea Miller, a spokeswoman for the state’s Department of Insurance and Financial Services. Georgia and Arkansas said last week that UnitedHealth will quit their exchanges for 2017.

...Fifteen insurers sold policies in the state for this year, U.S. data show.

OK, this is not only off topic, it's not even a particularly significant issue, but it bugs me because...well, frankly, because it's about my hometown.

Over on Twitter, several pundits/reporters have made this claim:

Trump dominated Oakland County Michigan, which includes Mitt Romney's hometown. ¯\_(ツ)_/¯ pic.twitter.com/wcsBcbFz7h

— Benny (@bennyjohnson) March 9, 2016

Childhood home of Willard Mitt Romney. https://t.co/BxH4b1nRUb

— Amy Sullivan (@sullivanamy) March 9, 2016

While this makes for a fun “Isn’t It Ironic??” meme, it’s not the case at all.

“Oakland County” has a whopping 1.23 million people, and includes very un-Romney cities like Pontiac, Southfield and so forth.

Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid, just announced that CMS has authorized expanding Medicaid to 15,000 children and pregnant women in Flint, Michigan, as well as expanding the services provided to 30,000 current Medicaid enrollees. Here's the full press release (emphasis mine): 

HHS Approves Major Medicaid Expansion for Flint

FLINT, Mich. – Today, the U.S. Department of Health and Human Services announced that the Centers for Medicare & Medicaid Services (CMS) has approved the State of Michigan’s 1115 demonstration to extend Medicaid coverage and services to Flint residents impacted by the lead exposure. In recognition of the public health crisis in Flint, it is a top priority for the Administration and for the Department to ensure that all children and pregnant women exposed to lead in their water in Flint have access to the services they need.  Approximately 15,000 additional children and pregnant women will be eligible for Medicaid coverage and 30,000 current Medicaid beneficiaries in the area will be eligible for expanded services under this new waiver agreement.

“Expanding Medicaid coverage to tens of thousands of expectant mothers and youth means the most vulnerable citizens served by the Flint water supply can now be connected to a wide range of needed health and developmental services, including lead-blood level monitoring and behavioral health services,” said HHS Secretary Sylvia M. Burwell.

Michigan will expand Medicaid coverage to children up to age 21 and pregnant women who were served by the Flint water system from April 2014 up to a date specified by the Governor, and who have incomes up to 400 percent of the federal poverty level (FPL).  Michigan will also set up a state program allowing pregnant women and children up to age 21 who were served by the Flint water system and individuals with incomes above 400 percent of FPL to purchase unsubsidized coverage.  This comprehensive health and developmental coverage includes lead-blood level monitoring and behavioral health services, among other services.

Last month, Michigan Governor Rick Snyder stated that he was planning on asking the Obama administration to expand Medicaid to cover...

... all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.

...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.

Specifically, the initiative, which is expected to be sent to the Obama administration in the next week, seeks expanding Medicaid eligibility to those affected regardless of income level. The request would also include the expansion of Medicaid coverage for people already enrolled in other forms of insurance.

UPDATE: OK, the live stream was over hours ago. I can no longer embed the entire hearing, but here's a direct link to watch it over at C-SPAN's website.

However, just to give you a taste of how jaw-dropping this hearing was, watch Rep. Elijah Cumming's question period with the head of Michigan's Dept. of Environmental Quality:

For a full write-up of the hearing, visit Eclectablog.

Isaac Bashevis Singer is famous for, among other things, his collection of Yiddish folk tales about The Wise Men of Chelm, a town in Poland which, according to the folk tales, was populated entirely by fools.

One of the stories about the people of Chelm was about a playground located near the top of a cliff. Every once in awhile, a child would fall off the cliff and injure themselves on the ground below.

The Wise Men of Chelm came up with an ingenious solution to the problem: They built a hospital at the bottom of the cliff. That way, the children could be rushed into the emergency room quickly for medical treatment.

I was reminded of this story when reading the following AP article posted moments ago:

LANSING, Mich. (AP) — Michigan Gov. Rick Snyder will propose $30 million in state funding...

(thanks to Hector Solon for the tip)

OK, as far as crimes and/or stupidity by the Michigan GOP goes, this is pretty small potatoes these days. Even so...

So, you may have heard that the Republican-controlled Michigan state legislature recently passed (and Governor Rick "Leadfoot" Snyder signed) a dead-of-night bill which, for absolutely no reason whatsoever...

...bans any public body or public official, except for “an election official in the performance of his or her duties,” from using public funds to issue any kind of communication that “references a local ballot question, and is targeted to the relevant electorate where the local ballot question appears on the ballot,” in the 60-day run-up to an election.

UPDATE: I thought this was obvious, but apparently not: I'm not saying that a complete relocation of the entire population of Flint will be necessary, I'm just trying to get some sort of feel for how much it would theoretically cost if they had to be relocated.

For example, Wired Magazine has posted a more detailed analysis of the actual cost/mechanics/logistics involved in ripping out and replacing the entire city's piping system. The good news? The estimate of just replacing the pipes comes in at "only" $60 million, vs. the $1.5 billion I've seen thrown around. The bad news?

"A September estimate, only recently released by Michigan governor Rick Snyder, puts the cost of replacing all the lead pipes in Flint at $60 million. And the project will take 15 years.

Presented without comment, because what the f*ck else am I supposed to add here?

LANSING -- In January of 2015, when state officials were telling worried Flint residents their water was safe to drink, they also were arranging for coolers of purified water in Flint's State Office Building so employees wouldn't have to drink from the taps, according to state government e-mails released Thursday by the liberal group Progress Michigan.

A Jan. 7, 2015, notice from the state Department of Technology, Management and Budget, which oversees state office buildings,references a notice about a violation of drinking water standards that had recently been sent out by the City of Flint.

...State officials could not immediately answer e-mailed questions about the water purchases, including how long the state continued to buy bottled water for state employees in Flint while telling Flint residents the water was safe to drink. An official said the administration was "looking into these issues."

A few minutes ago I noted that Michigan Governor Rick Snyder, currently in the hot seat for poisoning nearly 100,000 of his residents, has formally requested full Medicaid coverage for every Flint resident under the age of 21 (around 30,000 people, as far as I can tell). While my post was sarcastic, the need is real, and while it's revolting that Snyder would try to get the federal government to literally pay for his administration's crime, the move itself makes sense.

Here's a related development which makes sense as well (thanks to Rachel Karas for the link): A letter from U.S. Senator Gary Peters and U.S. Rep. Dan Kildee to HHS Secretary Sylvia Burwell (emphasis added):

January 22, 2016

Dear Secretary Burwell:

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