2018 MIDTERM ELECTION

Time: D H M S

Trumpcare

NOTE: The original focus of this diary was on the deliberate sabotage by the Trump Administration/HHS Dept. under Tom Price of the individual insurance market in general and HealthCare.Gov in particular, but the screen shot mentioned in passing in the diary below is actually far more important and disturbing the more I think about it than I had originally thought.

As noted below, it's an anonymous note sent to me on Thursday. Since it was sent I’ve confirmed the identity of the sender. This doesn’t prove that their specific claim is true, but there’s absolutely no reason I can think of for this person to risk their job and reputation by lying about this issue, and it matches everything else in the diary.

Several professional journalists have since contacted me and I’ve gotten them in touch with the sender. Stay tuned, this could be a big deal.

via Gawker, November 2013:

Only Six People Signed Up on Healthcare.gov's First Day

(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.

 

I actually used this exact same headline seven months ago, and now we've apparently come full circle and are right back where we started:

The New York Times, December 2nd:

“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”

Having talked to a number of CEOs & states, @SabrinaCorlette is right, if not understating.https://t.co/Ri5TtkHz7Z

— Andy Slavitt (@ASlavitt) December 3, 2016

 

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.

  • According to Trump's CMS division, the average unsubsidized premium for federal ACA exchange policies (ie, 39 states on HealthCare.Gov) in 2017 is $476/month.
  • Across the 21 states I've compiled data for so far, the average requested rate increase for ACA-coimpliant individual market policies in 2018 is around 34%.
  • Of that 34%, roughly 19% of it on average is due specifically to concerns that Cost Sharing Reduction reimbursements won't be made by the Trump administration next year.

 

Thanks to Emily Gee and the Center for American Progress for this:

This isn't a full/official New Jersey rate hike update, as it only refers to one carrier, and rounds things off a bit, but in the video above, if you watch from around 37:30 to 41:00, you'll hear New Jersey Congressman Frank Pallone talk about the negative impact that the CSR reimbursement threat/uncertainty/sabotage effect is having on Horizon Blue Cross Blue Shield...and since Horizon BCBS happens to hold something like 70% of the New Jersey individual market share (which is confirmed by Pallone in the video), the statewide weighted average rate hike will end up being largely determined by theirs.

The most relevant part:

"So Horizon, which is something like 70% of our market in New Jersey, filed like a 24% increase. And I asked the president (of Horizon) "why are you filing with a 24% increase?" I can't imagine that health insurance costs have gone up that much. And he said "Oh, they haven't, Congressman." I said, "well, what is this?"

 

(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?

The Colorado Dept. of Regulatory Agencies has made it pretty simple for me:

Division of Insurance releases preliminary 2018 health insurance information
Final approval expected in late September / early October

DENVER (July 14, 2017) – The Colorado Division of Insurance, part of the Department of Regulatory Agencies (DORA), today released the preliminary information for proposed health plans and premiums for 2018 for individuals and small groups. From this point until August 4, Colorado consumers can comment on these plans.

All counties in Colorado
As the Division of Insurance noted in its June 21 news release, based on the plans filed, there is at least one insurance carrier planning to offer individual, on-exchange plans in every Colorado county. However, the insurance companies have indicated to the  Division that they may be forced to reevaluate their participation in the marketplace if the lack of clarity at the federal level continues.

 

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.

I've been writing for months now about the impact of the Trump/GOP Sabotage Effect on 2018 rate hikes. Generally speaking, premium increases will be due to four things:

Medical Inflation: That is, the actual increases in charges by hospitals, doctors, medical equipment, prescription medication, administrative overhead and so on. In a perfect world, this would be the only reason rates ever go up.

Reinstatement of the Health Insurance Providers Fee: One of the ACA's funding sources is a broad-based fee placed on health insurance companies themselves. Basically, a small portion of all premiums for all enrollees (including the total nongroup (on & off-exchange), small group and large group markets) is paid as a tax to the federal government which in turn uses it to partially fund the ACA's tax credits, CSR payments and Medicaid expansion provisions. The carrier tax was waived for 2016-2017, but is scheduled to be reinstated next year, so premiums wiill go up a bit accordingly. It's supposed to total around $14 billion next year.

Both of these are unfortunate, but make total sense in an ACA world: Healthcare costs do rise year to year (though at a slower pace since the ACA passed), while the carrier tax helps cover a chunk of the subsidies and Medicaid expansion funding.

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)

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