2018 MIDTERM ELECTION

Time: D H M S

Trumpcare

I pretty much stole that headline from Politico, but how else was I supposed to word it?

Senate Republicans are working on a potential breakthrough that could help push through an Obamacare repeal bill – by making insurance subsidies look a lot like Obamacare.

There’s growing support for the idea of pegging the tax credits in the House repeal bill to income and making aid more generous for poorer people. But those moves — while they may win consensus among Senate moderates — are unlikely to sit well with House conservatives.

The financial assistance in the House bill “is just not robust enough to make sure that low-income individuals can actually afford a [health] plan,” said Sen. John Hoeven (R-N.D.). “If you bring those income limits down for people who really need the help, you can give them more help.”

I'm not sure what the original source for this is, but the following initial filing deadlines were provided by Stephen Holland via Twitter. I've already posted analyses of the Virginia, Maryland and Connecticut filings. The California and Oregon filings are supposed to have been submitted already but don't appear to be publicly available yet. In addition, it's my understanding that in many states the rates can still be adjusted/resubmitted until as late as August 16th, so I'm not really sure how useful these dates are anyway, but it's at least a guideline.

Headline pretty much says it all:

May 11, 2017 - 21% Of U.S. Voters Approve Of Revised GOP Health Plan, Quinnipiac University National Poll Finds; Voters Reject Trump Tax Plan Almost 2-1

Only 21 percent of American voters approve of the Republican health care plan passed by the U.S. House of Representatives last week, a slight improvement over the 17 percent who approved of the first health care plan in March, according to a Quinnipiac University national poll released today. Overall, the current health plan goes down 56 - 21 percent.

Apparently throwing $8 billion (over 5 years) to the junk pile gave it a 4 point increase. I wonder what would happen if they restored the $840 billion (over 10 year) that the bill takes away from Medicaid?

Except for an anemic 48 - 16 percent support among Republicans, every listed party, gender, educational, age and racial group opposes the plan, the independent Quinnipiac (KWIN- uh-pe-ack) University Poll finds.

Another very nice scoop by Sarah Kliff of Vox.com:

News: Tennessee’s empty shelf problem appears to be fixed! Blue Cross of TN will sell coverage in Knoxville area.

— Sarah Kliff (@sarahkliff) May 9, 2017

BCBS of TN says they’ll sell coverage in the 16 Eastern TN counties that had no carrier signed up for 2018. https://t.co/g3dkqU4G1m

— Sarah Kliff (@sarahkliff) May 9, 2017

Here's the full text of the letter; emphasis mine:

May 9, 2017

Dear Commissioner McPeak,

We appreciate getting to meet with you and your team yesterday to update you on BlueCross’s position relative to the individual Marketplace for Tennessee as the first deadline for 2018 approaches.

 

Read this. Read the whole thing, thanks. Then come back here.

Done?

To summarize: For months now I've been predicting/warning that regardless of whatever legitimate risk pool issues the ACA exchanges may still be having in many parts of the country which could lead to significant rate 2018 rate hikes no matter what, there's the additional Fear/Uncertainty/Doubt factor which is being deliberately created by Donald Trump, Tom Price and the Congressional GOP. Insurance carriers hate uncertainty above all else, and I've been expecting them to do one of two things as the 2018 rate filing deadlines approach: Either jack their rates up significantly to cover themeselves for the unholy mess brewing ahead...or to simply get out of Dodge by either dropping out of the exchanges or fleeing the entire individual market altogether, on & off exchange. Most likely, I've been saying, it'll be a combination of both.

There are so many stories I could be writing right now about the fallout, potential fallout, next steps and so forth of yesterday's House vote on the AHCA. But this one in particular really says it all.

Here's an article in the Buffalo News regarding New York Republican Congressman Chris Collins (NY-27), who voted for the bill:

Watch: Chris Collins admits he didn't read health care bill

WASHINGTON – Rep. Chris Collins told CNN that he didn't read the entire Republican health care bill that the House passed Thursday.

And then he told The Buffalo News that he was unaware of a key provision in the bill that decimates a health plan that serves 635,000 New Yorkers.

Asked by CNN's Wolf Blitzer if he had read the entire health bill, Collins, R-Clarence, said: "I will fully admit, Wolf, that I did not. But I can also assure you my staff did. We have to rely on our staff. ... I'm very comfortable that we have a solution to the disaster called Obamacare."

Welp. I've done everything I can to help stop them, but it looks like the House Republicans have decided to go ahead and vote on their big ol' dumpster fire of a bill after all.

No CBO score. No review. No debate. No transparency. No time for anyone to read the bill. Everything they falsely accused the Democrats of 7-8 years ago (yes, I gave a range of 7-8 years, because there was a solid year of debate, discussion, meetings, arguments and so forth before the final votes were cast).

Maybe they'll pull it off. Maybe they won't. If it passes the House, what'll happen to it in the Senate? Who the hell knows, but the fact remains that anyone who votes for this piece of crap doesn't deserve to hold office any more than the racist, misogynistic, xenophobic con-artist moronic pussy-grabbing asshole who leads their party.

So be it.

Remember this mess in November 2018.

Back in January, I wrote a long rant about High Risk Pools. The general thrust was that in theory HRPs aren't necessarily a horrible idea; on paper they can be made to work...assuming the math adds up and they're properly funded on a permanent basis.

However, I also pointed out that due to the very nature of HRPs (i.e., segregating out a small, highly vulnerable group of people from the rest of society), it's incredibly easy for legislators not to properly fund or maintain them, especially after the initial funding comes up for renewal.

 

No real analysis here, just some choice tweets from this morning on the latest insanity. I'll likely tack on a few more as the day progresses.

.@SteveScalise says the repeal bill has "layers of protection" for peeps w/pre-existing conditions. That's the new GOP talking point, guys

— Rachael Bade (@rachaelmbade) May 2, 2017

"Layers of protection." As Jeffery Young of the Huffington Post noted...

You always test out new talking points when you're winning. It's a sign of great confidence in the policy and politics of your situation. https://t.co/CTgnppDP01

— Jeffrey Young (@JeffYoung) May 2, 2017

Speaking of having tremendous confidence...

Ryan tells fellow Republicans behind closed doors to pray for the health vote they may be about to take this week.

The latest iteration of the AHCA is supposedly being scheduled for a vote (for real, this time) sometime this week. The pressure is high on both sides, the whip counts are bouncing around, the tension is palpable, etc etc.

The first time around, the biggest tug-of-war was over Medicaid expansion. This time, the major issue seems to be Pre-Existing Condition coverage...and along with it, Guaranteed Issue and Essential Health Benefits; the three have to be pretty much joined at the hip, since removing one effectively makes the other two pointless in practice. It doesn't do most people much good to be told that yes, they'll be covered even if they have cancer if that coverage is gonna cost them $50,000/month.

Anyway, people are furiously scrambling to call their member of Congress and lighting up social media spreading the word...while Donald Trump, MIke Pence and Paul Ryan are running around DC desperately trying to squeak out 216 "Yes" votes from the Republican caucus.

And then, Monday, four amazing things happened.

CBS News. Face the Nation. This morning:

JOHN DICKERSON: Let me ask you about health care -- Tucker Carlson interviewed you about six weeks ago when you were in the middle of health care negotiations. And you agreed with him that the health care bill wasn't going to help your supporters. That those who lived in rural areas, the older, were going to get hurt by that bill. And you told him--

PRESIDENT DONALD TRUMP: Excuse me, the health care bill is going to help my supporters.

"F*ck anyone who didn't support me, though."

JOHN DICKERSON: Well, hold on. Let me just finish the question, if I may, sir--

PRESIDENT DONALD TRUMP: Otherwise, I'm not going to sign it. I'm not going to do it.

JOHN DICKERSON: Well, this is why I wanted to ask you. You said to Tucker, "We will take care of our people, or I am not signing it." You said you were going to negotiate.

PRESIDENT DONALD TRUMP: Well, that's what I just said.

JOHN DICKERSON: So tell me what in the bill you've been negotiating to get--

PRESIDENT DONALD TRUMP: But let me--

 

I noted a week or so ago that according to David Anderson of Balloon Juice, rumor has it that many insurance carriers are making their actuaries work overtime to put together multiple rate filings for 2018 based on several different outlooks:

  • Trump/Price/GOP quit screwing around, officially fund CSR reimbursements, enforce the mandate penalty and generally implement the ACA in good faith.
  • Trump/Price/GOP cut off CSR funding but otherwise enforce the law somewhat reasonably
  • Trump/Price/GOP cut off CSR, don't enforce the mandate, keep mucking around with half-assed repeal/replacement bills
  • (etc, etc...several possible scenarios)

Today the California Insurance Commissioner, Dave Jones, made a formal announcement that this is exactly what CA insurance carriers will be allowed to do, and he isn't pussyfooting around with the reasons for the policy change either:

 

*(Disclaimer: No, that's not a direct quote from Dr. Molina, but it's a pretty damned spot-on paraphrase).

A couple of weeks ago I noted that a buttload of heavy players in the healthcare field sent a joint letter to Trump, Tom Price and everyone else under the sun making it pretty clear how vital resolving the CSR issue is, and what the consequences would be if Congress and Trump don't make good on them.

Today, Molina Healthcare, which has around 1 million ACA exchange enrollees at the moment (roughly 9% of all effectuated enrollees) lowered the boom even harder (via Bob Herman of Axios):

Molina will exit exchanges if ACA payments aren't made

UPDATE: Note that Anthem made these statements BEFORE Molina drew their line in the sand re. CSR payments. That could be a game changer.

I'll let Tami Luhby of CNN/Money take the floor:

Anthem says Obamacare business doing 'significantly better,' but still may exit some areas. https://t.co/ToFAvXj62t via @CNNMoney @luhby

— Tami Luhby (@Luhby) April 26, 2017

$antm CEO: "Individual business is doing markedly better than last year." But claims are slightly higher than expected.

— Tami Luhby (@Luhby) April 26, 2017

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