...and then went on to conclude that, given the insane amount of uncertainty and confusion about what Donald Trump, Tom Price and the Congressional GOP in general has in mind for the 2018 insurance market, on top of normal stuff like inflation, an aging population and so on, that there are five likely scenarios:
Now, put yourself in the position of an insurance carrier executive and/or one of their actuaries. The level of uncertainty in the air is mind boggling. You have five choices for your initial filing:
The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them.
The statement sends a small but potentially significant signal to insurers, encouraging them to stay in the market.
UPDATE 6/8/18: Welp. Given last night's bombshell development that Donald Trump's Department of Justice has decided to not only abandon doing their jobs by defending the law of the land but to actually actively argue in favor of tearing away the ACA's prohibition of denying coverage for (or charging more for) pre-existing conditions, it seemed appropriate to dust off this entry from over a year ago.
A couple of important caveats: The individual market has shrunk by one or two milion people since a year ago (due in large part to other forms of Trump/GOP sabotage, I should note), so most of the estimates for the last column are likely a bit smaller as well, although those with pre-existing conditions are the least-likely to drop their coverae for that very reason. Also, a good half-dozen Congressional Districts have had special elections over the past year and now have new members of Congress (SC-05, MT-AL, PA-18 and so on) or currently have vacancies not shown below (MI-13, TX-27, etc).
Last fall, when the insurance carriers were jacking up their rates on the individual market by an (unsubsidized) national weighted average of around 25%, aside from the understandable grumbling about such a dramatic all-at-once increase, the big question was whether that would be enough to stabilize the market going forward, or whether this was just the beginning of an inevitable Death Spiral, etc etc.
An analysis out Thursday says that health insurers are expected in 2016 "to start reversing" financial losses on their Obamacare business after "hitting bottom" in 2015.
And 2017 "will likely see continued improvement" for those insurers selling individual health plans, "with more insurers getting close to breakeven or better," according to the report by Standard and Poor's Global Ratings.
The report also says big price increases for Obamacare plans in 2017 were likely a "one-time pricing correction."
OK, I was about to go with the more obvious saying: "Sh*t or get off the pot", but I'm trying to avoid blatant profanity in the headlines, at least.
Here's a tweetstorm from fomer director of the Centers for Medicare & Medicaid, Andy Slavitt, from yesterday/continuing through today. He confirms everything I've been sounding the alarm about, especially regarding the CSR payment crisis:
One of the questions I get asked most frequently is why don't more health plans speak up about what a disaster AHCA would be. 1
A new Kaiser Family Foundation analysis finds that the average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies.
The efforts to replace the Affordable Care Act have caused worry for insurers, who aren’t sure about the law’s future or what would replace it. On Thursday, Aetna Inc. said it would pull out of Iowa’s Obamacare market, becoming the second major health plan to do so this week after Wellmark Inc. said it was quitting the state as well.
“Aetna will not participate in the Iowa individual public exchange for 2018 as a result of financial risk and an uncertain outlook for the marketplace,” spokesman T.J. Crawford said in an email Thursday. “We are still evaluating Aetna’s 2018 individual product presence in our remaining states.”
...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.
“The first question I think they’re trying to figure out is, do we actually own it for 2018?” said one health care lobbyist, speaking on background. “If premiums spike and plans exit, can we still blame it on Obama and get away with it? That’s one of the threshold questions that I don’t think they’ve answered.”
Immediately after the "death" of the AHCA (Trumpcare) bill, I posted the clip above (from the underrated suspense thriller "Dead Again"), noting that as much of a victory as it was, there was little time to pat ourselves on the back, because Trump and the GOP would no doubt be back for Round 2 at any moment.
At the time, I assumed that they would likely abandon the "official" attempt at repeal/replace for the time being, and focus instead "only" on sabotage efforts of the ACA itself by doing whatever they can to scare off the carriers...and for the most part, that's exactly what Trump has done ("It's gonna explode!" and so forth).
I see that I've been thrown into the crossfire of a wonk debate between John Cochrane (who I've never actually heard of before today) and Brad DeLong/Paul Krugman (both of whom I very much have heard of!) regarding the question of whether the individual healthcare market is or isn't in a Death Spiral and/or whether it will/won't enter one next year.
So The Plague is wreaking havoc on the world's population. Maybe Super Flu has killed millions, or some unknown biological agent is causing people to snap and kill each other. Heck, maybe we even have a good old fashioned Zombie Apocalypse on our hands. Either way, it's safe to say that for most of humanity, these are not fun times. How could things get much worse, you ask?
By the revelation that the disease in question has been manufactured by genetic engineering, and possibly is distributed by humans. The untold amount of death and destruction has been directly caused by the foolish or malicious action of Man himself.
It may have been designed for use as a biological weapon, or an unexpected result of an experiment gone wrong. Perhaps we just shouldn't have let monkeys watch TV for too long. However it came to be, it has now been unleashed on humanity at large, and has almost certainly gone far beyond what its designers had originally intended.
There's been a lot of talk, by myself and others, about just which populations would be screwed over by a full repeal of the Affordable Care Act. Analysts, reporters and pundits have sliced and diced the numbers every which way...by race, income level, geography and of course political leanings.
Of course, this gets awfully messy right out of the gate because some ACA provisions apply to everyone in the country, such as the cap removal on annual/lifetime coverage limits; the reassurance that you can't be denied coverage for having pre-existing conditions (which applies to those covered by employer insurance as well, I should note, since many of them may have to switch jobs or be without one at some point in their lives), and so on. Other benefits apply to subgroups which aren't talked about much, such as the Medicare fund being extended by years and the Medicare Part D "donut hole" being closed.