2018 MIDTERM ELECTION

Time: D H M S

Trumpcare

Over at the L.A. Times, Noam Levey has a fantastic story which underscores everything I've been shouting from the rooftops for months now regarding Trump/GOP sabotage of the ACA exchanges, through both active and passive measures:

Health insurers and state officials say Trump is undermining Obamacare, pushing up rates

Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues.

At the same time, state insurance regulators — both Democrat and Republican — have increasingly concluded they cannot count on the Trump administration to help them ensure that consumers will have access to a health plan next year.

As noted in my last post, it turns out that if the CBO score of the final version of the AHCA (that is, the one which passed two weeks ago) doesn't project the law to save at least $2 billion over a 10 year period, the House Republicans would have to start over again from scratch and re-vote on yet another version of their bill.

Now, the good news for them is that the CBO projected the prior version to save $150.3 billion over that period, so they have $148.3 billion worth of wiggle room, right? What are the odds of the CBO's new projection assuming that the passed version would eat up that much more money?

The key is does CBO assume lots of states waive benefits/community rating, and lots of healthy people use tax credits for skimpy insurance. https://t.co/vLx28MT5Bv

— Larry Levitt (@larry_levitt) May 18, 2017

Here's what Levitt is talking about:

 

Hey, remember this?

Cases upon cases of beer just rolled into the Capitol on a cart covered in a sheet. Spotted Bud Light peeking out from the sheet

— Alexandra Jaffe (@ajjaffe) May 4, 2017

Yeah, well, about that...

via Billy House of Bloomberg News:

House May Be Forced to Vote Again on GOP's Obamacare Repeal Bill

House Republicans barely managed to pass their Obamacare repeal bill earlier this month, and they now face the possibility of having to vote again on their controversial health measure.

This Axios piece by Caitlin Owens is extremely short...a mere 139 words in all...so sticking with a "fair use" quote is tricky, but I'll do my best:

Senate Finance Committee chairman Orrin Hatch says he could support delaying the repeal of the Affordable Care Act's individual mandate for a while, or even indefinitely, as a way to stabilize the marketplaces. "I wouldn't mind" postponing the repeal until after 2020, he told reporters this afternoon. "It all comes down to budgetary concerns and how it's going to be written." And he didn't rule out keeping it even longer:

"I'd like to not have it at all, but you know, it all comes down to, what's the art of the doable?"

Think about this for a moment.

A few days ago, CMS announced that they're retooling the ACA's SHOP program (at least on the federal exchange) so that instead of small businesses using HealthCare.Gov for eligibility verification, enrollment and payments, going forward it will only be used for verification, with the businesses then being kicked over to the actual insurance carrier website in order to actually enroll in the policies and make payments.

Although the Trump Administration and HHS Secretary Tom Price are hell bent on killing off the ACA altogether, this move didn't bother me for several reasons. For one thing, the SHOP program has always been kind of a dud anyway, with only around 230,000 people being enrolled in it nationally. For another, a business signing up their employees for coverage is a very different animal from an individual signing their family up for a policy. Finally, for several reasons, SHOP enrollment across the dozen or so state-based exchanges is actually higher than it is across the 3 dozen states covered by HC.gov, and the state-based exchanges aren't impacted by this policy anyway.

Julie McPeak is the Tennessee Insurance Commissioner. She was appointed by a Republican Governor, Bill Haslam, and while the position itself appears to be nonpartisan, I've found several links indicating that yes, she's a Republican herself. This is hardly surprising in Tennessee, of course, and there's nothing wrong with it...but it's noteworthy given that Tennessee is among the 19 states which has been fairly hostile towards the ACA in general over the years (no state exchange, no Medicaid expansion, total GOP control and so forth).

I've noted repeatedly that while every year brings some amount of premium rate hikes and/or carriers dropping out of the exchanges (or off the entire individual market), there's a major new factor impacting both this time around: The Trump/GOP Sabotage/Uncertainty Factor. This includes, but isn't limited to:

  • Total U.S. Population as of 2009: Around 306 million people
  • Total # of Mothers in U.S. as of 2009: Around 85.4 million
  • Assuming this ratio hasn't shifted much over the past 8 years, around 28% of the total U.S. population are mothers,

Of course, women over 64 (mostly on Medicare) are much more likely than the general population to be mothers...but girls under 18 are far less likely to be (well...under 16, anyway...the birth rate varies from state to state, of course), so I'm assuming that these cancel each other out, resulting in that 28% rate being roughly accurate.

If so, this means that out of the estimated 24 million people who would lose their healthcare coverage if GOP's "American Health Care Act" were to be signed into law, roughly 6.7 million would likely be moms.

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.

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