2018 MIDTERM ELECTION

Time: D H M S

Trumpcare

Not exactly a surprise: The stampede appears to be starting.

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.”

 

In our last episode of As the Stomach Churns, you may recall that after getting tired of having thousands of old white people screaming at them during town halls, the House GOP attempted to get them to shut up by demanding that the Senate throw $85 billion at them to make them go away.

The Congressional Budget Office determined that, nope, around 24 million people would still be kicked off their healthcare coverage due to how crappy the rest of the plan was. They would've just been pissing away another $85 billion for literally no reason.

The CEO of Molina Healthcare made it about as clear as he possibly could today:

Molina Healthcare CEO: GOP's 'piecemeal approach' to health-care reform will lead to a 'health-care disaster'

With the GOP's failure to repeal Obamacare last month, House Speaker Paul Ryan refused to give a time line for a new bill.

...But many health-care providers are wary of the fast pace the GOP seems to be taking with repealing Obamacare.

...Molina is particularly worried about the potentially higher premiums and misleading packages insurance companies can price and sell.

December 9, 2016:

...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.”

March 24, 2017:

 

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.

Back in January, the Congressional Budget Office concluded that, overall, they didn't see any death spiral forming if the ACA is kept mostly intact...but also concluded that growth of the exchange population has likely plateaued; around 13 million appears to be the enrollment ceiling barring any significant changes to the law. Interestingly, however, a couple of weeks ago they concluded that there would also be no death spiral if the GOP's AHCA "replacement" plan were to become law either.

Meanwhile, over at the Brookings Institute, Matthew Fiedler ran his own analysis of the exchange risk pool and concluded "No Death Spiral!" there either:

 

(This is an updated version of a post from February 1st):

COSMO: When I was in prison I learned that everything in this world, including money, operates not on reality...

MARTY: ...but on the perception of reality.

COSMO: Posit: People think a bank might be financially shaky.

MARTY: Consequence: People start to withdraw their money.

COSMO: Result: Pretty soon it is financially shaky.

MARTY: Conclusion: You can make banks fail.

COSMO: Bzzzzt! I've already done that. Maybe you've heard about a few? Think bigger.

MARTY: Stock market?

COSMO: Yes.

MARTY: Currency market?

COSMO: Yes.

MARTY: Commodities market?

COSMO: Yes.

MARTY: Small countries?

COSMO: I might even be able to crash the whole damned system.

Friday, January 20th:

via TV Tropes:

Synthetic Plague

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.

Politico, January 26th:

The Trump administration has pulled the plug on all Obamacare outreach and advertising in the crucial final days of the 2017 enrollment season, according to sources at Health and Human Services and on Capitol Hill.

Even ads that had already been placed and paid for have been pulled, the sources told POLITICO.

...Individuals may still sign up for Obamacare plans until the Jan. 31 deadline — but the Trump administration isn't advertising that fact any longer.

It is also halting all media outreach designed to spur signups in the days leading up to the deadline. Emails are no longer being sent out to individuals who visited HealthCare.gov, the enrollment website, to encourage them to finish signing up. Those emails had proven highly successful in getting stragglers to complete enrollment before the deadline.

Ron Pollack, executive director of Families USA, a consumer group that supports the law, called the decision "a mean-spirited effort that can only result in fewer people getting coverage who need it."

 

Robert Costa in the Washington Post:

President Trump called my cellphone to say that the health-care bill was dead

President Trump called me on my cellphone on Friday afternoon at 3:31 p.m. At first I thought it was a reader with a complaint since it was a blocked number.

Instead, it was the president calling from the Oval Office. His voice was even, his tone muted. He did not bury the lede.

“Hello, Bob,” Trump began. “So, we just pulled it.”

...The Democrats, he said, were to blame.

...Trump said he would not put the bill on the floor in the coming weeks. Instead, he is willing to wait and watch the current law continue and, in his view, encounter problems. And he believes Democrats will eventually want to work with him on some kind of legislative fix to Obamacare, although he did not say when that would be.

Late last night, just a few hours ahead of the actual vote in the House of Representatives, the House GOP released their final changes to the American Health Care Act (AHCA), otherwise known as Trumpcare. The last-minute changes range from pointless to insulting to disastrous:

  • It tacks on an additional one-time $15 billion to the "State Stability Fund", supposedly to cover maternity, newborn care and mental health services.
  • It pays for the above by holding onto the existing 0.9% Medicare tax on people earning over $200,000 for another 6 years
  • And, most significantly, it would get rid of the requirement that all qualifying healthcare policies cover the 10 Essential Health Benefits mandated by the federal government.

I want to take a moment to address the first two bullet points above, because they're basically the exact same thing that Paul Ryan did a few days earlier.

The original version of the AHCA would have resulted in older Americans having to pay exhorbitant premiums due to the idiotic restructuring of the tax credit system and the 5:1 age band change. This led the AARP to unleash their army to understandable scream bloody murder at Congressional town halls nationwide.

In response, the GOP added an oddly-worded amendment which "instructed" the Senate to pony up $85 billion which would be used to "increase tax credits for 50-64 year olds" in some vague fashion. Why they didn't simply cross out "$4,000" and replace it with "$10,000" in the language of their own text I have no idea, but whatever. The point is that they gummed up the works for older enrollees, got screamed at for it, and responded by throwing a boatload of cash at those folks to get them to STFU.

 

If it was any other politician, I'd call this a strategic bluff to try and get the bill to pass:

UPDATE: 7:42 p.m.: President Donald Trump is demanding a vote Friday in the House on the Republican plan to repeal and replace Obamacare, White House Budget Director Mick Mulvaney said. If the bill fails, Trump is prepared to move on and leave Obamacare in place, Mulvaney said.

In the case of Donald Trump, however, he could mean it. He doesn't actually give a rat's ass about healthcare or helping people anyway; the only reason he wants to repeal the ACA is because a) it'd let him stick it to Barack Obama; b) it'd give him another tax cut and c) he'd get to brag about "winning" by finally slaying the mighty Obamacare Beast, etc.

A couple of weeks ago, the Congressional Budget Office projected that Trumpcare 1.0, aka the "American Health Care Act" or AHCA would kick 14 million people off their healthcare coverage next year alone, followed by an additional 10 million getting the boot by 2026. It would, however, save the federal government around $336 billion over that time period, which was pretty much the only positive part of their analysis.

Unfortunately, it also meant that a 64-year old earning $26,500 per year would end up having to spend about 60% of their entire gross income in order to pay for health insurance even after their tax credits.

This didn't go over too well with the "moderate" wing of the House GOP, as the AARP crowd wouldn't stop screaming at them during town halls nationwide. Meanwhile, the "Freedom Caucus" (basically, the ultra-batcrap insane wing as opposed to the only-kinda-insane members) was angry because the Trumpcare bill didn't hurt enough people quickly enough.

 

House leaders postpone vote on their health-care plan

House leaders postponed a vote Thursday on their plan to overhaul the nation’s health care system, as they struggled to meet demands of conservative lawmakers who said they could not support the bill.

Earlier Thursday, conservative House Republicans had rebuffed an offer by President Trump on Thursday to strip a key set of mandates from the nation’s current health-care law, raising doubts about whether House Speaker Paul D. Ryan (R-Wis.) had the votes.

Trump met at the White House with the most conservative House Republicans, hoping to close a deal that would help ensure passage of the party’s health-care plan by shifting it even further to the right. But the session ended with no clear resolution, and some lawmakers said they needed more concessions before they would back the bill.

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