Yesterday was a Graham-Cassidy (or "Grassidy", as former CMS Administrator Andy Slavitt keeps trying to push) Fest, with all sorts of Grassidy-centric happenings, including the one-and-only Senate hearing on the bill; the Congressional Budget Office releasing their preliminary/partial score of G-C (the prior version, not the later version); Senator Susan Collins releasing her statement opposing the bill; and last night's CNN healthcare debate between Senators Graham & Cassidy vs. Senators Sanders and Klobucher. I might write something about these items later today, but right now I want to look at another development.
Why? Because, as noted at the link, while the current ACA structure (exchanges, tax credits, etc) would stay mostly in place for 2 more years, some provisions would be repealed immediately...including a nationwide ban on any exchange policy offering abortion coverage.
This morning JP Massar (who called my attention to the 1/1/18 effective date the first time) inquired as to whether that had changed with the new version of G-C. As you can see on pages 2 & 3 of the new bill...nope. It’s still in place.
Here's direct links to the bill itself and to the GOP's table showing what they claim would be the net federal funding changes from 2020-2026 for each state relative to current law...but they pulled one hell of a fast one.
it's pretty rare for the entire medical, hospital and insurance industry to agree on just about anything...and yet here we are (emphasis in the original):
The following statement was jointly released on September 23, 2017 by the American Medical Association, American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, America's Health Insurance Plans and the BlueCross BlueShield Association regarding the Graham-Cassidy-Heller-Johnson legislation.
We represent the nation's doctors, hospitals and health plans. Collectively, our organizations include hundreds of thousands of individual physicians, thousands of hospitals, and hundreds of health plans that serve tens of millions of American patients, consumers and employers every day across the United States.
Anyone who's followed me either here at ACASignups.net or over at Twitter over the past eight months knows that no one has been sounding the alarm louder or more frequently than me about both the real and potential sabotage of the ACA being carried out (or at least attempted) by the GOP in general and Donald Trump/Tom Price specifically. Hell, back in July, I even warned of a half-dozen things to look out for, several of which have since already been proven true:
This brings me to the main point of this entry: This is likely just the beginning. I'm not going to say that any or all of the following will happen--it's possible that Trump/Price/Verma will show some level of restraint--but I wouldn't be at all surprised to see any or all of these happen during this fall's Open Enrollment Period (which runs from Nov. 1st - Dec. 15th, by the way):
It's time to once again dust off the Three-Legged Stool visual aid to help explain just what the Graham-Cassidy bill would do to the individual insurance market. It's important to note that none of this has anything to do with Medicaid (expansion or traditional), the group market, Medicare and so forth; just the individual market.
Once again, here's what the "3-Legged Stool" was supposed to look like under the Affordable Care Act:
Here's what it actually looks like today, with some rather obvious gaps in the red (enrollee responsibility) and green (government responsibility) legs:
As the final deadline for final 2018 individual market rates to be locked in and the contracts signed, more states are coming into focus, and the pattern continues to be remarkably consistent.
In Mississippi, I originally pegged the requested rate hikes across the two individual market carriers (technically three, but "Freedom Life" is a phantom carrier with only 2 alleged enrollees) at 16.1% if CSR payments are made and 39.6% if they aren't. It turns out I was off by a bit, however, because I didn't realize that BCBS of Mississippi was only selling policies off-exchange next year. That means the CSR issue won't impact them either way, since none of their enrollees would receive the assistance anyway.
Alaska (along with Hawaii) will continue to receive Obamacare’s premium tax credits while they are repealed for all other states. It appears this exemption will not affect Alaska receiving its state allotment under the new block grant in addition to the premium tax credits.
Delays implementation of the Medicaid per capita caps for Alaska and Hawaii for years in which the policy would reduce their funding below what they would have received in 2020 plus CPI-M [Consumer Price Index for Medical Care].
Provides for an increased federal Medicaid matching rate (FMAP) for both Alaska and Hawaii."
Bird doesn't have the actual legislative text, but they threw Hawaii in there as well (not to win their votes...Dems Brian Schatz and Mazie Hirono are solid NOs no matter what). That means that the wording is probably along the lines of:
The Congressional Budget Office stated that they won't be able to provide a full score of the projected 10-year impact of the Graham-Cassidy bill for "at least several weeks". Instead, they expect to provide a partial score, focusing purely on the budget-related stuff necessary to "count" towards Senate reconciliation voting rules "early next week".
What won't be included are some pretty damned important details, like:
Impact on the federal deficit
Impact on insurance premiums, and of course...
Impact on the number of people with health insurance coverage
Unfortunately, Mitch McConnell and Senate Republicans are insisting on squeezing the vote on Graham-Cassidy through within the next 10 days, before the fiscal year ends on Sept. 30th, since that's the only way they have a chance at passing it using 50 votes (after the 30th, they would require 60 votes, which of course they have no chance at getting).
Jeff Stein: Senator, I wanted to ask you for a policy-based explanation for why you’re moving forward with the Graham-Cassidy proposal. What problems will this solve in the health care system?
Pat Roberts: That — that is the last stage out of Dodge City...I’m from Dodge City. So it’s the last stage out to do anything. Restoring decision-making back to the states is always a good idea, but this is not the best possible bill — this is the best bill possible under the circumstances.
If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel.
Jeff Stein: But why does this bill make things better for Americans? How does it help?
The fact that the Graham-Cassidy bill, like all of the prior Republican "replacement" healthcare bills, screws over people on both Medicaid and the individual market starting in 2020 is hardly news. A few provisions of the ACA are stripped out and/or bastardized immediately (and some, like the individual mandate penalty, are even repealed retroactively), but for the most part the pain doesn't start for another 2 years, well after the midterms are over.
However, JP Massar called something to my attention this morning:
Regular readers know that one of the issues I've spent the better part of the past year yammering on about endlessly is the importance of Congress formally appropriating Cost Sharing Reduction reimbursement payments to the insurance carriers on the individual market exchanges.
Thanks to the ongoing/pending ruling in the federal House vs. Burwell Price lawsuit, Donald Trump has the ability to pull the plug on CSR payments pretty much whenever he wants to (and he's threatened to cut them off every month since around March or April so far). CSR payments hang like a Sword of Damocles over the heads of every exchange-based insurance carrier each month, with them never knowing whether they'll get reimbursed or not.
CBO aims to provide preliminary assessment of Graham-Cassidy bill by early next week
CBO is aiming to provide a preliminary assessment of the Graham-Cassidy bill by early next week. That assessment, which is being prepared with the staff of the Joint Committee on Taxation, will include whether the legislation would reduce on-budget deficits by at least as much as was estimated for H.R. 1628, the American Health Care Act, as passed by the House on May 4, 2017; whether Titles I and II in the legislation would each save at least $1 billion; and whether the bill would increase on-budget deficits in the long term. CBO will provide as much qualitative information as possible about the effects of the legislation, however CBO will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.