2018 MIDTERM ELECTION

Time: D H M S

Trumpcare

 

(sigh) Yes, this is the second time I've used the same headline and clip.

According to The Hill, just moments ago:

WH to Dems: We’ll continue paying ObamaCare subsidies

The Trump administration has told Democrats it will continue paying controversial ObamaCare insurer subsidies, lowering fears that a fight over the issue could cause a government shutdown.

The move marks something of a shift for President Trump, who had threatened earlier this month to withhold the subsidies, known as cost-sharing reductions, as a way to move Democrats to negotiate on a healthcare overhaul.

"A shift"? He shifts so often he should be in the next Fast & Furious movie.

Rep. Tony Cardenas (D-Calif.), for one, said Wednesday that he doesn’t trust the president enough to take him at his word.

You don't say.

The Kaiser Family Foundation took a national survey from March 28 - April 3 (the week following the GOP's first failed attempt to pass their Trumpcare bill), and included among the questions they asked was this one:

With the future of any other replacement plans uncertain, this month’s survey also gauges who the public views as responsible for the 2010 health care law going forward. A majority (61 percent) of the public say that because President Trump and Republicans in Congress are in control of the government, they are now responsible for any problems with the ACA moving forward. About three in ten Americans (31 percent) say that because President Obama and Democrats in Congress passed the law, they are responsible for any problems with it.

UPDATE 7/17/17: Dusting it off AGAIN because with the Senate GOP's #BCRAP replacement bill supposedly dead, Mitch McConnell is now claiming he's gonna go back to "Repeal/Delay", while Trump is once again threatening to simply "let Obamacare fail completely"...which CSR sabotage would definitely be a part of. Simply substitute the month of "AUGUST" for "MAY" in the entry below.

UPDATE 5/19/17: I'm dusting this off again because it looks like (shocker) Trump has changed his mind again regarding whether or not he'll have HHS continue making CSR payments or not. According to Politico:

Trump said to favor move that could destabilize Obamacare

 

(sigh) Yes, this is the third time I've used the exact same clip from "Dead Again". That's no coincidence; Zombie Trumpcare keeps shuffling back every few weeks, but this time they appear to actually be serious about it (again).

Others have already written up more detailed explainers on the latest changes, so I'm not gonna go into too much detail, but Sarah Kliff of Vox wraps it up nicely:

Republicans’ new health amendment lets insurers charge sick people more, cover less

Here's the basics: In addition to (or in revised versions of) everything awful about the AHCA ("American Health Care Bill") which gave it a mere 17% approval and led to it being yanked off the House floor mere moments before it was scheduled to be voted on, the new version also includes the following:

A couple of weeks back, the Kaiser Family Foundation crunched the numbers to see just how much insurance carriers would likely raise their full-price premiums on individual market policies to make up for lost CSR assistance reimbursements in the event that Donald Trump makes good on his threat to discontinue them. Their conclusion?

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.

Again, that's an average onf 19% on top of whatever the carriers would otherwise be increasing rates for other reasons.

This has been confirmed by a separate report from the American Academy of Actuaries, which draws the same conclusion:

As I posted yesterday, here's a rough overview of what total Individual Market Enrollment has looked like since 2010, and how Trump's threat to cut-off CSR reimbursements would impact it:

The blue section is off-exchange enrollees...around 7 million people today, all of whom are paying full price. This includes perhaps 1.8 million people still enrolled in Grandfathered or Transitional plans (which are part of a separate risk pool), although that number is highly speculative.

Standard & Poor's, December 22, 2016:

Well THAT figures: Insurance carriers finally breaking even on ACA exchanges just in time for GOP to tear up the law.

Health insurers may finally be seeing improved results on their Obamacare plans just as a newly elected president is poised to follow through on promises to end the controversial coverage program, a new report suggests.

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.

 

UPDATE: ...or, perhaps not. Latest word is that there's basically little to see here; lots of big talk about pushing forward but very little action. Or perhaps there will be next week, who the heck knows? Wash, rinse, repeat.

On March 24th, just after the AHCA (Trumpcare) bill was yanked from the House floor with literally minutes to go, I posted the following headline:

CELEBRATE A FEW HOURS. Then come back and read this.

Well, according to Matt Fuller and Jonathan Cohn of the Huffington Post, Trumpcare 2: Electric Boogaloo may indeed be a go:

 

Exactly one month ago, I asked a rhetorical question:

How High will Initial 2018 Rate Hike Filings Be?

...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:

 

Last week, former CMS Administrator Andy Slavitt conveyed a warning to the Trump Administration and the GOP about how critical confirming ongoing Cost Sharing Reduction reimbursements (not just for the rest of 2017, but continuing into 2018) is, by paraphrasing multiple anonymous sources within the health insurance industry.

On Monday, it looked as though the Trump admin was finally providing some reassurance on the CSR issue; as Robert Pear reported in the New York Times:

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.

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.

Back in December, Standard & Poor's issued an analysis in which they concluded that:

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

— Andy Slavitt (@ASlavitt) April 5, 2017

A related question I get asked a lot is why don't health plans speak up more loudly about the impact of govt reneging on CSR payments. 2

— Andy Slavitt (@ASlavitt) April 5, 2017

By tomorrow, I will have asked 10 CEOs that question & will tweet back what they say. 3

— Andy Slavitt (@ASlavitt) April 5, 2017

Hot off the presses:

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.

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