A Roundup of Awful

Then, just this week, after Senators Collins, McCain, Paul—and potentially Murkowski—announced their opposition to the bill, the GOP leadership announced that the Senate would not vote on Graham-Cassidy. Given budget reconciliation rules, the Senate only has until September 30th to pass a repeal bill with just 50 votes (Vice President Pence then casting the tie-breaking vote). Thus, it would appear that repeal efforts will be delayed until the spring of 2018 when fiscal year 2019 begins, and new budget reconciliation rules are established. All of that said, I am sick and tired of sitting on pins and needles as this process has unfolded. Based on the submissions I received this week, many of my colleagues seem to share my sentiments, as very few posts focused on Graham-Cassidy. In recognition of that, I present you with the “Repeal Fatigue” edition of the Health Wonk Review.

But now that it’s over, the old Graham is back and more than willing to laugh at how improbable it was that a national-security expert briefly held the national limelight as a supposed health-policy wonk.

Graham, though, said he was not alone in his lack of understanding of health care. “Nobody in our conference believes Obamacare works. It must be replaced. But until now we didn’t know how to do it,” Graham told reporters in the Capitol on Tuesday, audio of which is posted below.

A reporter pointed out that such ignorance at this late stage is itself hard to understand. “You’ve been working to overhaul this for seven years. Why is this so hard?” she asked.

“Well, I’ve been doing it for about a month. I thought everybody else knew what the hell they were talking about, but apparently not,” Graham clarified, adding he had assumed “these really smart people will figure it out.”

The crash-course in health policy has been a romp, Graham said. “I’ve enjoyed this more than anything."

Yeah, I'm sure everyone with cancer, parents of children with heart defects and so forth have "enjoyed" the past 9 months as well, Senator.

Minnesota Gov. Mark Dayton (D) said today that state officials will continue to press CMS on its Sept. 22 response to the state's 1332 State Innovation Waiver request, in which the agency approved federal pass through funding for a state reinsurance program that will help lower premiums at the cost of about $369 million in Basic Health Plan funding, according to the state.

CMS in its letter says it approved the waiver for the pass through funding for a reinsurance program lasting from January 2018 through December 2022. The estimated pass through for the five years of the waiver is about $1 billion, with $139.2 million estimated for 2018. The state must provide CMS with final plan rates by Oct. 16 in order to determine actual calculations. But the agency did not agree to pass through the same amount that would have gone toward the BHP if the reinsurance program were not in effect. The BHP, or MinnesotaCare, is funded through the advanced pay tax credits that would have otherwise gone to state residents earning from 138 percent to 200 percent of the Federal Poverty Level,

State officials proceeded with the waiver on good faith that the lower premiums through the reinsurance would not be linked to the BHP, and were shocked and dismayed to discover otherwise, Dayton said Monday (Sept. 25), reiterating charges made in a Sept. 19 letter to HHS Secretary Tom Price.

Put another way, Trump Administration is forcing Minnesota to screw people earning $16,000 - $24,000/year in order to help out people earning over $48,000/year. Of course, I've long argued that the ACA's 400% FPL subsidy cap should be raised or removed entirely...but not at the expense of the BHP enrollees.

Executive action on association health plans could help Trump realize his goal, although at this point it’s difficult to know exactly what his administration is planning to do ― or even what the law would allow them to do.

...But the statute itself doesn’t state that explicitly, and the Department of Health and Human Services could attempt to reverse the Obama-era guidance, legal scholars told HuffPost on Wednesday ― in effect, exempting association health plans from some of the new rules. The National Federation of Independent Businesses, a conservative organization that has been among Obamacare’s most relentless critics, has urged the administration to take precisely this step.

If that happens, association health plans, also known as AHPs, might have more freedom to sell skimpier plans that, for healthier beneficiaries, would be cheaper than plans they are buying today ― either through HealthCare.gov or state-based exchanges, or directly from insurers. But the more healthy people flocked to those plans, as individuals or part of small businesses, the more carriers selling to everybody else would have to increase their premiums to reflect their new, sicker pool of enrollees.

The plans would still be subject to state regulation and some other federal guidelines, too, so analysts were scrambling on Wednesday to figure out just how far-reaching the effects could be.

“We don’t know exactly what the Trump administration is going to do on this front,” said Kevin Lucia, a research professor at Georgetown University’s Center on Health Insurance Reforms. “But if they allow AHPs to bypass the ACA’s consumer protections, like not covering maternity and other essential health benefits, it sets up an uneven playing field, destabilizes the state individual and small group markets, and ultimately puts consumers at risk.”

Assuming this is what Trump's semi-gibberish from yesterday meant, this is basically a throwback to Ted Cruz's terrible #BCRAP amendment from last summer, which would effectively turn the ACA exchanges into an insanely expensive de facto high risk pool.

President Donald Trump on Wednesday said he will likely sign an executive order allowing Americans to purchase health care across state lines.

But the idea is broadly opposed by state insurance commissioners, consumer advocates and insurers, and has failed in states where it's been tried.

“I’ll probably be signing a very major executive order where people can go out across state lines, do lots of things and buy their own health care, and that will be probably signed next week,” Trump told reporters on Wednesday afternoon. “It’s being finished now. It’s gonna cover a lot of territory and a lot of people — millions of people.”

Trump’s remarks revived a theme from his presidential campaign and came a day after the collapse of Senate Republicans’ efforts to repeal Obamacare with a simple majority.

If this is what his semi-gibberish meant, then there's now good word to describe how "can't even" I was when I read the news. I went off on a little rant:


— ☪️ Charles Gaba ✡️ (@charles_gaba) September 27, 2017

Plus, while the #ACA allows states to FORM COMPACTS to sell to/from each other, doing it via exec. order is likely ILLEGAL (states rights).

— ☪️ Charles Gaba ✡️ (@charles_gaba) September 27, 2017

Hey @realDonaldTrump, guess what? https://t.co/T2JLt1xORq pic.twitter.com/RpdXbPrxKt

— ☪️ Charles Gaba ✡️ (@charles_gaba) September 27, 2017