Charles Gaba's blog

This press release is mostly of interest because it came from the Governor's office, not the MA Health Connector itself:

Baker-Polito Administration Announces Health Connector Completes Successful Open Enrollment with Highest-Ever Membership, Covering 282,000 People with Health Insurance

Governor Baker announced today that the Massachusetts Health Connector completed Open Enrollment with the highest membership in the 13-year history of the state’s health insurance exchange, covering 282,000 people with health insurance.

Heh. "13-year history" took a moment to register...but of course Massachusetts has had a health insurance exchange website since 2006, when "RomneyCare" went into effect.

This just in from New York State of Health...

Press Release: NY State of Health Releases 2019 Enrollment Data by Insurer
Mar 12, 2019

  • New Yorkers Value Choice of Plans
  • 2019 Enrollment is Spread Across NY State of Health’s 12 Qualified Health Plan Insurers and 16 Essential Plan Insurers

ALBANY, N.Y. (March 12, 2019) - NY State of Health, the state’s official health plan Marketplace today released 2019 health plan enrollment by insurer. Twelve insurers offer Qualified Health Plans (QHP) and sixteen insurers offer the Essential Plan (EP) statewide in 2019. Most consumers have a choice of at least four QHP and EP insurers in every county of the state. 

“We are pleased to once again offer consumers a broad choice of high-quality, affordable health plan options in every county of the state,” said NY State of Health Executive Director, Donna Frescatore. “And the wide distribution of enrollment across insurers shows us that consumers value this choice.”

No, it won't go anywhere with the House held by Democrats, but even so:

President Trump is releasing a $4.7 trillion budget plan Monday that stands as a sharp challenge to Congress and the Democrats trying to unseat him, the first act in a multi-front struggle that could consume Washington for the next 18 months.

The budget proposal dramatically raises the possibility of another government shutdown in October, and Trump used to the budget to notify Congress he is seeking an additional $8.6 billion to build sections of a wall along the U. S.-Mexico border.

Here we go again...

Trump’s “Budget for a Better America” also includes dozens of spending cuts and policy overhauls that frame the early stages of the debate for the 2020 election. For example, Trump for the first time calls for cutting $845 billion from Medicare, the popular health care program for the elderly that in the past he had largely said he would protect.

OK, I'm not sure how this one slipped by me...over the past year, a half-dozen states having 1332 Waiver Reinsurance programs approved by CMS (among the few modifications of default ACA provisions approved by the Trump Administration that I agree with).

The states approved have included red ones like Wisconsin and Alaska...but also blue ones like Maryland and New Jersey. For whatever reason, CMS Administrator Seema Verma, while doing all she can to sabotage the ACA in other ways, seems to have a soft spot in her heart for reinsurance, which I'm not going to complain about.

In any event, along with the states which have already had their reinsurance waivers approved, there are several other states where reinsurance proposals have been proposed by either state legislators or governors, including the newly-elected governors of Michigan (Gretchen Whitmer) and Connecticut (Ned Lamont) respectively.

Minnesota's ACA exchange, MNsure, is among the better ones when it comes to data transparency. Here's some key data from their monthly board meeting on March 6th.

A couple of other interesting items of note:

  • It looks like MNsure's annual budget averages around $36 - $40 million per year, with between 50-60% of it coming from their 3.5% premium fee on exchange-based enrollments (I would think they'd spread the fee across off-exchange enrollments as well, as some other state exchanges do, for consistency's sake, which would reduce the amount of additional funding they need from the state Dept. of Human Services, but that's up to the state legislature, I presume).

via Covered California:

New Analysis Finds Leading State-Based Marketplaces Have Performed Well, and Highlights the Impact of the Federal Mandate Penalty Removal

  • The report examines the impact that federal and state actions have had on state-based marketplaces and the federally facilitated marketplace (FFM).
  • Cumulative premium increases in California, Massachusetts and Washington are less than half of the increases seen in FFM states, but 2019 premium increases spiked in California and Washington compared to Massachusetts, which continued its state-based penalty.

WASHINGTON D.C. — A new report highlights the benefits of state-based exchanges, particularly in the areas of controlling premium costs and attracting new enrollment. The report, which was produced by Covered California, the Massachusetts Health Connector and the Washington Health Benefit Exchange, found that premiums in these states were less than half of what consumers saw in the 39 states that relied on the federally facilitated marketplace (FFM) between 2014 and 2019.

With useful healthcare legislation extremely unlikely to pass the U.S. Senate until at least 2021, state-based public options will be all the rage for the next couple of years...

Connecticut lawmakers are joining other states that have unveiled proposals to expand government-run health coverage, with plans to extend state health benefits to small businesses and nonprofits, and to explore a public option for individuals.

Under two measures announced Thursday, officials would open the state health plan to nonprofits and small companies – those with 50 or fewer employees – and form an advisory council to guide the development of a public option. The legislation would allow the state to create a program, dubbed “ConnectHealth,” that offers low-cost coverage to people who don’t have employer-sponsored insurance.

I've posted so many "Great News!" updates out of New Mexico over the past month that I have a keyboard shortcut to select the NM icon graphic.

Here's the latest out of the Land of Enchantment:

HB 436 passed on the House floor by a vote of 40-24 on Thursday afternoon. The bill would bring New Mexico's state law dealing with pre-existing conditions into line with federal law. 

Rep. Liz Thomson, the bill's sponsor, says health insurance coverage for people with pre-existing conditions is already protected under the federal Affordable Care Act. She wants New Mexico's state law to do the same.

"Because before the Affordable Care Act came along, insurance companies could discriminate based on gender, they charge women more, and on pre-existing conditions," Thomson said. 

Last year, Republican Governor of Kentucky Matt Bevin, who had campaigned heavily on a promise to repeal ACA Medicaid expansion altogether, partly changed his tune once he actually took office. Instead of kicking all 450,000 low-income Kentucky residents off the program completely, he first imposed an absurdly insulting and cumbersome "frequent flyer"-style program:

Kentucky is moving closer to an overhaul of the state's Medicaid program Bevin has said is aimed at controlling costs and encouraging more personal responsibility in consumers, changes that include elimination of basic dental and vision benefits for most "able-bodied" adults who instead would have to earn them through a "rewards" program.

..."It is expensive to go to a dentist," he said. "These changes are just ludicrous."

(sigh) Here we go again...via CMS:

CMS seeks recommendations that allow Americans to purchase health insurance across state lines
Administration continues efforts to increase consumer choice, promote competition and drive down prices in the health insurance market

The Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) today that solicits recommendations on how to eliminate regulatory, operational and financial barriers to enhance issuers’ ability to sell health insurance coverage across state lines. This announcement builds on President Trump’s October 12, 2017 Executive Order, “Promoting Healthcare Choice and Competition Across the United States,” which intends to provide Americans relief from rising premiums by increasing consumer choice and competition.

I've attended Netroots Nation twice before. The first time was way back in 2007 in Chicago, back when it was actually called Yearly Kos (the conference started out as an offshoot of the Daily Kos progressive online community). They changed the name to "Netroots Nation" the following year to reflect that it had grown larger than any single website. The second time was here in Detroit in 2014, which happened to also be the same point I was at my peak media awareness (my "fifteen minutes of fame" so to speak).

For more than a decade, Netroots Nation has hosted the largest annual conference for progressives, drawing nearly 3,000 attendees from around the country and beyond. Netroots Nation 2019 is set for July 11-13 in Philadelphia.

 

Over at Inside Health Policy (paywall), Amy Lotven has an update regarding the eyebrow-raising decisions a few weeks ago by federal judges in several of the Cost Sharing Reduction (CSR) reimbursement payment lawsuits.

The general thinking at the time was that the judges would simply rule in the carriers favor and order the Trump Administration to pay the carriers the money owed to them from the last three months of 2017 (over $2 billion nationally, although the amounts at stake for each individual carrier suing is generally kmore along the lines of seven figures each). If this had been what happened there likely wouldn't have been much more to the story.

Instead, all three judges ruled--on behalf of dozens of carriers, since at least one of the cases is a class action suit--that the government owes them CSR payments for not only Q4 2017, but all twelve months of 2018 as well, assuming the carriers wanted to demand those payments.

Regular readers know that I've been calling for Congress to #KillTheCliff for years:

Once again: Under the ACA, if you earn between 100-400% FPL (between $12,140 and $48,560 for a single person), you're eligible for APTC assistance on a sliding scale. The formula is based on the premium for the Silver "benchmark" plan available in your area, which averages around $611/month in 2019.

Here's how the formula works under the current ACA wording:

...Here's the problem: If they earn exactly 400% FPL ($48,560), they'll also only have to pay 9.86% ($4,802), receiving $2,530 in subsidies for the year....

 

I don't know what the status is of H.R. 5155 (the House Democrats catch-all "ACA 2.0" bill which I've been pushing for awhile now), but it looks like individual elements of it are also in the works as standalone bills:

HEARING ON “STRENGTHENING OUR HEALTH CARE SYSTEM: LEGISLATION TO LOWER CONSUMER COSTS AND EXPAND ACCESS”

Date: Wednesday, March 6, 2019 - 10:00am
Location: 2123 Rayburn House Office Building
Subcommittees: Health (116th Congress)

The Health Subcommittee with hold a legislative hearing on Wednesday, March 6, at 10 am in the John D. Dingell Room, 2123 Rayburn House Office Building. The hearing is entitled, “Strengthening Our Health Care System: Legislation to Lower Consumer Costs and Expand Access.” The bills to be the subject of the legislative hearing are as follows.

Over at Balloon Juice, David Anderson notes that the Blue Cross & Blue Shield Association has released their own "ACA 2.0" proposal...and many elements line up pretty closely to my own vision of what ACA 2.0 should look like as well as both the House (H.R. 5155) and Senate (S.2582) Dem versions. Here's Anderson's summary of the BCBSA proposal:

  • Younger adults pay a lower percentage of their income (at a given level) for the benchmark plan
  • Older adults are held harmless
  • All individuals, regardless of income, are eligible for subsidy assistance
  • CSRs appropriated
  • CSRs expanded
  • Full advertising and outreach funded
  • Health insurance premium tax suspended

...It looks like the insurers are trying to lay markers for where they want to see things in 2021 or 2022. They are looking at a fix and expansion of the current paradigm instead of a complete replacement of the system.

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