Charles Gaba's blog

Not sure if the sender wants public credit or not, but a few Republican Goverors have some things to say about repealing the Affordable Care Act...especially Medicaid expansion:

Today, Republican Governors will meet with GOP Congressional leaders in DC to discuss – you guessed it –the Affordable Care Act. Medicaid expansion is a key factor in this discussion because, as Governors will tell you, Medicaid expansion is leading to lower uninsured rates, higher rates of care, and critical treatment for people fighting opioid use disorders. And if Republicans repeal the ACA without a replacement plan in the same bill, CBO would score a subsequent bill restoring Medicaid expansion funding as an almost $1 trillion spending increase over 10 years. Interestingly, a number of GOP Senators broke with their party on expansion related vote-a-rama measures last week, and Governors from both parties have spoken out about this issue, as well as about the dangers of repeal and delay.


OK, the guest host is actually Cliff Schecter, but I'll be a guest on the Leslie Marshall radio talk show this afternoon from 3:00 - 3:30pm EST today, talking ACA, repeal and so forth.

Listen to the Live Stream here!

You can also listen to the podcast after the show here.

OK, given the impending End of the World As We Know it (and, on a smaller scale, the potential End of the Affordable Care Act), this is a pretty minor thing, but worth noting.

This afternoon I did a write-up about today's Week 10/11 HealthCare.Gov Snapshot Report, which showed nearly flat enrollment growth from 12/31 to 1/14...two solid weeks with barely 64,000 additional signups across 39 states. As I noted, this particular stretch of Open Enrollment was expected to be pretty quiet, but even so, the numbers were still far lower than I expected.

In the Weeks 8/9 Snapshot Report, HHS reported exactly 8,762,355 QHP selections as of New Year's Eve via HealthCare.Gov specifically (which only includes 39 states).

Then, last week, the ASPE department released their "Mid-Season Report", which included more detailed enrollment data for every state...but cut off a week earlier (only through Christmas Eve). After filling in all the blanks, I concluded:

For weeks now, I (and many others) have been crunching the numbers and making projections to see just what the fallout would be on the individual market (and the total uninsured rate) if the GOP were to follow through with their promise to repeal the Affordable Care Act.

There's a lot of variables at play, and there's also no way of knowing what (if any) replacement plan they'd come up with instead, but there are two main scenarios to consider: First, what would things look like if the ACA were to be fully repealed (without a half-decent replacement ready to swoop in); second, what would happen if the ACA were to be partially repealed via the reconciliation process (ie, killing off the subsidies, individual/employer mandates, Medicaid expansion and so forth, but keeping the guaranteed issue, community rating and other regulatory provisions in place, which is what would happen if the Republicans were to continue on their present course).

With the Republicans scrambling to come up with a plan, any plan to replace the Affordable Care Act at the same time that they repeal it (as opposed to, you know, simply not repealing it, at least until they actually have a reasonable plan, which they could certainly do if they wished to), there was a huge amount of buzz generated Sunday night over this story from Robert Costa and Amy Goldstein of the Washington Post:

Trump vows ‘insurance for everybody’ in Obamacare replacement plan

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.

Drug negotiations aside, the rest of the article is exactly what you'd expect:


No, I'm not accusing him of murdering anyone (well, unless his ACA replacement bill becomes law, that is), but it's starting to look like the Senate would have to be on drugs to confirm orthopedic-surgeon-turned-Congressman Tom Price as the new HHS Secretary:

Exhibit A, via Manu Raju of CNN:

Trump's Cabinet pick invested in company, then introduced a bill to help it

Rep. Tom Price last year purchased shares in a medical device manufacturer days before introducing legislation that would have directly benefited the company, raising new ethics concerns for President-elect Donald Trump's nominee for Health and Human Services secretary.

...Less than a week after the transaction, the Georgia Republican congressman introduced the HIP Act, legislation that would have delayed until 2018 a Center for Medicare and Medicaid Services regulation that industry analysts warned would significantly hurt Zimmer Biomet financially once fully implemented.

OK. We're past the "mini-deadline" for February 1st coverage in 47 states (+DC). New York has extended their Feb. coverage deadline out until Wednesday (1/18), while Massachusetts, Rhode Island and Washington State are taking enrollments through next Monday (1/23).

The real "final" deadline to sign up for 2017 healthcare coverage is Tuesday, January 31st. Anyone who signs up between the dates above and the 31st will be enrolled in a policy starting coverage on March 1st.

After that, under the ACA, the only ones who are supposed to be able to sign up for 2017 coverage are people who qualify for:

In Minnesota, assuming 116,000 people enroll in private exchange policies by the end of January, I estimate around 58,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 234,000 enrolled in the ACA Medicaid expansion program and around 62,000 covered by their Basic Health Plan (BHP) program (aka MinnesotaCare) for a total of 354,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

A few days after the election, I posted:

Last spring, during the primaries, there was a month or so where there was still a small but not unreasonable possibility that Ted Cruz could have ended up pullling the nomination out of the grasp of Trump's hands. During that time, there was a lot of discussion among progressives (and some intellectually honest #NeverTrump conservatives) as to which one would be worse from a progressive/Democratic/liberal point of view.

After all, the reasoning went, Trump supposedly held strongly liberal positions on many key issues up until like 5 minutes ago (he was pro-choice, etc). He's promised a gargantuan infrastructure spending program (roads, bridges, etc)! Hell, during the very first GOP primary, he came right out and said that he thinks Single Payer healthcare is awesome in other countries! He later stated that whatever he came up with would "cover everyone" with "the government paying for it all". How awesome is that for a progressive!!

However, there are some major problems with this...