Charles Gaba's blog

 

David Anderson is a very happy camper this morning...

The LANDSCAPE FILES ARE HERE https://t.co/bQ64LgCT8h Thanks @CMSGOV @HealthcareGovIT
Time to grab lunch and then have a data party

— David Anderson (@bjdickmayhew) October 26, 2018

Here's what he's talking about: The massive searchable/filterable database which CMS maintains every year which includes pretty much every conceivable detail about every ACA-compliant health insurance policy available from every carrier in every region of all 39 states whose ACA exchanges are hosted on HealthCare.Gov (it doesn't include the 12 states which operate their own ACA exchanges, unfortunately).

Here's more details on what's available:

As regular readers know, every spring/summer I spend countless hours poring over the annual insurance carrier rate filings, plugging in increases (and occasionally decreases) in ACA-compliant premium changes for every carrier in every state. I actually do this twice for most states (and occasionally even three times), as the process moves from preliminary/requested rate changes to "semifinal" rates to "final/approved" rates throughout the fall.

For 2018 and again for 2019, I've taken this one step further; instead of simply running the overall weighted average premium changes in each state, I've also attempted to break out what portion of the change is caused by various factors...in particular, what portion is caused by legislative or regulatory changes by Congressional Republicans and/or the Trump Administration.

There's so many Republican candidates running around trying to gaslight America into completely ignoring their relentless, repeated attempts to strip away protections for people with pre-existing conditions that I've alread stopped bothering to try to keep up with them (I think my Rogues Gallery post stops at around 24 or so at the moment).

Here in Michigan, while I'm pretty sure all nine of our Republican members of Congress who voted for the AHCA last year are lying through their teeth about how they suddenly support "protecting coverage of pre-existing conditions", the one which seems to be getting the most attention is Mike Bishop (MI-08). Part of this is no doubt because Bishop is embroiled in one of the two closest races in the state (the other is MI-11, where Dave Trott also voted for the AHCA, but he's retiring so it's an open seat).

 

One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

State Innovation Waivers allow states to implement innovative ways to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state as would be provided coverage absent a waiver, and does not increase the federal deficit.

Fire up the Wayback Machine, Peabody, and take us to September 2015:

AP's NEW "HC.gov Security Flaws" story attacks problems FIXED UP TO A YEAR AGO.

Last night I posted what seemed, at first, to be a merely-amusing (if a bit depressing) story about a Florida news station website accidentally (?) reposting a year-old AP newswire story about potential security vulnerabilities at Healthcare.Gov:

"Critical" flaw found in HealthCare.gov security

WASHINGTON -- The government's own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability - but also came away with respect for some of the health insurance site's security features.

Those are among the conclusions of a report released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud.

 

With dozens of GOP candidates running around trying to gaslight America by pretending they didn't spend all last year (and in most cases, years before that) trying to rip away healthcare coverage for people with pre-existing conditions, here's a shorter, simpler version of last year's video which explains exactly WHICH conditions they tried to kill off...and the sole one they didn't, which they're now using as a feeble excuse.

 

As I've written about many times before, my home state of Michigan is, unfortunately, among the states which are trying to institute work requirements for ACA Medicaid expansion for 680,000 Michiganders. As I've also written about many times before, work requirements for Medicaid are not only burdensome and cruel, they're counterproductive in terms of efficiency, economics and even in the stated goal of such programs, which is supposedly to "inspire" low-income people to get a job.

Michigan’s Medicaid Proposal Would Harm Low-Income Workers — And Can’t Be Fixed

Specifically, the Michigan bill, or any similar proposal, would:

Last year I wrote a LOT about Silver Loading and Silver Switching for 2018...basically, the way which ACA individual market enrollees can save hundreds or even thousands of dollars on their 2018 insurance policies by taking advantage--perfectly legally and ethically--of the unusual pricing of different metal level policies this year.

The short version is this: Due to the way the ACA's tax credit formula works, Donald Trump's attempt at sabotaging the ACA exchanges by cutting off Cost Sharing Reduction (CSR) reimbursement payments to insurance carriers actually (partly) backfired on him, resulting in an unusual situation in which several million subsidized enrollees ended up benefitting from the pricing fallout, while millions of unsubsidized enrollees ended up being hurt by it...but other unsubsidized enrollees ended up being able to avoid being hurt by switching to a special off-exchange Silver plan (thus, the "Silver Switch").

OK, I had kind of forgotten about this. Back in early June, insurance carriers in Pennsylvania submitted their preliminary 2019 ACA market premium change requests. At the time, they averaged around a 4.9% increase statewide, which seemed pretty impressive under the circumstances.

Then, late July, the PA insurance department issued a press release stating that state regulators had modified the 2019 requests, and that the new, revised average was much lower...a mere 0.7% average rate hike. However, the individual carriers as well as the insurance department made it very clear that this nominal increase included a 6 point rate increase to account for the ACA's individual mandate being repealed and the Trump Administration's expansion of non-ACA compliant short-term and association plans.

I originally wrote about District of Columbia carrier requested 2019 ACA rate changes back in June. At the time, they were seeking a weighted average increase of around 15.5% across the District.

However, the DC exchange board was also working quickly in an attempt to counter the Trump Administration's #ACASabotage factors, by voting to restrict short-term plans, to lock in DC's Open Enrollment Period at a full 3 months as in years past, and to reinstate the ACA's individual mandate penalty at the local level.

As of early September, all of these things appeared to have been approved by the exchange board and/or the DC Council.

On September 19, the DC Dept. of Insurance, Securities & Banking posted the approved 2019 ACA rate changes, and the average increase for the individual market had been shaved down from 15.5% to 13.0%:

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