Charles Gaba's blog

In case you needed more evidence that Donald Trump doesn't give a rat's ass about actual policy as long as it means people lavish praise on him at any given moment:

Washington (CNN)President Donald Trump told Republican senators lunching at the White House Tuesday the House-passed health care reform bill he celebrated earlier this year was "mean," a source told CNN.

Trump made clear multiple times that he was pleased that the Senate negotiations appeared to be moving away from where the House version of the repeal and replace effort ended up, according to three sources familiar with the meeting.

Trump told the lawmakers that the House bill didn't go far enough in protecting individuals in the marketplace -- and appeared to use that as his rationale for why he has ambiguously called twice for the Senate to "add more money" to the bill.

...But the comment belies the celebratory Rose Garden ceremony Trump hosted earlier this year when the House passed the bill and the President championed it as "incredibly well crafted."

Normally I don't post my Rate Hike Project analysis for a state until I have rate filing data available for all (or nearly all) of the individual market enrollees on hand.

I'm making an exception in the case of Michigan, however, because a) it's my home state, and b) My wife, son and I happen to be enrolled in an ACA exchange policy ourselves, via Blue Care Network (the HMO division of Blue Cross Blue Shield of Michigan).

Unfortunately, as of today (6/13) only one carrier has submitted their 2018 rate filing for the ACA-compliant individual market...and it's BCBSMI itself. That is, the PPO division of Blue Cross, not the HMO division.

Every summer for the past few years, the CMS division of the HHS Dept. has released a quarterly report stating how many ACA exchange enrollees are still enrolled in effectuated policies as of March 31st of that year.

The precise wording of this is important, because (as Republicans and other ACA detractors have been shouting about since day one), just because someone signus up for a healthcare policy doesn't mean that they actually pay their first month's premium to be enrolled...and even if they do, some of them will then drop their policy a few months later for any number of reasons (new job with benefits, moving to a different state, turning 65 and moving to Medicare, falling on hard times and qualifying for Medicaid or, in some cases...dying).

The first year of ACA Open Enrollment, running from 10/1/13 - 3/31/14, was a bit of a mess, due not only to the technical meltdown at launch but also the whole system being brand-new to everyone on the individual market. A full six months was given for the enrollment period, and even then there was so much pent-up demand at the end of March that an extra 2 weeks was tacked onto the end, for a total Open Enrollment period of 197 days.

via Caitlin Owens, Axios (limiting the quote to fair use levels is tricky since the article itself is so short anyway):

Senate GOP won't release draft health care bill

Senate Republicans are on track to finish writing their draft health care bill this evening, but have no plans to publicly release the bill, according to two senior Senate GOP aides.

"We aren't stupid," said one of the aides. One issue is that Senate Republicans plan to keep talking about it after the draft is done: "We are still in discussions about what will be in the final product so it is premature to release any draft absent further member conversations and consensus."

...Democratic senators are already slamming Republicans for the secrecy of their bill writing process, and this isn't going to help. Republicans are sure to release the bill at some point, but it's unclear when — and they want to vote on it in the next three weeks, before the July 4 recess.

"We aren't stupid."

Laura Packard is a friend of mine. We first met about 10 years ago at a state convention in Detroit. She's an all-around awesome person, and one of the most accomplished people I know. Here's just a sampling:

I'm a partner at PowerThru Consulting, a growing national progressive digital consulting shop. At PowerThru we help nonprofits and Democratic campaigns use technology to spread their message and organize and activate their supporters online, to create change offline. We have staff in several states, and work with non-profits of all kinds and on progressive state and federal issues, campaigns and elections of all kinds. We've won four Reed awards and three Pollies for our work to date (including Best Congressional Website in both, Best State/Local Organization Website, Best County/Local/Judicial Website).

I'm a regular contributor to Campaigns & Elections magazine, Huffington Post, and Epolitics.

As I've written about more times than I can remember, for all the very real and highly damaging GOP sabotage of the ACA over the years, there are some problems which were, quite frankly, inherent in the law as passed itself. This should be no great revelation, since it is a major piece of legislation which impacts nearly 1/5th of the entire economy is always going to have some problems to deal with, just as the 1.0 version of any piece of software will always have to have updates and patches applied. If this wasn't the case, there wouldn't be any amendments to the U.S. Constitution (not even the 2nd, so beloved by the GOP).

This is rather amazing, really. With all the dramatic twists and turns that the Trumpcare/AHCA debacle has taken in the 3 months since it was slapped together by Paul Ryan & Co., you'd think that there would be some movement of the approval numbers, wouldn't you?

Well, technically there has been: It went from 17% approval in March to 21% approval in May...

...and as of last week, had dropped right back down again to the same 17% it started out with:

American voters disapprove 62 - 17 percent of the Republican health care plan, compared to a 57 - 20 percent disapproval in a May 25 Quinnipiac University poll. Today, Republicans approve of the health care plan 42 - 25 percent, as every other listed party, gender, education, age or racial group disapproves by wide margins. 

(sigh) OK, this is getting very confusing now.

The good news for me out of Maine is that they've released the filings for all three individual market carriers for 2018 (Aetna has around 1,000 enrollees but they're leaving the individual market entirely), and all three include the exact number of current enrollees, making the average rate hike request simple enough on the surface: 21.2% for Anthem, 39.7% for Harvard Pilgrim (HPHC) and 19.6% for Maine Community Health Options (one of the few remaining ACA-created CO-OPs*), for a weighted average unsubsidized increase request of 25.2%.

*UPDATE: My mistake! I accidentally confused MCHO with Evergreen Heatlh of Maryland, which is in the process of converting itself from a Co-Op into a private carrier! Thanks to Louise Norris for the catch!

UPDATE: Some people are crediting me with creating the "3-legged stool" metaphor, which simply isn't the case; that credit goes to (I believe) MIT Economics Professor Jonathan Gruber, who came up with the metaphor back in 2006 while helping develop Mitt Romney's "RomneyCare" model for Massachusetts, which was the basis for the ACA's exchange model for the individual insurance market.

I'm simply expanding on the metaphor to explain some of the terms and concepts which are swirling around these days during the repeal/replace brouhaha.

This just in from the Washington State insurance commissioner's office...

Eleven health insurers file for 2018 individual market in 37 counties, leaving two with no coverage
Kreidler: Trump administration’s actions fuel insurers’ uncertainty, harm consumers

Eleven health insurers have filed 71 plans for Washington state’s 2018 individual health insurance market:

  • Six insurers inside the Exchange, Washington Healthplanfinder.
  • Eight insurers outside the Exchange.
  • Two insurers selling both inside and outside the Exchange.
  • Currently, no insurer has filed plans in two counties – Klickitat and Grays Harbor.

Two insurers, Community Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, announced earlier this year that they will not participate in the 2018 individual health insurance market.

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