Charles Gaba's blog

Wow. If my estimates are accurate, this strikes me as being pretty significant.

I'm in the middle of my latest project, recompiling the Center for American Progress estimates of how many people have pre-existing conditions in every Congressional District nationally.

In additon to color-coding their data by the political party of each District's Representative, I'm also adding my own spin on the data: Estimates of how many people currently enrolled in the individual market suffer from "pre-existing conditions" which would likely mean them either being denied coverage altogether if the ACA's Guaranteed Issue, Essential Health Benefits and Community Rating provisions were to be stripped (Alternately, these people would charged massively higher rates to the point of likely not being able to afford the policy).

UPDATE 6/8/18: Welp. Given last night's bombshell development that Donald Trump's Department of Justice has decided to not only abandon doing their jobs by defending the law of the land but to actually actively argue in favor of tearing away the ACA's prohibition of denying coverage for (or charging more for) pre-existing conditions, it seemed appropriate to dust off this entry from over a year ago.

A couple of important caveats: The individual market has shrunk by one or two milion people since a year ago (due in large part to other forms of Trump/GOP sabotage, I should note), so most of the estimates for the last column are likely a bit smaller as well, although those with pre-existing conditions are the least-likely to drop their coverae for that very reason. Also, a good half-dozen Congressional Districts have had special elections over the past year and now have new members of Congress (SC-05, MT-AL, PA-18 and so on) or currently have vacancies not shown below (MI-13, TX-27, etc).

Last fall, when the insurance carriers were jacking up their rates on the individual market by an (unsubsidized) national weighted average of around 25%, aside from the understandable grumbling about such a dramatic all-at-once increase, the big question was whether that would be enough to stabilize the market going forward, or whether this was just the beginning of an inevitable Death Spiral, etc etc.

Back in December, Standard & Poor's issued an analysis in which they concluded that:

An analysis out Thursday says that health insurers are expected in 2016 "to start reversing" financial losses on their Obamacare business after "hitting bottom" in 2015.

And 2017 "will likely see continued improvement" for those insurers selling individual health plans, "with more insurers getting close to breakeven or better," according to the report by Standard and Poor's Global Ratings.

The report also says big price increases for Obamacare plans in 2017 were likely a "one-time pricing correction."

Ever since I started this venture, one of the most difficult types of data for me to hunt down have been the ever-elusive off-exchange individual market enrollment numbers.

Off exchange data is extremely difficult to come by for several reasons. First, because unlike enrollments via the ACA exchanges, off-exchange enrollment data is a purely private transaction between individuals and private corporation. Yes, publicly traded companies have to provide some level of data in their quarterly & annual reports, but that data usually focuses on the financial side. Yes, they generally do give some info about how many enrollees they have, but they don't always break out the individual market specifically...and when they do, they often don't distinguish between the on and off-exchange numbers. Finally, even when they do break it out into that much detail, you'll be hard pressed to find a carrier who breaks the numbers out by state (unless they only operate in one or two states to begin with).

OK, I was about to go with the more obvious saying: "Sh*t or get off the pot", but I'm trying to avoid blatant profanity in the headlines, at least.

Here's a tweetstorm from fomer director of the Centers for Medicare & Medicaid, Andy Slavitt, from yesterday/continuing through today. He confirms everything I've been sounding the alarm about, especially regarding the CSR payment crisis:

One of the questions I get asked most frequently is why don't more health plans speak up about what a disaster AHCA would be. 1

— Andy Slavitt (@ASlavitt) April 5, 2017

A related question I get asked a lot is why don't health plans speak up more loudly about the impact of govt reneging on CSR payments. 2

— Andy Slavitt (@ASlavitt) April 5, 2017

By tomorrow, I will have asked 10 CEOs that question & will tweet back what they say. 3

— Andy Slavitt (@ASlavitt) April 5, 2017

Hot off the presses:

A new Kaiser Family Foundation analysis finds that the average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies.

Not exactly a surprise: The stampede appears to be starting.

The efforts to replace the Affordable Care Act have caused worry for insurers, who aren’t sure about the law’s future or what would replace it. On Thursday, Aetna Inc. said it would pull out of Iowa’s Obamacare market, becoming the second major health plan to do so this week after Wellmark Inc. said it was quitting the state as well.

“Aetna will not participate in the Iowa individual public exchange for 2018 as a result of financial risk and an uncertain outlook for the marketplace,spokesman T.J. Crawford said in an email Thursday. “We are still evaluating Aetna’s 2018 individual product presence in our remaining states.”

 

In our last episode of As the Stomach Churns, you may recall that after getting tired of having thousands of old white people screaming at them during town halls, the House GOP attempted to get them to shut up by demanding that the Senate throw $85 billion at them to make them go away.

The Congressional Budget Office determined that, nope, around 24 million people would still be kicked off their healthcare coverage due to how crappy the rest of the plan was. They would've just been pissing away another $85 billion for literally no reason.

The CEO of Molina Healthcare made it about as clear as he possibly could today:

Molina Healthcare CEO: GOP's 'piecemeal approach' to health-care reform will lead to a 'health-care disaster'

With the GOP's failure to repeal Obamacare last month, House Speaker Paul Ryan refused to give a time line for a new bill.

...But many health-care providers are wary of the fast pace the GOP seems to be taking with repealing Obamacare.

...Molina is particularly worried about the potentially higher premiums and misleading packages insurance companies can price and sell.

December 9, 2016:

...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.

“The first question I think they’re trying to figure out is, do we actually own it for 2018?” said one health care lobbyist, speaking on background. “If premiums spike and plans exit, can we still blame it on Obama and get away with it? That’s one of the threshold questions that I don’t think they’ve answered.”

March 24, 2017:

Pages

Advertisement