there's some positive news for Iowa, at least; as noted by Cynthia Cox and reported on by Tony Leys of the Des Moines Register, Wellmark is joining the Iowa exchange next year:
Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies.
Wellmark Blue Cross & Blue Shield has not participated in the Affordable Care Act’s online health insurance marketplace, which launched in the fall of 2013. The main effect of the company’s decision was that moderate-income Iowans could not choose Wellmark insurance if they wanted to purchase policies that qualified for new federal subsidies to help pay premiums.
Immediately after the "death" of the AHCA (Trumpcare) bill, I posted the clip above (from the underrated suspense thriller "Dead Again"), noting that as much of a victory as it was, there was little time to pat ourselves on the back, because Trump and the GOP would no doubt be back for Round 2 at any moment.
At the time, I assumed that they would likely abandon the "official" attempt at repeal/replace for the time being, and focus instead "only" on sabotage efforts of the ACA itself by doing whatever they can to scare off the carriers...and for the most part, that's exactly what Trump has done ("It's gonna explode!" and so forth).
You may have noticed that among my 16 recommendations for repairing/improving the ACA, I foolishly failed to include one of the most important/obvious ones: Reinsurance. I didn't include it for two reasons: Partly because, quite frankly, I simply forgot about it and feel bad about myself now.
So far, two states (Alaska and Minnesota) have already established their own state-based reinsurance programs; in both cases, it was done as an act of sheer desperation...and, in both cases were put through in a bipartisan fashion (both states have GOP-held legislatures, but Minnesota's Governor is Democratic while Alaska's is Independent):
There was a time, just a few months ago, when it looked like Alaska, which had already suffered from massive rate hikes the past 2 years due to their unique healthcare situation, might have a complete catastrophe on their hands with a third year of massive individual market rate hikes.
...the assumption is that as long as insurance carriers either a) know they'll make a profit in a given market or b) think they'll make a profit at some point in the near future, they'll participate in that market, right?
However, that's not necessarily the case. As we saw last year in the case of Aetna, profitability itself doesn't necessarily guarantee participation. Aetna pulled out of 11 states, and while they were losing money on the indy market in most of them, there were at least 2 states (Pennsylvania and Florida) where they were making a profit, yet bailed anyway. In fact, in Florida, the only reason they were making a profit in the indy market was because of their exchange business (they were losing money off-exchange).
I see that I've been thrown into the crossfire of a wonk debate between John Cochrane (who I've never actually heard of before today) and Brad DeLong/Paul Krugman (both of whom I very much have heard of!) regarding the question of whether the individual healthcare market is or isn't in a Death Spiral and/or whether it will/won't enter one next year.
Back in January, the Congressional Budget Office concluded that, overall, they didn't see any death spiral forming if the ACA is kept mostly intact...but also concluded that growth of the exchange population has likely plateaued; around 13 million appears to be the enrollment ceiling barring any significant changes to the law. Interestingly, however, a couple of weeks ago they concluded that there would also be no death spiral if the GOP's AHCA "replacement" plan were to become law either.
Of course, as I (and others on both sides of the political spectrum) have written about many, many times, not everyone who selects a QHP (either on or off the exchanges) actually pays their first premium, and therefore is never actually enrolled in an active, effectuated policy. This amounted to roughly 12-13% of all QHP selections in 2014, but has improved over the past 3 years as people got used to how the system works and technical improvements were made. I've been using a 10% non-payment rate as a general rule of thumb for some time now.
Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.
Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.
Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:
As noted a few weeks ago, Humana has already decided that regardless of what actions Donald Trump, Tom Price or Congressional Republicans end up doing (or not doing), they expect the 2018 individual market to be a big mess they want no part of...either on or off the exchanges:
...based on its initial analysis of data associated with the company’s healthcare exchange membership following the 2017 open enrollment period, Humana is seeing further signs of an unbalanced risk pool. Therefore, the company has decided that it cannot continue to offer this coverage for 2018. Through the remainder of 2017, Humana remains committed to serving its current members across 11 states where it offers Individual Commercial products. And, as it has done in the past, Humana will work closely with its state partners as it navigates this process.
Again, it's important to stress that Humana isn't just bailing on exchange participation, but to the best of my knowledge, they're pulling up stakes off-excahnge as well.
So The Plague is wreaking havoc on the world's population. Maybe Super Flu has killed millions, or some unknown biological agent is causing people to snap and kill each other. Heck, maybe we even have a good old fashioned Zombie Apocalypse on our hands. Either way, it's safe to say that for most of humanity, these are not fun times. How could things get much worse, you ask?
By the revelation that the disease in question has been manufactured by genetic engineering, and possibly is distributed by humans. The untold amount of death and destruction has been directly caused by the foolish or malicious action of Man himself.
It may have been designed for use as a biological weapon, or an unexpected result of an experiment gone wrong. Perhaps we just shouldn't have let monkeys watch TV for too long. However it came to be, it has now been unleashed on humanity at large, and has almost certainly gone far beyond what its designers had originally intended.
