Over at Politico, Paul Demko has an extensive article (with an assist from Adam Cancryn, Jennifer Haberkorn and Rachana Pradhan) which confirms many of the things I've been saying for awhile now...although it also weakens one of my arguments as well. In an odd way, that's entirely in keeping with the overall theme of the article itself. That is, every one of the following statements appears to be true simultaneously:
The Trump administration is deliberately sabotaging the ACA exchanges.
The Trump administration is sort of trying to shore up the ACA exchanges.
Congressional Republicans are full-speed ahead on repealing the ACA.
Congressional Republicans are putting the brakes on repealing the ACA.
The Individual Market isn'tin a Death Sprial yet, but could be next year.
The Individual Market is already in a Death Spiral in some states but doing just fine in others.
A full replacement plan is ready to go at any moment.
A full replacement plan hasn't even made it past the first stages yet.
In a classic case of trying to have it both ways, the Trump Administration is simultaneously taking every action it can to damage/kill the ACA while also taking actions which are supposedly attempting to stabilize it. This is leading to some very...interesting...results, such as this press release sent out an hour or so ago:
CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018
The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.
Regarding the company’s individual commercial medical coverage (Individual Commercial), substantially all of which is offered on-exchange through the federal Marketplaces, Humana has worked over the past several years to address market and programmatic challenges in order to keep coverage options available wherever it could offer a viable product. This has included pursuing business changes, such as modifying networks, restructuring product offerings, reducing the company’s geographic footprint and increasing premiums.
Republicans' Struggles to Replace Obamacare Feel Like Deja Vu All Over Again
Republicans in Congress are hitting roadblocks as they try to devise a plan to replace Obamacare, stuck over issues like how to structure tax breaks they want to give people to buy insurance.
...Republicans, who have spent more than six years vowing to smash the Affordable Care Act, swept into control of the White House and Congress pledging a swift repeal. But they’ve made little progress in deciding how to do that, or what should come next.
...Republicans agreed on vague concepts such as tax breaks, letting insurers sell across state lines and letting states run Medicaid.
...In fairness, as Adam Cancryn noted in his epic Risk Corridor Autopsy piece, there were a lot of other factors which caused half of the Co-Ops to fail in the first two years. It's possible that some of them would have gone under even with the RC money, and there's no guarantee that all of the remaining ones will thrive or even survive. But there's no denying that the RC payments they were counting on were a major factor, and at least a few of them would almost certainly have survived if not for having the rug yanked out from under them.
So, to review, the end result of Marco Rubio's shenanigans are:
up to 800,000 people nationally lost their insurance coverage, on very short notice, and were forced to scramble to find alternate coverage
the new coverage these people ended up with is generally more expensive, and in many cases has worse networks
the federal government has to therefore pay out more in premium subsidies to cover the increased costs as benchmark plans were increased
over a dozen insurance carriers went out of business, meaning hundreds of people lost their jobs
the loss of over a dozen carriers means less competition in those markets, therefore less competition, therefore higher premiums, therefore even more cost to the federal government in subsidies to make up the difference
since all of the carriers which went out of business were little guys, this also means the big kahunas suck up even more market share
the original $2.5 billion which Rubio was supposedly trying to "save" taxpayers ends up being paid out anyway; and
it's possible that, in addition to all of this, assuming the government decides to just concede the point (which, by all rights, they should), it's conceivable that Marco Rubio's "genius" stunt from December 2014 could also very well end up costing taxpayers $2.5 billion MORE than it would have to just let the government make the payments they were supposed to in the first place.
...all so that Marco Rubio could earn a couple of political brownie points to help him win the GOP nomination for President...which he appears to be failing at anyway.
Here in Idaho, Gov. C.L. “Butch” Otter, a Republican, vowed to come up with a replacement after declining to fully embrace the Medicaid expansion that was offered as part of the Affordable Care Act. He’s tried to persuade his heavily Republican legislature to set aside their hands-off views about the government on this issue. Studies have been conducted. Proposals have been put forward. But after four years, lawmakers have come up with no alternative.
“While it is clear there is broad agreement on the fact there is a problem, agreement on what to do about it is another story,” Otter wrote in a statement to The Washington Post.
Over the past week or so, there've been several eyebrow-raising videos posted from Republican Congressional Town Hall meetings across the country. They show huge crowds of protesters demanding that the ACA be saved, ironically remnisicent of the Tea Party protests which showed up at Democratic Town Hall meetings just 7 years earlier.
There were two in particular from last night which caused Twitter to explode, however. The first is of Jason Chaffetz of Utah:
I've written a lot about the negative impact on enrollment this year due to deliberate sabotage efforts on the part of Donald Trump and the Congressional GOP, and I stand by it. I've run the numbers and honestly believe that I've proven pretty conclusively that these efforts--in particular, the last-minute yanking of millions of dollars' worth of HC.gov "Final Deadline!" advertising--had a significant negative impact, to the tune of several hundred thousand "lost" enrollments.
However, I've also repeatedly stressed that there were most definitely other factors as well which can't be pinned on Trump's efforts. Some of these are quantifiable and pretty obvious:
