When the Republican Party replaced the director of the Congressional Budget Office, Doug Elmendorf, with "one of theirs" (Keith Hall, who previously worked as an economist for George W. Bush), there was understandably plenty of concern (or hope, depending on your politics) that CBO projections would suddenly become radically different from what they had been under a "Democratic" CBO director, especially when it comes to politicized issues such as the Affordable Care Act.
Summary Over the past several years, a number of proposals have been advanced for repealing the Affordable Care Act (ACA), which became law in March 2010. In this report, the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) analyze the main budgetary and economic consequences that would arise from repealing that law.
Greg Sargent at the Washington Post does a nice job of summarizing the Republican response if they win their King v. Burwell court case at the Supreme Court:
The GOP argument is basically this: Obamacare is to blame for the awful outcome of millions of people losing Obamacare, so Republicans will protect all those people from Obamacare by temporarily restoring their Obamacare, before repealing it entirely for all its beneficiaries, and replacing it with … “oh, wow, look over there, a unicorn is wandering through the Capitol!”
Here it is in video form, compliments of South Park:
Over at Vox this morning, Ezra Klein has a good "big picture" look at the true impact of the plaintiffs winning King v. Burwell which goes beyond the specific numbers of people impacted or the dollar amounts involved. His main point, which I generally agree with, is that while the results would be pretty horrible, they wouldn't result in the law being repealed any more than the Medicaid expansion ruling did. In Klein's view, at worst (which, he admits, would be pretty bad), the 2-tier healthcare split between rational & irrational states would deepen...but only temporarily.
So King can't destroy Obamacare. What it can do is let Republican elected officials destroy Obamacare in states where they have a majority. That's a very different thing, and it will lead to very different political dynamics.
For the most part I agree with him, but there's two things I wanted to call attention to: One which he doesn't mention, another which I feel he shouldn't have.
I know I snarked about "nothing interesting happening" while I was out of town/unavailable yesterday/this morning, but the reality is that a whole mess of stuff is always going on in the healthcare/ACA field, so here's a quick roundup:
...lawmakers went along with Raimondo’s bid to raise the state’s $3.50-a-pack cigarette tax — already the third-highest in the nation — by 25 cents to reap an extra $7.1 million.
They backed a scaled-down version of the new health-insurance surcharge that Raimondo proposed to pay for the state-run health-care exchange that they expect to average 2.86 percent on individuals’ monthly premiums, and .59 percent on average for small-business groups’ monthly premiums.
There were also an estimated $120.9 million in spending cuts in the state’s fastest-growing subsidy program: Medicaid, including $70.5 million in projected state dollar savings.
Way back on April 30th I posted the first in a series of 2016 rate change request entries for Oregon. At the time, the initial news didn't look very good, with the weighted (by market share) average increase looking to be around 23%.
At the time, and since then, I've posted a whole bunch of stuff regarding the importance of keeping calm about these initial rate requests for a variety of reasons. One of those reasons is that none of the initial requests had actually been approved yet. Last year, many large rate increase requests were denied nationally, with only more modest increases being approved by state regulators, and the same is likely to happen in many cases this year.
THIS REMAINS LIKELY TO BE THE CASE OVERALL. However, there's another possibility which, while I always knew was possible, I wasn't aware of actually having happened until today:
Of the 14 "full" state-run exchanges remaining (i.e. running their own website platform), one of them (Hawaii) recently threw in the towel due to technological and funding issues. The other 13, funding issues aside, seem to mostly be operating pretty well, but a few are still having technical issues...one of which is tiny Vermont.
Vermont Health Connect Reports on Progress toward Key Milestones
Number of Customers Awaiting Changes Reduced by 1,600
ESSEX, VT –State officials delivered a regular monthly report on Vermont Health Connect to legislative oversight committees today. The report covered key performance indicators and enrollment data for the month leading up to recent system upgrades which greatly enhanced the speed at which Vermont Health Connect can process customer requests.
I was out of town all day yesterday, having flown down to Atlanta, Georgia to address the Society of Actuaries conference. It was a small audience but went very well; a great group and an interesting experience. I was up at 5am to catch the flight down, caught the red eye back at midnight and then had to get my kid to an MRI appointment this morning (nothing serious, it went fine; he has to take it easy the rest of the day while recovering from the anesthesia, but otherwise all is well). Needless to say, I'm pretty exhausted myself.
So...did I miss anything ACA-related the past day or so?
1. The King v. Burwell decision was not announced this morning, so we'll all be alternately twiddling our thumbs and holding our breath until at least Monday.
...because apparently King v. Burwell will be causing them for at least another 4 days.
No decision announced by the Supreme Court today. That leaves Monday the 22nd or Monday the 29th, unless they squeeze in another opinion day in between.
Mild touch of irony: As I noted the other day, the main reason I'm not in a position to post detailed entries this morning is because I'm at the hospital waiting for my son to undergo an MRI.
If the Supreme Court does side with the Republican Party/CATO Institute and kills federal exchange tax credits, we'd be among those who'd lose them.
Now, to be fair, it's a relatively small amount for us, so losing the credits wouldn't destroy us financially. In addition, thankfully, in my son's case, it's not a serious issue.
Even so, we would be among those who'd likely see a massive rate hike (on the order of 50% or more here in Michigan)...meaning that it's conceivable that we wouldn't be able to afford the procedure, say, 7 months from now.
Now, take our situation, increase the seriousness of the medical problem while lowering the household income level somewhat, and the situation becomes far more dire.
As I noted the other day, I'm flying out to Atlanta, Georgia early tomorrow morning to address the Society of Actuaries annual convention (expo? whatever), and won't be back until after midnight. Then, Thursday morning, my kid has an MRI scheduled (nothing serious, but it can't be rescheduled). As a result, I'll be either unavailable or completely wiped until at least Thursday afternoon.
Seeing how the Supreme Court has added Thursday morning (at 10am) to their list of decision announcement dates, there's a 1 in 3 chance that the King v. Burwell decision will be announced right in the middle of the procedure (although most experts seem to think they'll hold off until the 29th anyway).
This means, of course, that several hours could pass after the announcement before I'm able to write anything about it. The irony of this is not lost on me.
In any event, if they make the Big Announcement and any reporters/pundits/etc. wants a reaction/quote from me, please hold off until at least noonish, ok? Thanks!
