Charles Gaba's blog

UPDATE 5/19/15: SEE IMPORTANT UPDATE TO THE LUIS LANG SAGA!!

Yeah, that's right, I'll say it: Luis Lang is a hypocrite.

Over at Talking Points Memo, Josh Marshall has a story about a guy in South Carolina named Luis Lang who's in a nasty situation due to a combination of bad timing, Republican cold-heartedness and, to be blunt, his own stupidity.

First, the backstory:

As the Charlotte Observer explains, Lang is a self-employed handyman who works as a contractor with banks and the federal government to maintain foreclosed properties. He was making a decent living, enough to be the sole breadwinner in the family. As the Observer puts it, Lang "he has never bought insurance. Instead, he says, he prided himself on paying his own medical bills."

There's good news and bad news out of Iowa tonight. For 2015, there were originally only 2 insurance companies to choose from on Healthcare.gov: Coventry and CoOportunity. Unfortunately, the latter of these went belly-up for a variety of reasons, leaving Coventry the sole provider available on the exchange.

For 2016, it appears that 2 new companies (UnitedHealthcare and an unnamed one) will be jumping in to provide some competition:

Moderate-income Iowans who want to use Affordable Care Act subsidies to purchase health insurance will still not be able to choose policies from Wellmark Blue Cross & Blue Shield next year, but they should be offered policies from at least two competitors.

Oh, wait; that's a scarlet "S".

Roughly a million Texans with government-subsidized health coverage could see a new label on their health insurance cards, and critics say the designation is akin to a “scarlet letter.”

But instead of Hester Prynne’s infamous “A,” insurance cards for Texans with coverage under the federal Affordable Care Act would bear the letter “S,” for subsidy.

Supporters of House Bill 1514 by state Rep. J.D. Sheffield, R-Gatesville, say it’s necessary to standardize insurance cards and clarify the type of health coverage a patient has.

Needless to say, I'm appalled.

Joan McCarter over at Daily Kos has already given a proper takedown of this utterly unnecessary & shameful bill.

UPDATE 5/27/15: Well, the Texas Senate has now passed the same bill, although they've slightly modified it:

For months now, the ACA state exchanges in small states like Rhode Island, Vermont and Hawaii have been struggling mightily with either funding issues (RI) or both funding and technical problems (VT & HI). Most of my own focus has been on the 2 northeastern states.

Today, however (thanks to Sabrina Corlette for the heads' up), the HI Health Connector has apparently skipped ahead a few chapters and concluded that due to their inability to convince the state legislature to pony up more cash (they were originally seeking $10 million but only $2 million was approved), they're gonna have to close up shop:

May 09--The Hawaii Health Connector has prepared a contingency plan to shut down operations by Sept. 30 after lawmakers failed to pass legislation to keep the state's troubled Obamacare insurance exchange afloat.

OK, the actual headline over at The Hill is: Poll: Majority wants Supreme Court to uphold ObamaCare subsidies

The looming case of King v. Burwell threatens subsidies that help 7.5 million people* afford health coverage in the roughly three dozen states using the Affordable Care Act’s federally run marketplace.

*(Note: As I've stated repeatedly, the actual number who would lose tax subsidies is "only" about 6.5 million, but the number who would lose their insurance as a result is likely a couple million more, plus another 4-5 million who'd pay through the nose to keep their coverage).

The Associated Press-GfK poll released Monday finds 56 percent wants the justices to rule to continue the subsidies, while 39 percent wants them invalidated for the federally run marketplaces.

There's also some interesting numbers about the politicization of the Supreme Court (y'know, the one which isn't supposed to be politicized):

In the latest update to The Graph, in addition to simply updating both the currently confirmed and estimated exchange-based QHP totals, I've also made one significant addition: The estimated number of HC.gov-based enrollees who are currently receiving federal tax credits from the IRS, and how many of those I expect to lose those credits in the event that the Supreme Court rules for the plaintiffs in the King v. Burwell case.

The total numbers nationally are notable mainly because of the milestones which have now been passed: Over 11.9 million QHP selections have been confirmed as of today, and I estimate that the actual total should have passed the 12.4 million mark by now. I now expect to hit my official "Open Enrollment Period" QHP selection target of 12.5 million in another couple of weeks (hey, look at that!--I was right after all, just early by...um....3 months...ok, never mind...).

Colorado just released an updated enrollment report bringing things all the way up through April 30th...and as always, CO's report is both extremely comprehensive and extremely confusing at the same time.

Here's the relevant section:

The numbers, as I noted last time, need to be parsed quite a bit, since some of the numbers mix in SHOP (small business) enrollees while others mix in Dental coverage (which we all know is a big no-no!!)

If I'm reading/understanding this correctly, it looks like it breaks out to:

A week or so ago, U of Michigan assistant law professor Nicholas Bagley and his associate, Boston U. public health asst. professor David K. Jones) posted a lengthy, comprehensive analysis of potential post-King v. Burwell options for the HHS Dept. and/or the impacted states in the event that the Supreme Court rules in favor of the plaintiffs. As I noted at the time, several of their points were very close to my own last July...except that I was just shooting off at the mouth, whereas they actually know what they're talking about, legally speaking.

Today, Bagley has posted a follow-up which focuses even more closely on my line of thought:

What if HHS declared that any state that performs substantial, ongoing, and essential exchange functions has established an exchange, even if the state never formally elected to do so?

Last year, Connecticut was a perfect example of how the initial requested insurance policy rate changes from the companies involved in a given state can end up changing dramatically after the approval process (and in CT's case, change even more when the actual Open Enrollment period actually arrives). The original requested average increas in CT was 12.8%, but the approved changes ended up only being around 4.5%...and in the end they were far lower: Less than a 1% overall weighted average increase!

With that in mind, here's the story on 2016 requested changes in CT:

Four major health care providers that offer plans on Connecticut's health insurance marketplace have filed for rate increases for the upcoming open enrollment period that begins Nov. 1, 2015.

...The following increases have been proposed: 2 percent for ConnectiCare, 6.7 percent for Anthem, 12.4 percent for United Healthcare and 13.96 percent for Healthy CT.

  • Total U.S. Population as of 2009: Around 306 million people
  • Total # of Mothers in U.S. as of 2009: Around 85.4 million
  • Assuming this ratio hasn't shifted much over the past 6 years, around 28% of the total U.S. population are mothers

Obviously women over 64 (mostly on Medicare) are much more likely than the general population to be mothers...but girls under 18 are far less likely to be (well...under 16, anyway...the birth rate varies from state to state, of course), so I'm assuming that these cancel each other out, resulting in that 28% rate hopefully being roughly accurate.

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