Charles Gaba's blog

This Just In...

Thanks to Rachana D. Pradhan for the heads up. The HHS Department has just posted a 50-page PDF which lays out the regulations for insurers participating on the 2015 Federal ACA exchange.

I haven't read it yet (it literally went live just moments ago, and a lot of it is likely over my head anyway), but have at it...lemme know if you find anything noteworthy in it:

45 CFR Parts 146, 147, 148, 155, and 156
RIN 0938-AS32
Patient Protection and Affordable Care Act; Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs; Health Insurance Issuer Standards under the Affordable Care Act, Including Standards Related to Exchanges

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule.

(sigh) Here we go again. Over at Forbes, Avik Roy has decided that his contribution to celebrating the labor movement should be to trash the Affordable Care Act again, even though it's based primarily on his old boss's policy in Massachusetts.

There are some areas of his latest which I'm not equipped to address, but there are two points which jump out at me:

First, he brings up 2 surveys from the Federal Reserve Bank of New York about how business owners feel about the impact of the ACA on their expenses and employment.

I should first note that Roy refuses to refer to the healthcare law by anything close to its actual name. He doesn't call it the "Patient Protection & Affordable Care Act". He doesn't call it "the Affordable Care Act". He doesn't even call it "the ACA", which would make the most sense...not even once.

Nope, he refers to it as "Obamacare". Not just in the headline, not just once or twice in the article, but twenty-five times. I counted.

Now, I don't happen to have a problem with the "Obamacare" moniker. I think in the long run the GOP will regret tying the law to Barack Obama's name so closely. But THEY think it's an insult, and keep throwing it around as often as possible.

Thanks to the Kaiser Family Foundation's Larry Levitt, who linked to a PDF from the Florida Health Insurance Advisory Board. This report has data which has made the news twice already: First, because of the 13.2% "weighted average" premium increase for the state (which has come under fire for "weighting" based on projected membership instead of current membership), and secondly because of the exchange QHP enrollment number in June, which is 22.5% lower than the 4/19 total (but which, as I've already shown, isn't nearly as bad as right-wing outlets like the Daily Caller are claiming).

Levitt has noted a third interesting data point in this report:

Two-thirds of those buying their own insurance in Florida are now in ACA-compliant plans.

— Larry Levitt (@larry_levitt) September 2, 2014

I took a look to see what he's referring to, and it's interesting indeed:

This piece by Salon's Simon Maloy pretty much nails it on the head:

At this point it’s near-impossible to maintain the fiction that the Affordable Care Act is failing or that the Republicans have a coherent strategy for unmaking it. One by one, Republican-led states are abandoning their opposition to implementing the ACA.

This is obviously an unwelcome trend for groups like Americans for Prosperity, the Koch brothers’ main outlet for political activism.

...Now contrast AFP’s treatment of Pence with how the group reacted to Rick Snyder, the Republican governor of Michigan...AFP Michigan opposed the plan from the get-go.

...So what explains the disparate treatment? It may be that AFP is finally starting to see the writing on the wall and coming to grips with the slow, steady erosion of the Republican anti-Obamacare bulwark. But it could also be the fact that Mike Pence is the Koch brothers’ golden boy.

Several great ACA-related stories were written over the holiday weekend. First up is the NY Times' Austin Frakt, who looks into what sort of impact the addition of more companies onto the ACA exchanges is having on insurance premiums. Spoiler: More competition = lower prices (or at least less of an increase):

As a candidate in 2008, President Obama promised that health reform would reduce family premiums by up to $2,500, equivalent today to about a 15 percent reduction from the 2013 level. Though Mr. Obama might have been including the effects of premium subsidies in his calculation, a key premise of the Affordable Care Act is that competition among health insurers will drive premiums downward. So it’s worth asking: How much savings can additional competition produce?

...recent analysis by the Urban Institute found higher premiums in less competitive markets.

The good news is that markets will be more competitive in many exchangesin 2015, as more insurers offer plans. UnitedHealthcare has announced it will enter as many as 24 markets, for example.

Minnesota continues to quietly crank along...

latest enrollment numbers

August 27, 2014

Health Coverage Type Total Enrollments
Medical Assistance 187,112
MinnesotaCare 68,279
Qualified Health Plan (QHP) 54,060
TOTAL 309,451

For any tech geeks like me out there curious as to how the original website mess happened, this gives you an idea of how crazy the project became... faltered last fall in large part because it was built by a crowd of uncoordinated contractors with no one in charge of making sure all the interlocking pieces fit together.

As the White House tries to prevent a repeat catastrophe, government watchdogs are investigating why the Obamacare marketplace failed in the two months after it opened on Oct. 1, 2013. A new report (PDF) details the 60 separate government contracts, awarded to 33 companies, that contributed to building The chart above shows how much each contractor was awarded."

Of course, the Obama Administration also sent in an "Apollo 13" emergency tech wizard team to clean up the mess and salvage the project in November, and the rest is history, but it's still important to understand how the federal exchange came so close to failure in the first place...

This. Is. Awesome. News.

A little-known Obamacare tax on health insurance executives' salaries raised $72 million in new revenue last year.

For decades now, the United States has limited the corporation tax deduction for executive pay to $1 million for the company's top four employees. That deduction cap, however, excluded performance bonuses, creating a massive loophole allowing companies to pay their top employees more than $1 million without facing a higher tax burden.

Obamacare quietly changed the rules for health insurance executives. It lowered the cap to $500,000 — and, in that amount, now includes all forms of compensation. The health insurers' regulation also widens the scope of who it hits: while the general deduction cap only applies to the company's top four employees, the Obamacare rule hits any executive earnings more than $500,000.

These new limits kicked in last year. The Institute for Policy Studies ran the numbers and found that this one change resulted in the 10 largest insurers paying an additional $72 million in taxes in 2013.

Presented without comment (except for my emphasis):

INDIANAPOLIS (AP) — Indiana residents will have more than triple the number of health insurance plans to choose from when the federal insurance exchange enrollment period starts in November, according to a state official.

Indiana Department of Insurance attorney Tina Korty told a legislative panel Thursday that some insurers took a “wait-and-see” approach during the first year of the exchanges under the Affordable Care Act.

Nine companies will offer a total of 975 plans - not all will be available in every county - for Indiana residents on the federal exchange, she said. During the 2013-14 period, three companies offered 278 plans, The Times of Munster and the Post-Tribune reported.

“I think a lot of companies were waiting to see how the first year went,” Korty said. “Also were seeing some smaller providers that may offer a policy in only a few counties.”

Korty said a 5 percent average increase in exchange premiums is expected on Indiana policies.

This is flat-out wrong and should be stopped/fixed immediately:

A worrisome trend is emerging among some Californians who thought they were safe and secure under Covered California: Their plans are being canceled without consent and sometimes without notice.

...A growing number of Californians with Covered California plans are learning – sometimes through happenstance – that their plans no longer exist. Some, like Manahan, are getting shunted into Medi-Cal. Others are dropped outright.

...Covered California acknowledges that it is yanking some people off of its plans and putting them on Medi-Cal, months after they signed up or submitted income information.

We’re “in the process of manually verifying the documents provided by individuals who were conditionally eligible for obtaining health care coverage through our agency,” says Covered California spokesman James Scullary. “Through that process, some customers will receive notices indicating they are now eligible for no-cost or low-cost Medi-Cal coverage.”