Charles Gaba's blog

Politically, it's generally better to underpromise and overdeliver. Unfortunately, when it comes to the actual legislative process it's usually the other way around.

Case in point: Connecticut.

It was just twelve days ago that Connecticut Governor Ned Lamont rolled out his proposed ACA improvement policy package, which included a bunch of key elements including the ballyhooed "Connecticut Option"...a Public Option which would have opened up the existing state employee healthcare plan to anyone on the individual or small group markets.

The full suite was supposed to include nine major provisions:

This actually happened back in March but I missed it at the time:

Lawmaker proposes Medicaid buy-in and individual mandate for Oregonians

Representative Andrea Salinas, the new Chair of the House Health Care Committee, recently filed a bill that aims to establish a Medicaid buy-in option for Oregon residents. The bill, HB 2009, would also establish a “shared responsibility penalty,” or an individual mandate for Oregonians.

HB 2009 would essentially allow individuals who do not qualify for Medicaid, or for premium tax credits under the Affordable Care Act, to enroll in CCOs by paying premiums to cover their health services.

(Note: "CCOs" = "Coordinated Care Organizations", which I believe is how Oregon designates their Medicaid program.)

Last week I reported that California and New Jersey were pushing through a long list of "Blue Leg" ACA protections at the state level; it turns out that Rhode Island has been quietly pushing through their own suite of ACA protection legislation as well! This is from May 16:

PROVIDENCE — The state Senate approved legislation Thursday intended to protect Rhode Islanders’ access to health insurance in the face of threats to the federal Affordable Care Act.

The legislation was sponsored by Sen. Joshua Miller, D-Cranston, chairman of the Senate Health and Human Services Committee. The House version of the bill was sponsored by Rep. Joseph M. McNamara, D-Warwick,  chairman of the House Health, Education and Welfare Committee. The bill aims to ensure that the standards of the Affordable Care Act remain in effect in Rhode Island, even if the courts or Congress were to eliminate the federal laws that created it.

This Just In via the Washington State Insurance Commissioner's office...

Thirteen health insurers request record-low increase of less than 1%; Two new insurers join individual market in 2020

June 3, 2019

OLYMPIA, Wash. – Thirteen health insurers filed a record-low average proposed rate increase of 0.96% for the 2020 individual health insurance market. Also, two new insurers — PacificSource Health Plans and Providence Health Plan — are joining Washington’s market next year.

All 39 counties will have at least one insurer selling inside the Exchange, Washington Healthplanfinder.

Over at Axios, Drew Altman of the Kaiser Family Foundation has posted about a new focus group study which has some depressing, if not surprising findings:

...voters were only dimly aware of candidates’ and elected officials’ health proposals.

  • ...These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
  • Many had never heard the term “Medicare for all”...

Thanks to Dan Goldberg for the heads up; this Just In via the New York Dept. of Financial Services:

2020 INDIVIDUAL AND SMALL GROUP REQUESTED RATE ACTIONS

5/31/2019 - Health insurers in New York have submitted their requested rates for 2020, as set forth in the charts below. These are the rates proposed by health insurers, and have not been approved by DFS.

* Indicates the Company offers products on the NY State of Health Marketplace.

The NY DFS website also includes handy links to the actual enrollment numbers for every carrier on both the Individual and Small Group market, allowing me to break out the numbers further:

So far, only 4 states have released their preliminary 2020 ACA-compliant individual market premium rate filings: Maryland, Virginia, Vermont and Oregon.

So what's the deal with the other 46 states (+DC)? Well, here's a handy 2020 Submission Deadline table from SERFF (the System for Electronic Rates & Forms Filing, a database maintained by the National Association of Insurance Commissioners).

However, it's a bit overly cumbersome: It stretches out over 5 full pages, and includes columns for Standalone Dental Plans as well as a bunch of info regarding the Small Group Market. I used to try tracking Small Group rates as well, but that got to be too difficult to keep up with, and I haven't really done much analysis of standalone dental plans at all. Let's face it: About 90% of the drama, controversy and confusion regarding ACA premiums is all about the individual market.

To my readers:

As many of you know, I've been operating ACASignups.net since October 2013. At first the project was intended purely as a volunteer part-time hobby. The site quickly consumed virtually all of my time and energy, and that has never stopped in the 5 1/2 years since.

My official job as a freelance website developer began to suffer, and several years ago I pretty much gave up website development in order to devote full time to my work analyzing/blogging about healthcare policy in general while also educating people and advocating for progressive healthcare policy reform.

For a long time I've survived on a combination of the my banner ad arrangement with the Robert Wood Johnson Foundation, the generosity of individual donors, and the occasional freelance writing gig. And while I'm eternally grateful for all of these, there's always still been an income gap which I've never been quite able to fill.

Welp. That didn't take long...just a week ago, Connecticut Governor Ned Lamont announced that he and the state legislative leaders had put together a robust package of impressive healthcare reform bills, including:

  • expanding subsidies to at least some of those eanring more than 400% of the Federal Poverty Level (like California is in the process of doing)
  • expanding Medicaid up to 170% FPL (it used to be 201% FPL but was dropped down to 155% a couple of years ago)
  • reinstating the ACA's individual mandate penalty (similar to what Massachusetts, New Jersey and DC have done and what California is in the process of doing)
  • implementing a state-level reinsurance program (as over a half-dozen states, including several GOP-controlled ones, have done)

Holy Smokes! Right on top of my post earlier today about nearly twenty healthcare/ACA bills being pushed through the California legislature, here's a similar story about another batch of ACA improvement/protection bills being pushed through the New Jersey state assembly! via Lilo Stainton of NJ Spotlight:

Democratic lawmakers introduced a dozen bills late last week to create the infrastructure, funding, and regulatory structure for a state-based system that would enable New Jersey officials to create, market, and sell health insurance policies to low-income individuals and small businesses with fewer than 50 employees.

Yesterday I noted that both houses of the California state legislature (Assembly and Senate) voted to expand Medi-Cal (the state's Medicaid program) to anywhere between 147,000 - 175,000 undocumented immigrants (young adults age 19 - 25 and seniors over 65), entirely funded using state dollars.

It turns out that this was only part of a marathon voting session yesterday over the past few weeks. Either the state Senate, Assembly or both have also voted to pass three a bunch of other healthcare-related bills (I've included simple descriptions of each):

BREAKING: California Assembly passes our #AB1246(@Limon) to align consumer protections for all Californians, including those in large group coverage. #Care4AllCA

Back in 2016, California passed an important bill which allowed undocumented children to enroll in the state's Medicaid program (called Medi-Cal). The costs are borne entirely by the state, since federal law currently doesn't allow federal taxpayer dollars to be used to pay for Medicaid...although, I should note, this isn't entirely true:

Federal law generally bars illegal immigrants from being covered by Medicaid. But a little-known part of the state-federal health insurance program for the poor has long paid about $2 billion a year for emergency treatment for a group of patients who, according to hospitals, mostly comprise illegal immigrants.

The lion’s share goes to reimburse hospitals for delivering babies for women who show up in their emergency rooms, according to interviews with hospital officials and studies.

(update: the video of the town hall has been removed from YouTube for whatever reason, but I have the transcript below anyway)

Last night on the Last Word with Lawrence O'Donnell, Democratic U.S. Senator and Presidential candidate Kamala Harris took her fourth (or fifth) shot at explaining exactly where she stands on Medicare for All and the elimination of private primary heatlh insurance.

As I've noted (mostly on Twitter...I just checked and it looks like I haven't written much about it on the site aside from a quick mention here), Harris has struggled to explain her position in several town hall appearances; she'll boldly stated that she supports "Medicare for All", but then stumbles when it comes to the "elimination of private insurance" issue.

Back in March, I noted that Democratic Minnesota Governor Tim Walz had put forth a pretty ambitious budget proposal, which included two pretty eyebrow-raising ACA-related funding proposals:

The Governor will take immediate action by creating a subsidy program to reduce by 20 percent the monthly premiums for Minnesotans who receive their insurance through MNSure. This subsidy will be applied directly against a consumer’s premiums. This proposal provides relief to Minnesotans with incomes over 400 percent of the federal poverty level do not qualify for the federal premium tax credit which helps lower the costs of health insurance premiums. Up to 80,000 people could participate in the program, reducing the out-of-pocket costs of their health insurance premiums.

via Covered California:

Covered California Announces Grants to Community-Based Organizations Across California in Preparation for 2020 and Beyond

  • Community-based organizations and clinics will receive a total of $6.3 million in grant funding to help people enroll in quality health care coverage.
  • The 105 organizations reflect California’s diversity and will target populations that are hard to reach, uninsured and eligible for financial help through Covered California.
  • Approximately 89 percent of Californians live within a 15-minute drive of these community-based organizations.

Covered California announced Friday that it intends to partner with 105 community-based organizations to educate consumers about their health care options, offer in-person enrollment and renewal assistance and provide ongoing support on how to get the best value from their health plan. The Navigator grants announced are part of Covered California’s ongoing commitment to support robust marketing and outreach, including working with trusted organizations throughout the state to help hard-to-reach people understand this new era of health care.

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