Charles Gaba's blog

Back in March, the Health & Human Services (HHS) Dept. and the Centers for Medicare & Medicaid Services (CMS) proposed a so-called "Marketplace Integrity & Affordability Rule" which would include sweeping changes to how the ACA exchanges (both the federal one (HealthCare.Gov) and the 20-odd state-based ones (Covered California, MNsure, etc) operate, as well as who is or isn't eligible to enroll in ACA exchange coverage, restrictions on subsidy eligibility and so forth.

Many of these changes are simply repeals/reversals of improvements put into place during the Biden Administration; others are completely new ones being put into place by the Trump Regime under RFK Jr. & Dr. Oz.

However, until today, these were still technically only proposed changes. Now they're official. The final version isn't quite as bad as it could have been, and there's one or two items on the list which I'm not that upset about, but overall...yeah, it's pretty ugly.

I just received this from the HHS Dept:

MEDIA ADVISORY—FOR PLANNING PURPOSES ONLY

Secretary Kennedy, Administrator Oz to Host Press Conference to Discuss Groundbreaking Health Insurance Reform

WASHINGTON, DC—FRIDAY, JUNE 20, 2025—U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare and Medicaid Services Administrator Mehmet Oz will host a press conference to discuss a breakthrough in health insurance that will improve access to care for millions of Americans.

WHEN: Monday, June 23 at 2:45 PM ET

Press should arrive by 1:45 PM for priority placement

Press must have REAL ID to enter the building

WHERE:

Hubert H. Humphrey Building Auditorium
200 Independence Ave SW
Washington, D.C. 20009

PARTICIPANTS:

HHS Secretary Robert F. Kennedy, Jr.
CMS Administrator Mehmet Oz, M.D.

Be afraid. Be very afraid.

via the Minnesota Commerce Dept:

Federal policy shifts drive higher 2026 rates for individual and small group health plans

State actions blunt increases tied to the reconciliation bills and policy direction of the federal government

St. Paul, MN: Health insurers have submitted their proposed increased rates to the Minnesota Department of Commerce for 2026 plans available to Minnesotans who buy individual or small group health insurance through MNsure or directly through insurers. These proposed rates apply to coverage starting Jan. 1, 2026, with open enrollment beginning Nov. 1, 2025.

Blue Care Network:

BCN is filing a year-over-year average rate increase for 2026 for all individual products that were offered in 2025 of 16.3%. Significant contributors to rate change are outlined in the table below:

  • Experience Restate 4.0%
  • Medical and pharmaceutical price and utilization trend 5.4%
  • ARPA Subsidy Expiration Impact 4.6%
  • Benefit Change and CSR -2.6%
  • Margin Impact 1.2%

...Incorporated in the above, BCN assumed an additional pharmacy price trend due to tariffs, as follows:

  • Generic +2.5%
  • Brand +10%
  • Specialty 0%
  • Total Impact +2.5%

...Consistent with the 2025 filing, BCN has assumed no CSR payments will be made by the federal government for 2026. Therefore, rates for Silver plans offered on exchange are 20.5% higher than if the federal government funded CSR subsidies.

Blue Cross Blue Shield of Michigan:

Last month, in response to House Republicans passing their version of the budget resolution bill, I broke out total enrollment in Medicaid via ACA expansion, ACA exchange Qualified Health Plan (QHP) enrollment and ACA-based Basic Health Plan (BHP) enrollment by Congressional District in order to try and get a sense of just how many Americans healthcare coverage is at risk from the bill...and how that breaks out along partisan lines at the House District level.

As I noted at the time, Republicans seem to be under the impression that it will mostly be Democrats who get screwed by their bill, since 9 of the 10 non-expansion states are Republican strongholds...while some Democrats seem to be under the impression that it will mostly be rural MAGA republicans who get screwed.

via Politico:

Senate GOP tax bill would hit politically explosive Medicaid provision

The Finance Committee is due to brief members on its megabill draft text Monday night.

Senate Republicans are seeking to ratchet up savings from a politically explosive policy within Medicaid to pay for their megabill, and it’s already setting off shockwaves through Capitol Hill.

The Senate Finance Committee’s forthcoming portion of the party-line tax and spending package would lower the Medicaid provider tax to 3.5 percent, according to three people with direct knowledge of the legislation who were granted anonymity to discuss it.

Over the past couple of months I've compiled a master spreadsheet breaking out enrollment in ACA plans (Qualified Health Plans & Basic Health Plans), Medicaid/CHIP coverage (both traditional & via ACA expansion) and Medicare (both Fee-for-Services & Advantage) at the Congressional District levels.

With the pending dire threat to several of these programs (primarily Medicaid & the ACA) from the House Republican Budget Proposal which recently passed, I'm going a step further and am generating pie charts which visualize just how much of every Congressional District's total population is at risk of losing healthcare coverage.

USE THE DROP-DOWN MENU ABOVE TO FIND YOUR STATE & DISTRICT.

by Steve Beynon of Military.com:

The 4,000 California National Guard soldiers who President Donald Trump surged into Los Angeles remain unpaid due to delays in issuing official activation orders, leaving compensation and benefits in limbo.

According to more than a dozen Guardsmen across four units who spoke to Military.com, none has received formal activation orders, the critical paperwork that not only authorizes their duty status, but also unlocks pay, Tricare health benefits and eligibility for Department of Veterans Affairs services. Without those orders, troops remain in a legal and administrative limbo.

Multiple defense officials with direct knowledge of the situation told Military.com the chaotic and sudden activation of troops has effectively clogged up the flow of administrative work.

via the National Academy for State Health Policy:

16 Million Americans Would Become Uninsured Due to Reconciliation Bill and Loss of Tax Credits; 8.2 Million in Marketplaces Alone

Leaders from State-based Health Insurance Marketplaces, Enrollees, Providers, and Small Business Highlight Potential, Devastating Impacts

(Washington, DC) The Congressional Reconciliation bill and loss of federal tax credits would result in 16 million Americans losing health coverage, including 8.2 million enrolled in Health Insurance Marketplaces. By stripping millions of lives from the Marketplaces, health care will be more expensive, harder to access, create a strain on health care systems, and hurt small businesses.

via NY State of Health:

  • More Than 240,000 New Yorkers Would Experience Increased Premiums From Elimination of American Rescue Plan Enhanced Tax Credits and Additional Changes 
  • Average Monthly Costs Could Rise by More Than $228 — an Increase of 38% for a Couple — Due to Elimination of Enhanced Tax Credits 
  • Estimated 65,000 to 80,000 New Yorkers, Approximately One Third of Enrollees, Could Lose Individual Marketplace Coverage 
  • Regional Breakdown Of Cost Increases Available Here; Congressional District Breakdown Available Here

Governor Kathy Hochul today released new data showing the massive impact the GOP’s ‘Big Ugly’ Reconciliation Bill would have on New York families. The latest bill threatens to severely disrupt health coverage for millions of New Yorkers. In addition to increasing the number of uninsured by 1.5 million and stripping $13.5 billion in annual funding from New York’s healthcare system, the bill would trigger steep increases in private health insurance premiums for vulnerable New Yorkers and impose excessive burdens on consumers enrolling through NY State of Health, the State’s official health plan marketplace.

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