Charles Gaba's blog

On the last episode of "Who Wants to Try and Appease Joe Manchin?," the entire Democratic Senate caucus, as well as President Biden, had basically given up on trying to get West Virginia Senator Joe Manchin to be reasonable after spending a solid year listening to him come up with one excuse after another not to pass an ever-shrinking domestic "soft infrastructure" agenda.

In the end, they accepted that the $3.5 trillion "Build Back Better" package, which was later slashed to around $1.6 trillion by the time it passed the House of Representatives last fall, wasn't going to happen.

Instead, they were going to have to accept a shadow of its former self: A roughly $300 billion healthcare-only package which would primarily accomplish only two of the major provisions of the original pacakge (and only part of those):

via Jefferson Public Radio:

For years, consumer advocates and some legislators have been battling to rein in escalating health care costs. Now the state has created a new agency to limit future growth in health care costs — and it will have the power to enforce that mandate.

...In California and nationally, the most cited reason for people being uninsured or underinsured is cost. Even those with robust insurance sometimes struggle to afford hospital bills and their medication. Some take extreme measures, such as rationing their dosages or traveling south of the border for more affordable care. Half of Californians skipped or postponed medical care in 2021 because of costs, according to a California Health Care Foundation report.

...The recently approved state budget includes $30 million to create the office, whose key responsibility will be to set and enforce limits on cost growth for the industry, including hospitals, health insurers and physician groups.


Via the Alabama Insurance Dept:


The Affordable Care Act (ACA) requires that insurers planning to increase plan premiums submit their rates to the Alabama Department of Insurance for review.

The rate review process is designed to improve insurer accountability and transparency. It ensures that experts evaluate whether the proposed rate increases are based on reasonable cost assumptions and solid evidence. The ACA also requires that a summary of rate review justifications and results be accessible to the public in an easily understandable format. The Federal Rate Review website is designed to meet that mandate. For more information, see here.

The information is provided in the tables below. Also attached are links to the redacted actuarial memorandum, which support these changes. The rate changes are being proposed and reviewed by the Alabama Department of insurance (ALDOI). As soon as they are final, they may be purchased on the Federal Exchange or through private agents and brokers. The programs will be effective beginning on January 1, 2023. 

via the Centers for Medicare & Medicaid Services:

  • Awards to 36 grantees support President Biden’s Executive Orders on Strengthening Medicaid and the Affordable Care Act, and represent the largest outreach and enrollment investment ever made through Connecting Kids to Coverage program.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today awarded $49 million to organizations on the frontlines of reducing uninsured rates and connecting more children, parents, and families to health care coverage. In support of President Biden’s Executive Orders on Strengthening Medicaid and the Affordable Care Act, and HHS Secretary Xavier Becerra’s priority of expanding access to affordable, quality health care, these awards represent the largest investment CMS has ever made in outreach and enrollment through the Connecting Kids to Coverage program. 

Pennie Logo

OK, this is a bit odd...the press release is from March, but didn't post it on their site until today. Weird:

Governor Tom Wolf today announced that Pennsylvania’s state-based health insurance marketplace, known as Pennie, has added a new qualifying life event to allow low-income Pennsylvanians the ability to enroll in health insurance throughout the year.

“Since taking office, a top priority of mine has been to expand access to quality, affordable health insurance to all Pennsylvanians,” said Gov. Wolf. “I strongly believe that access to health care is a fundamental right, but it’s also good for Pennsylvania’s economy. This additional qualifying event will make health insurance accessible to some of Pennsylvania’s most vulnerable citizens, providing them the security of knowing they can receive medical care without the astronomical costs associated with seeking care without health insurance.

As depressing as it may be to see President Biden's original $3.5 trillion American Families Plan (that was the actual name of the "soft" infrastructure portion of the Build Back Better agenda; since then the "hard" infrastructure portion which passed has been rebranded as the "Bipartisan Infrastructure Bill" while the American Families Plan was rebranded as...Build Back Better) get whittled down to less than $300 billion, the good news (such as it is) is that it looks like at least that much is finally going to happen...probably:

It’s official. Democrats’ Manchin-ified health-care reconciliation bill is moving forward.

via Covered California:

Covered California Announces 2023 Plan Rates: Lower Than National Average Amid Uncertain Future of American Rescue Plan Benefits

  • California’s individual market will see a preliminary rate increase of 6 percent in 2023, due in part to the return of normal medical trends that existed prior to the COVID-19 pandemic and the uncertain future of the American Rescue Plan.
  • Despite the uncertainty, the rate change is below the national average thanks to Covered California’s 1.7 million enrollees and the state’s healthy consumer pool, which remains among the best in the nation.
  • Covered California also announced that a 13th carrier would join the marketplace, and an existing carrier would expand to become the second one to offer statewide coverage.
  • All Californians will have two or more choice of carriers, 93 percent will be able to choose from three or more, and 81 percent will have four or more choices.

Back in April, I did some minor champagne cork popping after the Centers for Medicare & Medicaid Services rightly put the kibosh on the so-called "Georgia Access Model" waiver pushed by GOP Governor Brian Kemp:

The Georgia Access model would eliminate the use of, transitioning consumers to decentralized enrollment through private web-brokers and insurers. The state would establish its own subsidy structure to allow for 1) the subsidization of plans that do not comply with all the ACA’s requirements; and 2) enrollment caps if subsidy costs exceed federal and state funds.

There's not a single part of the paragraph above which shouldn't be setting off major alarms:


As I (and many others) have been noting for many months now, the official end of the federal Public Health Emergency (PHE), whenever it happens, will presumably bring with it reason to celebrate...but will also likely create a new disaster at the same time:

What goes up usually goes back down eventually, and that's likely to be the case with Medicaid enrollment as soon as the public health crisis formally ends...whenever that may be.

Well, yesterday Ryan Levi and Dan Gorenstein of of the Tradeoffs healthcare policy podcast posted a new episode which attempts to dig into just when that might be, how many people could be kicked off of the program once that time comes and how to mitigate the fallout (I should note that they actually reference my own estimate in the program notes):

New Jersey

via the New Jersey Dept. of Banking & Insurance:

TRENTON — Building on the Murphy Administration’s efforts to expand access to affordable health coverage, Governor Murphy signed legislation (A-674/S-1646) on June 30 creating the New Jersey Easy Enrollment Health Insurance Program to make it easier for residents to obtain health insurance through Get Covered New Jersey, the State's official health insurance marketplace.

“New Jersey has made great strides in ensuring more residents have access to affordable health insurance. More than 324,000 New Jerseyans signed up for health coverage through Get Covered New Jersey during the Affordable Care Act Open Enrollment Period—a record high in New Jersey,” said Department of Banking and Insurance Commissioner Marlene Caride. “I want to thank Governor Murphy for signing the New Jersey Easy Enrollment Health Insurance Program into law—this is another step forward that reduces barriers to health coverage. Enrolling more residents in health plans will lead to better health outcomes for New Jersey families.”