Last summer, there was a hell of a bombshell dropped on the judicial system when the U.S. Dept. of Justice, under then-Attorney General Jeff Sessions, announced that instead of defending the Affordable Care Act against the Texas vs. U.S. lawsuit (which is their job, after all), they were effectively throwing the case by not only refusing to defend the law in court, but actively agreeing with the plaintiffs that the absurd premise of their lawsuit was correct:

Last night, the Washington Post posted a story with a headline which made top campaign representatives for both Bernie Sanders and Kamala Harris go nuts on Twitter:

Sen. Bernie Sanders changes how Medicare-for-all plan treats union contracts in face of opposition by organized labor

Sen. Bernie Sanders announced a key change to his Medicare-for-all insurance plan Wednesday, a move meant to assuage fears on the part of organized labor, whose support is being heatedly sought by all of the candidates for the Democratic presidential nomination.

Back in June, the New Mexico Insurance Dept. posted the preliminary 2020 rate change filings for the ACA individual and small group markets. At the time, the vcarriers were requesting the highest average premium increase in the country for next year: An increase of 13.0%.

The main source of this double-digit hike was New Mexico Health Connections, one of just a handful of original ACA Co-Op carriers to survive. They were requesting a whopping 30% average rate hike for 2020, and with over 1/3 of the market share, this was more than enough to drag the statewide average up. A second carrier, Presbyterian, only sells off-exchange but was requesting a 16.3% increase which also pushed the average up.

Well, today the approved rate filings have been released, and there's several eyebrow-raising developments.

First of all, there's this (first noted by Sabrina Corlette):

CHRISTUS HEALTH PLAN LOSES QUALIFIED HEALTH PLAN STATUS

If you've been following me on Twitter lately, you know that I've grown increasingly frustrated with two aspects of the Democratic Presidential primary process in recent months:

• First, Sen. Elizabeth Warren's seeming 180-degree turnaround from her March stance on achieving universal healthcare coverage ("a lot of different pathways") to her more recent rhetoric (a simple, point-blank "I'm with Bernie on Medicare for All.") at the first debate in late June. At the time, I assumed this was simply due to the absurdly short time constraints and the terrible framing of the question by the moderators, but it's mid-August now and so far she seems to be sticking to her guns re. being 100% onboard with BernieCare.

• Second, the almost complete ghosting of the dangers to and fixes needed for the the ACA itself regardless of what the Next Big Thing ends up being (whether Medicare for All, Medicare for America, Choose Medicare, Medicare X, etc).

  The only one to even mention the Texas vs. Azar (#TexasFoldEm) lawsuit during any of the four debates held to date was Sen. Cory Booker...and the only major candidate who's focused on improving the ACA specifically has been Joe Biden...and even his plan would also include the creation of a federal public option which would complicate and delay the implementation of the other provisions of his plan nearly as much as the other overhaul bills on the table, as David Anderson notes:

I wrote last month that Highmark BCBS, the sole individual market carrier operating in Delaware, has requested a 5.8% average premium reduction for 2020. In the press release from the state insurance department they noted:

It is important to note, that the proposed rate decrease is unrelated to Delaware’s intended submission of a 1332 Waiver to establish a reinsurance program. If the application process is successful, the actuarial consultant’s projections are correct, and the State of Delaware secures adequate funding, the waiver program may decrease rates by an additional 20%.

Well, today CMS indeed approved that ACA Section 1332 Reinsurance program waiver:

(OK, no, this does not appear to be a "Yelp!"-like system where enrollees can directly influence the star ratings...I just posted the logo for the hell of it)

I didn't catch this when the press release went out a few days ago, but this could be significant...or it could be a big batch of nothing:

CMS is Bringing Health Plan Quality Ratings to All Exchanges for the First Time
Consumers will have improved access to health plan quality information for the 2020 Open Enrollment Period

Cartoon: John Cole, Scranton Times-Tribune

I've written about this in vague terms a few times in the past, but Samuel Trachtman, a Political Science PhD candidate at US Berkely, has just published a fascinating study on the impact of political partisanship on enrollment in ACA exchange healthcare policies:

Context: Political partisanship can influence whether individuals enroll in government programs. In particular, Republicans, ceteris paribus, are less likely to enroll in Affordable Care Act (ACA) individual marketplace insurance than Democrats. The logic of adverse selection suggests low uptake among Republicans would generally put upward pressure on marketplace premiums, especially in geographic areas with more Republican partisans.

Long-time readers may recall that back during the first insane Open Enrollment Period in early 2014, I was constantly screamed at by Republicans demanding to know "BUT HOW MANY HAVE PAID???"

Ffor several months, conspiracy theories abounded about how many of those who selected Qualified Health Plans (QHPs) from the ACA exchanges actually followed through and paid their first monthly premium, thus actually being enrolled in effectuated policies.

A couple of days ago, the Centers for Medicare & Medicaid (CMS) issued a press release which included a five-year effectuated enrollment report for the entire ACA-compliant individual market, both on and off exchange:

The Trends in Subsidized and Unsubsidized Enrollment Report

The report shows that people who do not qualify for APTC continue to be priced out of the market. Following a decline of 1.3 million unsubsidized people in 2017, another 1.2 million unsubsidized people left the market in 2018. These enrollment declines among unsubsidized enrollees coincided with increases in average monthly premiums of 21 percent in 2017 and 26 percent in 2018.

Over the weekend, the New York Department of Financial Services issued a press release announcing approved 2020 ACA-compliant Individual and Small Group premium rate changes:

DFS ANNOUNCES 2020 PREMIUM RATES: LOWERS OVERALL REQUESTED RATES FOR INDIVIDUALS AND SMALL BUSINESSES TO PROTECT CONSUMERS AND FUEL A COMPETITIVE HEALTH INSURANCE MARKETPLACE