A couple of weeks ago I reported that the state legislature and governor of deep red Utah has agreed to partly expand Medicaid under the ACA...
Gov. Gary Herbert signed a measure Tuesday to give more than 70,000 needy Utahns access to government health coverage, ending years of failed attempts on Capitol Hill to expand Medicaid in the state.
But whether House Bill 472 ever takes effect still remains uncertain. Under President Obama’s signature Affordable Care Act (ACA), the Utah law needs approval by the federal Centers for Medicare and Medicaid Services (CMS), which has sent mixed signals on whether it will fully sign off.
Even if CMS does approve HB472, it will likely be about a year — even on an aggressive schedule — before the state can begin enrolling people for coverage.
This morning I was contacted on Twitter by a woman in Louisville, Kentucky who appears to be in pretty dire straits:
On 7/1/18, in Ky, my Medicaid/ ACA will be canceled. I may still need a brain shunt, LP #8, RXs, PT, etc. I was informed that my PCP could write a letter stating I was "Medically Fragile" but even then the provider has final say. Like fox guarding hen house. Please help me/DM
I am a disabled attorney living with my 76-year-old mother who takes care of me. In 2011, I was bitten by a tick and was infected with Ehrlichiosis Chaffeensis and Rickettsia. A week later, I contracted Coxsackie B4 virus. Because I was kept on antibiotics for 19 years, I had no immune system to fight these illnesses.
And now, with quick state-level action in both Maryland and New Jersey in recent days, I decided to expand this project across every state. I've started color-coding the status of each bill and am even adding some recent/past bills and/or waivers which have failed as I go (i.e., the failed/delayed mandate penalty restoration efforts in Connecticut and Maryland).
This is a work in progress, so the table is probably pretty incomplete for now and will likely be changing constantly as various bills are introduced, moved to committee, voted on, pass/fail, signed/vetoed by governors and actually implemented (or legally challenged).
UPDATE 4/20/18: Whew! OK, I've incorporated a bunch of Louise Norris' links for several states and have moved it to a full Google Docs spreadsheet. Be warned, it's pretty big now...
A few days ago I noted that Maryland Governor Larry Hogan had signed a bipartisan bill into law which creates a $380 million reinsurance fund which should cancel out up to 21% of next year's looming individual market premium hikes.
However, I forgot to mention the other important thing that the same bill does: Evidently it would also head off Donald Trump's attempt to open the floodgates on the type of minimally-regulated "short-term" and "association" plans which would further damage the ACA-compliant individual market risk pool:
(C) THIS SUBTITLE APPLIES TO ANY HEALTH BENEFIT PLAN OFFERED BY AN ASSOCIATION, A PROFESSIONAL EMPLOYEE ORGANIZATION, OR ANY OTHER ENTITY, INCLUDING A PLAN ISSUED UNDER THE LAWS OF ANOTHER STATE, IF THE HEALTH BENEFIT PLAN COVERS ELIGIBLE EMPLOYEES OF ONE OR MORE SMALL EMPLOYERS AND MEETS THE REQUIREMENTS OF SUBSECTION (A) OF THIS SECTION.
I've noted before that now that the Republicans in Congress have repealed the ACA's much-hated (but vitally necessary) individual mandate penalty (effective 2019), the odds of it being reinstated at the federal level are virtually zilch. Even if there's a massive blue wave in November and the Democrats are able to retake both the House and Senate, they're extremely unlikely to be willing to face the same type of firestorm/backlash that they did back in 2009-2010 over it.
As I noted last month, the Republican-controlled Michigan State Senate is planning on jumping on board the pointless, wasteful, cruel "work requirement" bandwagon which is all the rage among the GOP types these days.
Sure enough, they're planning on ramming it through within the next week: The Michigan Senate’s Competitiveness Committee is expected to hold a hearing on SB 897, a bill that would impose a work requirement on over 670,000 adult Michiganders with Medicaid health coverage...or nearly 7% of the state population.
The committee chair and the bill’s sponsor, Senator Mike Shirkey (SD-16) is planning on pushing the committee vote through ASAP and then kicking it over to the full state Senate right away.
The "stupidest thing possible" being referred to was whether or not CMS Administrator Seema Verma is planning on putting the kibosh on Silver Loading and the Silver Switcharoo starting in 2019:
The head of the Centers for Medicare and Medicaid Services would not say Thursday if the Trump administration is considering setting limits on how insurers that sell Obamacare plans structure subsidies for their customers.
"I'm not going to comment on the agency's deliberations," CMS Administrator Seema Verma said when asked by the Washington Examiner about rumors that had circulated about the issue. When pressed about whether any conversations had occurred, Verma said, "I'm just going to leave it at that."
WARNING: LOTS OF WONKY NUMBER-CRUNCHY STUFF BELOW.
Skip to the end if you just want to see my findings for every state, but be warned that there's a bunch of caveats/disclaimers involved.
UPDATE: To clarify, you're looking for the VERY LAST TABLE. Not that one...no, not that one either...the one at the very bottom of the post. I've added a highlighted note right above it.
The total individual/family policy health insurance market was roughly 10.6 million people in 2013. This included people enrolled in either "grandfathered" policies (i.e., policies enrolled in prior to the ACA being signed into law in 2010) or in "transitional" policies (those enrolled in between 2010 and late 2013, just before the ACA required all new individual market policies to be fully compliant with the new healthcare law.
How many of those 10.6 million people are still enrolled in grandfathered (GR) or transitional (TR) policies today? Unfortunately, there seems to be very little available data about just how many people are still in these policies. The Kaiser Family Foundation gave a rough estimate of around 2.1 million people last year, which sounded about right to me. However...Kaiser didn't include a state-level breakout of their estimates, and of course it's a year later so that number, if accurate, has probably shrunk a bit more.
Last month I noted that while Congressional Republicans spent all of 2017 desperately attempting to "blow up" the Affordable Care Act via a combination of legislation, the Trump Administration simultaneously tried to tear down the law via various regulatory sabotage efforts. This year the GOP Congress appears to have mostly given up on their mischief (they did manage to partially wound the ACA by repealing the individual mandate), the Trump Administration is doubling down on regulatory sabotage, laying what I've termed "Regulatory Siege" to the law.
In my mind, "phase one" included the non-legislative stuff Trump did last year, including stuff like cutting off CSR reimbursements, slashing the Open Enrollment Period in half, slashing marketing funding by 90%, slashing the outreach budget by 40% and so on. "Phase two" includes the previously-announced #ShortAssPlans executive order, CMS allowing work requirements for Medicaid and so forth (individual mandate repeal belongs here as well, although that was legislative, not regulatory...although there's overlap as you'll see below).
