My apologies. Between a death in the family and some other personal issues, I'm way behind the eight ball this week. As a result, I'm just now getting around to writing about not one, not two, not three, but FOUR major GOP attacks on the ACA and healthcare in general which either happened or had major developments this week.

Instead of getting even further behind by trying to do a full, detailed take on each of them, I'm going to crib like crazy from other healthcare reporters/articles to cover the gist of each.

3: Senate rejects Trump plan to claw back spending

via The Hill:

The Senate on Wednesday narrowly rejected President Trump's plan to claw back roughly $15 billion in spending approved by Congress earlier this year.

(Note: It was approved by Republicans in Congress earlier this year.)

In a 48-50 vote, senators failed to discharge the measure from committee. A majority vote was needed.

My apologies. Between a death in the family and some other personal issues, I'm way behind the eight ball this week. As a result, I'm just now getting around to writing about not one, not two, not three, but FOUR major GOP attacks on the ACA and healthcare in general which either happened or had major developments this week.

Instead of getting even further behind by trying to do a full, detailed take on each of them, I'm going to crib like crazy from other healthcare reporters/articles to cover the gist of each.

2: House GOP 2019 budget calls for deep Medicare, Medicaid spending cuts

Big shocker, I know...yeah, that's the actual headline of the Hill article, in which the GOP also proposes simply stripping out all funding for the ACA while they're at it:

Last year, Iowa's already-ugly individual market was rocked further yet by Big Kahuna Wellmark announcing that after finally entering the ACA exchange market in 2017, they were dropping back out again this year, leaving Medica as the only carrier offering ACA-compliant policies throughout the whole state. In response, Medica raised their 2018 ACA rates by a whopping 57% this year. This, in turn, led to the state legislature passing a law which stripped away pretty much any type of restriction or regulation of "Farm Bureau" plans, exacerbating the risk pool problem further yet.

My apologies. Between a death in the family and some other personal issues, I'm way behind the eight ball this week. As a result, I'm just now getting around to writing about not one, not two, not three, but FOUR major GOP attacks on the ACA and healthcare in general which either happened or had major developments this week.

Instead of getting even further behind by trying to do a full, detailed take on each of them, I'm going to crib like crazy from other healthcare reporters/articles to cover the gist of each.

#1: GRAHAM-CASSIDY 2.0 (via ThinkProgress):

Republicans renew attempts to repeal Obamacare

A group of Republicans and Washington D.C. think tanks released a proposal Tuesday that aims to resurrect Obamacare repeal. The consistent chatter around the proposal has drawn ire from the White House and GOP leadership, as the midterms are just months away, and repeal efforts haven’t proved to be winning strategies.

I'm addressing this Open Letter to Florida-based Politico reporter Marc A. Caputo, but the truth is there are hundreds of journalists out there who it could apply to as well. I know parts of it seem like a run-of-the-mill flame war between two people on Twitter, but I think there's a much deeper and more disturbing point here given Caputo's profession and status as a reasonably respected journalist.

Dear Marc:

First, let me say that I've followed your political reporting out of Florida for several years, so I know that you're a skilled, capable journalist.

That actually makes everything else in this letter more disturbing, because it proves that even intelligent, well-educated people can suffer from incredibly dangerous blind spots.

UPDATED 6/22/18: Added Indiana and Iowa to the table.
UPDATED 6/25/18: Added Florida, Kentucky, Ohio and Texas* to the table
*(Texas only has about 1/3 of the total ACA individual market accounted for, so it could easily change)
UPDATED 7/3/18: Added Montana and Georgia to the table
UPDATED 7/13/18: Added Tennessee, updated Texas to add BCBSTX
UPDATED 7/16/18: Added Colorado
UPDATED 7/17/18: Added Nevada
UPDATED 7/19/18: Added California
UPDATED 7/20/18: Added Connecticut

Well this is a nice surprise! Yesterday the Minnesota ACA exchange, MNsure, issued a press release a day ahead of the public posting of requested 2019 individual market insurance rate changes, advising people of the various ways they have to keep their premiums down via ACA tax credits, shopping around and so forth. I was immediately concerned that they might know something I didn't...perhaps they were expecting a batch of double-digit rate hikes as has happened in so many other states the past few years?

Well, today the Minnesota Commerce Dept. did release the preliminary 2019 rate requests, and I'm pleasantly surprised to report that for the second year in a row, Minnesota carriers are actually asking for rate decreases:

NOTE: I originally missed two carriers (McLaren and Molina); thanks to Louise Norris for calling attention to my error. The entire post, along with the table, has been updated to reflect the updated numbers including all 11 carriers.

Also note that while the headline originally reflected what the average rate change would be without the CSR load sabotage factor introduced in 2017, I've decided to be consistent with other states and only include 2018 sabotage impact.

My home state of Michigan just posted their preliminary requested rate changes for the 2019 Open Enrollment Period, and unlike most of the other states which have released their early requests so far, Michigan is a pleasant surprise: An overall average requested premium increase of just 1.7%!

Also noteworthy: According to the filings, eight of the carriers are specifically projecting exactly a 5% mandate repeal factor, which is remarkably consistent (usually the projections are all over the place). HAP is slightly lower (4.4%) while Molina is higher (7.2%). Priority Health didn't mention this at all, but it's safe to assume it'd be roughly 5% for them as well.

So, I just received the following press release from MNsure (Minnesota's ACA exchange)...

Tax Credits Through MNsure Can Help Lower Proposed Premiums for 2019
June 14, 2018

DULUTH, Minn.—Preliminary health insurance rates proposed by Minnesota health insurance companies will be available on the Minnesota Department of Commerce website on Friday, June 15.

Private insurance companies set premium prices, and the Minnesota Department of Commerce regulates those companies. Final, approved 2019 premium rates will be available by October 2, and the 2019 open enrollment period begins on November 1. Minnesotans shopping for health insurance through the individual market may be able to reduce premium costs in three ways:

1. See if you are eligible for tax credits only available through MNsure

Well this is rather unexpected.

Let's fire up the Wayback Machine, Sherman, and go back to 3 years ago, when the Risk Corridor Massacre first reared its ugly head.

The simplest explanation of how Risk Corridors worked is this:

• The ACA made dramatic changes to how the individual insurance policy market worked.
• Since it was so disruptive, it included several provisions to help stabilize the market.
• One of these programs, called "Risk Corridors", was a temporary (3 year) program which acted as sort of an insurance policy for insurance carriers.
• In a nutshell: Carriers which earned excessive profits on ACA policies had to place a chunk of those profits into a pool of money. Carriers which took excessive losses on ACA policies were supposed to be reimbursed for a chunk of those losses.
• If the profits exceeded the losses, the government got to keep the difference, so it was theoretically possible they'd actually profit off the system.
• If, however, the losses exceeded the profits, the government was supposed to pay out the difference.

(As an aside: For those claiming "government bailout! picking winners and losers!" etc etc, the ACA's risk corridor program is actually very similar in many ways to the permanent Medicare Part D risk corridor program, although there are some key differences between the two).