For the next two weeks, ALL HEALTHCARE-RELATED ATTENTION needs to be on the following three issues:
FIRST:September 27th is the final deadline for ACA exchange insurance carriers to actually sign the contracts to participate in the 2018 Open Enrollment Period. Yes, the deadline to submit their rate filings already passed a week or so ago, and most of them are fairly settled in for next year, but until they actually sign the contract, they can still bail from the individual and/or small business exchanges...and given the massive uncertainty over Cost Sharing Reduction reimbursements and other sabotage efforts of Trump and Tom Price as well as the ongoing repeal/replace saga by the Congressional GOP, many (most?) of the carriers are deliberately waiting until the last possible minute to do so.
Well this was unexpected, although I suppose I should have expected it given all the insanity surrounding the impending deadlines for insurance carriers to sign contracts (Sept. 27th, I believe); the end of the fiscal year on Sept. 30th (which is also the last chance for the GOP to try and squeeze through the hideous Cassidy-Graham Hail Mary repeal/replace bill); and the start of Open Enrollment on November 1st.
The CBO has issued a 17-page report with their latest projections for the types of healthcare coverage and federal spending on healthcare programs including Medicaid, CHIP, ACA tax credits and so forth over the next decade. here's what they foresee:
The federal government subsidizes health insurance for most Americans through a variety of programs and tax provisions. In 2017, net subsidies for people under age 65 will total $705 billion, CBO and the staff of the Joint Committee on Taxation (JCT) estimate.
Louisiana was one of the last states I ran rate hike analysis on just a month ago: Three carriers on the exchange (plus the "Freedom Life" phantom carrier), averaging around 21.4% rate increases on the assumption that CSR payments won't be made. According to the Kaiser Family Foundation, loading CSRs onto Silver plans only would bump them up by an additional 20 points; this translates into roughly 14.2 points if spread across all metal levels on & off the exchange. Based on that, I estimated LA's rate increases at 21.4% without CSRs but only 7.2% if they actually are paid.
I ran an updated analysis of the requested average rate hikes for Connecticut last month. At the time, the only two carriers operating on the CT exchange next year (Anthem and ConnectiCare) were still noncommittal about actually committing to doing so. Statewide, it looked like the carriers were asking for rate increases averaging around 23.8% if CSR payments were guaranteed or 33.5% if they weren't.
As reported by Louise Norris today, the Connecticut insurance dept. reported that both carriers have now committed to sticking around next year, and the approved average rate increases now assume that CSR payments won't be made after all. In the end, the statewide average looks like roughly 28.4% (Norris pegs it at 29.3%, but that's because she generally only includes individual market carriers participating on the ACA exchanges, while I also include carriers and plans offered off-exchange as well).
I've written not one, not two, but three different blog entries in the past 24 hours about Bernie Sanders' just-announced "Medicare for All" proposal...but the reality is, I shouldn't have. Frankly, while it's a discussion/debate that we do need to have, making a big thing about it right this moment is, the more I think about it, terrible timing, because the Affordable Care Act is still in being attacked and at risk in several ways:
FIRST: The CSR issue still hasn't been resolved, although at this point it's extremely unlikely that Patty Murray and Lamar Alexander are going to pull a CSR/reinsurance rabbit out of their hats after all. Last week things looked somewhat promising, but this week it appears to have gone off the rails again...and with just 17 days left in the fiscal year (and, I believe, only 14 days before the contracts have to be signed by carriers for 2018 exchange participation), there's almost no time left to get even a minor stabilization bill pushed through.
SECOND: On a related note, Bill "so much for the Jimmy Kimmel test!" Cassidy and Lindsey Graham are still trying to cram through their pile-of-garbage Hal Mary Trumpcare bill, which is at least as bad as the GOP's failed AHCA/BCRAP bills were earlier this year and even worse in some ways. Again, there's only 17 days left to pull it off, but remember what happened with AHCA last spring...anything's possible. Here's a summary of the impact of the Cassidy-Graham bill via Andy Slavitt and the Centers for Budget & Policy:
OK, here it is. I've linked to a PDF with the full legislative text at the bottom of this blog entry; here's the summary version, with some notes:
TITLE I—ESTABLISHMENT OF THE UNIVERSAL MEDICARE PROGRAM
Establishes a Universal Medicare Program for every resident of the United States, including the District of Columbia and the territories. Guarantees patients the freedom to choose their health care provider. Provides for the issuance of Universal Medicare cards that all residents may use to get the health care they need upon enrollment. Prohibits discrimination against anyone seeking benefits under this act.
OK, so it apparently would cover undocumented immigrants, and every doctor/hospital/clinic/etc. would be required to participate, with anyone in the country being covered by any healthcare provider nationally.
The official announcement is scheduled for Wednesday, presumably with much hoopla accompanying it (and a dozen or so Democratic Senators co-sponsoring it, many of whom are considered likely 2020 POTUS candidate prospects). Over at the Washington Post, Dave Weigel has a sneak peak. I'll wait until I've had a chance to read through the actual text of the bill itself to write up a full response/analysis, so I'll just post a few key excerpts from Weigel's piece for now:
Sanders’s bill, the Medicare for All Act of 2017, has no chance of passage in a Republican-run Congress. But after months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates — if not by most senators facing tough reelection battles in 2018.
For the past year and a half, of all the proxy battles between "Team Hillary" and "Team Bernie" on the left side of the aisle, no issue has been more repsentative of both how passionate people are or how much each "side" misunderstands the other than the future of the American healthcare system.
"Team Bernie", in essence, consisted of progressives (and Democrats) who believe that while the ACA may have improved things to some degree in some ways, it not only isn't enough long-term, it isn't nearly enough short-term either; the next step (and for many, the only acceptable next step) must be moving the entire U.S. population over to a universal Medicare-style Single Payer system, with everyone in the country being covered through a single, comprehensive healthcare program funded entirely (or nearly entirely) by taxes.
It appears that a formal letter was sent to HHS Secretary Tom Price and CMS Administrator Seema Verma from the Energy & Commerce Committee of the House of Representatives...it's 6 pages long, and unfortunately the text isn't selectable, so I had to embed the pages as images. I'm happy to report that I contributed to their inquiry.
If you look at the top of the website today, you'll notice a couple of new graphics, both relating to the Indivisible ACA Signup Project.
The short version is this:
Donald Trump is cutting ACA outreach, so we've started an Indivisible-based, state-by-state sign-up project group to counter the sabotage.
All you need to do (should you agree) is use social media to update people (on your advocacy and/or personal pages) in your state on key issues and dates/deadlines for sign-ups.
That's pretty much the whole thing in a nutshell, at least so far. It's a closed Facebook Group which you need to request permission to join, but they obviously want the materials to be disseminated as widely as possible (that's kind of the whole point!), so I've agreed to set up a permanent, public link for folks to access them.
