ACA Sabotage

 Back in June, Washington State delivered the bad news: They were expecting 2019 ACA-compliant premiums to increase by another 19.1% (due primarily to this year's sabotage of the law by Donald Trump and Congressional Republicans) on top of this year's 36% increase (10 points of which was due specifically to Trump's CSR reimbursement cut-off).

Today, Washington insurance commissioner Mike Kreidler announced the approved 2019 premium changes, and while the news certainly isn't great, it's not quite as bad as expected earlier this summer:

Reed O'Conner, the hard-right wing judge presiding over the idiotic #TexasFoldEm lawsuit which could potentially wipe out the Affordable Care Act as soon as January 1st, has been radio silent for the past week since he heard oral arguments over the case from the dueling bands of state Attorneys General.

However, if Tim Jost's description of how that hearing went is anything to go by, it's looking pretty ominous:

To enter the Fort Worth Courtroom of Judge Reed O’Connor on September 5, 2018, was to leave the real world.  The Affordable Care Act was once again on trial.  At stake was access to health care for the 20 million Americans who have gained coverage through the ACA, affordable coverage for 133 million Americans with preexisting conditions, and preventive services coverage for 44 million Medicare beneficiaries.

Hmmm...OK, this is rather curious.

New Mexico was one of the earlier states to post their initial, requested 2019 ACA individual market premium hikes back in June. At the time, the five carriers asked for rate increases ranging from a slight drop (-0.4% for Molina) to as high as an 18.5% increase for Presbyterian Health, which is currently only offering off-exchange policies this year. Based on their preliminary filings, New Mexico was looking at a weighted average increase of around 10.0% next year, which would have been more like 4% if not for this years sabotage efforts by Trump and the GOP (mandate repeal & expansion of #ShortAssPlans):

Normally at this point in the year I only do full rate hike write-ups for states when their approved rate changes are made public by insurance regulators. I'm making an exception for Texas, however, because my preliminary analysis of the statewide average premium changes back in June was missing a huge portion of the market--I only had around half the ACA individual market accounted for, and I repeatedly warned that the missing enrollment and rate change data could easily skew the statewide average higher or lower.

Well, it's early September now, and not only do I have access to pretty much all of the missing data now, some of the rate filings have changed significantly as well. At the time, I estimated Texas carriers as requesting average rate increases of just 1.5% overall, with them dropping around 10.6% if not for the ACA's individual mandate being repealed and Trump's expansion of #ShortAssPlans.

I received a tip about this early this morning...which, unfortunately, I was unable to scoop anyone with due to being bogged down/caught up with the #TexasFoldEm drama.

As a result, it looks like Shelby Livingston of Modern Healthcare was first to post about it:

Montana insurer wins lawsuit against feds over unpaid cost-sharing reduction payments

Several health insurers have sued the U.S. government over its failure to make cost-sharing reduction payments that help lower healthcare costs for certain consumers. One just scored the first victory. The U.S. Court of Federal Claims ruled in favor of Montana Health Co-op, which sued the federal government for $5.3 million in unpaid cost-sharing reduction payments, finding that the government violated its obligation under the Affordable Care Act when it stopped paying the CSRs in October 2017."

The rest of the article is behind a paywall, but the gist of it is as follows:

 

Welp. This doesn't look good. As I noted earlier this afternoon, the insane #TexasFoldEm lawsuit held their oral arguments today, and as expected, the Republican-appointed judge in the case, Reed O'Connor, isn't exactly a fan of the ACA. Paul Demko lays out the bottom line in Politico:

U.S. District Court Judge Reed O'Connor, a George W. Bush appointee, vigorously questioned attorneys during the three-hour hearing but gave no indication when he would rule.

Lawyers for the Trump administration partially agreed with the red states' argument, concluding that the removal of Obamacare's individual mandate requires striking down the law's insurance provisions, including protections for people with preexisting medical conditions.

But the administration disagreed on the need for immediate action, arguing that any remedies should not be applied until next year.

I noted this back in June, and the numbers are virtually identical today:

In June 2018, President Trump’s administration announced – as part of a lawsuit known as Texas v. United States, brought by 20 Republican state attorneys general – it will no longer defend the ACA’s protections for people with pre-existing medical conditions.

Yes, this is the #TexasFoldEm case which has oral arguments happening even as I'm typing this.

U.S. Senator Tammy Baldwin (D-WI) recently introduced a new bill which, while it has zero chance of actually passing (or even being voted on) neatly tackles not one but two different types of Republican sabotage of the Affordable Care Act: The expansion of short-term plans being pushed hard by Donald Trump and the elimination of pre-existing condition protections being pushed hard by 20 GOP Attorneys General in the idiotic #TexasFoldEm case. Per Dylan Scott in Vox last week:

Senate Democrats are preparing a long-shot procedural maneuver to reverse new Trump administration regulations that they say would sabotage the Affordable Care Act by expanding “junk” insurance that isn’t obligated to cover preexisting conditions.

Rhode Island is kind of an interesting state this year. The smallest state geographically and one of the smallest population-wise, they only have two carriers offering individual market coverage: Blue Cross Blue Shield and Neighborhood Health Plan. Way back in May both carriers submitted their preliminary 2019 ACA policy rate increase requests, averaging around 9.7% overall. What's most noteworthy is that unlike most other states, both carriers are mostly blowing off 2018 ACA sabotage factors like mandate repeal and #ShortAssPlans. Blue Cross isn't adding anything to account for the negative risk pool impact, while Neighborhood (which holds slightly more than half of the market share) is only tacking on about 2% in response.

Back in April, I started an ambitious project which set out to track every legislative or regulatory measure taken by every state to counter, cancel out or mitigate sabotage of the Affordable Care Act by the Trump Administration and Congressional Republicans. It resulted in this color-coded spreadsheet, which lists dozens of bills, proposals, amendments and so on at various stages of completion.

The bad news is that project has proven to be too large for me to keep up with--there's simply too many bills, too many stages and too much other stuff going on for me to keep track of it all.

The good news is that the Center for American Progress (which has slightly more resources than I do) has launched their own version of this project, and it's very slickly done:

Last year, Virginia residents experienced massive amounts of heartburn and ulcers as two major insurance carriers, Optima (Sentara Health) and Anthem (HealthKeepers) played musical chairs with both their 2018 rate filings and which areas of the state they offered plans on.

In May 2017, things didn't look too bad: Both Anthem and Optima were available in fairly large chunks of the state, and while Anthem wanted to raise rates an ugly 38% on average, Optima was only looking to increase rates by around 10-11%.

Hat tip to Louise Norris for the heads up about the Kentucky Dept. of Insurance issuing their final rulings for 2019 ACA individual market and small group policy premiums:

DOI Completes Review of Individual and Small-Group Health Insurance Rate Filings

The Kentucky Department of Insurance (DOI) announced today that it has completed its review of the individual and small-group insurance rates filed in the Kentucky market. The rates will be used to calculate insurance premiums in the 2019 benefit year.

Kentuckians in the individual market will once again experience changes in premiums and plan offerings. The rates that will be used reflect an average rate increase of 4.3 percent for Anthem Health Plans of Kentucky (Anthem) and 19.4 percent for CareSource. Since the actual premium charged will vary by individual and the plan level selected, some individuals may see a decrease in rates.

via Amy Lotven of Inside Health Politics...

Ethics Prof Says TX Judge's Attendance At Federalist Society Event Doesn't Cross Line
August 28, 2018 

The judge overseeing the high-profile case over the constitutionality of the Affordable Care Act, which could potentially land at the Supreme Court, is slated to attend a Federalist Society event featuring Supreme Court Justice Clarence Thomas -- and several members of the federal circuit court of appeals that would review the case before it landed at the high court. A key ethic professor suggests the Texas' judge's appearance at the event does not cross any lines.

Judge Reed O'Connor is also slated to monitor a panel entitled “Trump, Sessions and the States,” during the Texas Chapter meeting on Sept. 8, just days after the Sept. 5 arguments in the federal Texas court are scheduled.

Inside Health Policy asked ethics experts whether O'Connor's appearance pushed the envelope on judicial ethics, and those that responded generally suggested his appearance at the event is not an issue.

Pages