Trumpcare

*UPDATE: FOR GOD'S SAKE PEOPLE, THE HEADLINE IS SNARK. THAT'S KIND OF THE POINT. SHEESH.

So, the taxpayer-funded Trump/GOP propaganda campaign continues, with HHS Secretary Tom "Inside Trader" Price posting the following tweet:

Only 10.3 million Americans are on the #Obamacare exchanges while 28.2 million have no insurance at all. We need relief now. pic.twitter.com/s4RRoRGJlF

— Tom Price, M.D. (@SecPriceMD) June 30, 2017

How many things can you find wrong in this picture?

Oregon was among the first states to publish the rate hikes requested by carriers for the individual and small group markets for 2018.

Their initial requests ended up boiling down to a weighted average of around 17.2% on the individual market and 8.2% for the small group market. At the time, however, I was still figuring out how to sort out the Trump Tax Factor: That is, the portion of the requested rate hikes which can be blamed specifically on 2 major factors: The GOP's refusal to pass a 64-word bill formally appropriating CSR reimbursement payments unless it's tied to the rest of their #BCRAP bill (and Trump's constant, public threats to cut off CSR payments altogether unless the #BCRAP bill passes); and Trump/Tom Price's ongoing threats/overt suggestions that they're not going to bother enforcing the individual mandate penalty at all.

This year, to the best of my estimates, Tennessee's total individual market consists of roughly 300,000 people, around 2/3 of whom are enrolled via the federal ACA exchange. Humana is dropping out of the state next year, meaning roughly 79,000 enrollees will have to shop around.

To my knowledge, there are actually 6 individual market carriers in Tennessee this year: Aetna, TRH (Tennessee Rural Health), Blue Cross Blue Shield, Cigna, Humana and "Freedom Life" (which, again, is basically a phantom carrier with no enrollees). Aetna and Humana are out, so that leaves TRH, BCBSTN and Cigna. TRH doesn't appear to have submitted an official 2018 rate filing as of yet, but they only had 3,500 enrollees this time last year anyway, so likely won't have much impact on the overall weighted average rate hikes.

UPDATE 7/18/17 1:30pm: Well, that didn't last long...

Three GOP senators — Shelley Moore Capito, Susan Collins, and now Lisa Murkowski — all will vote "no" on the new plan to repeal and then replace the Affordable Care Act.

Why it matters: This guarantees what was already widely expected: that Senate Republicans wouldn't be any more successful with a straight repeal plan, without a replacement, than they were with the repeal-and-replace legislation that stalled yesterday. Republicans could only lose two votes.

What's next: Senate Republicans are still likely to schedule the vote — even if it fails — because they have to prove to conservative groups (and President Trump) that they've tried everything.

Then again, who the hell knows...

UPDATE 7/18/17: REPOSTING since Mitch McConnell is now back to a "repeal with a 2-year delay" strategy:

Gee, this all seems awfully familiar...

UPDATE 7/20/17: The CBO score of BCRAP 2.0 has just been released, and while there are some tweaks/changes to their conclusions here and there, they still project about 22 million people to lose coverage by 2026 if BCRAP 2.0 is signed into law. They still expect about 15 million Medicaid enrollees to lose coverage by 2026. The only significant change on the "net loss of coverage" front is that they estimate that instead of 7 million people losing individual market coverage, they now project a net indy market reduction of 5 million...but also now expect about 2 million people with employer-based coverage to lose that, resulting in a net loss of...22 million.

I don't know if CAP plans on recrunching their numbers, since the BCRAP 2.0 bill still doesn't include the Cruz amendment which is supposedly going to be part of the final version voted on, but in the meantime, I'd imagine all numbers below could be updated by simply lowering all Individual Market column numbers by 29%...and just adding those numbers over to a new, Employer Coverage column.

Back on March 24th, a couple of hours after Paul Ryan pulled the House GOP's first ACA repeal vote, I posted the following:

CELEBRATE A FEW HOURS. Then come back and read this.

TRUMP'S PLAN B: Do everything he can to sabotage the ACA, then blame Democrats.​

... there's the other doomsday possibilities, like Trump issuing an executive order stopping payment on CSR reimbursement payments to carriers.

I'll be addressing all of this and much more in the near future, of course, including my own suggestions for how the ACA should be changed to repair/improve the situation.

For the moment, however, I'm very tired, it's a beautiful Friday afternoon, and I'm going to go play with my kid for a few hours. I think I've earned it.

...and included this clip from the underrated film "Dead Again":

Kurt Busiek is a talented writer and comic artist (and he's apparently pretty famous in the industry...I'm out of the loop on that sort of thing).

He's also a pretty insightful guy. Yesterday he wrote the following Twitter thread:

So the ACA has fines for those who don’t have insurance, which spurs healthy people to buy insurance, which makes things work better. But...

— Kurt Busiek Resists (@KurtBusiek) June 24, 2017

…the AHCA is adding a penalty that says if you don’t buy insurance you can’t buy insurance for 6 months. Huh?

— Kurt Busiek Resists (@KurtBusiek) June 24, 2017

I suppose what they’re thinking is that it stops people from holding off buying insurance until they’re sick, because this way they can’t...

— Kurt Busiek Resists (@KurtBusiek) June 24, 2017

I've had to spend most of the afternoon/evening taking care of my kid (he has a 2-hour karate class Monday evenings), so I'm just now getting a chance to actually read the CBO's score of the GOP Senate's BCRAP bill, beyond their general summary of the score which I simply posted verbatim (with a handful of highlights and notes) earlier today.

There's a lot to digest; I'm sure everyone's already heard the main lowlights/takeaways: 22 million losing coverage by 2026 (14 million kicked off of Medicaid, 7 million losing individual market coverage, 1 million miscellaneous/rounding, I presume), "deficit savings" of around $321 billion (giving Mitch McConnell $202 billion to try and buy the votes he needs from a handful of "moderate" Senators) and so on. I'll be writing my full analysis for tomorrow, though there's probably not much point in it, since every other healthcare reporter will already have beaten me to the punch.

However, there's one little bit which infuriates me so much I have to get it off my chest right now. But first, the setup:

UPDATE 4:30pm: It's out:

(I don't have time for a full analysis right now, so I'm just highlighting some key points and making a couple of notes for the moment...plenty of other reporters/bloggers/wonks are furiously writing analysis right now as well, of course)

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Better Care Reconciliation Act of 2017, a Senate amendment in the nature of a substitute to H.R. 1628. CBO and JCT estimate that enacting this legislation would reduce the cumulative federal deficit over the 2017-2026 period by $321 billion. That amount is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House of Representatives.

Louise Norris gave me a heads' up regarding the Indiana 2018 rate filings. Anthem BCBS and MDwise, which currently have around 46,000 and 30,800 exchange enrollees each, are dropping out next year, meaning nearly 77,000 people will have to shop around. Anthem is sticking around the off-exchange market....but only in a handful of counties. Norris indicates around 64,687 total Anthem enrollees; minus the 46K on-exchange, that leaves roughly 18.7K off-exchange enrollees, virtually all of whom are expected to drop due to Anthem dropping out of all but 5 counties (plus, of course, the large rate hike).

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