UPDATE 4/15/17: ALL 50 STATES (+DC) NOW COMPLETE!!

Earlier this year, I crunched a mountain of numbers to try and put together an estimate of just how many people are at risk of losing healthcare coverage completely if & when the Affordable Care Act is "cleanly" repealed--that is, a full and complete repeal of the entire law, without any other significant healthcare law replacing it whatsoever. My rough estimate? Around 24 million people, broken out by Congressional District.

Sometime after that, the Congressional Budget Office ran the numbers to see just how many people they expected would lose healthcare coverage if the GOP's American Health Care Act (Trumpcare) "Obamacare replacement plan" were to be signed and put into effect. Their conclusion? ALSO around 24 million people.

UPDATE: If you scroll all the way to the bottom, I've added a completely updated state/national-level table as well, reflecting both the "clean repeal" and Trumpcare scenarios.

As I noted a few days ago, the Center for American Progress has outdone me. I crunched the numbers and broke out roughly how many people would lose healthcare coverage assuming the Affordable Care Act were to be fully repealed, with immediate effect and no replacement healthcare legislation whatsoever--that is, kicking nearly 15 million Medicaid expansion enrollees, over 750,000 Basic Health Plan enrollees and roughly 8.2 million significantly-subsidized individual market exchange enrollees off of their policies all in one shot. Add it all up and it comes to roughly 24 million people nationally.

Here's yesterday's press release from Covered California referred to by Dan Mangan of CNBC a little while ago:

New Analysis Shows Potentially Significant Health Care Premium Increases and Drops in Coverage If Federal Policies Change

  • California’s premiums could rise by 28 to 49 percent in 2018, and up to 340,000 consumers could lose individual market coverage if changes are made to existing federal policies.
  • The potential rate increase would mean billions of dollars in additional federal spending. The 1.2 million consumers who do not receive subsidies would bear the entire brunt of these increases.
  • The potential decrease of 340,000 insured consumers would not only represent many individuals losing access to potentially life-saving care, but it would result in a sicker risk mix in the individual market and higher premiums for everyone.

SACRAMENTO, Calif. — A new analysis shows the dramatic consequences facing Californians if federal policies are changed from the current structure and there is no longer direct federal funding of cost-sharing reduction (CSR) reimbursements and the individual shared responsibility payment is not enforced when a consumer chooses not to purchase coverage.

The analysis found that Covered California health plan premiums could rise up to 49 percent if two key elements that have been in place for the past four years are changed: Cost-sharing reduction reimbursements are no longer directly funded as reimbursements to carriers, and the shared individual responsibility payment is not enforced.

 

I noted a week or so ago that according to David Anderson of Balloon Juice, rumor has it that many insurance carriers are making their actuaries work overtime to put together multiple rate filings for 2018 based on several different outlooks:

  • Trump/Price/GOP quit screwing around, officially fund CSR reimbursements, enforce the mandate penalty and generally implement the ACA in good faith.
  • Trump/Price/GOP cut off CSR funding but otherwise enforce the law somewhat reasonably
  • Trump/Price/GOP cut off CSR, don't enforce the mandate, keep mucking around with half-assed repeal/replacement bills
  • (etc, etc...several possible scenarios)

Today the California Insurance Commissioner, Dave Jones, made a formal announcement that this is exactly what CA insurance carriers will be allowed to do, and he isn't pussyfooting around with the reasons for the policy change either:

Ben Sasse is a Republican U.S. Senator from Nebraska. As you might imagine, he's not a fan of the ACA.

About an hour ago, he tweeted the following:

Just heard from small-biz owner--whose plan was cancelled by ObamaCare--that he's been forced into this:
$13k/yr deductible
$15k/yr premium

— Ben Sasse (@BenSasse) April 28, 2017

...which I thought would be the first tweet in a brief thread including some additional details, such as:

 

*(Disclaimer: No, that's not a direct quote from Dr. Molina, but it's a pretty damned spot-on paraphrase).

A couple of weeks ago I noted that a buttload of heavy players in the healthcare field sent a joint letter to Trump, Tom Price and everyone else under the sun making it pretty clear how vital resolving the CSR issue is, and what the consequences would be if Congress and Trump don't make good on them.

Today, Molina Healthcare, which has around 1 million ACA exchange enrollees at the moment (roughly 9% of all effectuated enrollees) lowered the boom even harder (via Bob Herman of Axios):

Molina will exit exchanges if ACA payments aren't made

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA). By the end of March, the numbers in these 4 states had gone up by another 19,300.

It's the end of April now, so I checked in once more, and sure enough, the numbers continue to grow:

UPDATE: Note that Anthem made these statements BEFORE Molina drew their line in the sand re. CSR payments. That could be a game changer.

I'll let Tami Luhby of CNN/Money take the floor:

Anthem says Obamacare business doing 'significantly better,' but still may exit some areas. https://t.co/ToFAvXj62t via @CNNMoney @luhby

— Tami Luhby (@Luhby) April 26, 2017

$antm CEO: "Individual business is doing markedly better than last year." But claims are slightly higher than expected.

— Tami Luhby (@Luhby) April 26, 2017

UPDATE: Important to note that this story broke BEFORE Molina drew a line in the sand re. the CSR issue. That could be a game changer.

via the Oregon Register-Guard:

Insurer Centene commits to shaky ACA exchanges for 2018

One health insurer is eager to dive back into the Affordable Care Act’s troubled insurance exchanges next year, even as competitors waver and President Trump tweets doom about the law’s future.

Centene Corp. said Tuesday that its exchange enrollment has swelled 74 percent since last year, up to nearly 1.2 million people.

 

(sigh) Yes, this is the second time I've used the same headline and clip.

According to The Hill, just moments ago:

WH to Dems: We’ll continue paying ObamaCare subsidies

The Trump administration has told Democrats it will continue paying controversial ObamaCare insurer subsidies, lowering fears that a fight over the issue could cause a government shutdown.

The move marks something of a shift for President Trump, who had threatened earlier this month to withhold the subsidies, known as cost-sharing reductions, as a way to move Democrats to negotiate on a healthcare overhaul.

"A shift"? He shifts so often he should be in the next Fast & Furious movie.

Rep. Tony Cardenas (D-Calif.), for one, said Wednesday that he doesn’t trust the president enough to take him at his word.

You don't say.

The Kaiser Family Foundation took a national survey from March 28 - April 3 (the week following the GOP's first failed attempt to pass their Trumpcare bill), and included among the questions they asked was this one:

With the future of any other replacement plans uncertain, this month’s survey also gauges who the public views as responsible for the 2010 health care law going forward. A majority (61 percent) of the public say that because President Trump and Republicans in Congress are in control of the government, they are now responsible for any problems with the ACA moving forward. About three in ten Americans (31 percent) say that because President Obama and Democrats in Congress passed the law, they are responsible for any problems with it.

Huh. The White House just guaranteed the government funding bill will include ACA payments. https://t.co/caFX2fVKiV

— Topher Spiro (@TopherSpiro) April 26, 2017

As I warned back in September, again in November, and yet again a few weeks ago:

As noted later in my September post, this analysis was provided to me by a trusted source, and Prof. Bagley said that a cursory read of it suggests that yes, it does seem to be accurate:

 

(sigh) Yes, this is the third time I've used the exact same clip from "Dead Again". That's no coincidence; Zombie Trumpcare keeps shuffling back every few weeks, but this time they appear to actually be serious about it (again).

Others have already written up more detailed explainers on the latest changes, so I'm not gonna go into too much detail, but Sarah Kliff of Vox wraps it up nicely:

Republicans’ new health amendment lets insurers charge sick people more, cover less

Here's the basics: In addition to (or in revised versions of) everything awful about the AHCA ("American Health Care Bill") which gave it a mere 17% approval and led to it being yanked off the House floor mere moments before it was scheduled to be voted on, the new version also includes the following:

Presented without comment other than to say "My, how things have changed..."

In strategy and substance, the American public disagrees with the course that President Trump and congressional Republicans are pursuing to replace the Affordable Care Act with conservative policies, according to a new Washington Post-ABC News poll.

Large majorities oppose the ideas at the heart of the most recent GOP negotiations to forge a plan that could pass in the House.

...Public sentiment is particularly lopsided in favor of an aspect of the current health-care law that blocks insurers from charging more or denying coverage to customers with medical conditions. Roughly 8 in 10 Democrats, 7 in 10 independents and even a slight majority of Republicans say that should continue to be a national mandate...

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