2018 MIDTERM ELECTION

Time: D H M S

Charles Gaba's blog

So the Big News this week is that Ted Cruz has come up with what he thinks is a brilliant solution to the GOP Senate's BCRAP problem:

His proposal, which he’s circulating to his colleagues on typed handouts, wouldn’t explicitly create and fund the special insurance markets, as the House bill did. Instead, insurance experts said, it would create a sort of de facto high risk pool, by encouraging customers with health problems to buy insurance in one market and those without illnesses to buy it in another.

...There is no public legislative language yet, but here’s how Mr. Cruz’s plan appears to work, based on his handout and statements: Any company that wanted to sell health insurance would be required to offer one plan that adhered to all the Obamacare rules, including its requirement that every customer be charged the same price. People would be eligible for government subsidies to help buy such plans, up to a certain level of income. But the companies would also be free to offer any other type of insurance they wanted, freed from Obamacare’s rules.

At the top of the website I have a button linking to an article I wrote for Cracked.com back in May in which I explored about a half-dozen reasons why making major changes to healthcare policy in the U.S. is such a royal pain in the ass. I'm a Single Payer advocate at heart, so it was mostly written from that perspective, but really, most of the points I made would apply to any major policy change.

One thing you may notice in reading the piece is that at no point do I address the cost/payment side of moving the entire U.S. over to a universal, federally-funded Single Payer system; I stick mostly to the logistical side of things (What to do with 2-3 million industry workers? What about the Hyde Amendment? Etc, etc). These are all reasons why I'm convinced that achieving such a system would have to be done in stages. That doesn't mean tiny stages, mind you; "incremental" simply means "more than one step", so it could be, say, 4-5 stages phased in over 20 years or whatever...just not all in one shot.

As longtime readers know, I've often separated the problems with the ACA into several categories:

  • Some were inherent in the original bill as signed into law.

Yes, many of these only exist because of futile attempts to win over support from Republicans (or a handful of blue dog Dems), but the Democrats are still responsible for them. This includes things like the APTC tax credits being too skimpy, the "family glitch", the "skinny ESI glitch" and so forth. In these cases, the GOP can certainly be criticized for refusing to help resolve those issues, but that's a matter of "passive" obstruction as opposed to overtly doing so.

Several regular commenters here at ACA Signups have been wondering why the Congressional Budget Office keeps using March 2016 as the "baseline" for projecting the net impact on healthcare coverage numbers under the GOP's Trumpcare bills (the House's AHCA and the Senate's BCRAP), as opposed to the more recent January 2017 baseline. After all, according to the March 2016 baseline, the CBO was projecting that under the ACA, the total individual market would have 25 million people as of 2026 (18 million on the exchanges plus another 7 million off-exchange), whereas under the January 2017 baseline, their projections are for the individual market to only be 20 million as of 2027 (13 million on the exchanges plus 7 million off-exchange). Taken at face value, this would seem to suggest a 5 million enrollee discrepancy. This drumbeat has been taken up more recently by GOP Senators, particularly Wisconsin Senator Ron Johnson.

*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.

So, the other day the CBO issued their score of impact of the GOP Senate's #BCRAP bill on both healthcare enrollment as well as the U.S. Federal Budget. While most people have been focusing on the impact on how many additional people are projected to be uninsured as of 2026 if the bill becomes law, there's also been a lot of understandable backlash over the massive cuts to non-ACA Medicaid spending: A reduction in projected spending of 26% as of 2026 and 35% by 2036:

The Senate Republican healthcare plan's proposed cuts to Medicaid, one of the most contentious parts of the bill, get progressively steeper over time, according to a Congressional Budget Office analysis released Thursday.

The nonpartisan CBO on Monday released its first analysis for the Senate bill, the Better Care Reconciliation Act, and estimated that provisions in the BCRA would result in $772 billion in cuts to Medicaid by 2026.

That amounts to 26% less funding for the program than than under the current law, the Affordable Care Act.

It's the last day of the month, which means everyone's in boxes are flooded with obnoxious "FILING DEADLINE AT MIDNIGHT!" money beg emails from political candidates and campaigns. Worse yet, it's the last day of June, which means it's the end of the quarter as well, so those fundraising emails are even more obnoxious about it.

Well, I'm not a political candidate, I'm not running for office and I don't have a "filing deadline" or anything, but I do have bills to pay (including, as it happens, my own Blue Cross Blue Shield insurance premiums). I'm trying to maintain this website and my job at the same time, and needless to say, sometimes the day job falls through the cracks (especially at the moment).

So I figured what the hell; everyone else is sending out obnoxious donation appeals, why not join the club?

If you appreciate the work I do here at ACA Signups and would like to pony up a few bucks, feel free to do so via either PayPal or GoFundMe, thanks!!

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...

A few months ago, tech/media journalist Simon Owens interviewed me for a profile piece he wanted to write about ACASignups.net...basically, the whole story of how a Michigan website developer somehow became a national data/analysis source for All Things Obamacare. I had a couple of similar stories written about myself and the site by Sarah Kliff of Vox and Miranda Neubauer of TechPresident, but those were both over 3 years ago, in the midst of that insane first Open Enrollment Period, when the site was at peak media attention. I've been cited/quoted quite a bit since then, but most of that has been about the actual data and analysis, which of course makes sense.

Owens' story was published this week, and today just happens to be my birthday, so as a little present to myself, I'm doing a bit of #HumbleBragging by sharing the story link.

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:

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