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UPDATE: Late last night I was able to dig up the actual legislative text of the bill introduced by the House Democrats yesterday; after reading over the details, I've decided that it's a strong enough package overall that, in software terms, it would be considered a full version upgrade (2.0) as opposed to "only" a service pack/point upgrade (1.5). I've therefore changed the headline to reflect this.

I've also updated some sections fo the analysis below to include the details from the text itself.

A little under a year ago, I posted a lengthy list of 20 recommendations for repairing, improving and strengthening the Affordable Care Act, entitled "If I Ran the Zoo". Here's a summary list of all 20:

Over the past few weeks,I've posted partial 2018 Open Enrollment Period demographic data from Connecticut, Idaho, Maryland, New York and Washington State. Still missing are final wrap-up reports from the other 7 state-based exchanges...as well as The Big One: The official report from the Assistant Secretary for Planning and Evaluation (ASPE).

The 2014 ASPE report was released on May 1st, 2014...just 17 days after the first, tumultuous 2014 Open Enrollment Period ended (only 12 days, really, since the report actually ran through April 19th, 2014 even though the "overtime" period technically ended on April 15th).

Yesterday, the Center for American Progress announced their own proposal for a new, comprehensive, national, universal healthcare coverage system. I'm giving my initial thoughts annotation-style.

Medicare Extra for All: A Plan to Guarantee Universal Health Coverage in the United States
By the CAP Health Policy Team Posted on February 22, 2018, 6:00 am

OVERVIEW: This proposal guarantees the right of all Americans to enroll in the same high-quality plan modeled after the Medicare program.

This is exactly what Dave Anderson, Colin Ballio and I have been talking about for awhile now:

Under the Guise of “Health Insurance Stabilization,” Congress Should Not Axe Financial Help for Low-Wage Families

In negotiations over stabilizing the individual health insurance market, lawmakers are considering slashing federal health care assistance for low- and moderate-income consumers by more than $27 billion a year. In dollars terms, this would be a greater blow than completely eliminating, in one stroke, the Low-Income Home Energy Assistance Program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Child Care and Development Block Grant, the Community Development Block Grant, and federal grant programs for community-based mental health services and substance abuse prevention and treatment.

OK, first take a few minutes to read all of this.

I'll wait.

OK, done? Good. Now read this (via Stephanie Armour of the Wall St. Journal):

Health insurers and the Trump administration face a court decision shortly that will determine whether the government must pay insurers billions of dollars despite Republican efforts to block payments they view as an industry bailout.

Insurers have filed roughly two-dozen lawsuits claiming the federal government reneged on promises it made to pay them under the Affordable Care Act.

...It could also shape the outcome of other insurer lawsuits that would leave the government potentially owing as much as roughly $20 billion in past and future payments. Those cases, legal experts say, amount to the largest civil lawsuits ever.

Yesterday I noted that the GOP is attempting to tack on additional "abortion restriction" language into the proposed ACA stabilization portion of the "must-pass" Omnibus Spending Bill set to be voted on next week. However, the actual wording of the "abortion language" was left a bit vague:

Between the lines: This doesn't solve the partisan dispute over abortion language, as it'd bar plans that offer abortion coverage from receiving federal subsidies. But it hints that there's Republican support behind a set of policy changes that could substantially lower premiums ahead of the 2018 elections.

I wrote an extensive piece about the way abortion coverage is currently handled for ACA exchange policies back in October 2017:


Yesterday I came out against the pending ACA stability package because one of the 5 proposed provisions should be a flat-out dealbreaker for Democrats (the abortion ban), while another one is would hurt more people than it helps (CSR funding).

Today, I need to explain the problem with CSR funding in a bit more detail but to also note a new twist which makes it even more complicated...as well as taking note of a sixth provision being thrown into the mix by the GOP which, again, should be a dealbreaker for Democrats.

First up: CSR funding.

I'm on the record as being strongly in favor of a bill recently proposed by House Democrats Frank Pallone, Jr., Richard Neal and Bobby Scott which would repair, strengthen and expand the ACA in a half-dozen ways while also preventing or reversing another half-dozen types of sabotage of the ACA by the Trump Administration. Here's the full list of what would be included in what I've shorthanded "ACA 2.0":

As long as I'm snarking on Washington's exchange for getting so excited over what appear to be pretty minor tweaks (to the average Joe, anyway), I might as well also give a shout-out to Connect for Health Colorado as well, which just posted this tidbit:

To Our Valued Stakeholders,

We took an important step forward this week with our board’s decision to move ahead on building a new eligibility system. With our own system, we will be able to provide customers a better application and enrollment experience and at the same gain more control and predictability for IT expenses.

A simplified path for enrolling with financial help can be expected to help us grow enrollment while getting more Coloradans the Advance Premium Tax Credit and Cost Share Reduction benefits that they are eligible to receive. We will continue to support Health First Colorado (Medicaid) enrollments and ensure that customers are routed to the right program, whether they begin at our site or with the PEAK application.


via Caitlin Owens of Axios...

Sens. Lamar Alexander and Susan Collins have proposed a market stabilization package that would include funding for the Affordable Care Act's cost-sharing reduction subsidies for three years, three years of federal reinsurance at $10 billion a year, additional ACA waiver flexibility for states, and expanded eligibility for "copper" plans.

Alexander presented the plan yesterday to America's Health Insurance Plan's board of directors, adding that if Democratic leadership supports the bill, “it’ll be law by the end of next week." Alexander has long said the package should be included on the omnibus spending bill.

From Public Policy Polling this morning:

Exit Poll of PA-18 Shows Lamb Won Big On Health Care
Date: March 14, 2018

Public Policy Polling conducted a telephone exit poll election survey of voters who cast ballots in Pennsylvania’s 18th Congressional District special election yesterday. Voters who voted in the contest were asked about the role of health care in their decision.

The exit poll shows that health care was a top priority issue to voters in this district and that voters believed Democrat Conor Lamb’s views were more in step with theirs.

In 2016, voters in this district backed Donald Trump by 20 points, but last night they backed a Democrat for Congress in a referendum on the health care plans of the Republican Congress:

Wisconsin Senator Tammy Baldwin has been on a bit of an "Improve the ACA" tear lately. A couple of weeks ago she introduced the "Fair Care Act" to try and nip Donald Trump's #ShortAssPlans proposal in the bud. Now she's introduced another bill which would help shore up the ACA exchanges themselves: The "Advancing Youth Enrollment Act" via Kimberly Leonard of the Washington Examiner):

The Advancing Youth Enrollment Act would give higher federal subsidies to people between the ages of 18-34 so that the cost of private Obamacare plans for them would be lower.

...Under the proposal, young adults would see the maximum percentage of income they must pay toward health insurance under Obamacare decrease by 2.5 percentage points for people between the ages of 18 to 30. Each year after, until the age of 34, they would see a gradual phaseout of 0.5 percentage points a year.


I honestly can't make heads or tails out of what, exactly, the just-passed HB2516 from the Washington State legislature actually does, but the WA Health Benefit Exchange seems to be pretty happy about whatever it is:

Today, Pam MacEwan, CEO of the Washington Health Benefit Exchange, issued the following statement on the signing of House Bill 2516: 

“The Washington Health Benefit Exchange applauds today’s signing of House Bill 2516 by Gov. Jay Inslee.

“This state-level legislation protects important progress made in Washington state under the Affordable Care Act. Our position as the state’s health insurance gateway is now stronger than ever, and despite continued uncertainty we may see at the federal level, this bill enables us to continue improving the customer experience for the people in our state.

Last fall, Dem Senator Patty Murray and GOP Senator Lamar Alexander (among the few Republican Senators actually interested in improving the ACA) got together and hammered out a deal called Alexander-Murray. At the time, the bill would have done the following:

  • Two years of subsidy funding, along with funding for the rest of 2017. There will also likely be additional steps to help enrollees with their premiums in 2018.
  • A "copper plan" for people older than 30, which would be less comprehensive than other ACA plans but would have a lower premium.
  • $106 million in enrollment outreach funding in 2018 and 2019.
  • Shorter review time for states seeking waivers from some of the ACA's coverage requirements. It's unclear what other waiver changes have been agreed to at this time.
  • Authorization for funding to help states launch reinsurance programs, which would defray the costs of covering the sickest consumers.

Of these five items, it's really the first two which would have the biggest impact: CSR reimbursement payments and a low-end "Copper Plan".

I should note up front that despite the snarky headline, this is actually good news on the whole, and Premera does deserve some credit for it since part of the $250 million they refer to below is voluntary on their part.

Premera Blue Cross, the sole carrier offering ACA exchange individual market policies throughout the entire state of Alaska, and one of the major carriers on the indy market in Washington State, posted this press release today:

Premera Announces $250 Million Investment In Customers and Community

Mountlake Terrace, Wash. — (March 12, 2018) — Premera Blue Cross, a leading health plan in the Pacific Northwest, today announced $250 million in investments over five years across Washington and Alaska to help stabilize the individual market, improve access to care in rural areas and support local communities in their efforts to address the behavioral health issues impacting their residents.