UPDATED with my personal initial thoughts (see below):

A few weeks ago I noted that Michigan Republicans were pushing hard for new Democratic Governor Gretchen Whitmer to basically eliminate Michigan's unique unlimited catastrophic care requirement for no-fault auto insurance, which is the main reason our state has the highest auto insurance premiums in the country.

Whitmer and legislative Democrats don't want people to be stuck with massive auto injury medical claims, of course, and they also wanted a guarantee of significant rate reductions as well as the elimination of "redlining" (basing rates on zip codes) and other discriminatory auto insurance pricing practices, like basing premiums on credit ratings, gender and the like.

Last October, shortly before the midterm election, Democratic gubernatorial nominee Ned Lamont of Connecticut announced that if elected, he'd push hard for a robust reinsurance program along the lines of other states which have successfully implemented reinsurance 1332 waivers under the ACA:

HARTFORD, CT — Democratic gubernatorial candidate Ned Lamont has much lower expectations for what he’s going to be able to do to improve the health of Connecticut residents than one might expect from a Democratic candidate this year.

Sounds like Lamont would not push for CT to reinstate the ACA individual mandate penalty:

...Does he believe everyone in Connecticut has to purchase health insurance now that it’s not mandated by the federal government?

For a good six months or so from the fall 2017 to spring 2018, retiring Republican Senator Lamar Alexander and Democratic Senator Patty Murray tried to hash out a deal which would have, had it actually been passed and signed into law, resolved some (not all) of the ACA's stabilization issues...although at a pretty ugly cost:

  • Reinsurance: GOOD!
  • Guaranteed Ad/Outreach Funding: Good! (but only necessary due to Trump cutting funding in first place)
  • Short-Term Plan Notifications: Good! (but only necessary because of #ShortAssPlan EO in first place)
  • BHP Funding: Mostly Good w/a possible Meh.
  • Waiver Flexibility: Mostly Good.
  • Copper Plans: Meh.
  • CSR Funding (with Silver Loading allowed): (NET NEGATIVE)
  • CSR Funding (with Silver Loading prohibited): (it's complicated)
  • Short-Term Plan FEDERAL OVERRIDE: DEAL-BREAKER
  • Abortion Prohibition: DEAL-BREAKER
  • ShortAssPlan Expansion: DEAL-BREAKER (via separate bill)

This Just In via mailing list...

The Fifth Circuit just officially calendared the argument for the afternoon of July 9th. Here’s the docket entry:

CASE CALENDARED for oral argument on Tuesday, 07/09/2019 in New Orleans in the West Courtroom -- PM session. In accordance with our policy, lead counsel only will receive via email at a later date a copy of the court's docket and an acknowledgment form. All other counsel of record should monitor the court's website for the posting of the oral argument calendars.. [19-10011] (SME) [Entered: 05/23/2019 11:08 AM]

While I have you, I’m attaching the excellent reply briefs filed yesterday by the growing coalition of ACA defender states led by California Attorney General Xavier Becerra as well as the brief from the U.S. House of Representatives. Both completely take apart every single one of the absurd legal arguments put forward by the Trump-Barr DOJ and Texas et al.

Once more for those in the back:

One More Time: If the entire ACA were to be repealed:

With the idiotic #TexasFoldEm lawsuit scheduled for oral arguments by the 5th Circuit Court of Appeals this summer, many states have been scrambling to replicate ACA protections for those with pre-existing conditions at the state level, including California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Mexico and more.

In a red state like Louisiana, unfortunately, it's not so easy...the state has a Democratic Governor, but both the state House and Senate are solidly controlled by Republicans. In addition, the Governor, John Bel Edwards, is up for re-election this November, making everything politicized, thus making it likely impossible to get anything useful through this year. Still, Gov. Edwards is trying to do something to mitigate the problem:

As you can see, after yesterday's deep dive into the potential 10-year cost of the Medicare for America proposal, I'm easing back today with some easy quick hits. The DC Health Link exchange has posted their Individual and Small Business enrollment report as of May 5, 2019.

The numbers are all fairly small, of course, but a few noteworthy items: DC appears to have an 89% QHP enrollment retention rate as of May from the beginning of the year (they had 18,035 QHP selections as of 1/31/19), which is very good. SHOP enrollment is disproportionately high as always for DC, due to both the fact that they require all small business enrollments in the District to be handled via the exchange and the fact that members of Congress and their staff have to use the DC exchange to enroll in healthcare coverage.

Vermont Health Connect, the VT ACA exchange, doesn't post data reports very often, but they just did so, with enrollment data as of March 2019.

It's important to note that the numbers posted in the tables below include both Vermont's on and off-exchange enrollees in the individual and small group markets. It's also important to note that Vermont (like Massachusetts) merges both the individual and small group markets into the same risk pool for purposes of premium rate settings.

There are four tables...two for the Individual market (raw numbers and percentages) and two for the small group market. Perhaps the most noteworthy line is the "Reflective Silver" enrollments...those are people who took up the "Silver Switcharoo"...basically, unsubsidized individual market enrollees who switched from (or chose) on-exchange Silver plans to off-exchange Silver plans to save money on policies which are identical to the on-exchange Silver version but without the CSR premium load.

via Connect for Health Colorado:

Health Insurance Shopping Tool Optimized for Mobile Browsing

Posted on Tuesday, May 14, 2019

Contact: Monica Caballeros, mcaballeros@c4hco.com

DENVER – Coloradans shopping for health insurance through Connect for Health Colorado can now preview health plans and estimate costs on their mobile devices and tablets using the award-winning Quick Cost and Plan Finder tool.

Connect for Health Colorado has optimized the tool for mobile browsing of health insurance plans as part of its technology modernization effort, which includes a suite of tools such as live chat and scheduling a call. Development is also underway to optimize the complete application for mobile devices. Making the technology consistently mobile provides a smoother user experience and supports customers who do not have immediate access to traditional desktops and laptops.

via the Washington Insurance Commissioner's Office:

OLYMPIA, Wash. – Gov. Jay Inslee today signed Insurance Commissioner Mike Kreidler’s request legislation to end surprise medical billing, enacting arguably the strongest law in the country to protect consumers from this unfair practice.

The new law protects consumers from getting a surprise bill when they get either emergency services at an out-of-network emergency room or medical treatment at an in-network hospital or facility but are seen by an out-of-network provider.

 

OK, this probably won't be the most exciting Congressional hearing in the world, but it's a pretty important one both historically and for practical purposes. Any major healthcare reform bill will have to first be run through the Congressional Budget Office's scoring process...and before the CBO can do that, they first have to lay out the ground rules, which they did earlier this month.

Anyway, you can watch the hearings above; here's the details...which are pretty simple: Three CBO wonks will be testifying and questioned.

Key Design Components and Considerations for Establishing a Single-Payer Health Care System

Date: Wednesday, May 22, 2019 - 10:00am

Location: 210 Cannon House Office Building

Witnesses

WARNING: I can not emphasize enough just how many assumptions I'm making here. I could be ABSURDLY off at either end of the scale; the actual cost could turn out to be half as much as I project here...or twice as much. This is purely a crude, early attempt to game out the basic framework for determining the actual cost, and there's a lot of missing data, which means having to make some pretty big assumptions about the current situation, much less projecting things forward.

All of this being said, I decided to take a crack at figuring out just how much additional federal spending might be needed in order to properly fund the "Medicare for America" universal healthcare coverage proposal.

So, this is a thing which happened:

Had a great time discussing #MedicareForAll opposite @charles_gaba on Medicare for America for Ferndale Dems. Happy to report no one was called a neoliberal or a Bernie bro.

Follow @detroitdsam4a and @dsam4a for more on M4A. Charles' work can be found at https://t.co/RTP68atFhA

— Kyle Minton (@JuniorMinton) May 17, 2019

Your Health Idaho, the only red state standalone ACA exchange in operation since Kentucky's kynect exchange was shuttered a few years back, doesn't post updates very often, but when they do there's usually a few noteworthy items. Back in March they held a semi-annual board meeting which included a few items:

8. OPEN ENROLLMENT 2019 UPDATE

Mr. Kelly said YHI’s effectuations as of the end of January are just over 101,000 and prelim February results at 98,700. There were significant enrollment shifts between the carriers specifically with SelectHealth gaining membership due to a low-price position. Modest growth continues for the dental carriers overall with significant growth for Delta Dental. Strong seasonality is seen in effectuation trends in January and February. And as expected, the average premium is just under $500 which was anticipated with the rate increase of about 5 percent.

I'm not sure how this slipped by me, but NY State of Health (New York's ACA exchange) released their official 2019 Open Enrollment Period report about a week ago:

NY State of Health Releases 2019 Open Enrollment Report

  • Essential Plan and Qualified Health Plan Enrollment Reach Record Levels 

ALBANY, N.Y. (May 9, 2019)—NY State of Health, the state’s official health plan Marketplace, today released detailed demographic data on the more than 4.7 million New Yorkers enrolled in comprehensive health coverage through the close of the sixth open enrollment period on January 31, 2019. Marketplace enrollment is now at its highest point ever, and Essential Plan and Qualified Health Plan enrollment reached record levels of more than 1 million people.

“It’s evident in the numbers released today that there is high demand for quality, affordable health coverage,” said NY State of Health Executive Director, Donna Frescatore. “The 2019 record enrollment levels are proof that New York’s Marketplace remains strong.”

NY State of Health 2019 Open Enrollment Report Highlights

I didn't write about this yesterday because I was both swamped and a little confused about how the various bills were being packaged and voted on, but I think I have it straightened out now.

Back on March 26th, the House Democrats formally rolled out H.R. 1884. The official title of this bill is the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019", or PPECMHCMAA, which is terrible, so I've simply shorthanded it as "ACA 2.0".

HR 1884 is actually more of a catch-all collection of a dozen or so smaller, standalone ACA improvement bills, each of which either repairs an ACA provision which has been damaged or sabotaged in the past; protects an existing ACA provision from future sabotage; or strengthens & enhances the ACA going forward.

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