2018 MIDTERM ELECTION

Time: D H M S

As regular readers know, I've been a bit obsessive about tracking down and breaking out ACA Medicaid expansion enrollee numbers. This is more difficult than it sounds, because most Medicaid reports lump expansion enrollees in with the other ~58 million or so Medicaid enrollees; only a handful of states issue separate reports of the expansion-specific population on a regular basis.

Back in late November, I cobbled together the data as best as I could and came up with a total of roughly 11.3 million people nationally. However, that included a lot of 2-year old data and rough estimates.

A couple of weeks later, I stumbled upon a detailed analysis from an anti-ACA financial watchdog organization, the Foundation for Government Accountability, which provided hard numbers and confirmable data source links which included more recent numbers for many states. This brought the total up to over 12.3 million.

OK, all sorts of craziness happening, I've been swamped with stuff, so here's a quick roundup:

KANSAS, MISSOURI, NEVADA, FLORIDA, GEORGIA, INDIANA, OHIO, TEXAS, WASHINGON: CENTENE EXPANDING INTO ACA EXCHANGES:

Health insurer Centene Corp. plans a broad expansion of its Obamacare offerings next year at a time when many of its big rivals are retreating from the program.

Centene said Tuesday that it would sell Affordable Care Act plans in three additional states: Kansas, Missouri and Nevada. The company also said it will expand in six states where it already offers Obamacare plans.

“Centene recognizes there is uncertainty of new health-care legislation, but we are well positioned to continue providing accessible, high quality and culturally-sensitive health-care services,” Chief Executive Officer Michael Neidorff said in the statement.

The company specializes in providing Medicaid coverage for low-income people, and has said the skills it’s honed in that business have helped make it successful in Obamacare markets.

For heaven's sake. Here I sit, painstakingly digging up, downloading, compiling and analysing a mountain of 2018 SERFF rate filing forms for hours on end to find out what the weighted average requested rate hikes are in every state and to then go beyond that to figure out how much of the increases are due to normal factors vs. Trump/Price/GOP-specific sabotage efforts such as the threat to cut off CSR payments and/or not to enforce the individual mandate penalty...

...and then a big healthcare consulting firm like Oliver Wyman goes and steals my thunder by issuing hteir own analysis:

Two market influences, in particular, are complicating 2018 rate setting: the uncertainty surrounding continued funding of cost sharing reduction (CSR) payments and the question of how the relaxation of the individual mandate will impact enrollment and risk pools.

 

Earlier this week I busted the Trump Administration's CMS division for releasing a misleading report which tried to understate the enrollment retention rate of ACA exchange enrollees. I'm not entirely sure why they did this, since even their "fudged" number wasn't really that much worse than previous years (they tried to make itt look like a March attrition rate of 15.4% vs. the 12.8% and 12.6% from 2015 and 2016 respectively), but for whatever reason, they did so. The short version is that they only included enrollees who paid for their January and February policies instead of also including those who paid their March premiums, as was done in previous years. As far as I can figure, the actual 3/31/17 effectuation rate closer to 11.8%, a slight improvement over 2015 and 2016, though I can't be certain about this without knowing how many of the ~500,000 people who signed up in the last 2 weeks of January paid and were effectuated for March coverage.

The Centers for Medicare & Medicaid Services is administered by Trump/Price pick Seema Verma, who is openly doing everything possible to trash the ACA and push the AHCA, to the point of allegedly committing borderline extortion in order to help push it through.

Therefore, this came as a bit of as surprise a few days ago (yeah, I'm late to the party on this one...busy week). The lead actuary for CMS, Paul Spitalnic, issued his own scoring of the impact of the AHCA on healthcare coverage, premiums and the federal budget.

It's important to note--as Mr. Spitalnic himself does right at the top of the analysis--that:

Calculating the average requested rate hike in Delaware is easier than most states. This year they officially have 5 carriers participating in the individual market (3 on exchange, 2 off)...but one of those is "Freedom Life" which is a phantom carrier; another is Golden Rule which only has about 120 enrollees; and two of the others are divisions of Aetna, which is dropping out of Delaware's indy market next year altogether. That leaves just Highmark BCBS, unless Golden Rule has surprised me by enrolling a significant number of people off-exchange this year.

Today the Delaware Dept. of Insurance issued this press release:

Highmark Requests 2018 Health Insurance Rate Increase of 33.6%

Date Posted: Wednesday, June 14th, 2017

A couple of days ago, Trump's CMS division of the HHS Dept. released a Q1 2017 ACA exchange effectuation report. This should have been of mild interest to data geeks like me but not especially controversial...except that, as I noted at the time, they played fast & loose with which enrollment/payment data they did and didn't include. As a result, the report made it look like post-open enrollment attrition was dramatically worse in the first quarter of 2017 than it was in previous years. Instead, when you match up the data to match prior years, it looks like the retention rate as of March is actually pretty much exactly the same, or potentially even slightly better.

In case you needed more evidence that Donald Trump doesn't give a rat's ass about actual policy as long as it means people lavish praise on him at any given moment:

Washington (CNN)President Donald Trump told Republican senators lunching at the White House Tuesday the House-passed health care reform bill he celebrated earlier this year was "mean," a source told CNN.

Trump made clear multiple times that he was pleased that the Senate negotiations appeared to be moving away from where the House version of the repeal and replace effort ended up, according to three sources familiar with the meeting.

Trump told the lawmakers that the House bill didn't go far enough in protecting individuals in the marketplace -- and appeared to use that as his rationale for why he has ambiguously called twice for the Senate to "add more money" to the bill.

...But the comment belies the celebratory Rose Garden ceremony Trump hosted earlier this year when the House passed the bill and the President championed it as "incredibly well crafted."

Normally I don't post my Rate Hike Project analysis for a state until I have rate filing data available for all (or nearly all) of the individual market enrollees on hand.

I'm making an exception in the case of Michigan, however, because a) it's my home state, and b) My wife, son and I happen to be enrolled in an ACA exchange policy ourselves, via Blue Care Network (the HMO division of Blue Cross Blue Shield of Michigan).

Unfortunately, as of today (6/13) only one carrier has submitted their 2018 rate filing for the ACA-compliant individual market...and it's BCBSMI itself. That is, the PPO division of Blue Cross, not the HMO division.

Every summer for the past few years, the CMS division of the HHS Dept. has released a quarterly report stating how many ACA exchange enrollees are still enrolled in effectuated policies as of March 31st of that year.

The precise wording of this is important, because (as Republicans and other ACA detractors have been shouting about since day one), just because someone signus up for a healthcare policy doesn't mean that they actually pay their first month's premium to be enrolled...and even if they do, some of them will then drop their policy a few months later for any number of reasons (new job with benefits, moving to a different state, turning 65 and moving to Medicare, falling on hard times and qualifying for Medicaid or, in some cases...dying).

The first year of ACA Open Enrollment, running from 10/1/13 - 3/31/14, was a bit of a mess, due not only to the technical meltdown at launch but also the whole system being brand-new to everyone on the individual market. A full six months was given for the enrollment period, and even then there was so much pent-up demand at the end of March that an extra 2 weeks was tacked onto the end, for a total Open Enrollment period of 197 days.

via Caitlin Owens, Axios (limiting the quote to fair use levels is tricky since the article itself is so short anyway):

Senate GOP won't release draft health care bill

Senate Republicans are on track to finish writing their draft health care bill this evening, but have no plans to publicly release the bill, according to two senior Senate GOP aides.

"We aren't stupid," said one of the aides. One issue is that Senate Republicans plan to keep talking about it after the draft is done: "We are still in discussions about what will be in the final product so it is premature to release any draft absent further member conversations and consensus."

...Democratic senators are already slamming Republicans for the secrecy of their bill writing process, and this isn't going to help. Republicans are sure to release the bill at some point, but it's unclear when — and they want to vote on it in the next three weeks, before the July 4 recess.

"We aren't stupid."

Laura Packard is a friend of mine. We first met about 10 years ago at a state convention in Detroit. She's an all-around awesome person, and one of the most accomplished people I know. Here's just a sampling:

I'm a partner at PowerThru Consulting, a growing national progressive digital consulting shop. At PowerThru we help nonprofits and Democratic campaigns use technology to spread their message and organize and activate their supporters online, to create change offline. We have staff in several states, and work with non-profits of all kinds and on progressive state and federal issues, campaigns and elections of all kinds. We've won four Reed awards and three Pollies for our work to date (including Best Congressional Website in both, Best State/Local Organization Website, Best County/Local/Judicial Website).

I'm a regular contributor to Campaigns & Elections magazine, Huffington Post, and Epolitics.

As I've written about more times than I can remember, for all the very real and highly damaging GOP sabotage of the ACA over the years, there are some problems which were, quite frankly, inherent in the law as passed itself. This should be no great revelation, since it is a major piece of legislation which impacts nearly 1/5th of the entire economy is always going to have some problems to deal with, just as the 1.0 version of any piece of software will always have to have updates and patches applied. If this wasn't the case, there wouldn't be any amendments to the U.S. Constitution (not even the 2nd, so beloved by the GOP).

In any event, one of the biggest flaws with the ACA itself is that the formula and rules for individual market tax credit eligibility are, quite simply, too stingy. They only apply to those falling within 100-400% of the Federal Poverty Level (roughly $12,000 - $48,000 for a single adult, or $24,000 - $96,000 for a family of 4), Within that income range, subsidies drop off on a sliding scale, based on what percentage of household income the benchmark Silver policy costs. Here's the official chart:

This is rather amazing, really. With all the dramatic twists and turns that the Trumpcare/AHCA debacle has taken in the 3 months since it was slapped together by Paul Ryan & Co., you'd think that there would be some movement of the approval numbers, wouldn't you?

Well, technically there has been: It went from 17% approval in March to 21% approval in May...

...and as of last week, had dropped right back down again to the same 17% it started out with:

American voters disapprove 62 - 17 percent of the Republican health care plan, compared to a 57 - 20 percent disapproval in a May 25 Quinnipiac University poll. Today, Republicans approve of the health care plan 42 - 25 percent, as every other listed party, gender, education, age or racial group disapproves by wide margins. 

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