The latest iteration of the AHCA is supposedly being scheduled for a vote (for real, this time) sometime this week. The pressure is high on both sides, the whip counts are bouncing around, the tension is palpable, etc etc.
The first time around, the biggest tug-of-war was over Medicaid expansion. This time, the major issue seems to be Pre-Existing Condition coverage...and along with it, Guaranteed Issue and Essential Health Benefits; the three have to be pretty much joined at the hip, since removing one effectively makes the other two pointless in practice. It doesn't do most people much good to be told that yes, they'll be covered even if they have cancer if that coverage is gonna cost them $50,000/month.
Anyway, people are furiously scrambling to call their member of Congress and lighting up social media spreading the word...while Donald Trump, MIke Pence and Paul Ryan are running around DC desperately trying to squeak out 216 "Yes" votes from the Republican caucus.
Regular visitors know that I write an occasional freelance piece for healthinsurance.org. The only problem is that both that site and mine have pretty narrow audiences, comprised mainly of those who are already actively seeking out analysis/opinion about health insurance matters, as opposed to the general public.
I also cross-post my diaries frequently over at Daily Kos, where the ACA Signups project originated, of course.
I've attempted to fully explain how absurdly complex the U.S. healthcare system is (and thus why it's so difficult to make major changes to it) in a way which is easy for the average Joe to get (with a few poop jokes thrown in to keep within the Cracked tradition).
Anyway, I'm a long-time fan of Cracked, so I'm pretty geeked about this. Check it out!
JOHN DICKERSON: Let me ask you about health care -- Tucker Carlson interviewed you about six weeks ago when you were in the middle of health care negotiations. And you agreed with him that the health care bill wasn't going to help your supporters. That those who lived in rural areas, the older, were going to get hurt by that bill. And you told him--
PRESIDENT DONALD TRUMP: Excuse me, the health care bill is going to help my supporters.
"F*ck anyone who didn't support me, though."
JOHN DICKERSON: Well, hold on. Let me just finish the question, if I may, sir--
PRESIDENT DONALD TRUMP: Otherwise, I'm not going to sign it. I'm not going to do it.
JOHN DICKERSON: Well, this is why I wanted to ask you. You said to Tucker, "We will take care of our people, or I am not signing it." You said you were going to negotiate.
PRESIDENT DONALD TRUMP: Well, that's what I just said.
JOHN DICKERSON: So tell me what in the bill you've been negotiating to get--
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 subsidieswould 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
*(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
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.
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.
UPDATE 5/19/17:I'm dusting this off again because it looks like (shocker) Trump has changed his mind again regarding whether or not he'll have HHS continue making CSR payments or not. According to Politico:
Trump said to favor move that could destabilize Obamacare
President Donald Trump has told advisers he wants to end payments of key Obamacare subsidies, a move that could send the health law's insurance markets into a tailspin, according to several sources familiar with the conversations.
Many advisers oppose the move because they worry it will backfire politically if people lose their insurance or see huge premium spikes and blame the White House, the sources said. Trump has said that the bold move could force Congressional Democrats to the table to negotiate an Obamacare replacement.
Lawyers and other administration officials are trying to thread the needle.