2018 MIDTERM ELECTION

Time: D H M S

Trumpcare

via Kayla Tausche of CNBC:

The House of Representatives and Department of Justice plan to ask the DC federal appeals court to keep on hold for another 90 days a lawsuit that questions the legality of cost-sharing subsidies in the Affordable Care Act, according to four people familiar with the matter.

The White House, during that time, will continue to make payments to insurers, according to a senior administration official.

OK, assuming they do indeed ask for this, and assuming the court grants a third 90-day extension, this means that CSR reimbursement payments can continue for another 3 months. That's the good news.

Insurers planning to offer plans on the exchanges in 2018 must submit their pricing in the coming days and weeks.

This is the actual headline of an actual article posted on Breitbart.com right now:

I'm loathe to link to the article itself (I did include one somewhere on this page, feel free to look for it), but a Google search will bring it up. Even more remarkably for Breitbart, much of it is actually pretty darned accurate:

Obamacare will go into a death spiral on May 22 if the Trump administration chooses not to continue fighting in court to preserve cost-premium subsidies that were ruled illegal last year.

On May 12, 2016, U.S. District Court Judge Rosemary M. Collyer ruled House v. Burwell that the Obama Administration’s payment of cost-sharing subsidies without congressional approval was a violation of the Constitution’s Appropriations Clause.

 

About 5 weeks ago I noted that organizations representing pretty much the entire healthcare industry sent urgent letters to Donald Trump, HHS Secretary Tom Price, Treasury Secretary Steven Mnuchin, OMB Director Mick Mulveney and current CMS Administrator Seema Verma...basically, every major healthcare-related administration figure...practically begging them to fund the goddamned Cost Sharing Reduction reimbursements.

They made it crystal clear how vitally important doing this was, and Trump grudgingly went ahead and made the April payment, then later indicated that he was "probably" going to keep reimbursing carriers for the CSR funds legally owed to them on an ongoing basis, at least until the House vs. Price (formerly House vs. Burwell) lawsuit appeal process was completed.

Over at the L.A. Times, Noam Levey has a fantastic story which underscores everything I've been shouting from the rooftops for months now regarding Trump/GOP sabotage of the ACA exchanges, through both active and passive measures:

Health insurers and state officials say Trump is undermining Obamacare, pushing up rates

Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues.

At the same time, state insurance regulators — both Democrat and Republican — have increasingly concluded they cannot count on the Trump administration to help them ensure that consumers will have access to a health plan next year.

As noted in my last post, it turns out that if the CBO score of the final version of the AHCA (that is, the one which passed two weeks ago) doesn't project the law to save at least $2 billion over a 10 year period, the House Republicans would have to start over again from scratch and re-vote on yet another version of their bill.

Now, the good news for them is that the CBO projected the prior version to save $150.3 billion over that period, so they have $148.3 billion worth of wiggle room, right? What are the odds of the CBO's new projection assuming that the passed version would eat up that much more money?

The key is does CBO assume lots of states waive benefits/community rating, and lots of healthy people use tax credits for skimpy insurance. https://t.co/vLx28MT5Bv

— Larry Levitt (@larry_levitt) May 18, 2017

Here's what Levitt is talking about:

 

Hey, remember this?

Cases upon cases of beer just rolled into the Capitol on a cart covered in a sheet. Spotted Bud Light peeking out from the sheet

— Alexandra Jaffe (@ajjaffe) May 4, 2017

Yeah, well, about that...

via Billy House of Bloomberg News:

House May Be Forced to Vote Again on GOP's Obamacare Repeal Bill

House Republicans barely managed to pass their Obamacare repeal bill earlier this month, and they now face the possibility of having to vote again on their controversial health measure.

This Axios piece by Caitlin Owens is extremely short...a mere 139 words in all...so sticking with a "fair use" quote is tricky, but I'll do my best:

Senate Finance Committee chairman Orrin Hatch says he could support delaying the repeal of the Affordable Care Act's individual mandate for a while, or even indefinitely, as a way to stabilize the marketplaces. "I wouldn't mind" postponing the repeal until after 2020, he told reporters this afternoon. "It all comes down to budgetary concerns and how it's going to be written." And he didn't rule out keeping it even longer:

"I'd like to not have it at all, but you know, it all comes down to, what's the art of the doable?"

Think about this for a moment.

A few days ago, CMS announced that they're retooling the ACA's SHOP program (at least on the federal exchange) so that instead of small businesses using HealthCare.Gov for eligibility verification, enrollment and payments, going forward it will only be used for verification, with the businesses then being kicked over to the actual insurance carrier website in order to actually enroll in the policies and make payments.

Although the Trump Administration and HHS Secretary Tom Price are hell bent on killing off the ACA altogether, this move didn't bother me for several reasons. For one thing, the SHOP program has always been kind of a dud anyway, with only around 230,000 people being enrolled in it nationally. For another, a business signing up their employees for coverage is a very different animal from an individual signing their family up for a policy. Finally, for several reasons, SHOP enrollment across the dozen or so state-based exchanges is actually higher than it is across the 3 dozen states covered by HC.gov, and the state-based exchanges aren't impacted by this policy anyway.

Julie McPeak is the Tennessee Insurance Commissioner. She was appointed by a Republican Governor, Bill Haslam, and while the position itself appears to be nonpartisan, I've found several links indicating that yes, she's a Republican herself. This is hardly surprising in Tennessee, of course, and there's nothing wrong with it...but it's noteworthy given that Tennessee is among the 19 states which has been fairly hostile towards the ACA in general over the years (no state exchange, no Medicaid expansion, total GOP control and so forth).

I've noted repeatedly that while every year brings some amount of premium rate hikes and/or carriers dropping out of the exchanges (or off the entire individual market), there's a major new factor impacting both this time around: The Trump/GOP Sabotage/Uncertainty Factor. This includes, but isn't limited to:

  • Total U.S. Population as of 2009: Around 306 million people
  • Total # of Mothers in U.S. as of 2009: Around 85.4 million
  • Assuming this ratio hasn't shifted much over the past 8 years, around 28% of the total U.S. population are mothers,

Of course, women over 64 (mostly on Medicare) are much more likely than the general population to be mothers...but girls under 18 are far less likely to be (well...under 16, anyway...the birth rate varies from state to state, of course), so I'm assuming that these cancel each other out, resulting in that 28% rate being roughly accurate.

If so, this means that out of the estimated 24 million people who would lose their healthcare coverage if GOP's "American Health Care Act" were to be signed into law, roughly 6.7 million would likely be moms.

I pretty much stole that headline from Politico, but how else was I supposed to word it?

Senate Republicans are working on a potential breakthrough that could help push through an Obamacare repeal bill – by making insurance subsidies look a lot like Obamacare.

There’s growing support for the idea of pegging the tax credits in the House repeal bill to income and making aid more generous for poorer people. But those moves — while they may win consensus among Senate moderates — are unlikely to sit well with House conservatives.

The financial assistance in the House bill “is just not robust enough to make sure that low-income individuals can actually afford a [health] plan,” said Sen. John Hoeven (R-N.D.). “If you bring those income limits down for people who really need the help, you can give them more help.”

I'm not sure what the original source for this is, but the following initial filing deadlines were provided by Stephen Holland via Twitter. I've already posted analyses of the Virginia, Maryland and Connecticut filings. The California and Oregon filings are supposed to have been submitted already but don't appear to be publicly available yet. In addition, it's my understanding that in many states the rates can still be adjusted/resubmitted until as late as August 16th, so I'm not really sure how useful these dates are anyway, but it's at least a guideline.

Headline pretty much says it all:

May 11, 2017 - 21% Of U.S. Voters Approve Of Revised GOP Health Plan, Quinnipiac University National Poll Finds; Voters Reject Trump Tax Plan Almost 2-1

Only 21 percent of American voters approve of the Republican health care plan passed by the U.S. House of Representatives last week, a slight improvement over the 17 percent who approved of the first health care plan in March, according to a Quinnipiac University national poll released today. Overall, the current health plan goes down 56 - 21 percent.

Apparently throwing $8 billion (over 5 years) to the junk pile gave it a 4 point increase. I wonder what would happen if they restored the $840 billion (over 10 year) that the bill takes away from Medicaid?

Except for an anemic 48 - 16 percent support among Republicans, every listed party, gender, educational, age and racial group opposes the plan, the independent Quinnipiac (KWIN- uh-pe-ack) University Poll finds.

Another very nice scoop by Sarah Kliff of Vox.com:

News: Tennessee’s empty shelf problem appears to be fixed! Blue Cross of TN will sell coverage in Knoxville area.

— Sarah Kliff (@sarahkliff) May 9, 2017

BCBS of TN says they’ll sell coverage in the 16 Eastern TN counties that had no carrier signed up for 2018. https://t.co/g3dkqU4G1m

— Sarah Kliff (@sarahkliff) May 9, 2017

Here's the full text of the letter; emphasis mine:

May 9, 2017

Dear Commissioner McPeak,

We appreciate getting to meet with you and your team yesterday to update you on BlueCross’s position relative to the individual Marketplace for Tennessee as the first deadline for 2018 approaches.

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