2018 MIDTERM ELECTION

Time: D H M S

Trumpcare

 

Read this. Read the whole thing, thanks. Then come back here.

Done?

To summarize: For months now I've been predicting/warning that regardless of whatever legitimate risk pool issues the ACA exchanges may still be having in many parts of the country which could lead to significant rate 2018 rate hikes no matter what, there's the additional Fear/Uncertainty/Doubt factor which is being deliberately created by Donald Trump, Tom Price and the Congressional GOP. Insurance carriers hate uncertainty above all else, and I've been expecting them to do one of two things as the 2018 rate filing deadlines approach: Either jack their rates up significantly to cover themeselves for the unholy mess brewing ahead...or to simply get out of Dodge by either dropping out of the exchanges or fleeing the entire individual market altogether, on & off exchange. Most likely, I've been saying, it'll be a combination of both.

There are so many stories I could be writing right now about the fallout, potential fallout, next steps and so forth of yesterday's House vote on the AHCA. But this one in particular really says it all.

Here's an article in the Buffalo News regarding New York Republican Congressman Chris Collins (NY-27), who voted for the bill:

Watch: Chris Collins admits he didn't read health care bill

WASHINGTON – Rep. Chris Collins told CNN that he didn't read the entire Republican health care bill that the House passed Thursday.

And then he told The Buffalo News that he was unaware of a key provision in the bill that decimates a health plan that serves 635,000 New Yorkers.

Asked by CNN's Wolf Blitzer if he had read the entire health bill, Collins, R-Clarence, said: "I will fully admit, Wolf, that I did not. But I can also assure you my staff did. We have to rely on our staff. ... I'm very comfortable that we have a solution to the disaster called Obamacare."

Welp. I've done everything I can to help stop them, but it looks like the House Republicans have decided to go ahead and vote on their big ol' dumpster fire of a bill after all.

No CBO score. No review. No debate. No transparency. No time for anyone to read the bill. Everything they falsely accused the Democrats of 7-8 years ago (yes, I gave a range of 7-8 years, because there was a solid year of debate, discussion, meetings, arguments and so forth before the final votes were cast).

Maybe they'll pull it off. Maybe they won't. If it passes the House, what'll happen to it in the Senate? Who the hell knows, but the fact remains that anyone who votes for this piece of crap doesn't deserve to hold office any more than the racist, misogynistic, xenophobic con-artist moronic pussy-grabbing asshole who leads their party.

So be it.

Remember this mess in November 2018.

Back in January, I wrote a long rant about High Risk Pools. The general thrust was that in theory HRPs aren't necessarily a horrible idea; on paper they can be made to work...assuming the math adds up and they're properly funded on a permanent basis.

However, I also pointed out that due to the very nature of HRPs (i.e., segregating out a small, highly vulnerable group of people from the rest of society), it's incredibly easy for legislators not to properly fund or maintain them, especially after the initial funding comes up for renewal.

 

No real analysis here, just some choice tweets from this morning on the latest insanity. I'll likely tack on a few more as the day progresses.

.@SteveScalise says the repeal bill has "layers of protection" for peeps w/pre-existing conditions. That's the new GOP talking point, guys

— Rachael Bade (@rachaelmbade) May 2, 2017

"Layers of protection." As Jeffery Young of the Huffington Post noted...

You always test out new talking points when you're winning. It's a sign of great confidence in the policy and politics of your situation. https://t.co/CTgnppDP01

— Jeffrey Young (@JeffYoung) May 2, 2017

Speaking of having tremendous confidence...

Ryan tells fellow Republicans behind closed doors to pray for the health vote they may be about to take this week.

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.

And then, Monday, four amazing things happened.

CBS News. Face the Nation. This morning:

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--

PRESIDENT DONALD TRUMP: But let me--

 

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
  • (etc, etc...several possible scenarios)

Today the California Insurance Commissioner, Dave Jones, made a formal announcement that this is exactly what CA insurance carriers will be allowed to do, and he isn't pussyfooting around with the reasons for the policy change either:

 

*(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

UPDATE: Note that Anthem made these statements BEFORE Molina drew their line in the sand re. CSR payments. That could be a game changer.

I'll let Tami Luhby of CNN/Money take the floor:

Anthem says Obamacare business doing 'significantly better,' but still may exit some areas. https://t.co/ToFAvXj62t via @CNNMoney @luhby

— Tami Luhby (@Luhby) April 26, 2017

$antm CEO: "Individual business is doing markedly better than last year." But claims are slightly higher than expected.

— Tami Luhby (@Luhby) April 26, 2017

 

(sigh) Yes, this is the second time I've used the same headline and clip.

According to The Hill, just moments ago:

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.

You don't say.

The Kaiser Family Foundation took a national survey from March 28 - April 3 (the week following the GOP's first failed attempt to pass their Trumpcare bill), and included among the questions they asked was this one:

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.

 

(sigh) Yes, this is the third time I've used the exact same clip from "Dead Again". That's no coincidence; Zombie Trumpcare keeps shuffling back every few weeks, but this time they appear to actually be serious about it (again).

Others have already written up more detailed explainers on the latest changes, so I'm not gonna go into too much detail, but Sarah Kliff of Vox wraps it up nicely:

Republicans’ new health amendment lets insurers charge sick people more, cover less

Here's the basics: In addition to (or in revised versions of) everything awful about the AHCA ("American Health Care Bill") which gave it a mere 17% approval and led to it being yanked off the House floor mere moments before it was scheduled to be voted on, the new version also includes the following:

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