2018 MIDTERM ELECTION

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Trumpcare

A couple of weeks back, the Kaiser Family Foundation crunched the numbers to see just how much insurance carriers would likely raise their full-price premiums on individual market policies to make up for lost CSR assistance reimbursements in the event that Donald Trump makes good on his threat to discontinue them. Their conclusion?

A new Kaiser Family Foundation analysis finds that the average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies.

Again, that's an average onf 19% on top of whatever the carriers would otherwise be increasing rates for other reasons.

This has been confirmed by a separate report from the American Academy of Actuaries, which draws the same conclusion:

As I posted yesterday, here's a rough overview of what total Individual Market Enrollment has looked like since 2010, and how Trump's threat to cut-off CSR reimbursements would impact it:

The blue section is off-exchange enrollees...around 7 million people today, all of whom are paying full price. This includes perhaps 1.8 million people still enrolled in Grandfathered or Transitional plans (which are part of a separate risk pool), although that number is highly speculative.

Standard & Poor's, December 22, 2016:

Well THAT figures: Insurance carriers finally breaking even on ACA exchanges just in time for GOP to tear up the law.

Health insurers may finally be seeing improved results on their Obamacare plans just as a newly elected president is poised to follow through on promises to end the controversial coverage program, a new report suggests.

An analysis out Thursday says that health insurers are expected in 2016 "to start reversing" financial losses on their Obamacare business after "hitting bottom" in 2015.

And 2017 "will likely see continued improvement" for those insurers selling individual health plans, "with more insurers getting close to breakeven or better," according to the report by Standard and Poor's Global Ratings.

 

UPDATE: ...or, perhaps not. Latest word is that there's basically little to see here; lots of big talk about pushing forward but very little action. Or perhaps there will be next week, who the heck knows? Wash, rinse, repeat.

On March 24th, just after the AHCA (Trumpcare) bill was yanked from the House floor with literally minutes to go, I posted the following headline:

CELEBRATE A FEW HOURS. Then come back and read this.

Well, according to Matt Fuller and Jonathan Cohn of the Huffington Post, Trumpcare 2: Electric Boogaloo may indeed be a go:

 

Exactly one month ago, I asked a rhetorical question:

How High will Initial 2018 Rate Hike Filings Be?

...and then went on to conclude that, given the insane amount of uncertainty and confusion about what Donald Trump, Tom Price and the Congressional GOP in general has in mind for the 2018 insurance market, on top of normal stuff like inflation, an aging population and so on, that there are five likely scenarios:

Now, put yourself in the position of an insurance carrier executive and/or one of their actuaries. The level of uncertainty in the air is mind boggling. You have five choices for your initial filing:

 

Last week, former CMS Administrator Andy Slavitt conveyed a warning to the Trump Administration and the GOP about how critical confirming ongoing Cost Sharing Reduction reimbursements (not just for the rest of 2017, but continuing into 2018) is, by paraphrasing multiple anonymous sources within the health insurance industry.

On Monday, it looked as though the Trump admin was finally providing some reassurance on the CSR issue; as Robert Pear reported in the New York Times:

The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them.

The statement sends a small but potentially significant signal to insurers, encouraging them to stay in the market.

Last fall, when the insurance carriers were jacking up their rates on the individual market by an (unsubsidized) national weighted average of around 25%, aside from the understandable grumbling about such a dramatic all-at-once increase, the big question was whether that would be enough to stabilize the market going forward, or whether this was just the beginning of an inevitable Death Spiral, etc etc.

Back in December, Standard & Poor's issued an analysis in which they concluded that:

An analysis out Thursday says that health insurers are expected in 2016 "to start reversing" financial losses on their Obamacare business after "hitting bottom" in 2015.

And 2017 "will likely see continued improvement" for those insurers selling individual health plans, "with more insurers getting close to breakeven or better," according to the report by Standard and Poor's Global Ratings.

The report also says big price increases for Obamacare plans in 2017 were likely a "one-time pricing correction."

OK, I was about to go with the more obvious saying: "Sh*t or get off the pot", but I'm trying to avoid blatant profanity in the headlines, at least.

Here's a tweetstorm from fomer director of the Centers for Medicare & Medicaid, Andy Slavitt, from yesterday/continuing through today. He confirms everything I've been sounding the alarm about, especially regarding the CSR payment crisis:

One of the questions I get asked most frequently is why don't more health plans speak up about what a disaster AHCA would be. 1

— Andy Slavitt (@ASlavitt) April 5, 2017

A related question I get asked a lot is why don't health plans speak up more loudly about the impact of govt reneging on CSR payments. 2

— Andy Slavitt (@ASlavitt) April 5, 2017

By tomorrow, I will have asked 10 CEOs that question & will tweet back what they say. 3

— Andy Slavitt (@ASlavitt) April 5, 2017

Hot off the presses:

A new Kaiser Family Foundation analysis finds that the average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies.

Not exactly a surprise: The stampede appears to be starting.

The efforts to replace the Affordable Care Act have caused worry for insurers, who aren’t sure about the law’s future or what would replace it. On Thursday, Aetna Inc. said it would pull out of Iowa’s Obamacare market, becoming the second major health plan to do so this week after Wellmark Inc. said it was quitting the state as well.

“Aetna will not participate in the Iowa individual public exchange for 2018 as a result of financial risk and an uncertain outlook for the marketplace,spokesman T.J. Crawford said in an email Thursday. “We are still evaluating Aetna’s 2018 individual product presence in our remaining states.”

 

In our last episode of As the Stomach Churns, you may recall that after getting tired of having thousands of old white people screaming at them during town halls, the House GOP attempted to get them to shut up by demanding that the Senate throw $85 billion at them to make them go away.

The Congressional Budget Office determined that, nope, around 24 million people would still be kicked off their healthcare coverage due to how crappy the rest of the plan was. They would've just been pissing away another $85 billion for literally no reason.

The CEO of Molina Healthcare made it about as clear as he possibly could today:

Molina Healthcare CEO: GOP's 'piecemeal approach' to health-care reform will lead to a 'health-care disaster'

With the GOP's failure to repeal Obamacare last month, House Speaker Paul Ryan refused to give a time line for a new bill.

...But many health-care providers are wary of the fast pace the GOP seems to be taking with repealing Obamacare.

...Molina is particularly worried about the potentially higher premiums and misleading packages insurance companies can price and sell.

December 9, 2016:

...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.

“The first question I think they’re trying to figure out is, do we actually own it for 2018?” said one health care lobbyist, speaking on background. “If premiums spike and plans exit, can we still blame it on Obama and get away with it? That’s one of the threshold questions that I don’t think they’ve answered.”

March 24, 2017:

 

Immediately after the "death" of the AHCA (Trumpcare) bill, I posted the clip above (from the underrated suspense thriller "Dead Again"), noting that as much of a victory as it was, there was little time to pat ourselves on the back, because Trump and the GOP would no doubt be back for Round 2 at any moment.

At the time, I assumed that they would likely abandon the "official" attempt at repeal/replace for the time being, and focus instead "only" on sabotage efforts of the ACA itself by doing whatever they can to scare off the carriers...and for the most part, that's exactly what Trump has done ("It's gonna explode!" and so forth).

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