Virginia: Good News! Gov. Northam GETS IT, vetoes 4 #ShortAssPlans bills

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Having a doctor holding elected office is kind of hit or miss (former HHS Secretary Tom "Fly Me!" Price was an orthopedic surgeon, for instance, while Rand "Kneel before Aqua Buddha!" Paul is supposedly a "self-certified" opthamologist), but once in awhile it can be a very good thing.

Case in point: Ralph Northam, the new Governor of Virginia, a former Army doctor and pediatric neurologist, who just formally vetoed not one, not two, but four different GOP-passed healthcare bills, each of which would have further weakened and damaged the ACA individual market risk pool:

RICHMOND—Governor Ralph Northam today vetoed Senate Bills 844, 934, 935, and 964, which would put Virginians at risk of being underinsured, result in rapidly increasing Marketplace premiums, and undermine key protections in the Affordable Care Act. Governor Northam remains committed to expanding health care for nearly 400,000 uninsured Virginians, return millions to the state budget, and reduce Marketplace premiums. The Governor’s full veto statements are below.

The first bill (844) would have removed restrictions on short-term plans, allowing them to no longer be short-term...but without including any ACA protections, which would siphon off healthy people from the individual market, jacking up premiums for everyone remaining, just like Donald Trump wants.

To be honest, I'm a bit confused, because according to the very Urban Institute study referenced by Northam in his veto statements (see below), Virginia doesn't really have any restrictions on short-term plans now, and is thus in already in danger of massive price hikes as a result of Trump's executive order. Perhaps this is a matter of jurisdiction--my guess is that right now it's up to the state insurance commissioner to make the call, wheres if this bill had become law, there'd be no way to restrict STPs.

Bills 934 and 935 would have removed restrictions on association plans...again, without including ACA protections, again siphoning off healthy people, again raising premiums for the rest of the risk pool.

Finally, bill 964 would have opened up Catastrophic plans (currently restricted to those under 30 years old, plus certain exceptions) to be sold to anyone on the ACA exchange market. There's actually some debate about whether it would be a terrible idea to offer "Copper Plans" on the ACA exchanges if people really want them...except for one major problem: Catastrophic plans are part of a separate risk pool. If they were all part of the same risk pool it might not be a bad idea, but by isolating them into their own pool, this would once again damage the ACA pool, yet again raising premiums further yet:

This legislation would place consumers at risk of being underinsured and would fragment Virginia’s federal Marketplace risk pool, leading to rapidly increasing premiums. Senate Bill 964 would allow insurance carriers and individuals to circumvent the protections in the Affordable Care Act. Under current law, catastrophic plans are only available for individuals who are younger than 30 years of age and individuals who qualify for a hardship or affordability exemption. Catastrophic plans typically have lower premiums because they require individuals to pay deductibles in excess of $7,000 before the plan pays for health care costs. People with minimal current health care needs are more likely to purchase these threadbare plans. This adverse selection would contribute to the increase in Virginia Marketplace premiums. Virginia is already witnessing unnecessary premium increases in the preliminary rate filings insurance carriers have submitted for 2019, because of federal actions destabilizing the Marketplace.

In all four cases, Northam makes sure to point out that the best way to help expand healthcare coverage to more Virginians and lower ACA individual market premiums (or at least reduce the rate that the premiums increase) would be to expand Medicaid under the ACA:

We are fortunate to have a better opportunity to expand health care to people who need it and make it more affordable for all Virginians. Expanding Medicaid will connect nearly 400,000 people with insurance and return millions to the state budget to support other priorities that make life better for Virginians. Additionally, states that have expanded Medicaid have Marketplace premiums that are an average of 7% lower than states that have not, demonstrating that expansion will benefit far more people than just those who will receive coverage. Senate Bill [844, 934, 935, 964] would undermine efforts to make sure all Virginians have access to quality, affordable health care.