OK, Indivisible is all over the Graham-Cassidy disaster, so rather than try and cobble together my own action list, I'm cribbing from their email missive. I'll also be posting the latest Graham-Cassidy developments throughout the day.
STOP THE RETURN OF TRUMPCARE. TrumpCare is back and Republicans are as close as they’ve ever been to passing it. There are 12 days left for the Senate to ram healthcare through reconciliation with just 50 votes. This is TrumpCare’s last stand. Call your senators ASAP and tell them to vote no on “Graham-Cassidy” using all the latest resources at TrumpCareTen.org.
TrumpCare is back. REPEAT: TrumpCare is back. We really hoped we’d never have to say that, but you should know by now that this is the bill that just won’t die. Because of the rules of reconciliation, the special process Republicans are using to jam TrumpCare through the Senate, they have until September 30 to finish the job of repealing the Affordable Care Act. That gives them 12 more days to make good on their seven-year promise to repeal the Affordable Care Act. And nothing motivates Congress like a deadline.
I've been operating ACASignups.net for nearly 4 years now. It started out as a nerdy hobby thing in my spare time, but quickly overtook my life. I always planned to shut it down after the first Open Enrollment Period ended back in April 2014...and then in March 2015...and again in 2016. Year after year, people clamored for me to keep it going one more year.
At this point a year ago I really planned on winding things down as of around April 2017. My reasoning was simple: If Hillary Clinton succeeded Barack Obama as President, there probably wouldn't be that much ongoing interest in my work here. After all, I figured, it's not like there are websites devoted to breathlessly tracking Social Security enrollments in real time. After four years, I assumed that interest in the site would drop off enough that it would be time to archive the site and refocus on my day job. Yes, that's right: I have a day job as a freelance website developer. I know that's hard to believe given how much time I spend on ACA/healthcare matters, but it's true...and frankly, I've been increasingly neglecting that business more and more of late, right when I should have been building it back up again.
Anyone who's followed me either here at ACASignups.net or over at Twitter over the past eight months knows that no one has been sounding the alarm louder or more frequently than me about both the real and potential sabotage of the ACA being carried out (or at least attempted) by the GOP in general and Donald Trump/Tom Price specifically. Hell, back in July, I even warned of a half-dozen things to look out for, several of which have since already been proven true:
This brings me to the main point of this entry: This is likely just the beginning. I'm not going to say that any or all of the following will happen--it's possible that Trump/Price/Verma will show some level of restraint--but I wouldn't be at all surprised to see any or all of these happen during this fall's Open Enrollment Period (which runs from Nov. 1st - Dec. 15th, by the way):
Credit where due. Last time around McCain made everyone hold their breath in suspense (then again, in his defense, he had just been diagnosed with a brain tumor and had to schlep all the way back from Arizona to DC for the vote a day or so earlier).
This time around he’s being more clear and up front about it: He says he likes the idea of the bill in general, and would be influenced by AZ Gov. Ducey’s support of it, but the process has stunk and continues to stink from top to bottom:
Seriously, good for him. He’s being quite clear about not just his decisions but his reasons...and while it would be nice if he opposed the bill on the merits (it stinks), his actual reasons make perfect sense as well.
It's time to once again dust off the Three-Legged Stool visual aid to help explain just what the Graham-Cassidy bill would do to the individual insurance market. It's important to note that none of this has anything to do with Medicaid (expansion or traditional), the group market, Medicare and so forth; just the individual market.
Once again, here's what the "3-Legged Stool" was supposed to look like under the Affordable Care Act:
Here's what it actually looks like today, with some rather obvious gaps in the red (enrollee responsibility) and green (government responsibility) legs:
As the final deadline for final 2018 individual market rates to be locked in and the contracts signed, more states are coming into focus, and the pattern continues to be remarkably consistent.
In Mississippi, I originally pegged the requested rate hikes across the two individual market carriers (technically three, but "Freedom Life" is a phantom carrier with only 2 alleged enrollees) at 16.1% if CSR payments are made and 39.6% if they aren't. It turns out I was off by a bit, however, because I didn't realize that BCBS of Mississippi was only selling policies off-exchange next year. That means the CSR issue won't impact them either way, since none of their enrollees would receive the assistance anyway.
Alaska (along with Hawaii) will continue to receive Obamacare’s premium tax credits while they are repealed for all other states. It appears this exemption will not affect Alaska receiving its state allotment under the new block grant in addition to the premium tax credits.
Delays implementation of the Medicaid per capita caps for Alaska and Hawaii for years in which the policy would reduce their funding below what they would have received in 2020 plus CPI-M [Consumer Price Index for Medical Care].
Provides for an increased federal Medicaid matching rate (FMAP) for both Alaska and Hawaii."
Bird doesn't have the actual legislative text, but they threw Hawaii in there as well (not to win their votes...Dems Brian Schatz and Mazie Hirono are solid NOs no matter what). That means that the wording is probably along the lines of:
The Congressional Budget Office stated that they won't be able to provide a full score of the projected 10-year impact of the Graham-Cassidy bill for "at least several weeks". Instead, they expect to provide a partial score, focusing purely on the budget-related stuff necessary to "count" towards Senate reconciliation voting rules "early next week".
What won't be included are some pretty damned important details, like:
Impact on the federal deficit
Impact on insurance premiums, and of course...
Impact on the number of people with health insurance coverage
Unfortunately, Mitch McConnell and Senate Republicans are insisting on squeezing the vote on Graham-Cassidy through within the next 10 days, before the fiscal year ends on Sept. 30th, since that's the only way they have a chance at passing it using 50 votes (after the 30th, they would require 60 votes, which of course they have no chance at getting).
Jeff Stein: Senator, I wanted to ask you for a policy-based explanation for why you’re moving forward with the Graham-Cassidy proposal. What problems will this solve in the health care system?
Pat Roberts: That — that is the last stage out of Dodge City...I’m from Dodge City. So it’s the last stage out to do anything. Restoring decision-making back to the states is always a good idea, but this is not the best possible bill — this is the best bill possible under the circumstances.
If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel.
Jeff Stein: But why does this bill make things better for Americans? How does it help?
The fact that the Graham-Cassidy bill, like all of the prior Republican "replacement" healthcare bills, screws over people on both Medicaid and the individual market starting in 2020 is hardly news. A few provisions of the ACA are stripped out and/or bastardized immediately (and some, like the individual mandate penalty, are even repealed retroactively), but for the most part the pain doesn't start for another 2 years, well after the midterms are over.
However, JP Massar called something to my attention this morning:
Regular readers know that one of the issues I've spent the better part of the past year yammering on about endlessly is the importance of Congress formally appropriating Cost Sharing Reduction reimbursement payments to the insurance carriers on the individual market exchanges.
Thanks to the ongoing/pending ruling in the federal House vs. Burwell Price lawsuit, Donald Trump has the ability to pull the plug on CSR payments pretty much whenever he wants to (and he's threatened to cut them off every month since around March or April so far). CSR payments hang like a Sword of Damocles over the heads of every exchange-based insurance carrier each month, with them never knowing whether they'll get reimbursed or not.
CBO aims to provide preliminary assessment of Graham-Cassidy bill by early next week
CBO is aiming to provide a preliminary assessment of the Graham-Cassidy bill by early next week. That assessment, which is being prepared with the staff of the Joint Committee on Taxation, will include whether the legislation would reduce on-budget deficits by at least as much as was estimated for H.R. 1628, the American Health Care Act, as passed by the House on May 4, 2017; whether Titles I and II in the legislation would each save at least $1 billion; and whether the bill would increase on-budget deficits in the long term. CBO will provide as much qualitative information as possible about the effects of the legislation, however CBO will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.