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Charles Gaba's blog

Both Politico and Axios have picked up my story about the $60 million in ACA Open Enrollment Navigator/Outreach grants being cancelled at literally the last minute:

Politico:

Did CMS execute a last-minute reversal on navigator program? That's what independent blogger Charles Gaba is reporting, posting what appear to be internal CMS documents that show the agency was poised to essentially renew last year's funding for this year's ACA open enrollment.

One document posted by Gaba indicates that Randy Pate — tapped by the Trump administration to run Medicare's Center for Consumer Information and Insurance Oversight — signed off on $60 million in program funding on Aug. 24. More. However, CMS ultimately funded the program at less than $37 million for the upcoming enrollment, a 41 percent cut from last year.

Hey Michigan Residents! Do you live in the Birmingham/Bloomfield area?

If so, come on out to Bloomfield Hills on Saturday, September 9th, and join State Representatives Christine Greig, Robert Wittenberg, Adam Zemke and myself as we explain what the latest craziness is regarding the ACA, the GOP attempts to repeal and/or sabotage it and healthcare policy in general from 1:00pm - 3:00pm at the Birmingham Unitarian Church in Bloomfield Hills:

Utah has also finally released their requested 2018 individual market rate increases. There are six carriers offering individual policies next year, but only 2 of them are participating on the ACA exchange (and the 4 off-exchange carriers hold less than 4% of the total market combined). In fact, two of the off-exchange-only carriers are barely participating at all: BridgeSpan has only 8 enrollees, while "National Foundation" (a "phantom carrier" which also goes by "Freedom Life" in other states) once again supposedly only has a single "enrollee". Molina has a few hundred off-exchange enrollees, but the bulk of their 70,000-person membership are in exchange-based policies, and they're dropping off the exchange next year, so those 70K will have to choose from one of the two remaining exchange carriers: SelectHealth and the University of Utah.

Until recently, my 2018 Rate Hike project was still missing 4 states: Kansas, Missouri, Nevada and Utah. Last week Missouri finally posted their requested rate increases for next year. Today it looks like Kansas has done the same...at least partly.

As I noted back in June, there are 3 carrers on the KS individual market this year: Medica, Blue Cross Blue Shield of Kansas Solutions and Blue Cross Blue Shield of Kansas City. Any confusion between the BCBS names was made moot, however, as BCBS of KC announced they were dropping out of the indy market anyway.

That leaves Medica and BCBSKS, both of whom filed plans to stay on the market...but only Medica appears to have actually submitted rate requests, for a mere 7,600 enrollees:

ACA Signups isn't normally known for "big scoop" stories. Yes, I'm often the first one to openly post analysis and/or debunking of information/data/claims which have already been made public, but I'm not usually the first one to actually make the underlying data itself public in the first place.

This is an exception to that rule.

I've recently acquired documentation related to last weeks' shock announcement by the Trump Administration's Centers for Medicare & Medicaid that they're slashing the advertising/marketing budget for HealthCare.Gov for the upcoming 2018 Open Enrollment Period by 90%...as well as cutting the in-person outreach program budget by nearly 40%.

I've confirmed the veracity of these documents, and the claims related to them seem to be on the level.

According to my source, these are signed orders instructing the grant awarding officer to distribute $60,000,000 in grants with an effective date and time of August 31st, first thing in the morning.

Thanks to Zach Tracer for the heads up!

My 2018 Rate Hike project petered out a few weeks back with the requested rate increases posted for 46 out of 50 states (along with DC). Unfortunately, the last 4 states (Kansas, Missouri, Nevada and Utah) decided to keep their cards close to their chest, delaying any public viewing of even the requested rate increases for awhile longer.

Lori Lodes used to be Communications Director for the Centers for Medicare & Medicaid until last year under President Obama. As such, a big part of her job was administering ACA outreach efforts.

This evening, upon learning of the Trump administration's announcement that they're slashing advertising budget by 90% and outreach/navigation assistance funding by 39%, she was...not pleased. She took to Twitter to get a few things off her chest.

Instead of embedding a bunch of full Tweets, I'm pasting in the actual text of her thread to give the full picture:

Time to put on my "I used to run outreach for Obamacare" hat and talk about the Admin's decision to gut outreach and education.

***note*** This thread is long and barely touches on just how bad the impact of the Admin's decision will be.

First, it's the job of the government - in regs and everything - to educate people about signing up for health care.

Second, slashing navigator funding in a 3 yr cycle from $67m (2016) and $63m (2017) to $33m (2018) will mean that fewer people get covered.

via Sarah Kliff of Vox.com:

Trump is slashing Obamacare’s advertising budget by 90 percent

The White House will also cut the in-person outreach program by $23 million.

The Trump administration plans to deeply cut Obamacare outreach and advertising, officials announced Thursday.

Trump will reduce Obamacare advertising spending 90 percent, from the $100 million that Obama administration spent last year to $10 million this year. It will also cut the budget for the in-person enrollment program by 39 percent.

Administration officials cited “diminishing returns” from outreach activities. In a phone call with reporters, they said that most Americans already know about the Affordable Care Act.

As a reminder, here's what happened back in January, when Trump pulled the plug on advertising for HealthCare.Gov in the final, critical week of the 2017 Open Enrollment Period:

(I stole "Kasichlooper" from Zachery Tracer)

Right on top of the letter sent by all twelve state-based exchange heads to the Senate HELP Committee comes a similar open letter signed by eight sitting Governors to all four Congressional leaders (McConnell/Ryan & Schumer/Pelosi). It includes 5 Democratic Governors, but also 2 Republicans and one Independent.

The effort was spearheaded by Republican John "Yeah, he's definitely primarying Trump in 2020" Kasich of Ohio and Democrat John Hickenlooper of Colorado, but also includes Brian Sandoval (GOP, NV); Tom Wolf (Dem, PA); Bill Walker (Indy, AK); Terry McAuliffe (Dem, VA); John Bel Edwards (Dem, LA); and Steve Bullock (Dem, MT).

Here's a partial version of the letter with the meat of the asks:

Immediate federal action to stabilize markets.

via Robert Pear, New York Times:

A Trump administration official said Wednesday that the administration wanted to stabilize health insurance markets, but refused to say if the government would promote enrollment this fall under the Affordable Care Act or pay for the activities of counselors who help people sign up for coverage.

The official also declined to say whether the administration would continue paying subsidies to insurance companies to compensate them for reducing deductibles and other out-of-pocket costs for low-income people. Without the subsidies, insurers say, they would sharply increase premiums.

The administration, the official suggested, will do the minimum necessary to comply with the law, which Mr. Trump has called “an absolute disaster” and threatened to let collapse.

via Stephanie Armour of the Wall St. Journal:

State officials increasingly worry that this year’s turbulent health-care politics could threaten funding for the Children’s Health Insurance Program, a popular initiative that usually wins broad bipartisan support.

Federal funding for CHIP is set to end Sept. 30. The federal-state program provides health coverage to more than eight million low-income, uninsured children whose family incomes are too high to qualify for Medicaid.

Note: It's actually more than that: 8.4 million children as of 2015, and 8.9 million in 2016.

When I last checked in on Maryland's individual market rate hikes for next year, the picture was pretty grim: Overall requested increases of around 46%...and that assumed that CSR reimbursements are made in 2018. If you assume CSRs aren't paid, it looked even worse: A whopping 57% average increase statewide for unsubsidized enrollees. Ouch.

Today, the Maryland Insurance Dept. issued their approved rate changes for the individual and small group markets...and while they did knock the rate increased down significantly, there's still not much to be cheery about. It also includes a couple of handy additional data points:

The Maryland Insurance Administration Approves Non-Medigap Premium Rates for 2018 Small Group and Individual Markets

Open Enrollment Begins Nov. 1 in the Individual Market; Consumers Encouraged to Shop Rates

Not the highest-profile ACA/healthcare story in the world, but Wyoming almost never makes the news, and this is especially noteworthy given the state, the Governor and the GOP having total control over the federal government:

As health care debate simmers, Mead laments lack of Medicaid expansion in Wyoming

Gov. Matt Mead lamented the $100 million that Wyoming left on the table by choosing not to expand Medicaid, and he expressed concern for the state’s hospitals while discussing health care with the Star-Tribune recently.

Mead echoed some of the fears that many Wyoming hospital officials have expressed for months: that congressional proposals to overhaul the health care system may have negative effects on facilities here and that the state has suffered because it chose not to allow more people to qualify for Medicaid.

“The idea that we did not accept Medicaid expansion and things are going to be good just hasn’t turned out,” he said.

The following letter was just sent to GOP U.S. Senator Lamar Alexander and Dem U.S. Senator Patty Murray of the HELP (Health, Education, Labor & Pensions) Senate Committee:

Dear Chairman Alexander and Ranking Member Murray:

Thank you and members of the Senate Health Education Labor and Pensions Committee for your commitment to hold September hearings on actions that Congress should take to stabilize and strengthen the individual health insurance market. The State Health Exchange Leadership Network, an association of state leaders dedicated to the implementation and operation of the state-based health insurance marketplaces, appreciates this opportunity to submit testimony.

On Sunday, HHS Secretary Tom Price officially called it in Texas:

Health and Human Services Secretary Tom Price, MD, declared a public health emergency in Texas on Saturday as Hurricane Harvey was pounding the state's coast.

Harvey made landfall late Friday night with winds topping 130 mph. Forecasts called for the storm to hover over the state for 5 days or more, possibly drenching some areas with as much as 50 inches of rain. Hundreds of thousands were without power and the National Weather Service said parts of Texas could be "uninhabitable for weeks or months."

"Many Medicare beneficiaries have been evacuated to neighboring communities where receiving hospitals and nursing homes may have no health care records, information on current health status or even verification of the person's status as a Medicare beneficiary. Due to the emergency declaration and other actions taken by HHS, CMS is able to waive certain documentation requirements to help ensure facilities can deliver care," an HHS statement read.

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