Charles Gaba's blog

Last week, after Donald Trump dropped another massive turd in the punchbowl by telling his Justice Dept. to ask for the entire ACA to be ruled unconstitutional (as opposed to "only" the pre-existing condition protection provisions, as if that wasn't bad enough), Congressional Republicans were caught completely blindsided and at first, couldn't distance themselves from him fast enough:

Senate Majority Leader Mitch McConnell (R-Ky.) told President Trump in a conversation Monday that the Senate will not be moving comprehensive health care legislation before the 2020 election, despite the president asking Senate Republicans to do that in a meeting last week.

McConnell said he made clear to the president that Senate Republicans will work on bills to keep down the cost of health care, but that they will not work on a comprehensive package to replace the Affordable Care Act, which the Trump administration is trying to strike down in court.

NOTE: CLICK THE IMAGES FOR HIG-RES VERSIONS.

The Centers for Medicare and Medicaid released the official 2019 Open Enrollment Period report over a week ago. Normally I pounce all over these reports and spend a couple of days analyzing every last data point, seeing how that's the core of what I do here at ACASignups.net.

However, this report was released amidst a gusher of other major ACA/healthcare news stories over the course of the week, and I never really got around to a deep dive. I'm still swamped, but I figured I should at least go back and do a little more analysis today.

OK, first of all, I need to clean up the discrepancies between the OE6 enrollment data I had and what's in the official CMS report. Every year there are always slight variations in a few states, usually when it comes to the state-based exchanges, and this year is no exception. There were differences reported in six states; in five of them, CMS reported lower enrollment numbers; in one the CMS tally is higher:

(sigh) Here we go again:

Everybody agrees that ObamaCare doesn’t work. Premiums & deductibles are far too high - Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance. The Republicans.....

— Donald J. Trump (@realDonaldTrump) April 2, 2019

Yes, I'm still fiddling around with the 3-Legged Stool metaphor. I wasn't gonna mess with it any further, but gvien that Donald Trump has decided that making healthcare the biggest topic of the 2020 election cycle (again) is a brilliant strategy for the Republican Party, I figured it was time for an update.

The version below includes a bunch of changes; some are corrections; others are enhancements:

  • Moved "Maximum Out-of-Pocket Costs" to the Blue Leg, since that's really a carrier covrerage requirement.
  • Added "Stay on Parents Plan until Age 26" to the Blue Leg. I never had it listed before, not sure why.
  • Added "Health Insurance Exchanges" to the Green Leg. I never had them actually listed on the graphic, but they're an important Government Responsibility, after all.

A big news story out of New York State today is about Governor Andrew Cuomo reaching a budget deal with the state legislature:

Governor Andrew M. Cuomo, Senate Majority Leader Andrea Stewart-Cousins and Assembly Speaker Carl Heastie today announced an agreement on the FY 2020 Budget. The Budget holds spending growth at 2%for the ninth consecutive year and cuts taxes for the middle class.

The Budget includes several landmark policies that will bring sweeping transformation and social justice reform to the state with the passage of the permanent 2% property tax cap that has already saved New Yorkers $25 billion since it was first implemented in 2012; a strategic MTA reform plan and steady revenue stream to fund the next capital plan through Central Business District Tolling; an additional $1 billion to support education, bringing total education funding to $27.9 billion; and landmark criminal justice reforms, including reforming the cash bail system, speedy trial, and the discovery process for a more fair and just New York for all.

I swear to God, Thanos must have invoked the Time Stone, because we’re right back to two years ago with this crap. I could just re-promote old blog entries from April 2017 and no one would know the difference:

White House working on secret healthcare plan with three conservative think tanks https://t.co/I6Uutj1CVT

— Kimberly Leonard (@leonardkl) April 1, 2019

The White House is quietly working on a healthcare policy proposal to replace the Affordable Care Act, according to multiple sources with knowledge of the matter.

...The analyst said the administration has been “having conversations” on healthcare policy and has reached out to numerous think tanks, including the Heritage Foundation, the Mercatus Center, and the Hoover Institute.

There's over a half a dozen major healthcare reform bills swirling around the Democratic side of the aisle these days. The two biggest contenders at the moment are the universal, 100% mandatory single payer "Medicare for All" bill being pushed by the Progressive Caucus in the House (led by Pramila Jayapal) and, of course Bernie Sanders in the Senate; and the universal, 50% mandatory (over time) "Medicare for America" being championed by Reps. Rosa Delauro and Jan Schakowsky in the House and Presidential contender Beto O'Rourke.

Regular ACA Signups readers know that I'm a huge fan of the Medicare for America approach (although I think we also need a robust ACA 2.0 upgrade to tide things over until Med4Am can be ramped up). However, there are still a bunch of other proposals out there, and there's nothing wrong with any of them; it's mostly a question of how far you want to set your marker.

Virginia Governor Ralph Northam has been out of the national news for the past month or so, keeping a low profile since the media frenzy over the "med school blackface photo" debacle subsided. Rightly or wrongly, in the end, in spite of pretty much everyone under the sun demanding that he resign, he stuck it out and outlasted the scandal by simply...not.

He isn't up for reelection (and in fact under Virginia law he can't run again anyway), he didn't actually commit any crimes or anything else impeachable, so it sounds like the state has pretty much just sort of accepted that he's gonna stick it out for another couple of years. In fact, according to this article in the Virginian-Pilot, he seems to have regained some of his pre-scandal stature:

Two months after a blackface photo in an old yearbook nearly ended the political career of Virginia Gov. Ralph Northam, his life seems mostly back to normal.

Over the past week or so, I've written several posts explaining how the new ACA 2.0 bill rolled out by the House Democrats would improve the law. So far I've mainly focused on the impact on health insurance policy premiums, since that's the single most obvious improvement.

In particular, I posted an extensive explainer, with colorful graphs and tables, showing how single adults at various ages would fare under ACA 2.0 compared to current law (households with more than one person would follow a similar patter, with the dollar amounts simply being higher across the board).

However, it's probably a good idea for people to also understand how age bands work. The age band is the reason an (unsubsidized) 64-year old pays so much more than a 21-year old.

From February:

The full expansion initiative passed last fall, of course, is supposed to cover Utah residents earning up to 138% of the poverty line, or around 150,000 people...without any work requirements.

The bill barreling through the Utah Legislature was “an effort to override the will of the people,” said Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit group that supported the full expansion of Medicaid.

Utah lawmakers, worried that the sales tax increase might not fully cover the costs, are rushing through a bill that would limit the expansion of Medicaid to people with incomes less than or equal to the poverty level, about $12,140 for an individual.

State officials say that the bill, which is estimated to cover 90,000 people, could be on the desk of Gov. Gary R. Herbert, a Republican, in a week or two.

In an excellent scoop by Dan Diamond and Adam Cancryn this morning, Politico reports that CMS Administrator Seema Verma--the woman in charge of Medicare and Medicaid who takes great joy in trashing Medicare and Medicaid--has spent millions of dollars on partisan consulting firms to boost her own image:

The Trump appointee who oversees Medicare, Medicaid and Obamacare quietly directed millions of taxpayer dollars in contracts to Republican communications consultants during her tenure atop the agency — including hiring one well-connected GOP media adviser to bolster her public profile.

Lost amidst all the other overwhelming ACA-related news this week is one other important nugget: The Affordable Care Act's "individual mandate penalty", which was lowered to $0 in December 2017, was still the law of the land until December 31, 2018. It may have been changed at the time, but that change didn't become effective until January 1, 2019.

Here's the exact text:

PART VIII--INDIVIDUAL MANDATE SEC. 11081.

ELIMINATION OF SHARED RESPONSIBILITY PAYMENT FOR INDIVIDUALS FAILING TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.

(a) In General.--Section 5000A(c) <<NOTE: 26 USC 5000A.>> is amended--
(1) in paragraph (2)(B)(iii), by striking ``2.5 percent'' and inserting ``Zero percent'', and
(2) in paragraph (3)--

(A) by striking ``$695'' in subparagraph (A) and inserting ``$0'', and
(B) by striking subparagraph (D).

(b) <<NOTE: 26 USC 5000A note.>> Effective Date.--
The amendments made by this section shall apply to months beginning after December 31, 2018.

So much crazy healthcare policy/legal news is happening this week I'm having trouble keeping up.

This happened yesterday:

BREAKING: federal judge strikes down Kentucky's Medicaid work requirements. Again. Remands them back to HHS

— Nathaniel Weixel (@NateWeixel) March 27, 2019

Same judge also strikes down work requirements in Arkansas

— Nathaniel Weixel (@NateWeixel) March 27, 2019

And since I was too swamped with other stuff, I didn't have a chance to write about it until now. A bunch of other outlets have already posted the details, so here's Dylan Scott of Vox.com to save me the trouble:

A federal district judge has blocked Medicaid work requirements approved by the Trump administration in Arkansas and Kentucky.

There's been so many Big Important Breaking News stories about healthcare this week I haven't been able to keep up. On top of the ACA 2.0 rollout and Trump's kamikaze #TexasFoldEm maneuver via the Dept. of Justice memo and the release of the 2019 Open Enrollment Period report and a major judicial ruling which torpedoed Medicaid expansion work requirements in Kentucky (again) and Arkansas which also had immediate implications for Idaho and Iowa...and potentially other states as well!!

And then, this evening, THIS just happened:

It's been a long time since I last wrote a piece for healthinsurance.org, but the latest chapter in the neverending "GOP attack on the ACA" drama compelled me to do so yesterday.

I left out one tidbit in my latest post, however: There's been a lot of speculation the past two days about the timing of both Trump's DOJ memo formally asking the 5th Circuit Court of Appeals to repeal the entire Affordable Care Act on Monday the 25th and the timing of the House Democrats' ACA 2.0 press conference/bill rollout the very next day on March 26th.

The House Dems announced on Saturday the 23rd that they were scheduling their big ACA 2.0 rollout on Tuesday the 26th.

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