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Charles Gaba's blog

Alabama, Alaska and Wyoming only have a single insurance carrier participating in each of their individual markets. While this is a bad thing from a competitiveness POV, it cetainly makes things easier for me from a tracking-average-rate-hikes POV.

ALSO IMPORTANT: The HHS Dept. is also starting to upload the rate filings to the official RateReview.Healthcare.Gov database, which should make things easier for me going forward (assuming that the data is uploaded properly and isn't messed with, which is a distinct possibility when it comes to the Trump Administration)

Officially, Alabama has the infamous "Freedom Life" phantom plan which is asking for a whopping 71.6% rate hike...to allegedly cover exactly one (1) person statewide. Un-huh.

Aside from that, however, it's Blue Cross Blue Shield across all three states...and they're asking for the following:

This isn't a full analysis, since I only have 2018 rate hike data for one of Arizona's carriers so far...on the other hand, AZ only has a couple of carriers on the individual market these days anyway. From AZCentral:

The Affordable Care Act insurer in 13 of Arizona's 15 counties plans to raise average rates across all plans a moderate 7.2 percent next year.

But Blue Cross Blue Shield of Arizona officials said the rate increases would be flat if President Donald Trump's administration did not plan to eliminate a key Affordable Care Act funding source.

7.2% isn't bad at all...of course, that comes after last years massive 57% average rate hike. Still, 0% would obviously be much better than 7%...

Trump suggested in a weekend tweet that " ... bailouts for insurance companies and bailouts for members of Congress will end very soon" unless Congress acts quickly on a new health bill.

Here it is...the Big Kahuna! Covered California just issued a detailed press release and accompanying PDF brochure breaking out their proposed 2018 market participation and rate changes:

Covered California Releases 2018 Rates: Continued Stability and Competition in the Face of National Uncertainty

Covered California remains stable, with an average weighted rate change of 12.5 percent. The change is lower than last year and includes a one-time increase of 2.8 percent due to the end of the health insurance tax “holiday.”

The competitive market allows consumers to limit the rate change to 3.3 percent if they switch to the lowest-cost plan in the same metal tier.

For 2017, unsubsidized enrollees on the Minnesota individual market faced massive rate hikes averaging 57%. It was so bad that the only way they could convince some carriers to participate in the market was to allow most of them to put a cap on how many people they'd enroll (with the balance being shunted over to Blue Plus, the HMO division of BCBSMN). This resulted in a massive initial surge of enrollment, as it was on a first-come, first-serve basis...but also left off-exchange and unsubsidized exchange enrollees high and dry.

In response, the state scrambled to pull together a $300 million package to help supplement premiums for those folks...knocking a flat 25% off of their premiums for 2017. This helped ease the problem in the short term, but the larger issue still loomed going forward.

It feels almost silly for me to spend so much time crunching the average 2018 rate hike numbers at this point. Between the (supposedly failed?) GOP repeal effort and Donald Trump's ongoing sabotage efforts--including what could be him officially pulling the plug on CSR reimbursements as early as sometime today--it's probably a bit of a futile effort. Besides, a dozen other wonks/analyses have already confirmed what the Kaiser Family Foundation projected months ago and which I've been proving on a state-by-state basis for months now: The CSR threat is causing average rate hikes of around 20 points on average, and the threats to individual mandate enforcement are tacking on another 4-5 points on top of that, beyond the ~10 points which rates would normally be increasing on average.

However, I've plugged in 21 states, so I might as well finish the job. With that in mind, the state of Idaho has done most of the dirty work for me:

(Special thanks to folks like Josh Schultz, David Anderson, Andrew Sprung, Amy Lotven, Wesley Sanders and others for helping me make heads or tails out of the CSR brouhaha)

NOTE 5:30pm: See update at the bottom of page.

  • Mark Farrah Associates estimates the total individual market was roughly 17.6 million people as of early 2017.
  • Of that, I estimate that roughly 1.6 million are probably still enrolled in "grandfathered" or "transitional" policies, which are not ACA compliant and are part of a completely separate risk pool.
  • That leaves around 16,000,000 people enrolled in ACA-compliant policies at the moment.
  • As of March, around 10.7 million were enrolled in ACA exchange policies, the other 5.3 million or so in off-exchange policies.
  • Roughly 9.1 million of the exchange enrollees receive APTC subsidies; around 6.1 million also receive CSR subsidies.
  • That leaves roughly 3 million receiving APTC but not CSR and 6.9 million not receiving either (1.6 million on exchange, 5.3 million off exchange)

Based on these ratios, here's a scenario for you:

Let's suppose you run an insurance company currently offering a Bronze, Silver, Gold and Platinum individual market plan both on and off the ACA exchange. You currently (2017) have a total individual market enrollment of exactly 16,000 people, broken out as follows (the on exchange breakout is based on actual OE4 enrollment data; the off exchange breakout is unknown, but Andrew Sprung thinks it's roughly a 40/40/20 Bronze/Silver/Gold split, which sounds about right to me).

 

Well, now...suddenly it feels like putting together this video series isn't such a waste of time after all!

Last week I posted the first in a video slideshow explainer series giving an overview of the pre-ACA landscape, circa 2009.

It was pretty crude, but I was scrambling to upload it ahead of the big Senate repeal/replace vote...and frankly, I felt a little silly bothering afterwards, since there was a very good chance that none of this would matter soon anyway.

Fortunately, late last night, something unexpected happened...and it now appears that the ACA will indeed live on for awhile, albeit still with serious issues to work out.

That being the case, I've recorded and uploaded the second slideshow video in the series...and yes, this one includes the (in)famous Three-Legged Stool.

Enjoy (well, as much as anyone can enjoy a dull 18-minute slideshow about healthcare policy, anyway).

As always, support is appreciated!

Here's Part One again:

Those were Democratic Senate Minority Leader Chuck Schumer's words tonight in response to Republican Senate Majority Leader Mitch McConnell's claims that those on the left were "celebrating" the defeat of his Godawful "Skinny Repeal" bill late Thursday night. And that's a perfect description of how I feel, for several reasons:

  • 1. This wasn't so much a case of an "Actively Positive" thing happening (as was the case with, say, the Obergefell v. Hodges Supreme Court decision) as it was stopping a negative thing (as was the case with the King v. Burwell SCOTUS decision, which actually was announced the very same day as Obergefell). That is to say, it's not that a good piece of legislation passed, it's that a bad piece of legislation was blocked. This isn't to minimize the importance of what just happened tonight (not just in terms of healthcare policy, but also the state of our democratic process, legislative norms and of course the ramifications for the rest of this ongoing nightmare we call the Trump Administration), but it does tend to dampen my emotional response a bit.
  • 2. As I keep stressing: There are real problems with the ACA as it currently stands, and some of them require more than simple "tweaks" as some ACA defenders are prone towards describing them. All of these problems are definitely fixable, but most of those solutions still won't be easy to push through. Furthermore, these issues are exacerbated by two other problems:
  • 3. THE CLOCK IS TICKING for 2018: The final carrier rate filing deadline is rapidly approaching; the carriers need to make their final decisions about how much to charge next year soon...assuming they decide to stick around the individual market next year at all, which isn't a guaranteed thing, especially due to...
  • 4. THE TRUMP SABOTAGE FACTOR will now almost certainly go into overdrive. I'm about 90% certain that Trump will indeed pull the plug on Cost Sharing Reduction reimbursement payments staring next month (August), which could still devastate the indy market almost instantly. Of course, Congressional Republicans could resolve the CSR issue in about 5 minutes with a simple, 87-word bill which would receive unanimous consent from every Democrat in both the House and Senate as long as it was either standalone or not attached to some other poison pill piece of legislation.

    For that matter, while the individual mandate repeal died with the "Skinny Repeal" bill failing, House Republicans have also started pushing through a different bill which would prevent the IRS from enforcing the individual mandate anyway, causing the exact same problems. And even if that doesn't happen, HHS Sec. Tom Price could simply start issuing hundreds of thousands of highly-questionable "hardship exemptions" letting pretty much everyone off the hook for the mandate penalty anyway...which, once again, would amount to the same fallout.

...and so on and so forth.

HOWEVER, having said all of that, for the moment, I'm going to allow myself the most basic of celebration anyway. I think we've earned it...

For the past six months, I've been giving a PowerPoint presentation to various activist clubs/meetings around Southeast Michigan about the Affordable Care Act and Republican attempts to repeal it, including the basics of how the ACA was supposed to work, which parts are and aren't working (and why), how I'd recommend fixing the real problems and, of course, just what the heck the GOP has been trying to do to tear it all apart.

Many people have requested an online version of the slideshow. I posted an earlier version of it this past spring, but obviously things have changed dramatically over the past few months.

I've updated and enhanced about 3/4 of the slideshow. Unfortunately, I haven't had a chance to update the GOP repeal section yet--it's sort of a mish-mash of AHCA and BCRA slides right now, but I thought it was more important to get it posted for the moment under the circumstances.

Then again, that section keeps changing every five minues anyway, so perhaps it's just as well if I hold off on that part. I'll swap out this version for a newer one at a later date.

 

(yes, I know she actually says "bumpy night"...I'll update the title this evening if need be...)

OK...here's where things stood as of last night...

UPDATE 7/27/17 12:00pm: OK, here's the latest (at least, as of around noon, anyway):

Apparently, in order to win over a few more votes and squeeze the bill in under the "budget savings" wire, they're now planning on scrapping repeal of the medical device tax and delaying repeal of the employer mandate (but still repealing it eventually). They're also going to throw in defunding Planned Parenthood even though that was previously scrapped by the Senate parlimentarian.

Finally, they're apparently bringing back the Essential Health Benefit State Waiver provision, which would, once again, blow a massive hole in the "Guaranteed Issue and Community Rating" rules.

 

UPDATE: Hey, who's that up there? Why it's the guy who Republicans wanted to become President just 5 years ago, explaining why, if you're going to guarantee solid health insurance policies to everyone regardless of their medical history and without discriminating on price, you have to include some sort of incentive for them to do so: A carrot and a stick. The tax credits and out of pocket maximums are the carrot. The individual mandate and open enrollment period are the stick.

(sigh) I debated whether to even write a post about the last-minute "Skinny Repeal" plan slapped together by Mitch McConnell yesterday morning for a couple of reasons: First, because even if it passes, the sole purpose of "Skinny Repeal" is to get past the 50-vote Senate threshold...at which point it would be scrapped and replaced with whatever Godawful pile of garbage McConnell comes up with via reconciliation afterwards anyway.

Second, and more to the point, they're supposed to be voting on "Skinny Repeal" within the next few hours, so it's possible that it could be a moot point before anyone even reads this.

OK. Here we go. First, just as a refresher: Here's what the Individual Market was supposed to look like under the Affordable Care Act:

Here's what it actually looks like for a variety of reasons, including both legitimate glitches in the ACA itself as well as a whole lot of flat-out sabotage by the GOP over the past 7 years. While there are plenty of other issues which need to be addressed, the most obvious ones are that the tax credits need to be beefed up and applied to enrollees over the 400% FPL threshold, and the mandate penalty should really be increased. In short, two legs of the stool need to be lengthened...to continue the metaphor, we need a couple of shims. Around $12 billion per year or so should do the trick on the tax credit side. As it happens, one of the few useful parts of most of the GOP plans is that they do include a good $120 billion or so in "reinsurance/stabilization" funding over 10 years...which, in practice, would amount to about the same thing. The key is that this funding would have to be added to the existing ACA funding, not replacing it, which is what these plans do instead:

Back in early June, I took the misleading, disingenuous, incomplete report from Trump's ASPE head which tried to make it appear that the Affordable Care Act had caused individual market health insurance premiums to "more than double" by 105%.

Regular readers may recall that this study was deeply flawed in several ways:

 

As regular readers know, I've spent the past few months speaking at various political/activist club meetings giving a lengthy presentation which gives a basic overview of the healthcare coverage situation in America, how the ACA was supposed to work, which parts of it are/aren't working, how I think the parts which aren't working should be fixed/improved, and of course what the Republican Party's plan of the day is to screw up everything which works while making the existing problems far, far worse.

By popular demand, I've embarked on a project to bring a version of this presentation to the web, by way of a series of short, simple videos (narrated slideshows, really) which give the basics. The first one can be viewed above.

As I note at the outset: I realize how incredibly basic and crude this is. I actually have some experience in video editing from my wannabe film producer days (long story, don't ask) in the 1990's, but I'm more than a little rusty at it...and frankly, given that the Senate vote is coming up in just a few days, I don't exactly have a lot of time for fancy effects and the like.

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