Charles Gaba's blog

 

As I'm typing this, the House Energy & Commerce Health Subcommittee is holding markup hearings regarding twelve different healthcare-related bills. The first six relate to prescription drug pricing and regulation, and some of them appear to have genuine bipartisan support.

The other six are directly related to the ACA...these are the six "mini ACA 2.0" bills which cover six of the eleven ACA repairs & improvement provisions included the the larger ACA 2.0 bill introduced yesterday. Here's summaries of all twelve bills being debated today:

 

Most people know that over the past three years, I've gone from being a fan of Vermont U.S. Senator Bernie Sanders to...well, not being a fan; let's just leave it at that. They also know that while I support an eventual move towards a single payer-based healthcare system, I simply feel that it will have to be achieved via incremental steps (preferably large steps, not baby ones).

However, for the past year, I've repeatedly made sure to temper my concerns and criticisms of Sen. Sanders views by making sure to note that Bernie himself cosponsored the Senate version of ACA 2.0 introduced by Sen. Elizabeth Warren, aka the Consumer Health Insurance Protection Act, or CHIPA.

I addressed this point at the time in response to earlier attacks on me by MFA purists:

I need to take a moment here to call out progressives who badmouthed and scolded me last week for promoting the House ACA 2.0 bill by insisting that ONLY Bernie's M4A bill will do, and ANYTHING short of that--even in the short term--is unacceptable.

OK, the House Democrats just wrapped up their press conference at which they officially introduced...The Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act, or #PPECMHMAA.

Just rolls off the tongue, huh?

(sigh) Naming-wise, this is actually worse than the title of last year's ACA upgrade bill ("The Undo Sabotage and Expand Affordability of Health Insurance Act", or #USEAHIA), H.R.5155, which I didn't think was possible.

In any event, last year I went with simply calling it "ACA 2.0", which seems even more appropriate today. Others seem to agree:

The bill Democrats are rolling out to shore up Obamacare is called the Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act. I think @charles_gaba calling it ACA 2.0 is going to catch on pretty quickly.

— Kimberly Leonard (@leonardkl) March 26, 2019

(sigh) I was planning on writing up an in-depth analysis of the 2019 ACA Open Enrollment Period report which was just released by CMS a few hours ago.

Instead, in a bit of sick irony, I have to spend the evening writing about this (via Nicholas Bagley):

The Trump Administration Now Thinks the Entire ACA Should Fall

In a stunning, two-sentence letter submitted to the Fifth Circuit today, the Justice Department announced that it now thinks the entire Affordable Care Act should be enjoined. That’s an even more extreme position than the one it advanced at the district court in Texas v. Azar, when it argued that the court should “only” zero out the protections for people with preexisting conditions.

UPDATE 3/26/19: In light of last night's bombshell announcement that the Trump DOJ is now officially calling for the entire ACA to be repealed in the #TexasFoldEm lawsuit, the wording of yesterday's press release from Trump's CMS division is straight out of 1984 territory:

CMS Issues the 2019 Exchange Open Enrollment Period Final Report
Agency also extends the policy allowing issuers to continue “grandmothered” plans

The Centers for Medicare & Medicaid Services (CMS) today released the Health Insurance Exchanges 2019 Open Enrollment Report. With the Trump Administration’s focus on making healthcare more affordable, the report confirms another successful open enrollment period coinciding with a stabilization of premiums after years of substantial increases. Specifically, the report shows plan selections in Exchange plans in the 50 states and D.C. remained steady at 11.4 million. This represents a minimal decline of around 300,000 plan selections from the same time last year. Also, as outlined in the report, average total premiums for plans selected through HealthCare.gov dropped by 1.5 percent from the prior year, the first decline since the Exchanges began operations in 2014.

A couple of weeks ago, I noted that Colorado is joining over a half-dozen other states in moving forward with their own ACA reinsurance program 1332 waiver request. At the time, I was a bit vague as to just how much the program, if approved, would actually lower unsubsidized premiums, especially since the wording of the bill differentiates between different rating areas:

The Commissioner shall set the payment parameters at amounts to achieve:

On Saturday, the 9th Anniversary of the Patient Protection and Affordable Care Act being signed into law, the news broke that on Tuesday, House Speaker Nancy Pelosi and other House Democratic leaders will be formally rolling out some sort of major "ACA 2.0" legislation:

Pelosi, House Democrats to Unveil Sweeping Legislation to Protect People with Pre-Existing Conditions and Lower Health Costs

Marking the 9th anniversary of the Affordable Care Act being signed into law in 2010 this weekend, Speaker Nancy Pelosi, Majority Leader Steney Hoyer, Chairman Frank Pallone, Chairman Richard Neal, Chairman Bobby Scott and Freshmen House Democrats will hold a press event Tuesday, March 26, at 2:30pm ET in the Rayburn Room to unveil legislation to protect people with pre-existing conditions, reverse the Trump Administration's health care sabotage, and take new measures to lower health premiums and out-of-pocket costs for families.

UPDATE 3/26/19: I'm watching the actual press conference right now. I just wanted to note that there will likely be a few changes/tweaks in the bill/bills introduced today vs. last year's H.R.5155, but it sounds like it'll be about 95% the same. More details this evening.

Back in early January, in an MSNBC interview with Joy Reid, House Speaker Nancy Pelosi noted that she did indeed intend on moving on legislation to, at the very least, raise or remove the ACA subsidy income threshold to allow financial assistance to be available to more people:

The new Speaker of the U.S. House of Representatives said this weekend she wants changes in the income threshold to allow more Americans to gain subsidies so they can buy individual coverage known as Obamacare. Helping more people get subsides are among the "couple of things" she would like to do to improve the ACA and expand health coverage to more Americans, Pelosi, a California Democrat, told MSNBC Friday night.

This one came completely out of left field, but it's a pleasant surprise.

Last year, New Jersey Governor Phil Murphy, along with the Democratically-controlled state legislature, passed several sweeping laws and policies designed to either protect the ACA from sabogate efforts by the Trump Administration or to cancel out existing sabotage measures.

The laws passed included:

  • Establishing a robust reinsurance program to lower insurance premiums,
  • Reinstating the ACA's individual mandate penalty,
  • Canceling out Trump's expansion of Association Health Plans (Short-Term plans were already banned), and
  • Protecting enrollees from out-of-network "surprise plans" (this one didn't really have anything to do with the ACA itself, but is an important issue regardless)

In addition, Murphy issued an executive order directing state agencies to help protect/promote the ACA including:

About a month ago, I noted that new DLC Minnesota Governor Tim Walz rolled out an ambitious state budget proposal with a ton of awesome-sounding healthcare reform stuff, including:

Provide a 20 Percent Health Insurance Premium Subsidy

The Governor will take immediate action by creating a subsidy program to reduce by 20 percent the monthly premiums for Minnesotans who receive their insurance through MNSure. This subsidy will be applied directly against a consumer’s premiums. This proposal provides relief to Minnesotans with incomes over 400 percent of the federal poverty level do not qualify for the federal premium tax credit which helps lower the costs of health insurance premiums. Up to 80,000 people could participate in the program, reducing the out-of-pocket costs of their health insurance premiums.

Establish a Health Insurance Tax Credit

Nearly two years ago, normally deep red Kansas came within a whisker of pulling off the impossible:

Kansas House fails to override Brownback Medicaid expansion veto

The effort to expand Medicaid in Kansas fell apart Monday as the House failed to override Gov. Sam Brownback’s veto of a bill that would have expanded the health care program to thousands of low-income people in the state.

The 81-44 vote, three shy of the 84 needed to overcome the governor’s opposition, effectively ends the Medicaid expansion push in Kansas after it successfully passed both chambers with bipartisan support earlier this year.

That was then. This is now. Kansas now has a Democratic governor who supports Medicaid expansion, and yesterday this happened (via Jim McLean of the Kansas News Service):

Ugh:

CMS gives thumbs-up to Medicaid work requirements in Ohio

The Centers for Medicare & Medicaid Services has approved a waiver request for work requirements in Ohio’s Medicaid program.

...CMS rolled out guidance on these waivers in January 2018, and since then eight states, including Ohio, have had requests approved. Several additional states have submitted waivers that the agency has yet to weigh in on.

...Arkansas is the only state where such work requirements have formally been launched, and in the last several months of 2018, more than 18,000 people lost Medicaid coverage as a result of the work requirement. The Kaiser Family Foundation estimated that most of these losses were a result of the administrative requirements associated with reporting work hours.

Double Ugh:

This was actually released a month ago, but I was a bit preoccupied with my kid's Bar Mitzvah at the time (he did great, by the way, thanks for asking!).

Access Health CT, Connecticut's state-based ACA exchange, released their 2019 Open Enrollment Period report, and it's one of the most extensively detailed & granual looks at the year's enrollment data. They've included the normal stuff, of course (subsidized vs. unsubsidized, metal levels, age and income brackets, etc)...but they've also done a very deep dive into data points I haven't seen before by cross-indexing categories.

For instance, not only did they break out "enrollment attrition reasons" (that is, why 2018 enrollees who didn't renew their policies chose not to), but they actually broke that out into what those enrollees' financial assistance status was.

The level of detail here is pretty impressive and somewhat overwhelming (there's 25 pages of charts & graphs), but if you're a healthcare nerd interested in what's going on in the Nutmeg State, knock yourself out!

Via Email from the Connect for Health Colorado exchange...

Customers Receiving Financial Help Through Connect for Health Colorado® Seeing a 14% Drop in Net Monthly Premium Cost

DENVER – Coloradans who get financial help buying health insurance through Connect for Health Colorado® are paying an average 14 percent less in “net premium” – what they pay after assistance – compared to the average net premium in 2018, according to data released today.

Three of every four current Connect for Health Colorado customers qualify for financial help to reduce the monthly cost of health insurance. The average net premium for those Coloradans is $117 per month, down from $136 per month last year.

“We are happy that we are able to make health insurance affordable for so many people,” said Kevin Patterson, Chief Executive Office of Connect for Health Colorado. “The number of our customers receiving help rose this year by seven percentage points, to 76 percent, an important increase. We know we have more work to do, and are committed to expanding our impact as we work with policy makers, our stakeholders and our customers throughout the state.

In light of the flurry of state-level legislation locking in ACA protections in New Mexico and Maine over the past few weeks, this seems like a good point to check in on other states as well.

One more time: Here's what the ACA's "3-Legged Stool" looks like as of March 2019. The Trump Administration and Congressional Republicans tried to sabotage the Green Leg by cutting off Cost Sharing Reduction reimbursement payments...but the insurance carriers mostly cancelled this out by Silver Loading. The end result of this is that the federal government is actually shelling out up to $20 billion more in APTC subsidies per year, more than cancelling out the $10 billion or so they're saving in unpaid CSR costs (and they may still have to pay that as well anyway!)

Pages