Charles Gaba's blog

2018 MIDTERM ELECTION

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What the heck, I'll make this Medicaid Expansion News Day:

Virginia’s Republican-led legislature is on the verge of doing something that would’ve been almost unthinkable just a year ago: approving legislation that would use money from the Affordable Care Act to expand Medicaid to as many as 400,000 people.

That coverage expansion would come at a price for Democratic legislators, progressive activists and low-income Virginians, however. Any Medicaid expansion bill that makes it out of the General Assembly will carry with it new work requirements for Medicaid enrollees, a priority for the GOP at large and for President Donald Trump’s administration.

Democrats in the Virginia legislature have tried in vain for six years to persuade their GOP counterparts that accepting federal dollars to extend Medicaid coverage to poor adults is the right thing to do. Accepting a work-requirements policy that would create bureaucratic obstacles to eligible Virginians appears to be the compromise needed to win the bigger fight.

As long as I'm focusing on Medicaid expansion news (and since I write about Montana pretty rarely), here's a mildly interesting tidbit:

Last June I noted that ACA Medicaid expansion in Montana had increased dramatically in a year and a half, from 47,000 in early 2016 to over 77,000 enrollees as of May 2017.

According to this article, they're now up to 91,000:

HELENA — There are 91,563 Montanans participating in the Medicaid expansion HELP act as of Jan. 15, generating nearly $40 million in savings in Medicaid benefits, a state panel was told Thursday.

Members of the Legislature’s Children, Families, Health and Human Services Interim Committee reviewed a report on Medicaid expansion. The committee took no immediate action after hearing the report.

As noted earlier, I've been a bit lax with posting for a few days as I've worked on my latest 2-part video explainer about risk pools and #ShortAssPlans.

However, there's been a lot going on, so I figured I should try and at least do a quick update on a few items. First up: Medicaid expansion!

Here in my home state of Michigan, I've written several posts about how the GOP-controlled state legislature trying to shove through a draconian "work requirement" bill for Healthy Michigan, our name for ACA Medicaid expansion program which has been working just fine, thank you very much, for nearly 5 years now. The bill easily passed the state Senate (where the GOP holds a supermajority), and is now under consideration by the state House (where they have a smaller but still solid majority at the moment). The good news is that GOP Governor Rick Snyder--who championed passage of Healthy Michigan in the first place and seems to think it's fine mostly the way it is--is likely to veto the senate version of the bill. The bad news is that it might simply be tweaked somewhat by the House.

 

So apparently Donald Trump's former Health & Human Services Secretary (and lover of first-class airfare on the taxpayer's dime) Tom Price addressed the World Health Care Conference this morning, and offered this gem:

Price says that he's not a big fan of the GOP tax bill's 2019 individual mandate repeal-- says it will harm the pool in the exchange markets & drive up costs

— Ariel Cohen (@ArielCohen37) May 1, 2018

Really. Gee. you don't say.

Making my eyeballs roll even further back in my head, here's what Price said just nine months ago (shortly before he was given the boot from the HHS Dept.):

Tom Price before/after shot/chaser:

...I'm working on my latest crudely-produced-but-hopefully-informative explainer video!

It's actually a two-parter. The first part gives an overview of how Risk Pools actually work and why quarantining sick people into a separate High Risk Pool is such a terrible idea. The second part goes into why Donald Trump's recent Short-Term/Association Plan executive order will make a problem which already existed in 2017, made worse by design in 2018, even worse starting in 2019.

Here's a sneak peak. I hope to have Part One uploaded this week and Part Two either towards the end of the week or early next week.

UPDATE: OK, Part One is now live for Patreon supporters today! It'll be made public on Thursday. I'm hoping to get Part Two posted by the end of the week at this point.

 

5/16/18: IMPORTANT UPDATE BELOW.

(sigh) Stop me if you've heard this one before...this is an Op-Ed in the Washington Examiner from a columnist and failed Republican Congressional candidate:

Time and opportunity still exist to replace Obamacare.

...I reported in January that a number of conservative groups, under the leadership of former Sen. Rick Santorum, was working hard to craft a new Obamacare replacement...Behind the scenes, those groups...have continued to meet and tweak their plan, and they seem just a few weeks away from being able to unveil it.

...I listened in on a March 21 conference call among numerous interested parties, and received further updates within the past week from Santorum.

Back in January, I noted that Wisconsin GOP Governor Scott Walker, who has followed the party line on the ACA since it was first signed into law, has suddenly found religion:

It looks to me like after his short-lived 2016 Presidential campaign (seriously,it only lasted 70 days...heck, even Lincoln Chafee's campaign lasted twice as long), Wisconsin Governor Scott Walker decidedto go back to shoring up his image in his home state...and since Wisconsin is one of 14 states which doesn't have any term limits for the top spot, it looks like he'sscrambling to move back to the center policy-wisejust in time to run for a third term this November:

Scott Walker proposes plan to prop up Obamacare marketplace

After years of fighting Obamacare, Gov. Scott Walker is now seeking to stabilize the state marketplace under the law.

Wisconsin plans to permission to cover expensive medical claims for health insurers on the marketplace, which should lower premium increases and could bring back companies that dropped out, the governor said in an interview with reporters on Friday ahead of his election-year State of the State address Wednesday.

The state will also ask to permanently continue SeniorCare, a prescription drug program Walker has previously sought to pare down, he said.

Walker also said he’ll ask the state Senate to pass a bill authored by Democratic lawmakers and passed by the Assembly that would enshrine into state law access to private insurance for people with pre-existing conditions.

In the most significant of his health care proposals, Walker will ask the Legislature to join a few other states in adopting a reinsurance programto prop up the individual market, which is used by some 216,000 residents, in a state innovation waiver allowed under the Affordable Care Act, or Obamacare.

Last month I urged Democrats to go strongly on offense re. campaigning on healthcare policy in 2018 given the general landscape but especially the exit polling out of the special Congressional election in Pennsylvania:

  • Health care was a top issue to voters. Health care was ranked as a top issue for 52% of voters (15% saying it was the most important issue and another 37% saying it was very important). Only 19% said it was not that important or not important at all.
  • Conor Lamb won big especially among voters for whom health care was a top priority. Among voters who said health care was the most important issue for them, Lamb beat Rick Saccone 64-36 and among the broader group of voters who said it was either the most important or a very important issue Lamb beat Saccone 62-38.
  • On health care, voters said Lamb better reflected their views by 7 points (45% to 38%) over Saccone. With independents, that gap widened to 16 points with 50% saying Lamb’s health care views were more in line with theirs to only 34% for Saccone.

A week or so I noted that activists in Utah had managed to secure enough ballot petition signatures to get full, no-strings-attached ACA Medicaid expansion placed on the ballot this November...superseding legislation signed by the Governor which would otherwise only expand it to fewer than half as many people, while also imposing a work requirement on enrollees:

If approved, the initiative would require the state to expand Medicaid to people making up to 138 percent of the federal poverty level, and would prohibit enrollment caps.

Under ObamaCare, the federal government would cover 90 percent of the costs of expansion. The state share would be funded through a 0.15 percent increase in the sales tax.

...The ballot initiative would cover more than 150,000 people.

Well, today it looks like residents of Idaho will also have a chance to decide whether or not they want ACA Medicaid expansion as well:

Reclaim Idaho meets signature goal, marches on

Covered California Analysis Shows Major Declines in New Enrollment Nationally and Identifies Policies That Could Lower Premiums in 2019

  • Enrollment in the federally facilitated marketplace has dropped 9 percent over the past two years, with a nearly 40 percent drop in new enrollment, while enrollment in state-based marketplaces remained steady during the same period.

Nothing new under the sun here; this is the core of what I do at ACASignups.net. In fact, this press release underplays the point slightly: The official enrollment tallies are down 10% on the federal exchange since 2016 and up 1.5%, although the discrepancy might be partly due to Kentucky shifting from state-based status to federal status in 2017.

I know I tend to pitch for folks to support my work here at ACA Signups fairly frequently, but today I want to pass the hat a bit for my friend Chris Savage of Eclectablog (and yes, there's even a healthcare angle here). From his post earlier today:

You may recall that earlier this year, I had a run-in with a bad dude named Diverticulitis that put me in the hospital for ten days. As it turns out, I need to have surgery next month to keep that scary situation from ever happening again. Because this is happening during the time when we normally hold our annual fundraising party, we are going to postpone the party until late August when I am back on my feet.

The upshot is that the Eclectablog bank account is nearly depleted and won’t be significantly refreshed until almost September. Therefore, this quarterly fundraiser is more important than most. We need to raise enough money to keep paying our fabulous contributors until the annual party.

There was a bit of confusion on Twitter this morning (shocker!) over a Modern Healthcare story which reported on a new physician payment policy from the Centers for Medicare & Medicaid (CMS) for Medicare enrollees.

At first it looked like CMS was planning on allowing doctors to "balance bill" Medicare patients. Balance billing is already a controversial issue with private insurance; it's the practice of a doctor/hospital charging the patient directly for the difference between what the doctor wants to be paid and what the insurance company agrees to pay them.

 

Former Acting CMS Administrator Andy Slavitt and Huffington Post healthcare reporter Jeff Young have each written up a fairly comprehensive list of the various types of ACA/healthcare sabotage which the Trump Administration and/or other Republicans in Congress or at the state level have attempted (or are in the process of attempting today).

Young posted an excellent roundup under a nice headline which says it all:

The GOP Has One Big Idea For Health Care Reform: Crappier Insurance

As I noted last week, the Republican-controlled Michigan state Senate rammed through a draconian work requirement bill for ACA Medicaid expansion enrollees in spite of the fact that it would serve no positive purpose and would only "save money" by kicking thousands of low-income Michiganders off their healthcare coverage while actually harming the economy.

I further noted that while I was pretty sure the bill would easily pass the state Senate (where the GOP holds a supermajority) and will likely pass the GOP-controlled state House as well, there is a decent chance that it could be vetoed by GOP Gov. Rick Snyder. Snyder is guilty of a long list of sins during his time as Governor, including being indirectly responsible for the water supply for the entire city of Flint being poisoned a few years back. At the same time, oddly, once in a blue moon he'll actually do something decent and good, and the one he deserves the most praise for on this front is pushing to get Medicaid expansion through in the first place.

So, about a week ago I tweeted this out:

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