Back in March, I wrote about a clever and absurdly simple (on the surface) bill being passed through the Maryland state legislature which could result in the state lowering their uninsured rate substantially...by as many as 120,000 people:

In early 2018, Maryland state legislators introduced a bill which included a twist on the coverage mandate penalty--those who failed to sign up had another option: They could either pay the penalty or they could choose to have the penalty amount be used to automatically enroll them in the lowest-cost insurance policy available. If they qualified for ACA subsidies, those would even be baked into the equation as well. This was a clever way of softening the blow, while also increasing enrollment and helping out the ACA risk pool.

Over the past year or so I've written numerous entries about Michigan Republicans pushing through an ineffective, inefficient, cruel and pointless work requirement addition to Michigan's implementation of Medicaid expansion under the Affordable Care Act, culminating in this one:

New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.

Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.

That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.

As I noted at the time, MI GOP claims that the work requirements will "fill job openings" is a load of hot, steaming garbage:

Long-time readers of this site may remember that I have a "special place" in my heart (more like in the pit of my stomach) for Ralph Hudgens, the now-former Georgia state Insurance Commissioner, ever since I read about this ugly incident way back in 2013:

“Let me tell you what we’re doing (about ObamaCare),” Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month: “Everything in our power to be an obstructionist.”

After pausing to let applause roll over him, a grinning Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.

Initial filings reveal stabilization as rate review season kicks off

Salem, OR—Oregon consumers can get a first look at requested rates for 2020 individual and small group health insurance plans.

In the individual market, seven companies submitted rate change requests ranging from an average 3.2 percent decrease to an average 13.5 percent increase, for an average of 3.3 percent. In the small group market, nine companies submitted rate change requests ranging from an average 0.3 percent decrease to an average 13.1 percent increase, for an average of 8.7 percent. See the chart for the full list of rate change requests.

“It’s early in the process, but we are encouraged to see carriers providing more options to Oregonians by expanding into both rural and coastal communities, and the market stabilizing in spite of uncertainty at the federal level,” said Insurance Commissioner Andrew Stolfi. “Now it is time to start our open and thorough review process that allows Oregonians to provide input on the filings that affect them.”

Last year, the two insurance carriers offering individual market policies in Vermont, BCBS and MVP, originally requested rate increases averaging 7.5% and 10.9% respectively, or a weighted average of 8.6%. These were eventually whittled down to 5.8% and 6.6% respectively, for a weighted average increase of 6.1% in 2019.

It's important to keep in mind that Vermont is one of only two states (the other is Massachusetts) which merges their Individual and Small Group risk pools into one.

Two states in two days...just 24 hours after the Washington State Insurance Commissioner pulled the plug on the "Aliera Healthcare" and "Trinity Healthshare" healthcare sharing ministries for fraud, the New Hampshire Insurance Dept. is issuing a similar warning (although they don't appear to be actually shutting the operation down just yet):

Consumer Alert on Potential Unlicensed Health Insurance Company

CONCORD, NH – As a result of a recent Georgia court order, the New Hampshire Insurance Department is advising consumers that Aliera, a company that markets itself as a health care sharing ministry, may be operating illegally in New Hampshire.

I haven't written about "Healthcare Sharing Ministries" as much as I should have. This is from my only substantive blog post about them 3 years ago:

A health care sharing ministry is an organization that facilitates sharing of health care costs between individual members who have common ethical or religious beliefs in the United States. A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance polices on behalf of its members.

Members of health care sharing ministries are exempt from the individual responsibility requirements of the Patient Protection and Affordable Care Act, often referred to as Obamacare. This means members of health care sharing ministries are not required to have insurance as outlined in the individual mandate.

Earlier today I once again dusted off my ACA Individual Market Rate Change project for the 5th year, as the state of Maryland has issued their preliminary 2020 premium rate filings. With that in mind, I decided to go back and look at my personal projections for average 2019 premiums (from June - October of 2018) and compare them against the actual average 2019 premiums as reported by the Centers for Medicare & Medicaid 2019 Open Enrollment Period Public Use Files.

Bottom line: I was pretty damned close, coming within 2% of the actual average premium in 27 states and within 5% in 42 states. Nationally, I was off by 2.0%, projecting an average monthly premium of $611 vs. the $599 actual average.

The outliers were:

Every year for 4 years running, I've spent the entire spring/summer/early fall painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

The actual work is difficult due to the ever-changing landscape as carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it next to impossible to find the specific data I need.

The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

Back in January, I noted that California Governor Gavin Newsom was proposing a stripped-down version of one of the most important ACA 2.0 provisions I've been pushing for years now: Raising the ACA's APTC subsidy income eligibility cap and beefing up the underlying subsidy formula.

At the time, he was

Well, the latest official revision to the proposed CA 2019 - 2020 state budget has been released, and not only are both the mandate reinstatement and the enhanced subsidies included, the subsidies have actually been increased a bit more than Newsom was originally proposing:

EXPANDED SUBSIDIES TO PROMOTE AFFORDABLE COVERAGE

To improve affordability and access to health care, the Governor's Budget proposed subsidies to help more low and middle class Californians afford health coverage through Covered California.

About three weeks ago I noted that the Nevada state Senate had passed a bill which locks in many of the ACA's patient protections at the state level, just in case the idiotic #TexasFoldEm lawsuit prevails and the ACA is repealed after all.

Yesterday, the Nevada state House followed through as well:

Nevada stands to become the fifth state to fully incorporate the federal Affordable Care Act’s protections for patients with pre-existing conditions into state law after unanimous passage of a bill Tuesday in the state Senate.

"Fully incorporate" isn't quite accurate; as I noted with the Senate version, it looks like the three most important ones are covered (Guaranteed Issue, Community Rating and the ACA's 10 Essential Health Benefits), along with a pre-ACA law letting young adults stay on their parents plan until age 24 (but only if they're unmarried and enrolled in school).

A few days ago I noted that North Dakota had jumped onto the ACA reinsurance train; now it looks like Montana is onboard as well:

Governor Signs Bill Meant to Lower Some Insurance Premiums

HELENA — Gov. Steve Bullock has signed legislation meant to lower premiums for Montana customers who receive health insurance through the Affordable Care Act’s individual marketplace.

Bullock signed the bill Tuesday creating a reinsurance program to help reimburse insurers for high-cost claims so those costs aren’t included in determining individual marketplace premiums for the following year.

U.S. health officials also must approve the plan, which is estimated to offset 2020 premium increases by 10% to 20%.

After writing about the newly-signed laws in Georgia and Ohio banning virtually all abortions after 6 weeks (when most women don't even know they're pregnant), even in most cases of rape, incest of the health of the mother, I didn't think that a story about abortion-related legislation could get more horrific and insane.

I was wrong:

A new Ohio bill would ban most private insurance coverage for abortions. Opponents say it would also ban effective methods of birth control.

One-fifth of representatives in the House, all Republicans, have signed onto House Bill 182 sponsored by state Rep. John Becker (R-Union Twp.) that would prohibit most insurance companies from offering coverage for abortion services.

“The intent is to save lives and reduce the cost of employers and employees health care insurance," Becker says.

UPDATE: It's been pointed out that the Supreme Court has ruled that minors can't receive the death penalty, so I guess that means "only" life in prison for them. If they're 18 or older, however...

On the other hand, several people have noted that an 11-year old pelvis isn't generally developed enough to even deliver a baby safely, along with other health risks, so it could very well be a death sentence regardless, so I'm leaving the headline as is.

Georgia's "pro-life" Republicans have passed a law that would subject a woman who self-terminates after six weeks to life imprisonment or capital punishment. https://t.co/vbBpfRzIgj @Slate pic.twitter.com/Djqn0LbLf6

— Mark Joseph Stern (@mjs_DC) May 7, 2019

 

In the far simpler days of 2001, when the President of the United States didn't suck up to genocidal dictators and thank Russia for helping him win the Electoral College, an episode of The West Wing aired entitled "The Indians in the Lobby".

I was instantly reminded of the scene above* (in reverse) when I read this story by Justin Sink at Bloomberg News:

The Trump administration may alter the way it determines the national poverty threshold, putting Americans living on the margins at risk of losing access to welfare programs.

The possible move would involve changing how inflation is calculated in the “official poverty measure,” the White House Office of Management and Budget said in a regulatory filing on Monday. The formula has been used for decades to determine whether people qualify for certain federal programs and benefits.

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