Time: D H M S


Yesterday the House Democrats laid out a completely rational, reasonable, responsible list of serious improvements to the Affordable Care Act.

Today, the Trump White House responded with...this hot mess of pig vomit:

The White House is seeking a package of conservative policy concessions — some of which are certain to antagonize Democrats — in return for backing a legislative package bolstering Obamacare markets, according to a document obtained by POLITICO.

The document indicates the administration will support congressional efforts to prop up the wobbly marketplaces, in exchange for significantly expanding short-term health plans and loosening other insurance regulations.

Washington State Insurance Commissioner Mike Kreidler has decided to shut down Donald Trump's #ShortAssPlans executive order before it starts infecting the Evergreen State (yes, that's their official nickname...I looked it up):

Kreidler announces intention to being rulemaking on short-term medical plans

March 6, 2018

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler announced his intention today to begin rule-making to create protections for Washington consumers who buy short-term medical plans. He is taking this action in response to the recent rules the Trump administration proposed to increase the duration of short-term medical plans from 90 days to up to 364 days.

In a statement last week, Kreidler shared his concerns about short-term medical plans:

I don't write much about Rhode Island outside of the actual Open Enrollment Period each year, and I almost never write about the ACA's "SHOP" (Small Business Health Options Program...which should really be labelled SB-HOP) these days (the program has never enrolled more than perhaps 200,000 people nationally at most)...but both the state and the program could use a little love, so what the heck:

HealthSource RI for Employers enrolls its 700th small business

RUMFORD, RI (March 6, 2018) – HealthSource RI for Employers today announced it has hit a major milestone. The health insurance marketplace for small employers has now enrolled its 700th small business. These 700 local businesses reflect over 5,200 Rhode Islanders.


With the 2018 Open Enrollment Period coming up just 5 days from now, it's time to put this to bed: After 6 months of painstaking research and analysis, I've compiled a comprehensive analysis of the weighted average rate changes for unsubsidized ACA-compliant individual market policies in 2018, including both the on- and off-exchange markets. It's already been confirmed by a different analysis by healthcare consulting firm Avalere Health, which used a completely different methodology to arrive at the exact same conclusion: The national average increase is between 29-30%, ranging from as low as a 22% average premium drop in Alaska (thanks to their successful reinsurance program) to as high as a painful 58% increase in Virginia.

Interesting timing of this, coming right on top of the other ACA stabilization/improvement bill introduced by the House Democrats today:

From Sen. Baldwin's official Senate website:


“The Fair Care Act is an opportunity for lawmakers to keep their word on guaranteed protections for pre-existing conditions.”

WASHINGTON, D.C. – Following the Trump Administration’s recent proposed rule allowing insurance companies to once again sell ‘junk’ health care plans, U.S. Senator Tammy Baldwin today announced new legislation to block the rule and guarantee protections for people with pre-existing conditions.

“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”

--Douglas Adams, The Hitchhiker's Guide to the Galaxy

Over a year and a half ago, I noticed that aside from the usual names being listed as insurance carriers offering individual market policies in various states (Humana, Molina, Blue Cross Blue Shield, etc), there was one other name which kept popping up over and over again: "Freedom Life":

Over the past few weeks,I've posted partial 2018 Open Enrollment Period demographic data from Connecticut, Idaho, Maryland, New York and Washington State. Still missing are final wrap-up reports from the other 7 state-based exchanges...as well as The Big One: The official report from the Assistant Secretary for Planning and Evaluation (ASPE).

The 2014 ASPE report was released on May 1st, 2014...just 17 days after the first, tumultuous 2014 Open Enrollment Period ended (only 12 days, really, since the report actually ran through April 19th, 2014 even though the "overtime" period technically ended on April 15th).

Two weeks ago the United States House of Representatives voted to pass HR 620, officially titled the "ADA Education and Reform Act", with 225 members of Congress voting Yea and 192 voting Nay.

While the vote was mostly along party lines, I was saddened to see that a dozen Democrats joined 213 Republicans to vote for it...putting it over the top.

What would H.R. 620 actually do? I don't know a whole lot about disability advocacy, I admit, but according to the American Civil Liberties Union:

The so-called “ADA Education and Reform Act”weakens the Americans with Disabilities Act and undermines one of the key goals of the law.

via Raw Story:

Sen. Orrin Hatch (R-UT) on Thursday called supporters of the Affordable Care Actsome “of the stupidest, dumbass people I’ve ever met” during a speech before the American Enterprise Institute.

We […] finally did away with the individual mandate tax that was established under that wonderful bill called ‘Obamacare,’” Hatch said, according to Fox News 13. “Now, if you didn’t catch on, I was being very sarcastic.”

“[The Affordable Care Act] was the stupidest, dumbass bill that I’ve ever seen. Now, some of you may have loved it. If you do, you are one of the stupidest, dumbass people I’ve ever met. This was one—and there are a lot of ’em up on Capitol Hill from [that] time,” Hatch added.

Matt Whitlock, a spokesman for Hatch, defended the senators comments, telling Fox News 13, “The comments were obviously made in jest, but what’s not a joke is the harm Obamacare has caused for countless Utahns.”

Today must be Healthcare Survey day. First it was the Kaiser Family Foundation's monthly tracking poll; now comes the Commonwealth Fund, which has released their own survey results regarding the Affordable Care Act and healthcare coverage in general:

To gauge the perspectives of Americans on the marketplaces, Medicaid, and other health insurance issues, the Commonwealth Fund Affordable Care Act Tracking Survey interviewed a random, nationally representative sample of 2,410 adults ages 19 to 64 between November 2 and December 27, 2017, including 541 people who have marketplace or Medicaid coverage. The findings are compared to prior ACA tracking surveys, the most recent of which was fielded between March and June 2017. The survey research firm SSRS conducted the survey, which has an overall margin of error is +/– 2.7 percentage points at the 95 percent confidence level.

Covered California’s Executive Director Addresses Harvard Study on Impact of Eliminating Individual Mandate on Enrollment and Premium

SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee issued the following statement in connection with the Harvard Medical School Study, “Eliminating the Individual Mandate Penalty in California: Harmful but Non-Fatal Changes in Enrollment and Premiums,”published in Health Affairs. The Harvard study, conducted by a team lead by Dr. John Hsu, is the first national effort to measure the potential impacts of removing the individual mandate penalty based on surveying actual California consumers about their likely actions in the face of there being no penalty.

Back in January, I wrote:

Millions of people who failed to make sure they were enrolled in ACA-compliant healthcare coverage are going to file their tax returns this spring thinking that they don't have to pay a penalty for not doing so only to discover that the penalty is still in effect.

Then, next spring (assuming the IRS sticks to its guns on the issue and there's no further legislative changes made), anyone who didn't #GetCovered for 2018 are also going to have to pay the penalty (which, again, is either $695 per adult/$348 per child or 2.5% of their household Modified Adjusted Gross Income).

The damage caused by the mandate being repealed to the individual market risk pool (and rate premiums) will be felt this November, when people start shopping around for 2019 coverage...but the actual "benefit" (i.e., those who don't get covered not having to pay the mandate penalty) won't show up until spring 2020.

The Kaiser Family Foundation runs a highly respected monthly national tracking poll on healthcare issues. Their latest was just released, and while there's a bunch of interesting stuff included, there are two main takeaways. Here's the first:

The February Kaiser Health Tracking Poll finds a slight increase in the share of the public who say they have a favorable view of the Affordable Care Act (ACA), from 50 percent in January 2018 to 54 percent this month. This is the highest level of favorability of the ACA measured in more than 80 Kaiser Health Tracking Polls since 2010. This change is largely driven by independents, with more than half (55 percent) now saying they have a favorable opinion of the law compared to 48 percent last month. Large majorities (83 percent) of Democrats continue to view the law favorably (including six in ten who now say they hold a “very favorable” view, up from 48 percent last month) while nearly eight in ten Republicans (78 percent) view the law unfavorably (unchanged from last month).

I noted a few weeks ago that as many as 9 states are ramping up plans to reinstate one version or another of the ACA's just-repealed Individual Mandate. I concluded:

My only advice is that if they do take the political risk of imposing a mandate penalty, at least make sure it's more stringent than the one which was just repealed--I'd probably recommend making it something like the same cost as the least-expensive Bronze plan available on the exchange after whatever tax credits they'd otherwise have applied.

Well, I don't know about the details, but it looks like the District of Columbia, at least, is full-steam ahead:

DC Health Benefit Exchange Authority Executive Board Recommends Policies to Protect Health Insurance for District Residents
Friday, February 23, 2018

This just in...I used to track the monthly Medicaid/CHIP reports pretty religiously, but the total numbers have actually stayed fairly stable month to month for the past year or so (mainly because the states which expanded Medicaid under the ACA have mostly "maxed out" by now). This should start changing in Maine later this year as they voted to expand the program via ballot initiative last November, and Virginia may end up expanding Medicaid to up to 400,000 people there as well later this year.

In the meantime, here's where things stood as of the end of 2017, according to CMS:

Highlights from the December 2017 Report

Medicaid and CHIP Total Enrollment