END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

2018 Open Enrollment Quick Links


Last week I broke the story (later picked up by Axios, NY Magazine and Vox.com) that the Graham-Cassidy bill would make thousands of current insurance policies illegal starting on January 1, 2018...just 98 days from now.

Why? Because, as noted at the link, while the current ACA structure (exchanges, tax credits, etc) would stay mostly in place for 2 more years, some provisions would be repealed immediately...including a nationwide ban on any exchange policy offering abortion coverage.

This morning JP Massar (who called my attention to the 1/1/18 effective date the first time) inquired as to whether that had changed with the new version of G-C. As you can see on pages 2 & 3 of the new bill...nope. It’s still in place.

 

Late Sunday night, Axios managed to get ahold of a copy of the revised version of the Graham-Cassidy bill...and it's a complete and utter travesty.

Here's direct links to the bill itself and to the GOP's table showing what they claim would be the net federal funding changes from 2020-2026 for each state relative to current law...but they pulled one hell of a fast one.

Here's the original table...

 

it's pretty rare for the entire medical, hospital and insurance industry to agree on just about anything...and yet here we are (emphasis in the original):

The following statement was jointly released on September 23, 2017 by the American Medical Association, American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, America's Health Insurance Plans and the BlueCross BlueShield Association regarding the Graham-Cassidy-Heller-Johnson legislation.

We represent the nation's doctors, hospitals and health plans. Collectively, our organizations include hundreds of thousands of individual physicians, thousands of hospitals, and hundreds of health plans that serve tens of millions of American patients, consumers and employers every day across the United States.

Anyone who's followed me either here at ACASignups.net or over at Twitter over the past eight months knows that no one has been sounding the alarm louder or more frequently than me about both the real and potential sabotage of the ACA being carried out (or at least attempted) by the GOP in general and Donald Trump/Tom Price specifically. Hell, back in July, I even warned of a half-dozen things to look out for, several of which have since already been proven true:

This brings me to the main point of this entry: This is likely just the beginning. I'm not going to say that any or all of the following will happen--it's possible that Trump/Price/Verma will show some level of restraint--but I wouldn't be at all surprised to see any or all of these happen during this fall's Open Enrollment Period (which runs from Nov. 1st - Dec. 15th, by the way):

The past few weeks, while trying to push the Godawful "Graham-Cassidy" ACA repeal bill, Louisiana Republican Senator Bill Cassidy has used the following as one of his standard talking points:

.@BillCassidy shares the story of a Louisiana man paying more than $40,000 for his special needs son’s health care under Obamacare. pic.twitter.com/AaZ0IQIfF7

— GOP (@GOP) September 21, 2017

He's posted several variants of the "$40,000 premium" tweet of late.

The tweet above includes an embedded Twitter video, which I've reposted to YouTube:

 

Credit where due. Last time around McCain made everyone hold their breath in suspense (then again, in his defense, he had just been diagnosed with a brain tumor and had to schlep all the way back from Arizona to DC for the vote a day or so earlier).

This time around he’s being more clear and up front about it: He says he likes the idea of the bill in general, and would be influenced by AZ Gov. Ducey’s support of it, but the process has stunk and continues to stink from top to bottom:

!!! McCain is a NO on Cassidy-Graham pic.twitter.com/a9gC2Li7TZ

— Jennifer Bendery (@jbendery) September 22, 2017

Seriously, good for him. He’s being quite clear about not just his decisions but his reasons...and while it would be nice if he opposed the bill on the merits (it stinks), his actual reasons make perfect sense as well.

Here’s his full statement:

It's time to once again dust off the Three-Legged Stool visual aid to help explain just what the Graham-Cassidy bill would do to the individual insurance market. It's important to note that none of this has anything to do with Medicaid (expansion or traditional), the group market, Medicare and so forth; just the individual market.

Once again, here's what the "3-Legged Stool" was supposed to look like under the Affordable Care Act:

Here's what it actually looks like today, with some rather obvious gaps in the red (enrollee responsibility) and green (government responsibility) legs:

As the final deadline for final 2018 individual market rates to be locked in and the contracts signed, more states are coming into focus, and the pattern continues to be remarkably consistent.

In Mississippi, I originally pegged the requested rate hikes across the two individual market carriers (technically three, but "Freedom Life" is a phantom carrier with only 2 alleged enrollees) at 16.1% if CSR payments are made and 39.6% if they aren't. It turns out I was off by a bit, however, because I didn't realize that BCBS of Mississippi was only selling policies off-exchange next year. That means the CSR issue won't impact them either way, since none of their enrollees would receive the assistance anyway.

Haley Byrd of The Independent Journal Review has the skinny about the latest attempt to bribe Alaska Senator Lisa Murkowski into voting for the Graham-Cassidy bill:

  • Alaska (along with Hawaii) will continue to receive Obamacare’s premium tax credits while they are repealed for all other states. It appears this exemption will not affect Alaska receiving its state allotment under the new block grant in addition to the premium tax credits.
  • Delays implementation of the Medicaid per capita caps for Alaska and Hawaii for years in which the policy would reduce their funding below what they would have received in 2020 plus CPI-M [Consumer Price Index for Medical Care].
  • Provides for an increased federal Medicaid matching rate (FMAP) for both Alaska and Hawaii."

Well, now.

Bird doesn't have the actual legislative text, but they threw Hawaii in there as well (not to win their votes...Dems Brian Schatz and Mazie Hirono are solid NOs no matter what). That means that the wording is probably along the lines of:

The Congressional Budget Office stated that they won't be able to provide a full score of the projected 10-year impact of the Graham-Cassidy bill for "at least several weeks". Instead, they expect to provide a partial score, focusing purely on the budget-related stuff necessary to "count" towards Senate reconciliation voting rules "early next week".

What won't be included are some pretty damned important details, like:

  • Impact on the federal deficit
  • Impact on insurance premiums, and of course...
  • Impact on the number of people with health insurance coverage

Unfortunately, Mitch McConnell and Senate Republicans are insisting on squeezing the vote on Graham-Cassidy through within the next 10 days, before the fiscal year ends on Sept. 30th, since that's the only way they have a chance at passing it using 50 votes (after the 30th, they would require 60 votes, which of course they have no chance at getting).

Here's the latest enrollment data from the Louisiana Department of Health.

I've embedded screen shots below, but there's various interactive stuff you can do at the site itself; LA did a very nice job, I'd love it if every state put up a similar "dashboard" style website.

In short:

  • 434,594 Louisianans enrolled in Medicaid via ACA expansion
  • 126,229 have received preventative care
  • 22,058 women have received breast cancer screenings
    • 225 women have been diagnosed with breast cancer as a result of ACA Medicaid expansion
  • 13,994 adults have received a colon cancer screening
    • 4,337 have averted colon cancer by having polyps removed
    • 199 have been diagnosed with colon cancer thanks to ACA Medicaid expansion
  • 3,774 have been diagnosed with diabetes
  • 9,575 have been diagnosed with hypertension
  • 32,912 are receiving outpatient mental health services
  • 6,025 are receiving inpatient mental health services
  • 5,559 are receiving outpatient substance abuse services
  • 6,026 are receiving residential substance abuse services

 

As NBC News reporter Hallie Jackson notes, there are too many quotable lines to count in this Vox piece, in which Jeff Stein tracked down 9 Republican Senators to ask them what the hell the purpose of the Graham-Cassidy bill actually is. The responses pretty much say it all.

Jeff Stein: Senator, I wanted to ask you for a policy-based explanation for why you’re moving forward with the Graham-Cassidy proposal. What problems will this solve in the health care system?

Pat Roberts: That — that is the last stage out of Dodge City...I’m from Dodge City. So it’s the last stage out to do anything. Restoring decision-making back to the states is always a good idea, but this is not the best possible bill — this is the best bill possible under the circumstances.

If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel.

Jeff Stein: But why does this bill make things better for Americans? How does it help?

9/25/17: SEE IMPORTANT UPDATE BELOW!

The fact that the Graham-Cassidy bill, like all of the prior Republican "replacement" healthcare bills, screws over people on both Medicaid and the individual market starting in 2020 is hardly news. A few provisions of the ACA are stripped out and/or bastardized immediately (and some, like the individual mandate penalty, are even repealed retroactively), but for the most part the pain doesn't start for another 2 years, well after the midterms are over.

However, JP Massar called something to my attention this morning:

Graham-Cassidy, Sections 102 and 103:

Section 102: Modification and Repeal of Premium Tax Credits

 

Regular readers know that one of the issues I've spent the better part of the past year yammering on about endlessly is the importance of Congress formally appropriating Cost Sharing Reduction reimbursement payments to the insurance carriers on the individual market exchanges.

Thanks to the ongoing/pending ruling in the federal House vs. Burwell Price lawsuit, Donald Trump has the ability to pull the plug on CSR payments pretty much whenever he wants to (and he's threatened to cut them off every month since around March or April so far). CSR payments hang like a Sword of Damocles over the heads of every exchange-based insurance carrier each month, with them never knowing whether they'll get reimbursed or not.

Pages