GRAHAM-CASSIDY REPEAL BILL DEADLINE:

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OE5

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):

I've written not one, not two, but three different blog entries in the past 24 hours about Bernie Sanders' just-announced "Medicare for All" proposal...but the reality is, I shouldn't have. Frankly, while it's a discussion/debate that we do need to have, making a big thing about it right this moment is, the more I think about it, terrible timing, because the Affordable Care Act is still in being attacked and at risk in several ways:

  • FIRST: The CSR issue still hasn't been resolved, although at this point it's extremely unlikely that Patty Murray and Lamar Alexander are going to pull a CSR/reinsurance rabbit out of their hats after all. Last week things looked somewhat promising, but this week it appears to have gone off the rails again...and with just 17 days left in the fiscal year (and, I believe, only 14 days before the contracts have to be signed by carriers for 2018 exchange participation), there's almost no time left to get even a minor stabilization bill pushed through.
  • SECOND: On a related note, Bill "so much for the Jimmy Kimmel test!" Cassidy and Lindsey Graham are still trying to cram through their pile-of-garbage Hal Mary Trumpcare bill, which is at least as bad as the GOP's failed AHCA/BCRAP bills were earlier this year and even worse in some ways. Again, there's only 17 days left to pull it off, but remember what happened with AHCA last spring...anything's possible. Here's a summary of the impact of the Cassidy-Graham bill via Andy Slavitt and the Centers for Budget & Policy:

If you look at the top of the website today, you'll notice a couple of new graphics, both relating to the Indivisible ACA Signup Project.

The short version is this:

Donald Trump is cutting ACA outreach, so we've started an Indivisible-based, state-by-state sign-up project group to counter the sabotage.

All you need to do (should you agree) is use social media to update people (on your advocacy and/or personal pages) in your state on key issues and dates/deadlines for sign-ups.

That's pretty much the whole thing in a nutshell, at least so far. It's a closed Facebook Group which you need to request permission to join, but they obviously want the materials to be disseminated as widely as possible (that's kind of the whole point!), so I've agreed to set up a permanent, public link for folks to access them.

A week ago, Vox's Sarah Kliff reported that the Trump Administration was slashing the 2018 Open Enrollment Period advertising budget by 90% and the navigator/outreach grant budget by nearly 40%. As I noted at the time, the potential negative impact of these moves on enrollment numbers this fall--coming on top of the period being slashed in half, the CSR reimbursement and mandate enforcement sabotage efforts of the Trump/Price HHS Dept. and the general confusion and uncertainty being felt by the GOP spending the past 7 months desperately attempting to repeal the ACA altogether could be significant. In states utilizing the federal exchange (HealthCare.Gov), 2017 enrollment was running neck & neck with 2016 right up until the critical final week...which played out under the Trump Administration, which killed off the final ad/marketing blitz.

Result? A 5.3% total enrollment drop (or 4.7% if you don't include Louisiana, which expanded Medicaid halfway through the year) via HC.gov, while the 12 state-based exchanges--which run their own marketing/advertising budgets--saw a 1.8% increase in total enrollment year over year.

Thanks to Louise Norris of healthinsurance.org for saving me the trouble of tracking all of the state exchange deadlines down. It's possible that a few more state-based exchanges (CT, ID, MD, NY & VT) could also extend their open enrollment deadlines beyond the official one on the federal exchange, but here's where things stand as of today (I'll update the graphic as necessary). Feel free to share widely.

Update 9/7/17: Two more state-based exchanges have chimed in: Vermont has clarified that they're sticking with December 15th, 2017; New York issued a press release that they're joining California & DC in extending Open Enrollment all the way through January 31st, 2018. The graphic below has been updated to include the New York extension.

ACA Signups isn't normally known for "big scoop" stories. Yes, I'm often the first one to openly post analysis and/or debunking of information/data/claims which have already been made public, but I'm not usually the first one to actually make the underlying data itself public in the first place.

This is an exception to that rule.

I've recently acquired documentation related to last weeks' shock announcement by the Trump Administration's Centers for Medicare & Medicaid that they're slashing the advertising/marketing budget for HealthCare.Gov for the upcoming 2018 Open Enrollment Period by 90%...as well as cutting the in-person outreach program budget by nearly 40%.

I've confirmed the veracity of these documents, and the claims related to them seem to be on the level.

According to my source, these are signed orders instructing the grant awarding officer to distribute $60,000,000 in grants with an effective date and time of August 31st, first thing in the morning.

Lori Lodes used to be Communications Director for the Centers for Medicare & Medicaid until last year under President Obama. As such, a big part of her job was administering ACA outreach efforts.

This evening, upon learning of the Trump administration's announcement that they're slashing advertising budget by 90% and outreach/navigation assistance funding by 39%, she was...not pleased. She took to Twitter to get a few things off her chest.

Instead of embedding a bunch of full Tweets, I'm pasting in the actual text of her thread to give the full picture:

Time to put on my "I used to run outreach for Obamacare" hat and talk about the Admin's decision to gut outreach and education.

***note*** This thread is long and barely touches on just how bad the impact of the Admin's decision will be.

First, it's the job of the government - in regs and everything - to educate people about signing up for health care.

Second, slashing navigator funding in a 3 yr cycle from $67m (2016) and $63m (2017) to $33m (2018) will mean that fewer people get covered.

via Sarah Kliff of Vox.com:

Trump is slashing Obamacare’s advertising budget by 90 percent

The White House will also cut the in-person outreach program by $23 million.

The Trump administration plans to deeply cut Obamacare outreach and advertising, officials announced Thursday.

Trump will reduce Obamacare advertising spending 90 percent, from the $100 million that Obama administration spent last year to $10 million this year. It will also cut the budget for the in-person enrollment program by 39 percent.

Administration officials cited “diminishing returns” from outreach activities. In a phone call with reporters, they said that most Americans already know about the Affordable Care Act.

As a reminder, here's what happened back in January, when Trump pulled the plug on advertising for HealthCare.Gov in the final, critical week of the 2017 Open Enrollment Period:

(I stole "Kasichlooper" from Zachery Tracer)

Right on top of the letter sent by all twelve state-based exchange heads to the Senate HELP Committee comes a similar open letter signed by eight sitting Governors to all four Congressional leaders (McConnell/Ryan & Schumer/Pelosi). It includes 5 Democratic Governors, but also 2 Republicans and one Independent.

The effort was spearheaded by Republican John "Yeah, he's definitely primarying Trump in 2020" Kasich of Ohio and Democrat John Hickenlooper of Colorado, but also includes Brian Sandoval (GOP, NV); Tom Wolf (Dem, PA); Bill Walker (Indy, AK); Terry McAuliffe (Dem, VA); John Bel Edwards (Dem, LA); and Steve Bullock (Dem, MT).

Here's a partial version of the letter with the meat of the asks:

Immediate federal action to stabilize markets.

via Robert Pear, New York Times:

A Trump administration official said Wednesday that the administration wanted to stabilize health insurance markets, but refused to say if the government would promote enrollment this fall under the Affordable Care Act or pay for the activities of counselors who help people sign up for coverage.

The official also declined to say whether the administration would continue paying subsidies to insurance companies to compensate them for reducing deductibles and other out-of-pocket costs for low-income people. Without the subsidies, insurers say, they would sharply increase premiums.

The administration, the official suggested, will do the minimum necessary to comply with the law, which Mr. Trump has called “an absolute disaster” and threatened to let collapse.

The following letter was just sent to GOP U.S. Senator Lamar Alexander and Dem U.S. Senator Patty Murray of the HELP (Health, Education, Labor & Pensions) Senate Committee:

Dear Chairman Alexander and Ranking Member Murray:

Thank you and members of the Senate Health Education Labor and Pensions Committee for your commitment to hold September hearings on actions that Congress should take to stabilize and strengthen the individual health insurance market. The State Health Exchange Leadership Network, an association of state leaders dedicated to the implementation and operation of the state-based health insurance marketplaces, appreciates this opportunity to submit testimony.

File this one under "Be Careful What You Wish For".

Just a couple of days ago I reported that the New York Dept. of Financial Services had issued their approved 2018 rate changes for the 15 insurance carriers participating in the state's individual and small group markets...and, in some welcome news, they whittled down the rate increases by a bit, from 17.7% on average to 14.5% on average in the individual market, and from 11.7% to 9.3% in the small group market.

Then, the very next day, Zach Tracer of Bloomberg News broke this story:

New York State’s biggest hospital system plans to stop selling Obamacare plans, blaming a costly plank of the law and uncertain prospects for a fix amid a wider Washington brawl over health care.

Over at Balloon Juice, David Anderson has whipped up a nifty little graph which attempts to break out just which ACA exchange enrollees would be positively or negatively impacted by the CSR reimbursement brouhaha under different scenarios.

As I noted last month with my "Silver Switcharoo" explainer, for carriers which remain in the ACA exchanges next year, there's three potential scenarios which could happen (well, four, actually, if you include "Congress manages to sneak a full CSR appropriation bill into law just under the wire", although that seems pretty unlikely at this point given the time crunch and the fact that it'd need a 2/3 majority in both the House and Senate to avoid being vetoed by Trump anyway):

Quick recap: As of 2013, the pre-ACA individual market consisted of around 10.7 million people. The vast majority of the policies these folks were enrolled in were not ACA-compliant for one reason or another, including not covering one or more of the 10 Essential Health Benefits (EHBs) required by the ACA, having annual/lifetime caps on benefits or any number of other reasons.

Under ACA regulations, non-compliant policies which people were enrolled in prior to March 2010 (when President Obama signed the ACA into law) were grandfathered in...that is, insurance carriers could continue to offer them to existing enrollees for as long as they wanted to, and existing enrollees could stay on them for as long as they wished, but they couldn't be offered to anyone else, and once a current enrollee dropped out of a grandfathered plan they aren't allowed to rejoin it later on. The number of "grandfathered" enrollees has gradually declined since 2013, of course, as people either move to other coverage, die off (hey, it happens) or the carriers decide to discontinue the policies altogether.

As I noted earlier today, there’s a gazillion ways the Trump Administration could sabotage (and in some cases, is already sabotaging) the 2018 Open Enrollment period this fall, doing everything in their power to dampen, obstruct and otherwise minimize the number of people who actually enroll in a healthcare policy via the federal ACA exchanges.

However, as I've noted before (and as the CBO confirmed last week), due to the confusing, inside out way in which the APTC and CSR subsidy formulas happen to work, there's also the potential for one of the most pressing sabotage schemes by Trump and the GOP to backfire completely, leading to the potential for a significant increase in ACA exchange enrollment.

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