GRAHAM-CASSIDY REPEAL BILL DEADLINE:

Time: D H M S

Trumpcare

This is rather amazing, really. With all the dramatic twists and turns that the Trumpcare/AHCA debacle has taken in the 3 months since it was slapped together by Paul Ryan & Co., you'd think that there would be some movement of the approval numbers, wouldn't you?

Well, technically there has been: It went from 17% approval in March to 21% approval in May...

...and as of last week, had dropped right back down again to the same 17% it started out with:

American voters disapprove 62 - 17 percent of the Republican health care plan, compared to a 57 - 20 percent disapproval in a May 25 Quinnipiac University poll. Today, Republicans approve of the health care plan 42 - 25 percent, as every other listed party, gender, education, age or racial group disapproves by wide margins. 

UPDATE: Some people are crediting me with creating the "3-legged stool" metaphor, which simply isn't the case; that credit goes to (I believe) MIT Economics Professor Jonathan Gruber, who came up with the metaphor back in 2006 while helping develop Mitt Romney's "RomneyCare" model for Massachusetts, which was the basis for the ACA's exchange model for the individual insurance market.

I'm simply expanding on the metaphor to explain some of the terms and concepts which are swirling around these days during the repeal/replace brouhaha.

So, I got back from my trip to the NIHCM awards dinner in DC late last night, and am groggily attempting to bone up on all the healthcare stuff which happened while I was gone (ironic, of course, given that I was attending a healthcare-related event filled with other healthcare wonks/reporters).

In the past 2 days...

I've been warning for months now that the Trump administration is doing everything possible to disrupt, undermine and otherwise sabotage the ACA exchanges as much as possible. Yes, the GOP in general has been doing so for 7 years now, but they've really shifted it into overdrive now that they hold all the cards.

In the past, some of those sabotage efforts were obvious and had a direct impact on the exchanges (the Risk Corridor Massacre, for instance) while others were smaller, less obvious and harder to pinpoint a precise cause/effect relationship (red states attempting to obstruct ACA navigators, for example). Donald Trump and his rogue's gallery of cretins are not exactly known for their subtlety, however, so his obstruction/sabotage efforts have been pretty blatant, including:

Last week Donald Trump's new Assistant Secretary for Planning & Evaluation, Stephen Parente (an avowed and open opponent of Obamacare) issued a hit piece on the ACA just one day ahead of the Congressional Budget Office's devastating report on the GOP's AHCA "replacement" healthcare plan.

The ASPE report made a simple claim: That average individual market premiums have more than doubled since ACA-compliant policies were launched in 2014. It plugged in the average individual market premiums for this year and compared them against the average indy market premiums for 2013 (the last year before all newly-enrolled policies had to be ACA compliant). It only included the 39 states maintained by the federal exchange, HealthCare.Gov, and concluded that on average, monthly premiums had increased from $224 in 2013 to $476 in 2017...a 105% increase over 4 years.

IMPORTANT: ALL ESTIMATES BELOW are based on the CBO score of the HOUSE GOP version of the Trumpcare bill (AHCA).

Here's the updated link to the state/district breakout of the SENATE GOP version of Trumpcare (BCRAP) as of 6/27/17.

ALL 435 CONGRESSIONAL DISTRICTS NOW INCLUDED (broken out by state)

(this is Part Two of my analysis of the CBO score of AHCA 2.0 (the version which actually passed the House 3 weeks ago). Part One is here.

OK, digging into the PDF itself, let's see what else there is of interest... (this is a blog post in progress...check back for frequent updates...)

Here's a list of what HASN'T changed from the "1.0" version of the AHCA:

In this cost estimate, as in the preceding estimates, the budgetary effects related to health insurance coverage would stem primarily from the following provisions:

  • Reducing the federal matching rate for adults made eligible for Medicaid by the ACA to equal the rate for other enrollees in the state, beginning in 2020.

Goodbye 90% Federal funding! States would have to pony up anywhere from 25-50% of the funding if they wanted to keep those folks covered.

 

UPDATE 4:30PM: SCROLL DOWN FOR THE ANALYSIS OF THE CBO SCORE.

Yes, this is it, kids...the Big Day all healthcare wonks have been waiting for: The Congressional Budget Office is releasing their score of the final version of the AHCA (that is to say, the version which was actually voted on and passed by a whisker 3 weeks ago) later on today.

Remember, Paul Ryan and the House GOP insisted on ramming the vote through before the CBO score came out, which means that due to the way Congressional budget rules work, depending on how much the CBO think the final changes to the bill impact the budget, they may have to go back and make more changes which would require another vote in the House...and that's all before it moves onto the Senate, where the GOP Senators have already said they plan on starting from scratch anyway. Fun times!

via Bob Herman of Axios:

Health Care Service Corp. — the parent company of the Blue Cross and Blue Shield affiliates in Illinois, Montana, New Mexico, Oklahoma and Texas — recorded an $869 million profit in the first quarter of 2017, according to the company's latest financial documents. That was a $1.3 billion turnaround after HCSC lost $442 million in the first quarter of 2016.

How to interpret this: The Affordable Care Act exchanges in some areas are hurting, but overall are not imploding. Many insurance companies continue to do well (like Florida Blue) or are turning things around (like HCSC). And HCSC carries a lot of weight, since it covers nearly 1.1 million people in ACA plans and is the largest Blue Cross and Blue Shield company after Anthem.

Something to consider:

Note: Given the time constraint--today is the deadline for submitting a letter--I've stolen some of the following from Andrew Sprung:

Topher Spiro of the Center for American Progress acquired a letter from Senate Finance Committee Chair Orrin Hatch to healthcare "stakeholders," inviting their input by May 23 on Republican senators' efforts to write an ACA repeal bill. Hatch asked that letters be sent to HealthReform@Finance.Senate.gov.

Since the Republican senators' bill-writing process is as secretive and rushed as the House's, Spiro seized the opportunity to encourage non-privileged "stakeholders" -- all of us -- to send their two cents to the email address provided. He has offered to tweet any letters tweeted at him, with a screenshot.

Here's mine:

Dear Members of the Senate Finance Committee:

via Kayla Tausche of CNBC:

The House of Representatives and Department of Justice plan to ask the DC federal appeals court to keep on hold for another 90 days a lawsuit that questions the legality of cost-sharing subsidies in the Affordable Care Act, according to four people familiar with the matter.

The White House, during that time, will continue to make payments to insurers, according to a senior administration official.

OK, assuming they do indeed ask for this, and assuming the court grants a third 90-day extension, this means that CSR reimbursement payments can continue for another 3 months. That's the good news.

Insurers planning to offer plans on the exchanges in 2018 must submit their pricing in the coming days and weeks.

This is the actual headline of an actual article posted on Breitbart.com right now:

I'm loathe to link to the article itself (I did include one somewhere on this page, feel free to look for it), but a Google search will bring it up. Even more remarkably for Breitbart, much of it is actually pretty darned accurate:

Obamacare will go into a death spiral on May 22 if the Trump administration chooses not to continue fighting in court to preserve cost-premium subsidies that were ruled illegal last year.

On May 12, 2016, U.S. District Court Judge Rosemary M. Collyer ruled House v. Burwell that the Obama Administration’s payment of cost-sharing subsidies without congressional approval was a violation of the Constitution’s Appropriations Clause.

 

About 5 weeks ago I noted that organizations representing pretty much the entire healthcare industry sent urgent letters to Donald Trump, HHS Secretary Tom Price, Treasury Secretary Steven Mnuchin, OMB Director Mick Mulveney and current CMS Administrator Seema Verma...basically, every major healthcare-related administration figure...practically begging them to fund the goddamned Cost Sharing Reduction reimbursements.

They made it crystal clear how vitally important doing this was, and Trump grudgingly went ahead and made the April payment, then later indicated that he was "probably" going to keep reimbursing carriers for the CSR funds legally owed to them on an ongoing basis, at least until the House vs. Price (formerly House vs. Burwell) lawsuit appeal process was completed.

Over at the L.A. Times, Noam Levey has a fantastic story which underscores everything I've been shouting from the rooftops for months now regarding Trump/GOP sabotage of the ACA exchanges, through both active and passive measures:

Health insurers and state officials say Trump is undermining Obamacare, pushing up rates

Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues.

At the same time, state insurance regulators — both Democrat and Republican — have increasingly concluded they cannot count on the Trump administration to help them ensure that consumers will have access to a health plan next year.

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