UPDATE 2/17/18: I've also embedded the full speech of Cameron Kasky's fellow Stoneman Douglas student Emma Gonzalez, who gave one hell of an impassioned speech today at a rally.

I'm incredibly impressed by students like Kasky, Gonzalez, as well as David Hogg (a student reporter who actually recorded interviews with the students while they were hiding from the murderer and Sarah Chadwick, who's pretty much obliterated Donald Trump and the NRA on Twitter. These "kids" are far more mature, eloquent and savvy about what's going on than most adults and should be listened to.

This isn't normally the sort of thing I write about, but gun violence is absolutely a healthcare policy issue, whether you're talking about the physical injuries, rehabilitation, mortality rates, psychological/emotional trauma or, of course, mental health. But even if it wasn't, I really don't care; I'm posting this anyway:

UPDATE 2/18/18: I noted in my original post last night that "it's important to note that the [3/14] walkout doesn't appear to have started with the Stoneman Douglas students themselves, but the Women's March folks. Or perhaps it was suggested to them by some students, I don't really know."

Well, it sounds like there may have been a bit of message co-opting, well-intentioned though it may have been. Apparently there's a third date being touted for a different event: #MarchForOurLives, on March 24, nationally...and this one is officially endorsed/touted by the students themselves, which I think is critically important:

Last November, along with voting to keep a Democrat in the Governor's office, Virginia voters also swept a huge wave of Democrats into office in the state legislature. They didn't quite take a majority, but they came within a single vote of taking the state Assembly, matching their one-vote shortfall in the state Senate.

New Governor Ralph Northam has solidly promised to finally push through ACA Medicaid expansion for 400,000 Virginians, but those one-vote margins have made doing so incredibly frustraing. Fortunately, it looks like the dam may have finally been broken:

A prominent Republican state legislator from southwest Virginia announced his support Thursday for expanding Medicaid, an about-face that could make it easier for other rural conservatives to get on board after four years of steadfast opposition.

As everyone's heard by now, there was ANOTHER horrific school massacre by a white supremacist Trump supporter, this time at Stoneman Douglas High School in Parkland, Florida. Seventeen students and teachers were murdered, and another fourteen were wounded and hospitalized.

In a sickly ironic bit of timing, just an hour or so 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.

From October 17,2017:

On the other hand, assuming there isn't enough time to re-set the premiums back to "CSRs funded" levels for 2018, that means that prices will spike for next year [2018]...and then presumably would drop by about 15-20% starting in 2019, just in time for the midterms. If that happens, I guarantee that the GOP will run around trying to claim that they "fixed" Obamacare and "saved" the American public from spiraling premiums, bla bla bla. Of course they'll try to do that whether it kicks in for 2018 or 2019, but if prices go up this year and drop next, it'll make for much more dramatic campaign ads.

Trump, of course, will claim to have "saved" (or even "repealed") Obamacare no matter when anything kicks into effect. If the deal falls through, of course, he'll once again blame everyone but himself as he always does.

Cut to February 15, 2018: (via Stephanie Armour of the Wall St. Journal)

 

From the Cabinet Meeting scene in the comedy "Dave":

DAVE: Now the Commerce Department..,

SECRETARY OF COMMERCE (sitting erect): Yes, Mr. President?

DAVE (from a card): You're spending forty-seven million dollars on an ad campaign to... (reading) 'Boost consumer confidence in the American auto industry.'

SECRETARY OF COMMERCE: Um...yes, sir...it's designed to bolster individual confidence in a previous domestic automotive purchase.

DAVE: So we're spending forty-seven million dollars so someone can feel better about a car they've already bought?

SECRETARY OF COMMERCE: Yes, sir, but I wouldn't characterize it that way...

DAVE (indignant): Well I'm sure that's really important, but I don't want to tell some eight- year-old kid he's got to sleep in the street because we want people to feel better about their cars. (beat) Do you want to tell him that?

SECRETARY OF COMMERCE (quietly): No sir...(looks at TV cameras)...no sir, I sure don't.

Freedom's just another word for..."better not get sick."

In Idaho, "Freedom" comes with limits
— Zachary Tracer (@ZTracer) February 14, 2018

— Katherine Hempstead (@khemp64) February 14, 2018

Two weeks ago, Idaho Governor "Butch" Otter issued an executive order allowing insurance carriers to basically just ignore federal law altogether and start offering non-ACA compliant healthcare policies. As Sarah Kliff of Vox.com noted at the time:

OK, let me get this out of the way up front: Yes, this is pretty self-serving of me, and kind of stupid, but it's something which has been bugging me for four years now, so I finally decided to do something about it.

As longtime readers know, ACA Signups didn't start out as a full website. Originally it consisted entirely of a Google Docs spreadsheet with a domain name pointing to it. The domain wasn't even ACASignups.net; I started out using ObamacareSignups.net, which still repoints to the site today. I changed it after the first month or so not because I have a problem with "Obamacare" but because ACASignups.net is simply faster to type out.

The ACA Signups project actually started out as a series of blog posts over at Daily Kos, one of the largest online progressive political sites in the country, where I had already been posting under the name Brainwrap on any number of issues for nearly a decade.

Healthcare reporter extraordinaire Margot Sanger-Katz has been picking through the horror show known as Donald Trump's proposed annual federal budget, and it's every bit as awful as you might expect:

The first one I already wrote about this morning...

The White House’s preferred Obamacare replacement now appears to be Graham-Cassidy.
https://t.co/stjZMYSeMO pic.twitter.com/wS62MkbgVp

— Margot Sanger-Katz (@sangerkatz) February 12, 2018

In a surprise to no one, Planned Parenthood would appear to be defunded...

This would be a big policy change. pic.twitter.com/1UoylIyHRJ

 

Hot Off the Presses, via Kimberly Leonard of the Washington Examiner...

President Trump’s budget plan released Monday endorsed an Obamacare repeal and replace bill that gives funding to states and makes cuts to Medicaid.

...Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., are behind the legislation that takes Obamacare’s funding for the Medicaid expansion and tax subsidies for lower premiums and gives it to states through block grants. The senators introduced the bill in September along with Sens. Ron Johnson, R-Wis., and Dean Heller, R-Nev.

The bill would end the Medicaid expansion under Obamacare but supporters say states can implement it individually if they want. However, the bill makes cuts to Medicaid overall by capping federal funding per beneficiary.

The bill failed to get enough support in Congress in September, as some senators from expansion states worried about Medicaid cuts and protections for people with pre-existing conditions.

(sigh) One More Time, folks...

According to this article from last May, the total budget for operating HealthCare.Gov, the federal ACA marketplace/exchange which covers 39 states,was around $2.1 billion in 2016. Donald Trump proposed slashing the budget down by about 20% to $1.7 billion in 2017.

Where does that money come from? Well, HealthCare.Gov, the federal ACA marketplace/exchange which covers 39 states, is not funded out of the general federal budget. Instead, it's funded by assessing a 3.5% premium surcharge on policies sold on it.

OK, that's not quite true; the 3.5% only applies to the 34 states which are fully operated by the federal exchange; there are 5 states (Arkansas, Kentucky, Nevada, New Mexico and Oregon) which have their own exchange operations but "piggyback" on HC.gov's technical platform; those states were charged just 1.5% of premiums in 2017 and 2.0% for 2018. However, those 5 states combined only make up around 5% of all HC.gov enrollments, so the lower fees only knock perhaps 2% off the total user fee revenue.

Hey, remember this?

So @SenatorCollins sold out for bills which won’t help much and aren’t gonna happen anyway.@jeffflake sold out for a promise to attend a meeting which won’t happen.@lisamurkowski sold out for destroying her own environment.@SenJohnMcCain sold out for...nothing at all. Huh.

— Charles GetCoveredBa (@charles_gaba) December 3, 2017

 

On October 1st, 2013, the first Open Enrollment Period (OE1) under the Affordable Care Act kicked off to much hoopla. As everyone knows, the largest of the ACA exchange websites, HealthCare.Gov, infamously melted down at launch due to a multitude of hardware and software problems ranging from insufficient server capacity to poor workflow design to buggy coding and much, much more. However, as Steven Brill detailed in the March 10, 2014 issue of Time magazine, by early December, the worst of the problems had been resolved, and by the time the second Open Enrollment Period came along a year later, HealthCare.Gov had been completely overhauled, with additional improvements and enhancements every year since.

The difference has been dramatic: On October 1, 2013, only six people (not six thousand or six hundred...six) were able to actually make it all the way through the HC.gov interface and enroll in a healthcare policy. On December 15, 2016, six hundred and seventy thousand enrolled.

 

May 11, 2015:

Wellmark spurns Obamacare exchange, but two competitors don't

Moderate-income Iowans who want to use Affordable Care Act subsidies to purchase health insurance still won't be able to choose policies from Wellmark Blue Cross & Blue Shield next year. But they should be offered policies from at least two competitors.

April 25, 2016:

Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies.

One of the most popular provisions of the Affordable Care Act's Three-Legged Stool's "Blue Leg" is the prohibition of caps on annual or lifetime benefits. When you consider that a baby born prematurely or a cancer patient undergoing chemotherapy can eat up several million dollars worth of care within a few months, this makes perfect sense. Even a moderately wealthy family can be brought down by high medical costs, and a middle class family can be financially wiped out. If you're lower income, don't even get me started.

Naturally, the Trump Administration's response to everything above is "Hmmmmm...screw all that:"

After approving Medicaid work requirements, Trump’s HHS aims for lifetime coverage limits

After allowing states to impose work requirements for Medicaid enrollees, the Trump administration is now pondering lifetime limits on adults’ access to coverage.

Pages