(sigh) OK, let's take a look at CMS's "rate drop" claims...

2018 MIDTERM ELECTION

Time: D H M S

Less than 4 weeks away from the midterms, after a year and a half of doing everything possible to tear it down, the Trump Administration is suddenly thrilled with Obamacare. From HHS Secretary Alex Azar's chutzpah-filled Op-Ed in the Washington Post a few weeks back to Donald Trump's 870 word pile of steaming bullshit in USA Today this week, the Trumpsters are now gaslighting to a breathtaking degree.

The latest volley in their attempt to gaslight the country on healthcare is this morning's press release from CMS about 2019 ACA premiums. Let's take a look:

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the average premium for second lowest cost silver plans (SLCSP) for the 2019 coverage year will drop by 1.5 percent, the first time average premiums have dropped since the implementation of the Federally- facilitated Exchange in 2014. Tennessee being the largest with a 26.2 percent reduction. These premium reductions along with increased issuer participation strongly suggest that the numerous actions taken by the Trump administration to stabilize the market are working.

First of all, it's important to clarify that the average 1.5% drop only includes 39 states, and only includes the benchmark Silver plans in each. The state-by-state breakout linked to in the press release also mentions the lowest-cost Bronze plans averaging a 1.0% drop. When you include all policies in those 39 states, both on- and off-exchange, the weighted average is actually a 1.8% increase, and when you include all plans, on and off-exchange, in all 50 states +DC, it's around a 3.1% increase.

I realize that none of these modifications change the larger point, which is that yes, it's still a dramatically different story than it was in years past, so why is CMS fudging their numbers? Simple: From a marketing/PR standpoint, a rate reduction--even if only by one or two percent--sounds much better than a rate increase--even if only by two or three percent. The headline is "rates drop!" vs. "rates only increase a little!", even if there's only a couple percentage point difference between the two.

HOWEVER, this is a fairly minor point. The larger issue is that regardless of how much rates are increasing or, in some states, decreasing in 2019 compared to 2018, they'll still be a whopping 30% higher than they were in 2017, with the vast bulk of that due specifically to sabotage actions taken by the Trump Administration and Congressional Republicans.

While the administration's numbers may vary a bit from mine due to their non-comprehensive data (they leave off the 12 state-based exchanges as well as off-exchange plans, while I include both whenever possible), they flat out admit this in the same press release:

After the Patient Protection and Affordable Care Act (PPACA) regulations took effect in 2014, average individual market premiums more than doubled from $2,784 per year in 2013 to $5,712 on HealthCare.gov in 2017, an increase of $2,928 or 105 percent.1In the HealthCare.gov states, between 2017 and 2018, the average premium for the second-lowest cost silver plan increased by 37 percent. Between 2016 and 2017, the hike in average premiums was 25 percent.

Why yes, average 2018 premiums did jump up dramatically (over 26% on average nationally, and 37% for benchmark silver plans, as CMS itself just admitted). What caused that 37% benchmark increase?

Trump administration policies...specifically, his decision to cut off CSR reimbursement payments in October 2017, which in turn led to roughly 14 points of the 2018 increase, plus another 3 points or so due to other oddball sabotage efforts including slashing the HC.gov marketing budget by 90%, slashing navigator funding by 40% and so forth:

THEN, for 2019, Congressional Republicans repealed the individual mandate penalty while Trump announced he was going to allow carriers to flood the market with junk plans, aka #ShortAssPlans, aka unrestricted "short-term, limited duration" and "association" plans. Combined, these are causing premiums to increase another 9 points or so...even as other factors which have little or nothing to do with Trump Administration actions (with one exception) are lowering 2019 premiums.

With the latter factors cancelling out the former, average 2019 premiums are increasing by around 3%...but they would be dropping by 5-6% without Trump Administration interference.

Here's what all of this looks like visually:

The dotted line shows what average unsubsidized premiums would have looked like if the ACA had never been passed in the first place. This is based on assuming a 9% average annual medical trend, which is actually slightly lower than the actual 9.2% average from 2008 - 2013 (remember, major ACA provisions didn't kick in until 2014).

The blue section shows my best estimates of what average premiums would have been without Trump Administration sabotage efforts both last year and this year. Average premiums would have likely risen just 9% or so in 2018 before dropping back somewhat for 2019, ending up just 3% higher than they were in 2017.

The yellow section shows the real dollar impact of last year's #ACASabotage (mostly CSR payments being cut off): A whopping $79 per month per unsubsidized enrollee, or nearly $950 for the year...plus another $950 or so this year, although that's still a rough projection for now.

Finally, the red section shows the real dollar impact of this year's sabotage (mainly mandate repeal) on next year's premiums: Around $50/month or $600 for the full year per unsubsidized enrollee.

All told, that's either $1,500 or $2,500 (depending on how you look at it) in Trump/GOP sabotage taxes being billed to unsubsidized ACA enrollees over a two year period.

Put another way, the Trump Administration, in collusion with Congressional Republicans, deliberately increased unsubsidized premiums by $1,500 and now wants you to be thankful that they (using their own "1.5%" claim) knocked about $100 off of that.