Charles Gaba's blog

2018 MIDTERM ELECTION

Time: D H M S

EVERYONE in the country should be either calling their Senator at (202) 224-3121 or watching this.

OK, a little more self-serving news...until last week I hadn't been interviewed, quoted or cited by other media outlets for awhile, but with both the #TexasFoldEm lawsuit, the Brent Kavanaugh SCOTUS hearings and the 2019 Open Enrollment Period all coming up fast, I've had one of each of the above happen over the past week:

INTERVIEW: If you want to hear me flap my gums explaining the #TexasFoldEm lawsuit and the implications of it for 40 minutes or so, check out last week's special episode of Hopping Mad podcast with Arliss Bunny and Will McLeod:

The Big News this week is all about the #TexasFoldEm court case (which could potentially destroy the Affordable Care Act as soon as January 2019) and the Brent Kavanaugh SCOTUS confirmation hearings (which could potentially destroy both the Affordable Care Act and the rest of United States as soon as, oh, let's call it within a year or so).

I hope neither of these things happens, of course...but regardless of how things play out, I also hope to still be around to document, analyze and explain the latest healthcare policy drama as it happens for years to come.

ACASignups.net has been kept alive for nearly five years thanks to two main sources: Individual supporters who donate either once or monthly, and banner ads, which are usually generic. Today I'm honored to announce that the Robert Wood Johnson Foundation, one of the most respected sources for healthcare knowledge and education, has also agreed to advertise on this site.

This shouldn't come as a surprise to anyone, of course, but it's actually good to have Vice President Pence state it point-blank:

Vice President Pence said Thursday that Republicans plan to give another try to repealing and replacing ObamaCare if they do well enough in November’s elections.

Pence made the remarks to reporters while in Wisconsin to campaign for GOP Senate candidate Leah Vukmir, saying that if she wins, it would help Republicans with their goal of eventually repealing the health-care law.

“We made an effort to fully repeal and replace ObamaCare and we'll continue, with Leah Vukmir in the Senate, we'll continue to go back to that,” Pence told reporters.

This comes on top of similarly unequivocal statements by several Republican Senators a day earlier:

Back in April, I started an ambitious project which set out to track every legislative or regulatory measure taken by every state to counter, cancel out or mitigate sabotage of the Affordable Care Act by the Trump Administration and Congressional Republicans. It resulted in this color-coded spreadsheet, which lists dozens of bills, proposals, amendments and so on at various stages of completion.

The bad news is that project has proven to be too large for me to keep up with--there's simply too many bills, too many stages and too much other stuff going on for me to keep track of it all.

The good news is that the Center for American Progress (which has slightly more resources than I do) has launched their own version of this project, and it's very slickly done:

Last year, Virginia residents experienced massive amounts of heartburn and ulcers as two major insurance carriers, Optima (Sentara Health) and Anthem (HealthKeepers) played musical chairs with both their 2018 rate filings and which areas of the state they offered plans on.

In May 2017, things didn't look too bad: Both Anthem and Optima were available in fairly large chunks of the state, and while Anthem wanted to raise rates an ugly 38% on average, Optima was only looking to increase rates by around 10-11%.

Hat tip to Louise Norris for the heads up about the Kentucky Dept. of Insurance issuing their final rulings for 2019 ACA individual market and small group policy premiums:

DOI Completes Review of Individual and Small-Group Health Insurance Rate Filings

The Kentucky Department of Insurance (DOI) announced today that it has completed its review of the individual and small-group insurance rates filed in the Kentucky market. The rates will be used to calculate insurance premiums in the 2019 benefit year.

Kentuckians in the individual market will once again experience changes in premiums and plan offerings. The rates that will be used reflect an average rate increase of 4.3 percent for Anthem Health Plans of Kentucky (Anthem) and 19.4 percent for CareSource. Since the actual premium charged will vary by individual and the plan level selected, some individuals may see a decrease in rates.

via Amy Lotven of Inside Health Politics...

Ethics Prof Says TX Judge's Attendance At Federalist Society Event Doesn't Cross Line
August 28, 2018 

The judge overseeing the high-profile case over the constitutionality of the Affordable Care Act, which could potentially land at the Supreme Court, is slated to attend a Federalist Society event featuring Supreme Court Justice Clarence Thomas -- and several members of the federal circuit court of appeals that would review the case before it landed at the high court. A key ethic professor suggests the Texas' judge's appearance at the event does not cross any lines.

Judge Reed O'Connor is also slated to monitor a panel entitled “Trump, Sessions and the States,” during the Texas Chapter meeting on Sept. 8, just days after the Sept. 5 arguments in the federal Texas court are scheduled.

Inside Health Policy asked ethics experts whether O'Connor's appearance pushed the envelope on judicial ethics, and those that responded generally suggested his appearance at the event is not an issue.

Breaking News via the Lincoln Journal Star...

A Lancaster County District judge has dismissed a challenge to the Medicaid expansion petition initiative, allowing the initiative to be placed on the November ballot.

The lawsuit was brought by former state Sen. Mark Christensen and Sen. Lydia Brasch. They alleged the initiative was an unconstitutional delegation of legislative authority, contained more than one subject, which the state Constitution prohibits, and that it failed to identify Nebraska Appleseed as a sworn sponsor.

Last week, Secretary of State John Gale confirmed that enough signatures were gathered by petition circulators to put the question of whether to expand Medicaid to about 90,000 uninsured adult Nebraskans on the Nov. 6 ballot. 

...The campaign has said Medicaid expansion will create and sustain 10,000 new jobs, reduce medical bankruptcies, bring $1.1 billion of Nebraskans’ tax dollars back from Washington, D.C., and produce savings by reducing uncompensated care for those who lack health coverage.

This just in from the Florida Office of Insurance Regulation...

OIR Announces 2019 PPACA Individual Market Health Insurance Plan Rates  

TALLAHASSEE, Fla. – The Florida Office of Insurance Regulation (OIR) announced today that premiums for Florida individual major medical plans in compliance with the federal Patient Protection & Affordable Care Act (PPACA) will increase an average of 5.2 percent beginning January 1, 2019. Per federal guidelines, a total of nine health insurance companies submitted rate filings for OIR’s review in June with final rate determinations due by August 22, 2018. 

Following OIR’s rate filing review, the average approved rate changes on the Exchange range from a low of -1.5 percent to a high of 9.8 percent. This information can be located in the Individual PPACA Market Monthly Premiums for Plan Year 2019 document available here.

When I first ran the preliminary 2019 ACA individual market rate filings for Virginia way back in May, I concluded that the average premium increase will be around 13.4%. However, a lot has changed since then.

For one thing, Virginia expanded Medicaid to 400,000 low-income residents, which should help improve the ACA risk pool and in turn knocked the average rate increase down by 2.2 points, to around 11.3%.

For another, Anthem made a last-minute decision to expand their coverage areas in the state dramatically, which also provides much-needed competition for Optima in the Charlottesville area, among others.

With the deadline for submitting 2019 rate filings having passed a week or so ago, the approved rates from the various state insurance regulators have been popping up left and right. Today I took a look at the Arkansas Insurance Dept. website and sure enough, they've posted the approved filings for all 4 carriers on the individual market (as well as the small group market).

On the one hand, the statewide average rate increase hasn't changed much from the preliminary average; it dropped 0.4 points from 4.5% to 4.1%...and some of that change is simply because I had misestimated the actual enrollment/market share for a couple of the carriers.

On the other hand, in Arkansas, at least, it appears that the carriers don't think the repeal of the individual mandate and/or the Trump Administration's expansion of short-term and association health plans will have nearly as big of an adverse selection impact as other estimates/projections have...including my own.

It's been awhile since I last updated my "ACA Protection Spreadsheet", which is an attempt to track a whole mess of bills designed to protect the Affordable Care Act from sabotage at the federal level by the Trump Administration and Congressional Republicans. My last update was over a month ago, when Hawaii's Governor signed a law which locks in several ACA protections, including:

  • Ensure that young adults can continue to remain on their parents’ health insurance plans until age 26
  • Prohibit insurers from using applicants’ gender to set premiums
  • Prohibit insurers from rejecting an application based on an applicant’s medical history, or imposing coverage exclusions based on pre-existing conditions.

Today, however, there were major developments regarding #ShortAssPlan restrictions (and a few other important patient protection bills) in three states: Two positive, one negative.

CALIFORNIA:

There were several stories over the past few days about a new, just-released report from the General Accounting Office (GAO) which examined how well/poorly the Trump Administration handled the 2018 Open Enrollment Period last year.

Many of the findings were things which I had been either predicting or documenting all year:

  • Enrollment through Healthcare.gov Was 5 Percent Lower in 2018 than 2017
  • Stakeholders Reported That Plan Affordability Likely Played a Major Role in Enrollment
  • HHS Reduced Consumer Outreach for 2018 and Used Problematic Data to Allocate Navigator Funding
  • HHS Did Not Set Numeric Enrollment Targets for 2018, and Instead Focused on Enhancing Certain Aspects of Consumers’ Experiences

We identified a list of factors that may have affected 2018 healthcare.gov enrollment based on a review of Department of Health and Human Services information, interviews with health policy experts, and review of recent publications by these experts related to 2018 exchange enrollment.

Factors related to the open enrollment period:

With the idiotic #TexasFoldEm lawsuit coming up for oral arguments in just two weeks and the midterms in just ten, Senate Republicans appear to be in a bit of a panic over how to deal with the massive negative fallout if they win their court case (technically it was brought by 20 GOP attorneys general, not the Senators themselves, but they've spent the past 8 years trying to accomplish the same goal).

As a quick reminder: The #TexasFoldEm case uses the World's Flimsiest Excuse to try and eliminate the Affordable Care Act's critical health insurance coverage protections for the 130 million Americans who have pre-existing conditions.

In response, Republican Senators Tillis, Alexander, Grassley, Ernst, Murkowski, Cassidy, Wicker, Graham, Heller and Barrasso have introduced a new bill which they claim would ensure pre-existing coverage protections. Unfortunately, it...doesn't.

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