Charles Gaba's blog

Regular readers know that I've been calling for Congress to #KillTheCliff for years:

Once again: Under the ACA, if you earn between 100-400% FPL (between $12,140 and $48,560 for a single person), you're eligible for APTC assistance on a sliding scale. The formula is based on the premium for the Silver "benchmark" plan available in your area, which averages around $611/month in 2019.

Here's how the formula works under the current ACA wording:

...Here's the problem: If they earn exactly 400% FPL ($48,560), they'll also only have to pay 9.86% ($4,802), receiving $2,530 in subsidies for the year....

 

I don't know what the status is of H.R. 5155 (the House Democrats catch-all "ACA 2.0" bill which I've been pushing for awhile now), but it looks like individual elements of it are also in the works as standalone bills:

HEARING ON “STRENGTHENING OUR HEALTH CARE SYSTEM: LEGISLATION TO LOWER CONSUMER COSTS AND EXPAND ACCESS”

Date: Wednesday, March 6, 2019 - 10:00am
Location: 2123 Rayburn House Office Building
Subcommittees: Health (116th Congress)

The Health Subcommittee with hold a legislative hearing on Wednesday, March 6, at 10 am in the John D. Dingell Room, 2123 Rayburn House Office Building. The hearing is entitled, “Strengthening Our Health Care System: Legislation to Lower Consumer Costs and Expand Access.” The bills to be the subject of the legislative hearing are as follows.

Over at Balloon Juice, David Anderson notes that the Blue Cross & Blue Shield Association has released their own "ACA 2.0" proposal...and many elements line up pretty closely to my own vision of what ACA 2.0 should look like as well as both the House (H.R. 5155) and Senate (S.2582) Dem versions. Here's Anderson's summary of the BCBSA proposal:

  • Younger adults pay a lower percentage of their income (at a given level) for the benchmark plan
  • Older adults are held harmless
  • All individuals, regardless of income, are eligible for subsidy assistance
  • CSRs appropriated
  • CSRs expanded
  • Full advertising and outreach funded
  • Health insurance premium tax suspended

...It looks like the insurers are trying to lay markers for where they want to see things in 2021 or 2022. They are looking at a fix and expansion of the current paradigm instead of a complete replacement of the system.

A big shout-out to Josh Dorner for providing a roundup of the current status of a five different lawsuits (six, really, although two of them are on the same topic in two different states) fighting back against GOP/Trump Administration sabotage of the Affordable Care Act, including:

There's also the various CSR reimbursement payment lawsuits filed by various insurance carriers. Those should have been a fairly minor issue only relating to about $2 billion in payments dating back to the 4th quarter of 2017...but as I explained in detail here, these suits may instead turn into an even more massive headache for the Trump Administration, and rightly so.

Amidst all the depressing news about various GOP states moving backwards on healthcare policy by gunking up Medicaid programs to add draconian work requirements, lowering the eligibility thresholds, stripping benefits and so forth, there were two positive developments in deep red territory last week, both relating to Medicaid work requirements:

First, in West Virginia:

A bill that sought to place work or other requirements on Medicaid recipients in West Virginia has died in the House of Delegates.

A House committee put the bill on its inactive calendar Wednesday, Feb. 27, the final day that legislation could be passed in their chamber of origin. The full House earlier Wednesday debated the bill but stopped short of voting on it, and did not take up the bill during a late evening session before adjourning.

The bill would have required able-bodied adults to work, participate in workforce training or community service, or attend a drug treatment or recovery program for at least 20 hours per week.

UPDATE: Please see Esther F's comment below this post for some important caveats/points regarding survey bias.

I had to think long and hard about what headline to use for this blog post. The first ones which came to mind were pretty crude, along the lines of "I've got mine, f*ck you!". After giving it some thought, I went with something a bit more genteel.

eHealth is one of the largest private online insurance brokers in the country. They sell ACA-compliant healthcare policies, but also sell other types of coverage, including non-ACA "short-term" plans, which regular readers (as well as eHealth) are aware I am not a fan of, to put it mildly.

Regardless, while I may not care for some of their offerings, they seem to be a reasonable company overall, and they regularly provide handy customer surveys on various ACA/healthcare topics which I find useful from time to time.

Today, no doubt in response to the new "Medicare for All" bill just released by the House Democrats, eHealth has released a new survey about Medicare attitudes:

When I last checked in to see how Virginia's newly-enacted ACA Medicaid expansion program was doing, they had already enrolled around half of the 400,000 estimated residents eligible to do so statewide.

Last fall, I estimated that perhaps 85,000 of those newly eligible to enroll in Medicaid would actually be "cannibalized" from the existing ACA exchange enrollee population...and sure enough, when the 2019 Open Enrollment numbers were posted, exhange enrollment in Virginia was down by 72,000 people, putting them dead last nationally in terms of year over year performance (down 18% from 2018).

Unfortunately, without an income demographic breakout, there's no way of being certain how much of that dropoff was due to Medicaid expansion as opposed to middle-income enrollees simply choosing to drop their coverage.

Today, however, Virginia state delegate Danica Roem posted the following update, which includes a link to a very nifty interactive graphic Medicaid expansion dashboard:

I visited DC last month for the Families USA healthcare conference. While I was there, I managed to arrange to meet with staffers for four U.S. Senators and two House members (in fact, the House members themselves stopped by to talk for awhile as well. None of the Senators did, but they were a bit busy dealing with Donald Trump's idiotic temper tantrum government shutdown at the time).

In my meetings, we discussed a variety of healthcare policy-related issues, but the two most important ones I focused on were:

 

Note: This is just an initial, cursory glance, not a deep dive.

Yesterday, amid much hoopla, the House Democrats official released an updated version of the long-awaited national universal single payer healthcare bill, aka "Medicare for All".

The official title of the bill is literally "The Medicare for All Act of 2019", and for the most part it's pretty similar to the Senate version rolled out in September 2017 by Sen. Bernie Sanders and a dozen or more Democratic Senators. However, there are several key differences between the two:

I don't analyze or write about the ACA's SHOP (Small business Health Options Program) exchange enrollment very much these days. The main reason for this is that SHOP enrollment is extremely difficult to come by. The federal exchange (HealthCare.Gov) has mostly pretended the program doesn't even exist, at least when it comes to enrollment...in fact, to my knowledge, they've only issued a single hard number for HC.gov SHOP enrollment...in 2015:

On November 15th, 2014 we launched the HealthCare.gov portal for 33 states to enroll in SHOP Marketplaces. As of May 2015, approximately 85,000[1] Americans have 2015 coverage through SHOP Marketplaces with about 10,700 small employers participating in SHOP Marketplaces. These totals do not include employers that began coverage in 2014 and have not yet renewed their coverage through HealthCare.gov for 2015.

The Washington Health Benefit Exchange today announced that more than 200,000 people purchased their 2019 health insurance coverage through Washington Healthplanfinder, the state’s online health insurance marketplace, during the most recent open enrollment period held Nov. 1 through Dec. 15 of last year.

Even with the four percent decrease in total number of enrollments reported from February of 2018, the Exchange saw more than 90 percent of those who selected a 2019 health plan during the open enrollment period make their initial premium payment.

A 4% drop may sound bad, but total QHP selections during OE6 were actually down 8.3% year over year (from 243K to 223K), so this is actually an improvement in that sense. 90.5% of those who selected policies are still effectuated as of February this year vs. 86.4% as of February in 2018.

A week or so ago, I reported that the Vermont Health Connect had finally released their official 2019 Open Enrollment Period data.

Vermont is among the few states which also releases their off-exchange numbers, and it's a good thing they do that because it helps explain the 12.3% drop in on-exchange enrollment this year. In short, thanks to VT making the move to active #SilverSwitching for 2019, several thousand people moved from on-exchange Silver ACA plans to nearly-identical off-exchange Silver plans.

Anyway, today they issued a formal press release with additional details...and at the same time bumped up the official enrollment tally by a bit:

2019 Individual Enrollment Report Shows More Vermonters are Covered

Shoutout to James Medlock for digging up this relic from the 2008 Presidential primariy race: A lit piece from then-Senator Barack Obama's campaign slamming then-Senator Hillary Clinton over her insistence on her proposed healthcare policy bill including an Individual Mandate Penalty. How many Republican talking points can you spot below?

There's a lot going on here. For starters, the couple on the first page are basically 2008 versions of "Harry & Louise"...it's a white, middle-age, middle-class suburban couple poring over their finances. Considering that the 1993 "Hillarycare" proposal was destroyed in large part due to the health insurance lobby's successful series of Harry & Louise "there's got to be a better way" ads, Obama using this same tactic had to sting.

New York State of Health, NY's ACA exchange, posted their final statewide 2019 Open Enrollment Period numbers a few weeks back.

A few days ago, they broke that data out further, providing county-level granular data as well:

Press Release: NY State of Health Announces 2019 Enrollment Increases in All Counties of New York State
Feb 22, 2019

HealthSource RI enrollments up by nearly 2,000 customers as RI’s uninsured rate reaches all-time low

Feb 25, 2019

  • According to the latest Rhode Island’s Health Information Survey, only 3.7% of Rhode Islanders were uninsured in 2018, down from 4.2% in 2016.
  • HealthSource RI’s individual and family enrollments increased by 1,849. This Open Enrollment, 32,486 customers enrolled and paid compared to 30,637 last year.

The "...and paid" caveat is important. Last month HealthSource RI reported 34,533 QHP selections after the 2019 OEP wrapped up, so that's an impressive 94% paid/effectuated rate. For comparison, last year 30,637 paid out of 33,021, or 92.8%, so they've improved on that front as well.

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