*("major" is obviously a subjective term depending on who's using it.)

Until this weekend, "Medicare for All or Bust" seemed to be the most critical litmus test for any major 2020 Democratic Presidential candidate. No fewer than sixteen Democratic Senators co-sponsored Bernie Sanders' S.1804 "Medicare for All" single payer bill in September 2017, including five of the six U.S. Senators currently running for the 2020 nomination: Sanders himself, Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren (the only Senator running who didn't cosponsor the bill was Amy Klobuchar.)

Recently, however, there have been a few interesting developments along the "Where do the Dem candidates stand on healthcare policy" front:

 

In the 5 1/2 years that I've been operating this website (has it really been that long?), I was surprised (pun intended) to realize that out of the 5,600+ blog entries that I've posted, only 2-3 have mentioned "Surprise Bills" (also known as "Balance Billing", although I think there are some differences between the two):

Since Congressional Republicans effectively repealed the ACA's individual mandate penalty at the federal level back in December 2017 (by reducing the penalty amount from $695 or 2.5% of income down to $0 or 0.0%), causing premiums on the individual market to shoot up an average of $580 per unsubsidized enrollee nationally, a half-dozen states or so have sprung into action.

Massachusetts, didn't really have to do much, since they never repealed their own state-level pre-ACA mandate penalty; they simply dusted it off and ramped up a statewide outreach/awareness campaign to make sure everyone knew it was still in place. Result: Record-breaking enrollment numbers and the lowest uninsured rate in the nation.

This happened yesterday:

Senate OKs small business health-care bill
By Richard Craver Winston-Salem Journal

The state Senate gave initial approval Wednesday to a Senate bill that would allow small-business employers to offer an association health-insurance plan, or AHP, that could provide lower premium costs.

Senate Bill 86 received a 40-8 vote on second reading, but an objection to a third reading kept it on the Senate calendar until at least today.

The GOP holds a majority in the NC Senate, but only by 29 to 21, so stopping this there was apparently a lost cause. They also hold a 65 to 54 majority in the state House. I'm not sure whether SB 86 has already been voted on there or not. If it passes both, it would be up to Democratic Governor Roy Cooper to veto the bill.

Over the past year or so, ever since Donald Trump issued an executive order re-opening the floodgates on non-ACA compliant "short-term, limited duration" (STLD) healthcare policies (otherwise known as "junk plans" since they tend to have massive holes in coverage and leave enrollees exposed to financial ruin in many cases), numerous states have passed laws locking in restrictions on them or, in a few cases, eliminating them altogether:

(sigh) Well, it was a good run while it lasted. As I noted last week, New Mexico's new Democratic trifecta government has been on something of a tear in the first few months of 2019, either passing or advancing a number of positive healthcare policies, including:

In addition, there was one more important piece of legislation which looked like it was going to go through without too much fuss: HB 436, which would simply lock in protections for New Mexico residents with pre-existing conditions at the same level that the Affordable Care Act already does nationally:

This press release is mostly of interest because it came from the Governor's office, not the MA Health Connector itself:

Baker-Polito Administration Announces Health Connector Completes Successful Open Enrollment with Highest-Ever Membership, Covering 282,000 People with Health Insurance

Governor Baker announced today that the Massachusetts Health Connector completed Open Enrollment with the highest membership in the 13-year history of the state’s health insurance exchange, covering 282,000 people with health insurance.

Heh. "13-year history" took a moment to register...but of course Massachusetts has had a health insurance exchange website since 2006, when "RomneyCare" went into effect.

This just in from New York State of Health...

Press Release: NY State of Health Releases 2019 Enrollment Data by Insurer
Mar 12, 2019

  • New Yorkers Value Choice of Plans
  • 2019 Enrollment is Spread Across NY State of Health’s 12 Qualified Health Plan Insurers and 16 Essential Plan Insurers

ALBANY, N.Y. (March 12, 2019) - NY State of Health, the state’s official health plan Marketplace today released 2019 health plan enrollment by insurer. Twelve insurers offer Qualified Health Plans (QHP) and sixteen insurers offer the Essential Plan (EP) statewide in 2019. Most consumers have a choice of at least four QHP and EP insurers in every county of the state. 

“We are pleased to once again offer consumers a broad choice of high-quality, affordable health plan options in every county of the state,” said NY State of Health Executive Director, Donna Frescatore. “And the wide distribution of enrollment across insurers shows us that consumers value this choice.”

No, it won't go anywhere with the House held by Democrats, but even so:

President Trump is releasing a $4.7 trillion budget plan Monday that stands as a sharp challenge to Congress and the Democrats trying to unseat him, the first act in a multi-front struggle that could consume Washington for the next 18 months.

The budget proposal dramatically raises the possibility of another government shutdown in October, and Trump used to the budget to notify Congress he is seeking an additional $8.6 billion to build sections of a wall along the U. S.-Mexico border.

Here we go again...

Trump’s “Budget for a Better America” also includes dozens of spending cuts and policy overhauls that frame the early stages of the debate for the 2020 election. For example, Trump for the first time calls for cutting $845 billion from Medicare, the popular health care program for the elderly that in the past he had largely said he would protect.

OK, I'm not sure how this one slipped by me...over the past year, a half-dozen states having 1332 Waiver Reinsurance programs approved by CMS (among the few modifications of default ACA provisions approved by the Trump Administration that I agree with).

The states approved have included red ones like Wisconsin and Alaska...but also blue ones like Maryland and New Jersey. For whatever reason, CMS Administrator Seema Verma, while doing all she can to sabotage the ACA in other ways, seems to have a soft spot in her heart for reinsurance, which I'm not going to complain about.

In any event, along with the states which have already had their reinsurance waivers approved, there are several other states where reinsurance proposals have been proposed by either state legislators or governors, including the newly-elected governors of Michigan (Gretchen Whitmer) and Connecticut (Ned Lamont) respectively.

Minnesota's ACA exchange, MNsure, is among the better ones when it comes to data transparency. Here's some key data from their monthly board meeting on March 6th.

A couple of other interesting items of note:

  • It looks like MNsure's annual budget averages around $36 - $40 million per year, with between 50-60% of it coming from their 3.5% premium fee on exchange-based enrollments (I would think they'd spread the fee across off-exchange enrollments as well, as some other state exchanges do, for consistency's sake, which would reduce the amount of additional funding they need from the state Dept. of Human Services, but that's up to the state legislature, I presume).

via Covered California:

New Analysis Finds Leading State-Based Marketplaces Have Performed Well, and Highlights the Impact of the Federal Mandate Penalty Removal

  • The report examines the impact that federal and state actions have had on state-based marketplaces and the federally facilitated marketplace (FFM).
  • Cumulative premium increases in California, Massachusetts and Washington are less than half of the increases seen in FFM states, but 2019 premium increases spiked in California and Washington compared to Massachusetts, which continued its state-based penalty.

WASHINGTON D.C. — A new report highlights the benefits of state-based exchanges, particularly in the areas of controlling premium costs and attracting new enrollment. The report, which was produced by Covered California, the Massachusetts Health Connector and the Washington Health Benefit Exchange, found that premiums in these states were less than half of what consumers saw in the 39 states that relied on the federally facilitated marketplace (FFM) between 2014 and 2019.

With useful healthcare legislation extremely unlikely to pass the U.S. Senate until at least 2021, state-based public options will be all the rage for the next couple of years...

Connecticut lawmakers are joining other states that have unveiled proposals to expand government-run health coverage, with plans to extend state health benefits to small businesses and nonprofits, and to explore a public option for individuals.

Under two measures announced Thursday, officials would open the state health plan to nonprofits and small companies – those with 50 or fewer employees – and form an advisory council to guide the development of a public option. The legislation would allow the state to create a program, dubbed “ConnectHealth,” that offers low-cost coverage to people who don’t have employer-sponsored insurance.

I've posted so many "Great News!" updates out of New Mexico over the past month that I have a keyboard shortcut to select the NM icon graphic.

Here's the latest out of the Land of Enchantment:

HB 436 passed on the House floor by a vote of 40-24 on Thursday afternoon. The bill would bring New Mexico's state law dealing with pre-existing conditions into line with federal law. 

Rep. Liz Thomson, the bill's sponsor, says health insurance coverage for people with pre-existing conditions is already protected under the federal Affordable Care Act. She wants New Mexico's state law to do the same.

"Because before the Affordable Care Act came along, insurance companies could discriminate based on gender, they charge women more, and on pre-existing conditions," Thomson said. 

Last year, Republican Governor of Kentucky Matt Bevin, who had campaigned heavily on a promise to repeal ACA Medicaid expansion altogether, partly changed his tune once he actually took office. Instead of kicking all 450,000 low-income Kentucky residents off the program completely, he first imposed an absurdly insulting and cumbersome "frequent flyer"-style program:

Kentucky is moving closer to an overhaul of the state's Medicaid program Bevin has said is aimed at controlling costs and encouraging more personal responsibility in consumers, changes that include elimination of basic dental and vision benefits for most "able-bodied" adults who instead would have to earn them through a "rewards" program.

..."It is expensive to go to a dentist," he said. "These changes are just ludicrous."

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