(sigh) Here we go again...via CMS:

CMS seeks recommendations that allow Americans to purchase health insurance across state lines
Administration continues efforts to increase consumer choice, promote competition and drive down prices in the health insurance market

The Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) today that solicits recommendations on how to eliminate regulatory, operational and financial barriers to enhance issuers’ ability to sell health insurance coverage across state lines. This announcement builds on President Trump’s October 12, 2017 Executive Order, “Promoting Healthcare Choice and Competition Across the United States,” which intends to provide Americans relief from rising premiums by increasing consumer choice and competition.

I've attended Netroots Nation twice before. The first time was way back in 2007 in Chicago, back when it was actually called Yearly Kos (the conference started out as an offshoot of the Daily Kos progressive online community). They changed the name to "Netroots Nation" the following year to reflect that it had grown larger than any single website. The second time was here in Detroit in 2014, which happened to also be the same point I was at my peak media awareness (my "fifteen minutes of fame" so to speak).

For more than a decade, Netroots Nation has hosted the largest annual conference for progressives, drawing nearly 3,000 attendees from around the country and beyond. Netroots Nation 2019 is set for July 11-13 in Philadelphia.

 

Over at Inside Health Policy (paywall), Amy Lotven has an update regarding the eyebrow-raising decisions a few weeks ago by federal judges in several of the Cost Sharing Reduction (CSR) reimbursement payment lawsuits.

The general thinking at the time was that the judges would simply rule in the carriers favor and order the Trump Administration to pay the carriers the money owed to them from the last three months of 2017 (over $2 billion nationally, although the amounts at stake for each individual carrier suing is generally kmore along the lines of seven figures each). If this had been what happened there likely wouldn't have been much more to the story.

Instead, all three judges ruled--on behalf of dozens of carriers, since at least one of the cases is a class action suit--that the government owes them CSR payments for not only Q4 2017, but all twelve months of 2018 as well, assuming the carriers wanted to demand those payments.

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

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