Trumpcare

2018 MIDTERM ELECTION

Time: D H M S

 

Last week, former CMS Administrator Andy Slavitt conveyed a warning to the Trump Administration and the GOP about how critical confirming ongoing Cost Sharing Reduction reimbursements (not just for the rest of 2017, but continuing into 2018) is, by paraphrasing multiple anonymous sources within the health insurance industry.

On Monday, it looked as though the Trump admin was finally providing some reassurance on the CSR issue; as Robert Pear reported in the New York Times:

The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them.

The statement sends a small but potentially significant signal to insurers, encouraging them to stay in the market.

Last fall, when the insurance carriers were jacking up their rates on the individual market by an (unsubsidized) national weighted average of around 25%, aside from the understandable grumbling about such a dramatic all-at-once increase, the big question was whether that would be enough to stabilize the market going forward, or whether this was just the beginning of an inevitable Death Spiral, etc etc.

Back in December, Standard & Poor's issued an analysis in which they concluded that:

An analysis out Thursday says that health insurers are expected in 2016 "to start reversing" financial losses on their Obamacare business after "hitting bottom" in 2015.

And 2017 "will likely see continued improvement" for those insurers selling individual health plans, "with more insurers getting close to breakeven or better," according to the report by Standard and Poor's Global Ratings.

The report also says big price increases for Obamacare plans in 2017 were likely a "one-time pricing correction."

OK, I was about to go with the more obvious saying: "Sh*t or get off the pot", but I'm trying to avoid blatant profanity in the headlines, at least.

Here's a tweetstorm from fomer director of the Centers for Medicare & Medicaid, Andy Slavitt, from yesterday/continuing through today. He confirms everything I've been sounding the alarm about, especially regarding the CSR payment crisis:

One of the questions I get asked most frequently is why don't more health plans speak up about what a disaster AHCA would be. 1

— Andy Slavitt (@ASlavitt) April 5, 2017

A related question I get asked a lot is why don't health plans speak up more loudly about the impact of govt reneging on CSR payments. 2

— Andy Slavitt (@ASlavitt) April 5, 2017

By tomorrow, I will have asked 10 CEOs that question & will tweet back what they say. 3

— Andy Slavitt (@ASlavitt) April 5, 2017

Hot off the presses:

A new Kaiser Family Foundation analysis finds that the average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies.

Not exactly a surprise: The stampede appears to be starting.

The efforts to replace the Affordable Care Act have caused worry for insurers, who aren’t sure about the law’s future or what would replace it. On Thursday, Aetna Inc. said it would pull out of Iowa’s Obamacare market, becoming the second major health plan to do so this week after Wellmark Inc. said it was quitting the state as well.

“Aetna will not participate in the Iowa individual public exchange for 2018 as a result of financial risk and an uncertain outlook for the marketplace,spokesman T.J. Crawford said in an email Thursday. “We are still evaluating Aetna’s 2018 individual product presence in our remaining states.”

 

In our last episode of As the Stomach Churns, you may recall that after getting tired of having thousands of old white people screaming at them during town halls, the House GOP attempted to get them to shut up by demanding that the Senate throw $85 billion at them to make them go away.

The Congressional Budget Office determined that, nope, around 24 million people would still be kicked off their healthcare coverage due to how crappy the rest of the plan was. They would've just been pissing away another $85 billion for literally no reason.

The CEO of Molina Healthcare made it about as clear as he possibly could today:

Molina Healthcare CEO: GOP's 'piecemeal approach' to health-care reform will lead to a 'health-care disaster'

With the GOP's failure to repeal Obamacare last month, House Speaker Paul Ryan refused to give a time line for a new bill.

...But many health-care providers are wary of the fast pace the GOP seems to be taking with repealing Obamacare.

...Molina is particularly worried about the potentially higher premiums and misleading packages insurance companies can price and sell.

December 9, 2016:

...Many Republicans would prefer to argue the Obamacare markets were already in their death throes before they took charge — the question is whether they can get away with it.

“The first question I think they’re trying to figure out is, do we actually own it for 2018?” said one health care lobbyist, speaking on background. “If premiums spike and plans exit, can we still blame it on Obama and get away with it? That’s one of the threshold questions that I don’t think they’ve answered.”

March 24, 2017:

 

Immediately after the "death" of the AHCA (Trumpcare) bill, I posted the clip above (from the underrated suspense thriller "Dead Again"), noting that as much of a victory as it was, there was little time to pat ourselves on the back, because Trump and the GOP would no doubt be back for Round 2 at any moment.

At the time, I assumed that they would likely abandon the "official" attempt at repeal/replace for the time being, and focus instead "only" on sabotage efforts of the ACA itself by doing whatever they can to scare off the carriers...and for the most part, that's exactly what Trump has done ("It's gonna explode!" and so forth).

I see that I've been thrown into the crossfire of a wonk debate between John Cochrane (who I've never actually heard of before today) and Brad DeLong/Paul Krugman (both of whom I very much have heard of!) regarding the question of whether the individual healthcare market is or isn't in a Death Spiral and/or whether it will/won't enter one next year.

Back in January, the Congressional Budget Office concluded that, overall, they didn't see any death spiral forming if the ACA is kept mostly intact...but also concluded that growth of the exchange population has likely plateaued; around 13 million appears to be the enrollment ceiling barring any significant changes to the law. Interestingly, however, a couple of weeks ago they concluded that there would also be no death spiral if the GOP's AHCA "replacement" plan were to become law either.

Meanwhile, over at the Brookings Institute, Matthew Fiedler ran his own analysis of the exchange risk pool and concluded "No Death Spiral!" there either:

 

(This is an updated version of a post from February 1st):

COSMO: When I was in prison I learned that everything in this world, including money, operates not on reality...

MARTY: ...but on the perception of reality.

COSMO: Posit: People think a bank might be financially shaky.

MARTY: Consequence: People start to withdraw their money.

COSMO: Result: Pretty soon it is financially shaky.

MARTY: Conclusion: You can make banks fail.

COSMO: Bzzzzt! I've already done that. Maybe you've heard about a few? Think bigger.

MARTY: Stock market?

COSMO: Yes.

MARTY: Currency market?

COSMO: Yes.

MARTY: Commodities market?

COSMO: Yes.

MARTY: Small countries?

COSMO: I might even be able to crash the whole damned system.

Friday, January 20th:

via TV Tropes:

Synthetic Plague

So The Plague is wreaking havoc on the world's population. Maybe Super Flu has killed millions, or some unknown biological agent is causing people to snap and kill each other. Heck, maybe we even have a good old fashioned Zombie Apocalypse on our hands. Either way, it's safe to say that for most of humanity, these are not fun times. How could things get much worse, you ask?

By the revelation that the disease in question has been manufactured by genetic engineering, and possibly is distributed by humans. The untold amount of death and destruction has been directly caused by the foolish or malicious action of Man himself.

It may have been designed for use as a biological weapon, or an unexpected result of an experiment gone wrong. Perhaps we just shouldn't have let monkeys watch TV for too long. However it came to be, it has now been unleashed on humanity at large, and has almost certainly gone far beyond what its designers had originally intended.

There's been a lot of talk, by myself and others, about just which populations would be screwed over by a full repeal of the Affordable Care Act. Analysts, reporters and pundits have sliced and diced the numbers every which way...by race, income level, geography and of course political leanings.

Of course, this gets awfully messy right out of the gate because some ACA provisions apply to everyone in the country, such as the cap removal on annual/lifetime coverage limits; the reassurance that you can't be denied coverage for having pre-existing conditions (which applies to those covered by employer insurance as well, I should note, since many of them may have to switch jobs or be without one at some point in their lives), and so on. Other benefits apply to subgroups which aren't talked about much, such as the Medicare fund being extended by years and the Medicare Part D "donut hole" being closed.

Politico, January 26th:

The Trump administration has pulled the plug on all Obamacare outreach and advertising in the crucial final days of the 2017 enrollment season, according to sources at Health and Human Services and on Capitol Hill.

Even ads that had already been placed and paid for have been pulled, the sources told POLITICO.

...Individuals may still sign up for Obamacare plans until the Jan. 31 deadline — but the Trump administration isn't advertising that fact any longer.

It is also halting all media outreach designed to spur signups in the days leading up to the deadline. Emails are no longer being sent out to individuals who visited HealthCare.gov, the enrollment website, to encourage them to finish signing up. Those emails had proven highly successful in getting stragglers to complete enrollment before the deadline.

Ron Pollack, executive director of Families USA, a consumer group that supports the law, called the decision "a mean-spirited effort that can only result in fewer people getting coverage who need it."

 

Robert Costa in the Washington Post:

President Trump called my cellphone to say that the health-care bill was dead

President Trump called me on my cellphone on Friday afternoon at 3:31 p.m. At first I thought it was a reader with a complaint since it was a blocked number.

Instead, it was the president calling from the Oval Office. His voice was even, his tone muted. He did not bury the lede.

“Hello, Bob,” Trump began. “So, we just pulled it.”

...The Democrats, he said, were to blame.

...Trump said he would not put the bill on the floor in the coming weeks. Instead, he is willing to wait and watch the current law continue and, in his view, encounter problems. And he believes Democrats will eventually want to work with him on some kind of legislative fix to Obamacare, although he did not say when that would be.

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