Two states in two days...just 24 hours after the Washington State Insurance Commissioner pulled the plug on the "Aliera Healthcare" and "Trinity Healthshare" healthcare sharing ministries for fraud, the New Hampshire Insurance Dept. is issuing a similar warning (although they don't appear to be actually shutting the operation down just yet):

Consumer Alert on Potential Unlicensed Health Insurance Company

CONCORD, NH – As a result of a recent Georgia court order, the New Hampshire Insurance Department is advising consumers that Aliera, a company that markets itself as a health care sharing ministry, may be operating illegally in New Hampshire.

I haven't written about "Healthcare Sharing Ministries" as much as I should have. This is from my only substantive blog post about them 3 years ago:

A health care sharing ministry is an organization that facilitates sharing of health care costs between individual members who have common ethical or religious beliefs in the United States. A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance polices on behalf of its members.

Members of health care sharing ministries are exempt from the individual responsibility requirements of the Patient Protection and Affordable Care Act, often referred to as Obamacare. This means members of health care sharing ministries are not required to have insurance as outlined in the individual mandate.

Earlier today I once again dusted off my ACA Individual Market Rate Change project for the 5th year, as the state of Maryland has issued their preliminary 2020 premium rate filings. With that in mind, I decided to go back and look at my personal projections for average 2019 premiums (from June - October of 2018) and compare them against the actual average 2019 premiums as reported by the Centers for Medicare & Medicaid 2019 Open Enrollment Period Public Use Files.

Bottom line: I was pretty damned close, coming within 2% of the actual average premium in 27 states and within 5% in 42 states. Nationally, I was off by 2.0%, projecting an average monthly premium of $611 vs. the $599 actual average.

The outliers were:

Every year for 4 years running, I've spent the entire spring/summer/early fall painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

The actual work is difficult due to the ever-changing landscape as carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it next to impossible to find the specific data I need.

The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:

Back in January, I noted that California Governor Gavin Newsom was proposing a stripped-down version of one of the most important ACA 2.0 provisions I've been pushing for years now: Raising the ACA's APTC subsidy income eligibility cap and beefing up the underlying subsidy formula.

At the time, he was

Well, the latest official revision to the proposed CA 2019 - 2020 state budget has been released, and not only are both the mandate reinstatement and the enhanced subsidies included, the subsidies have actually been increased a bit more than Newsom was originally proposing:

EXPANDED SUBSIDIES TO PROMOTE AFFORDABLE COVERAGE

To improve affordability and access to health care, the Governor's Budget proposed subsidies to help more low and middle class Californians afford health coverage through Covered California.

About three weeks ago I noted that the Nevada state Senate had passed a bill which locks in many of the ACA's patient protections at the state level, just in case the idiotic #TexasFoldEm lawsuit prevails and the ACA is repealed after all.

Yesterday, the Nevada state House followed through as well:

Nevada stands to become the fifth state to fully incorporate the federal Affordable Care Act’s protections for patients with pre-existing conditions into state law after unanimous passage of a bill Tuesday in the state Senate.

"Fully incorporate" isn't quite accurate; as I noted with the Senate version, it looks like the three most important ones are covered (Guaranteed Issue, Community Rating and the ACA's 10 Essential Health Benefits), along with a pre-ACA law letting young adults stay on their parents plan until age 24 (but only if they're unmarried and enrolled in school).

A few days ago I noted that North Dakota had jumped onto the ACA reinsurance train; now it looks like Montana is onboard as well:

Governor Signs Bill Meant to Lower Some Insurance Premiums

HELENA — Gov. Steve Bullock has signed legislation meant to lower premiums for Montana customers who receive health insurance through the Affordable Care Act’s individual marketplace.

Bullock signed the bill Tuesday creating a reinsurance program to help reimburse insurers for high-cost claims so those costs aren’t included in determining individual marketplace premiums for the following year.

U.S. health officials also must approve the plan, which is estimated to offset 2020 premium increases by 10% to 20%.

After writing about the newly-signed laws in Georgia and Ohio banning virtually all abortions after 6 weeks (when most women don't even know they're pregnant), even in most cases of rape, incest of the health of the mother, I didn't think that a story about abortion-related legislation could get more horrific and insane.

I was wrong:

A new Ohio bill would ban most private insurance coverage for abortions. Opponents say it would also ban effective methods of birth control.

One-fifth of representatives in the House, all Republicans, have signed onto House Bill 182 sponsored by state Rep. John Becker (R-Union Twp.) that would prohibit most insurance companies from offering coverage for abortion services.

“The intent is to save lives and reduce the cost of employers and employees health care insurance," Becker says.

UPDATE: It's been pointed out that the Supreme Court has ruled that minors can't receive the death penalty, so I guess that means "only" life in prison for them. If they're 18 or older, however...

On the other hand, several people have noted that an 11-year old pelvis isn't generally developed enough to even deliver a baby safely, along with other health risks, so it could very well be a death sentence regardless, so I'm leaving the headline as is.

Georgia's "pro-life" Republicans have passed a law that would subject a woman who self-terminates after six weeks to life imprisonment or capital punishment. https://t.co/vbBpfRzIgj @Slate pic.twitter.com/Djqn0LbLf6

— Mark Joseph Stern (@mjs_DC) May 7, 2019

 

In the far simpler days of 2001, when the President of the United States didn't suck up to genocidal dictators and thank Russia for helping him win the Electoral College, an episode of The West Wing aired entitled "The Indians in the Lobby".

I was instantly reminded of the scene above* (in reverse) when I read this story by Justin Sink at Bloomberg News:

The Trump administration may alter the way it determines the national poverty threshold, putting Americans living on the margins at risk of losing access to welfare programs.

The possible move would involve changing how inflation is calculated in the “official poverty measure,” the White House Office of Management and Budget said in a regulatory filing on Monday. The formula has been used for decades to determine whether people qualify for certain federal programs and benefits.

For years, Michigan, the state which put America on the road, has held the dubious honor of having the highest auto insurance premiums in the nation:

Michigan is the most expensive state for car insurance for the sixth consecutive year.

The Wolverine State is in a league of its own when it comes to car insurance with an average annual premium that is $313 higher than that of Louisiana, which ranked second. A Michigan car insurance policy averages $2,611, which is almost 80 percent higher than the national average of $1,457.

Louisiana remained in second place for the third year in a row, while Florida secured third place. Oklahoma and Washington D.C. rounded out the top five.

In most cases, a high number of uninsured drivers combined with less than stellar weather and high population density led these states onto the most expensive states for car insurance list.

There's several reasons for this, but one stands out above all others:

Last fall I wrote about Yet Another Sabotage Attack® on the ACA by the Trump administration, this time in the form of CMS Administrator Seema Verma completely warping the entire point behind the 1332 Waiver provision. Here's the backstory:

One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

Last September I noted that North Dakota was considering going one of two ways when it comes to making a major change in their individual insurance market: EIther joining over a half-dozen other states in pushing for a reinsurance program (which I strongly support doing), or going the other way and starting to offer weaker policies without some ACA protections the way states like Idaho, Tennessee, Iowa and Kansas either already do or are in the process of doing.

Fortunately, it looks like they ultimately decided to go the former route after all:

The bill started out on the right track...

Florida lawmakers approved a health insurance bill Wednesday that would require insurers keep covering pre-existing conditions if the Affordable Care Act disappears, though the bill would not keep protections in the federal law to control how much those patients can be charged.

...but quickly went off the rails after that:

The bill, Senate Bill 322, which the House approved by a 70-42 vote after the Senate passed it last week, would also expand short-term and association health plans and change requirements for “essential health benefits” covered by insurers, regardless of the status of the Affordable Care Act. It must be approved again by the Senate before it heads to Gov. Ron DeSantis for his signature.

A few minutes ago the Congressional Budget Office released a new report on a national, universal single payer healthcare system (commonly known as "Medicare for All" these days, although that's a bit of a misnomer since the proposed "Medicare for All" bills are quite different from today's definition of Medicare).

It's important to note that while this report came from the CBO, it is not a budget analysis of either the House or Senate MFA bills; it instead lays out the structural components which would be required to be in place in order to put such a system together and, I presume, in order to run such a budget analysis.

I'm swamped today between the rollouts of both the Choose Medicare Act and the revised Medicare for America Act as well as this new CBO report, so for the moment I'll just repost the summary and link to the report itself, along with a few notes as I'm able to add them:

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