Over the past few years I've had a somewhat contentious relationship with some die-hard single payer/"Medicare for All" activists over the feasibility, logistical practicality, fiscal and political realities and so forth of transitioning to a "pure" universal single payer healthcare system versus other healthcare expansion/improvement measures.

However, I've also developed great relationships with a few M4All activists, including friendships.

With that in mind, I wanted to share with you the story of Rebecca Wood and her adorable daughter Charlie. I've had the opportunity to meet Rebecca twice and Charlie once so far, and they're both remarkable people.

This Just In from the Delaware Insurance Dept...

Dover, DE -- Highmark Blue Cross Blue Shield of Delaware (Highmark BCBS) has submitted its required annual rate filing to the Delaware Department of Insurance. After years of substantial increases, Delaware’s Marketplace has stabilized and premiums have decreased. Highmark BCBS, the only insurer continuing to offer insurance coverage in Delaware’s individual market, has proposed a 5.8% decrease for 2020. The proposed 2020 rate decrease will affect over 20,000 Delawareans.

The decrease comes after last year’s 3% rate increase and the Department’s decision to silver load. By applying the rate increase to silver level plans only, a practice known as ‘silver-loading,’ Delaware’s Marketplace received more federal subsidies, helping to assist in stabilizing the market and lowering premiums.

via University of Michigan Law Professor and all-around mensch Nicholas Bagley (this is all via Twitter...I've reformatted to clean it up a bit):

The Justice Department has filed its supplemental brief with the Fifth Circuit. In it, the Department clarifies that a case or controversy still exists because, "critically," the government "continues to enforce the ACA."

The Justice Department nonetheless thinks that neither the House of Representatives nor the blue states have standing. And if the Fifth Circuit dismisses the appeal, the Department says that O'Connor's opinion should *not* be vacated.

Significantly, the Justice Department now says that it will continue to enforce the ACA "pending a final judicial determination of the constitutionality of the individual mandate as well as the severability of the ACA's other provisions."

Huh. This is an interesting development...

Republican attorneys general suing to strike down the Affordable Care Act asked the 5th U.S. Circuit Court of Appeals to delay oral arguments in the case, which are set to take place on July 9.

The Republican states said they need more time to file a supplemental brief on whether the U.S. House of Representatives and the Democratic states that are defending the landmark healthcare law have standing to intervene in the case and if not, what that means for the appeal. The Republican attorneys general asked to extend the July 3 deadline to file the brief by 20 days and reschedule oral arguments for after that date.

...The Democratic states and the House urged the court to deny the request, arguing that moving ahead with the case would reduce uncertainty in the healthcare sector.

...except that the court has already responded with a big, fat bucket of Nope:

via the Washington Informer:

D.C. residents are among tens of thousands of Americans left uninsured by a health insurance scam that collected more than $100 million in premiums for junk plans.

A special enrollment period from now through Aug. 30, via the DC Health Benefits Exchange Authority, has been earmarked for residents who bought the junk plans from a Florida-based operation that was recently shut down by a federal court.

This Just In from the Indiana Insurance Dept...

INDIANA 2020 ACA FILINGS

The overall average rate increase for 2020 Indiana individual marketplace plans is 9.0%. CareSource and Celtic (MHS/Ambetter) have filed to participate in the 2020 Indiana Individual Marketplace. The Department of Insurance anticipates that all 92 counties in Indiana will be covered by both CareSource and Celtic (MHS/Ambetter).

Anthem has filed to offer a 2020 Off-Marketplace plan in Indiana. This plan is a catastrophic plan and is offered only in Benton, Jasper, Newton, Warren and White Counties.

Filing a rate does not guarantee it will be approved for use on the Marketplace, nor does the filed rate guarantee to be the final rate. Therefore, the Department of Insurance is not able to ascertain the amount of any final rates at this time. The state has until September 24, 2019 to review and submit dispositions to U.S. Department of Health and Human Services.

This Just In from the Montana Insurance Commissioner's office:

2020 Rate Filings and Rate Review

Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Montana State Auditor’s Department of Insurance for review and before plans can be sold to consumers.

What is rate review?

The rate review process, established by the Montana Legislature in 2013, does not give the Commissioner the authority to disapprove rates or prevent them from taking affect. It does give the commissioner the chance to review the factors insurance companies use in setting rates.

If the commissioner finds a rate increase to be excessive or unjustified, the insurer can voluntarily lower the rate increase. If the insurer decides to use the rate anyway, the commissioner will issue a public finding announcing that the rate is unjustified.

What does the department consider?

This Just In from the Kentucky Insurance Commissioner's office:

Proposed Insurance Rates Submitted to DOI for Review

Rates Subject to Review

Frankfort, Ky. (June 25, 2019) – Insurance Carriers have submitted proposed rates to the Department of Insurance (DOI) for Kentucky’s 2020 individual and small group markets. Anthem Health Plans of Kentucky, Inc. (Anthem) filed requests for 13 different plans to be offered on the Exchange with a proposed average rate increase of 12%. CareSource Kentucky Co. requested an average rate decrease of 4.5% for 12 different plans to be offered on the Exchange. This decrease follows the 19.4% rate increase approved last year for the 12 plans it offered. The submitted rates are subject to review by the Department.

After some last-minute drama in one state and a surprising lack of drama in another, both New Jersey and Pennsylvania have officially passed bills allowing them to each establish their own ACA exchanges and enrollment platforms, splitting off from the federal exchange and HealthCare.Gov:

New Jersey:

New Jersey Gov. Phil Murphy signed into law a bill establishing a state-based health care marketplace.

Murphy signed the legislation on Friday in a private ceremony.

Under current law, New Jersey uses a federal exchange, or marketplace, letting people shop for and enroll in coverage under the Affordable Care Act.

With all the fuss & bother being made over whether Democratic Presidential candidates support or don't support eliminating private insurance in favor of a universal, fully-mandatory "Medicare for All" single-payer healthcare system (especially after the first official debates over the past couple of days), I decided to attempt to put together a comprehensive table listing which healthcare expansion/overhaul bills each of the candidates actually support or oppose.

This may sound like a simple question: Senators Booker, Gillibrand, Harris, Sanders (obviously) and Warren are all cosponsors of Bernie Sanders' "Medicare for All" bill, S.1129, while Representatives Gabbard, Ryand and Swalwell have cosponsored the House version (H.R.1384). Pretty cut 'n dry, right?

Not much of an entry, but still: A month ago, the Oregon Division of Financial Regulation posted the requested 2020 rate changes for the Individual and Small Group health insurance markets: 3.3% on average for the Indy market, 8.7% for the sm. group market.

Today, after reviewing the requests from the insurance carriers, the department has posted their "semi-final" rates. These may still see some additional tweaking before the final, approved rates are locked in, but the odds are that these will be the final rates:

Salem — Oregonians can now see the state’s preliminary rate decisions for 2020 individual and small employer health insurance plans. The Division of Financial Regulation must review and approve any rates before they can be charged to policyholders.

Preliminary rate decisions are for individuals who buy their own coverage rather than getting it through an employer and for small businesses.

Here's the transcript of the entire healthcare segment of Night One of the Democratic Candidate Presidential Debate:

HOLT: Senator Warren, you signed on to Bernie Sanders’ Medicare-for-all plan. It would put essentially everybody on Medicare and then eliminate private plans that offer similar coverage. Is that the plan or path that you would pursue as president?

WARREN: So, yes. I'm with Bernie on Medicare for all. And let me tell you why.

I spent a big chunk of my life studying why families go broke. And one of the number-one reasons is the cost of health care, medical bills. And that's not just for people who don't have insurance. It's for people who have insurance.

Here's the transcript of Sen. Elizabeth Warren's response to a question about Universal Healthcare Coverage from a March CNN Town Hall:

Senator Warren, thank you so much for being here this evening and your tireless advocacy for universal health care. As a supporter of universal health care and an advocate for organized labor, I do worry about the current bill...that would eliminate the private health employer-based plans that so many unions have advocated for. Can you explain how Medicare for all would be better for workers than simply improving the Affordable Care Act?

WARREN: OK, so it's a good question. Let's start with our statement that we should make every time we start to talk about changes in our health care, and that is health care is a basic human right and we fight for basic human rights. And then let's put these in order, because I appreciate that your question starts with the Affordable Care Act. Let's all remember when we're talking about what's possible, let's start where we are and the difference between Democrats and Republicans.

via Susan Livio of NJ.com (thanks to Andrew Sprung for the heads' up):

New Jersey’s most powerful state lawmaker said he will delay a vote to create the state’s own online shopping portal for health insurance, one of Gov. Phil Murphy’s priorities intended to guard against the possible repeal of the Affordable Care Act.

The delay means the state won’t meet an Aug. 1 deadline to submit an application to the federal government to create the exchange. The anticipated launch of a Fall 2020 open enrollment period would have to be postponed until 2021, a group of health policy experts warned.

State Senate President Stephen Sweeney, D-Gloucester issued a statement Tuesday affirming his support for creating New Jersey’s own health exchange. Sweeney said he just disagrees with the way fellow lawmakers want to go about it because it doesn’t include a means to automatically enroll low-income people into the Medicaid program.

Jibbers Crabst on a stick. Any time University of Michigan Law Professor Nicholas Bagley begins his Twitter threads with a screenshot of legalese, it's bad news.

First, here's his full thread:

The panel in the Fifth Circuit that's about to hear Texas v. United States has just asked for further briefing on standing -- and in particular on whether the intervenor states and the House of Representatives can properly appeal the case.

— Nicholas Bagley (@nicholas_bagley) June 26, 2019

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