ShortAssPlans

2018 MIDTERM ELECTION

Time: D H M S

Two big developments (or in one case, a lack of development) out of Virginia this evening.

First: Just yesterday I was noting that it looked as though after 8 years, Virginia's state legislature might finally be going ahead and expanding Medicaid under the ACA as soon as today:

The stage is set for a showdown in the Virginia Senate on Tuesday over a budget compromise negotiated by Senate Finance Co-Chairman Emmett Hanger, R-Augusta, and House Appropriations Chairman Chris Jones, R-Suffolk, to expand the state’s Medicaid program and pay for the state’s share through a new tax on hospital revenues that also would boost Medicaid payments for inpatient provider care.

Unfortunately...that didn't happen:

Governor Northam Statement on Virginia Senate Budget Process

This evening brought three major pieces of ACA-related news out of three different states:

First, in California, the State Senate passed SB-910, which wouldn't just limit short-term plans, but would outright prohibit them altogether. To my knowledge, CA would be the only state where STPs wouldn't be allowed at all:

SACRAMENTO – Today, the State Senate approved passage of Senate Bill 910, which prohibits the sale of short term limited duration health insurance in California.

Authored by Senator Ed Hernandez, O.D. (D-West Covina) and approved by bipartisan a vote of 27-10, SB 910 was introduced in response to the Trump Administration’s recent proposed regulations to expand short term limited duration coverage to less than 12 months.

Having a doctor holding elected office is kind of hit or miss (former HHS Secretary Tom "Fly Me!" Price was an orthopedic surgeon, for instance, while Rand "Kneel before Aqua Buddha!" Paul is supposedly a "self-certified" opthamologist), but once in awhile it can be a very good thing.

Case in point: Ralph Northam, the new Governor of Virginia, a former Army doctor and pediatric neurologist, who just formally vetoed not one, not two, but four different GOP-passed healthcare bills, each of which would have further weakened and damaged the ACA individual market risk pool:

RICHMOND—Governor Ralph Northam today vetoed Senate Bills 844, 934, 935, and 964, which would put Virginians at risk of being underinsured, result in rapidly increasing Marketplace premiums, and undermine key protections in the Affordable Care Act. Governor Northam remains committed to expanding health care for nearly 400,000 uninsured Virginians, return millions to the state budget, and reduce Marketplace premiums. The Governor’s full veto statements are below.

I've written quite a few entries bashing the Short-Term Plan portion of Donald Trump's executive order opening up the floodgates on non-ACA compliant policies. However, I've written far less about the other shoe he's dropping: Association Health Plans, or AHPs. In fact, while I discussed AHPs briefly in Part Two of my Risk Pool video, the only blog post I've written to date which specifically focuses on them just quoted from this Avalere Health article:

Association Health Plans (AHPs) are health insurance arrangements sponsored by an industry, trade, or professional association that provide health coverage to their members—typically small businesses and their employees. Health insurance coverage offered through AHPs aims to make coverage available and affordable for small groups and individual employees. Importantly, these arrangements are currently governed by state and federal requirements and are subject to state oversight, including standards related to premiums and benefit requirements.

A couple of weeks ago, Donald Trump's former HHS Secretary Tom Price openly (and rather casually) admitted at the World Health Care Conference that the GOP's repeal of the ACA's individual mandate will "harm the pool in the exchange markets & drive up costs" when it actually goes into effect in 2019.

Well, today, the other 2018 sabotage shoe dropped as the chief actuary for the HHS Department stated the obvious regarding Trump's #ShortAssPlans scheme:

WASHINGTON — President Trump’s plan to expand access to skimpy short-term health insurance policies, as an alternative to the Affordable Care Act, would affect more people and cost the government more money than the administration estimated, an independent federal study says.

Normally, I don't start posting natoinal projections for my annual Rate Hike Project until I have at least filing data for at least a dozen or so states because the national weighted average jumps around so much early on. A "national average" of, say, 10% based on numbers from, say, Vermont, Wyoming and the District of Columbia (collective population: 1.9 million people) is gonna change radically once you add California or Florida to the mix if they're looking at a 20% hike, for example.

Having said that, seeing how advocacy organization Protect Our Care has decided to launch their own version of my Rate Hike Project, and seeing how I do have preliminary 2019 rate increase projections from at one large state (Virginia) and two mid-sized states (Maryland and Oregon), I've decided to go ahead and start posting the national projections early, with a major caveat that the national average will likely change dramatically until at least 2/3 of the states have been plugged in.

 

As promised, here's Part 2 of my Risk Pool explainer video!

Part 1 went over the basics of how risk pools work in general, and why segregating sick people into a separate pool is a terrible idea.

In Part 2, I go into more detail about the different types of NON-ACA plans available on the individual market, why they mostly stink, and how the repeal of the Individual Mandate Penalty, especially when combined with Trump's yanking away restrictions on "short-term" and "association" plans, will take an existing problem and make it far worse.

Oh, yeah: It involves Dabney Coleman and Morgan Freeman.

Aside from Virginia, it's likely going to be another month or so before the 2019 ACA policy rate filings start trickling in, since the deadline for initial rate requests isn't until late June in most states. However, there's some interesting non-ACA policy filing stuff which is available as well. Given all the concern about non-ACA compliant policies siphoning healthy people away from the ACA market, I figured I should take a look at a few of these.

Here in Michigan, I've found three such filings: One is for "transitional" plans from Golden Rule (a subsidiary of Unitedhealthcare, I believe). The other two are for "short-term" plans (the type which Donald Trump is basically removing any regulation on).

First up, Golden Rule:

I've repeatedly written about how Donald Trump is still deperately trying to sabotage the ACA by any means necessary. Last year it was all about a combination of regulatory and legislative attacks, but aside from repealing the ACA's individual mandate (which was, admittedly, a pretty ugly blow), the GOP-held Congress was unsuccessful at tearing it down legislatively.

Therefore, for 2018, Trump has decided to double down on the regulatory side...and one of the main ways he hopes to achieve this is by opening up the floodgates on so-called "Short-Term, Limited Duration" policies, which aren't subject to most ACA requirements and therefore are a) free to siphon off healthy ACA-compliant enrollees into b) substandard healthcare plans which can leave thousands of people in dire straits.

Over at the Kaiser Family Foundation, Karen Pollitz and Gary Claxton have published a handy explainer which goes over the basics of the various types of NON-ACA individual market policies...specifically, the "Short Term" and "Association" plans which Donald Trump is attempting to flood the market with by essentially removing any restrictions or regulations on them, but also the "Idaho Style" plans which were rejected by HHS for being flat-out illegal as well as the "Farm Bureau" junk plans which Iowa recently decided to open the floodgates on (Tennessee already had a similar setup, and sure enough, it has proven pretty devastating to Tennessee's ACA market since 2014 as a result). The whole thing is worth a read, but in the early part of their explainer, however, they also happened to neatly lend support to my estimates from last week regarding the unsubsidized market:

Christina Lechner Goe has written up a detailed explainer going over the various types of NON-ACA-Compliant healthcare policies available and how each of them impacts the individual and small group markets. The report was commissionerd by consumer representatives of the National Association of Insurance Commissioners (NAIC):

This morning I took a look at the "Short Term, Limited Duration" policies (aka "Short-Term Plans"). Now comes the other half of Donald Trump's #ShortAssPlans executive order: "Association Plans".

I've obviously already written a bunch of stuff about this, including links to a few impact projection analyses, but this one was put together by Avalere Health on behalf of America's Health Insurance Plans (AHIP), which is one of the two major insurance carrier lobbying groups (the other one is BCBSA). On the surface you may expect a whitewash: "Oh, look at that, a report commissioned by Big Insurance is releasing a report claiming that these policies would be awesomesauce, big surprise!"

However, the actual analysis is quite different than what you might expect:

For some time now, I've been railing against Donald Trump's executive order pushing for the expansion of both "Short Term, Limited Duration" plans as well as "Association Plans". I've scornfully referred to his EO with the hashtag #ShortAssPlans.

Something which has gotten lost in the shuffle, however, is that I don't think short-term plans should necessarily be scrapped altogether, at least until we're able to achieve a comprehensive, universal coverage system in the future. Under our current patchwork heatlhcare system, I do think they serve a purpose for certain people in certain circumstances. I just think they need to be strongly regulated and limited in scope, partly to prevent siphoning off healthy people from the individual market risk pool...but partly to prevent people from being hit with financial catastrophe in the event of unexpected high medical expenses.

The problem is that Trump's executive order--which would effectively open the floodgates for them to be mutated into year-round plans, completely destroying one of the major points of the ACA in the first place.

*(OK, much of it is already here, actually)

Former CMS representative and current healthcare policy advisor for Sen. Brian Schatz, Aisling McDonough, made an important point last night:

If you have a pre-existing condition and live in a rural area, especially in VA, TN, OH, IN, MO, IA, or NV, then I'm worried there might not be a plan available for you next year.

(I pulled those states from this KFF brief: https://t.co/WgCWO16wOa)

— Aisling McDonough (@AislingMcDL) March 12, 2018

People should be worried about bare ACA counties in 2019 b/c of GOP sabotage.

Between mandate repeal, short-term plans, health ministries, farm bureaus, etc, the guaranteed $ for the lone ACA insurer is getting smaller. It's not the same calculus as it was in 2017 & 2018.

— Aisling McDonough (@AislingMcDL) March 12, 2018

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