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If the label reads Republican health care market stabilization, the box will not contain market stabilization

[ 53 ] April 14, 2017 |
CDC - Early Release of Estimates From the National Health Interview Survey, January–September 2016

CDC – Early release of estimates from the National Health Interview Survey, January–September 2016

That’s the kind of certainty we can expect for the next four years.

The Trump administration released a final rule on Thursday aimed at stabilizing the Affordable Care Act marketplaces.

The final version of the rule is largely unchanged from the proposed rule, which the administration released in February.

In a statement announcing the final rule, Centers for Medicare & Medicaid Services Administrator Seema Verma emphasized that the tweaked regulations are not an endorsement of the ACA.

“While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system,” she said.

People are avoiding ruinous debt and illness and enjoying better lives though improved access to health care! Health care providers, including hospitals, have more paying clients! Communities are benefiting from healthier members! And worst of all, billionaires are being deprived of additional tax breaks!

Perhaps slashing the enrollment period will hold back the horror of healthier Americans.

First, we are changing the dates for open enrollment in the individual markets for the benefit year starting January 1, 2018, from November 1, 2017 through January 31, 2018 (the previously established open enrollment period for 2018), to extend from November 1 through December 15, 2017.

I hope politicians and organizations that support health care access have plans to advertise the enrollment period, because the current HHS has a vested interest in low enrollment numbers.

In other bad news, AHIP is OK with most of the final rule.

For its part, major trade group America’s Health Insurance Plans appreciates changes in the final rule such as tightening up rules for special enrollment periods, greater flexibility in product and benefit design and simplified administrative processes, spokeswoman Kristine Grow wrote in an emailed statement.

The good news: AHIP, is not a fan of Dick a l’Orange’s cunning plan to torch subsidies collect underpants force Democrats to make a deal pro???fi???t??? +++Redo from start+++

“However, there is still too much instability and uncertainty in this market,” she wrote. “Most urgently, health plans and the consumers they serve need to know that funding for cost-sharing reduction subsidies will continue uninterrupted.”

AHIP is one of eight organizations that co-signed a letter to tRump that spells out the consequences of his attempt to play Let’s Make a Deal with no contestants.

  • Choices for consumers will be more limited. If reliable funding for CSRs is not provided, it may impact plan participation, which would leave individuals without coverage options.
  • Premiums for 2018 and beyond will be higher. Analysts estimate that loss of CSR funding alone would increase premiums for all consumers – both on and off the exchange – by at least 15 percent. Higher premium rates could drive out of the market those middle-income individuals who are not eligible for tax credits.
  • If more people are uninsured, providers will experience more uncompensated care which will further strain their ability to meet the needs of their communities and will raise costs for everyone, including employers who sponsor group health plans for their employees.
  • Hardworking taxpayers will pay more, as premiums grow and tax credits for low-income families increase, than if CSRs are funded.
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  • Rob in CT

    I especially like Ron Wyden’s response to Biff on this point:

    “We don’t negotiate with hostage-takers.”

    • Steve LaBonne

      This time Democrats need to BE the hostage takers. Want votes to avert a government shutdown? Then fund the CSR payments.

      • Rob in CT

        We’ll see how this works now that the party that wants government to function is out of power and the party of “government’s the problem” is in power. I always saw this as asymmetrical – a threat that works far better on Dems than on Reps.

        Perhaps we’ll get a “natural experiment” to test this. Joy.

        • humanoid.panda

          I seem to recall that Pelosi said something about demanding CSR payments yesterday, and she doesn’t usually issue idle threats.

          • Steve LaBonne

            That’s excellent news.

          • Dr. Ronnie James, DO

            Every major medical group you can name plus the *Chamber of Commerce* issued a joint statement this week asking Trump to release the CSR money already. I’d say the wind is at her back.

      • Murc

        This time Democrats need to BE the hostage takers.

        I don’t think we should try this, because its an obvious and transparent bluff. The Republicans are the one who have a majority of their caucus not caring if shit burns down. We… don’t have that advantage.

        That said, we may not have to do so. Paul Ryan is likely to end up in the same position John Boehner did, where he needs Democratic votes to get a budget or even a CR that isn’t DOA in the Senate. Pelosi just has to do what she did with Boehner; wait for him to come to her.

        • Steve LaBonne

          Not buying that. Their guy is in the White House, they’ll get blamed. I don’t believe that’s something that differs among low-to-moderate info voters regardless of allegiance.

          • NonyNony

            I think the GOP will get the blame, but I don’t want the country to get wrecked, so I would prefer the Dems cut a deal.

            This is the problem – most Democratic voters actually don’t want their country wrecked just because Republicans are in power. From what I’ve seen over my lifetime the opposite is not true – most Republican voters seem to be perfectly happy to see the country destroyed when Democrats have power. To the point where they will actively pretend that the country has been destroyed when we have a Democratic president despite all evidence to the contrary.

            • efgoldman

              most Republican voters seem to be perfectly happy to see the country destroyed when Democrats have power.

              Of course, like Granny Starvercare, they have no fucking idea what that means.
              Funny how they woke up when there was actually a take-insurance-away-and-let-them-die bill on the table.
              And there’s more of that coming down the road (although even a RWNJ congress isn’t going to take away Meals on Wheels, rural airport service, etc.)

          • Murc

            Not buying that. Their guy is in the White House, they’ll get blamed.

            … who is talking about blame? I was talking about the fact that Democrats actually care about, you know, the real-life consequences of shutting it down.

            Republicans know this, which means pretending we don’t actually care is a transparent bluff.

            • Steve LaBonne

              By always rolling over we make the victims’ plight much worse in the medium and long terms.

            • kped

              Here’s the thing, you are right, we can’t pretend we don’t care…but, when their offer is “help us take away health care for 25 million, or we will take away health care for 25 million”, we don’t have to pretend anything. They aren’t offering a real alternative. They are shooting the hostage in the right side of the head or the left side.

              • ColBatGuano

                Yeah, there’s no room for negotiating in this situation. Trump will offload that boring shit to Pence or Mulavey and we know they aren’t going to go along.

          • econoclast

            I think a government shut-down is one of the few actions of Congress that penetrate the puny little brains of voters. The Republicans would have been hurt by the last shut-down, except immediately afterwards the healthcare.gov fiasco blew up, and it got forgotten.

      • Alex.S

        https://www.bloomberg.com/politics/articles/2017-04-13/democrats-want-guarantee-for-health-subsidies-after-trump-threat

        The three Democratic aides, who spoke on condition of anonymity, said both Senate Minority Leader Chuck Schumer and House Minority Leader Nancy Pelosi agree that CSR payments must be included in the omnibus spending bill being negotiated as permanent, mandatory spending.

  • humanoid.panda

    Perhaps slashing the enrollment period will hold back the horror of healthier Americans.

    I hate to go all neo-liberal on you, but this is not a simple issue. Basically, as long as community rating exists and the mandate penalty is low and easily avoidable, we will have the problem of free riders. The logic of a shorter enrollment window is that it weeds out people who are healthy enough in December to decided they don’t have to enroll, but who develop a medical condition in January, and then decide to enroll. One could quibble about dates and times, but as long as we don’t have the political will to really squeeze out free-riding, there is a delicate balance between maximizing enrollment windows and minimizing people who game the system.

    • Rob in CT

      I wonder how much of it is deliberate free riding and how much is just people (particularly young people) being… people (particularly young people). Leaving things to the last minute, blowing a deadline and then being potentially screwed.

      • humanoid.panda

        Sure, which is why mandatory insurance is far superior to the system we have. But this is the system we have, and we need to make it work.

        • Bri2k

          I work in the industry and I don’t see the change in the open enrollment period as a big deal. If anything, it might help insurance companies have a better idea what enrollment is looking like for the coming year which should help them manage things better. Not too long ago there was a more drastic change to the Medicare Part D open enrollment period and I saw little impact to overall membership.

          Please don’t take this as my endorsing anything Orange Julius or his awful confederates want to do to ACA. What we have now is far from perfect but it’s a vast improvement over how things were.

          • Alex.S

            It’s not a big deal for insurance companies, and probably makes their job simpler.

            I think it’s a bigger deal for the public — one of the largest issues with Obamacare is that more people are paying the penalty than expected, instead of getting the mandated insurance. Convincing people that insurance exists, that they should sign up, and that they probably qualify for subsidies is apparently difficult. And in previous years, the federal government worked to expand the open enrollment period to get more people signed up.

            • Redwood Rhiadra

              Most of them know that it exists. I’ve talked to a fair number of these folks, and they’ve *deliberately* decided to pay the penalty rather than accept one of those Obamacare plans. And then they have the gall to complain about how much it costs them to visit the doctor, and blame Obama for *that*.

    • Alex.S

      It’s a pseudo-simple issue, since it should be possible to look into enrollment times and coverage provided. If there’s no significant difference between the health care provided for people who enrolled in December vs people who enrolled in January, then there’s no strong need to change enrollment periods.

      I haven’t seen any research on this.

      • NonyNony

        Exactly. instead of assuming that people are committing massive voter fraud cheating the system, why not actually look for evidence of cheating and use that to decide the course of action?

        And hell here they actually have the numbers – the insurance companies can tell them if they’re seeing this kind of game playing. At least the voter fraud people are arguing about something that you can’t detect and can’t gather statistics on to support/refute.

        • humanoid.panda

          I understand this was an insurance company ask – and insurance companies are very interested in getting more healthy people enrolled. So, maybe they have the data?

    • Dr. Ronnie James, DO

      This assumes good faith on the part of the people running HHS. The fact they cancelled enrollment ads earlier this year that were ALREADY PAID FOR suggests otherwise.

    • epidemiologist

      …No.

      I realize this is hard for many LGM commenters to relate to or even imagine, apparently, but interacting with the health care system is intimidating, confusing, and generally difficult for many (maybe even most) people. In the case of signing up for health insurance, many people expect it to be even more confusing than it is and to involve some bad news. And not surprisingly, after only a few years there is not great public awareness of when open enrollment is.

      Many regular people (including many people here, probably without realizing it) are highly susceptible to even simple messages or basic help with taking care of their health. This is good news if you want to do something about it, but the flip side is that many normal people weren’t going to deal with it in a timely manner without the reminder or the help. Shortening open enrollment has no upsides for patients. It just gives them less time to realize it’s open enrollment, decide to do something about it, prepare to participate, and get around to doing something they expect to be difficult and unpleasant.

      I have no idea if there is research on the type of free riding you are describing (really not my area). However I would say basic common sense should tell you that the combined prevalence of lack of awareness or not wanting to deal with open enrollment is much, much greater than the total incidence of conveniently timed illnesses and injuries among people who decided ahead of time to free ride if possible.

      I mean really.

      • This strikes me as essentially correct, with the caveat that I’m honestly not sure it’s possible to think the process of signing up for health insurance is more complicated than it is. Granted, maybe I just had a particularly horrible experience the last time around, but it took about five separate visits before everything got sorted out. I honestly can’t imagine how it would be possible to have a more convoluted health care system than ours, though I’m sure that, given the opportunity, the GOP would design one.

      • DocAmazing

        People who have complicated lives, or who live at a high level of disorganization, or who lack resources (e.g, live in very rural areas and can’t get transportation to the clinics and offices where enrollment occurs) are going to be hosed by this.

      • PunditusMaximus

        “Moral hazard” and its buddy “Free Riding” are phrases Class Warriors to cover up their assaults on the poor and middle class.

        They’re never used, for example, to discuss letting banks steal houses, agribusiness trash the environment, or suburbia refusing to provide affordable housing.

        • Breadbaker

          Indeed, it’s expressly forbidden to discuss about anything having to do with national defense, except in the case of wounded soldiers, who apparently have to reach out for charity because the Republicans in Congress won’t fund their needs fully.

        • econoclast

          This is true — economists default to a kind of bourgeois respectability in their moral judgements — but it’s a real problem in insurance markets. If you are unlikely to get sick, and you can wait until you get sick before you get insurance, then it makes sense to wait.

        • Perhaps the appropriate response to this is to reclaim these phrases for those particular issues, then, rather than simply cede them to reactionaries.

          • PunditusMaximus

            ^reactionaries^Establishment Democrats and Republicans

            • Modern establishment Republicans are reactionaries, without exception (with the exception of rare state-level ones), and I don’t see mainstream Democrats doing the first two much. Maybe some of the more conservative-leaning ones are, but overall not much.

      • efgoldman

        I would say basic common sense should tell you that the combined prevalence of lack of awareness or not wanting to deal with open enrollment is much, much greater than the total incidence of conveniently timed illnesses

        Contrast ACA open enrollment with Medicare supplemental / advantage (which Granny Starver, the kkkrazy kkkaukus and the maladministration haven’t fucked with… yet) where the open enrollment / change plans period and deadlines are extremely widely advertised.

    • Robespierre

      The ACA is a workaround to give people healthcare while pretending they’re paying through market mechanisms – who cares if somebody is free-riding?

      Edit: Ideally, everyone should be in. We don’t want “free riders” out.

      • humanoid.panda

        If we wanted everyone in, we would have either auto-enrollment with teeth. Since we don’t people who enroll only after they get sick could be a real problem. (and we now that a lot of younger healthier people don’t enroll..).

      • econoclast

        I think if we’re going to keep private health insurance (which might be hard to get rid of because it’s so entangled with jobs for most people), then the simplest mechanism would be simply to have the government offer (mandatory) reinsurance for new subscribers that turn up sick. Even if it were priced at actuarily fair levels it would be an improvement, though the government would have the option to subsidize.

    • PunditusMaximus

      #SinglePayerNow

    • efgoldman

      The logic of a shorter enrollment window is that it weeds out people who are healthy enough in December to decided they don’t have to enroll

      You might be right if actual reasonable people had proposed it.
      Since the maladministration of Amber Asswipe, Mulvaney, Price, etc, along with Granny Starver’s kkkrazy kkkaukus is involved, Occam says they actively want to hurt people and reduce the number of covered individuals.

      • humanoid.panda

        As I said, the thing is that I follow health policy people who are not sociopaths, and they seem to think that this policy, in itself, is not a major problem.

        • West of the Cascades

          This seems to hit on the conundrum here — shortening the enrollment period is not, per se, a bad policy (it also ensures that some enrollees pay an additional two months of premium, which in theory reduces the overall cost of insurance to all individuals in the marketplace). Implemented properly (mandated weekly snail mail and daily email blasts “YOU ARE GOING TO DIE IF YOU DON’T RENEW YOUR INSURANCE BY DECEMBER 15TH, YOU ONLY HAVE 27 DAYS LEFT, ACT NOW, DO NOT WAIT, YOU WILL DIE!” e.g.) there is probably a limited downside to keeping people signed up. But it’s obvious that the current administration has no interest in implementing anything properly, and, even if it had an interest in doing so, is utterly incapable of it.

  • Hogan

    If it ain’t broke, break it.

    • And especially if the fix is in, break it.

  • Joe Bob the III

    I live in a state where the individual market has been a complete cockup. I cannot understand where the premiums in the individual market are coming from.

    I’m in an employer-sponsored group plan. Individual premiums are about $375 per month. Annual deductible is $2,250. I was listening on the radio this morning to some woman in the exchange who is paying $850/month for a policy with a $6,500 deductible…and that is far below the most outrageous numbers I have heard over the past couple of years.

    Insurers claim they are losing their shirts on individual policies in the exchanges at the same time they are charging people 200% more and up what they are charging people in profitable group plans. How the hell does this happen?

    I look around my office and see a range of young to old people in varying states of health. How can the risk pool for individuals be so dramatically different that people are paying double or triple what I do?

    • Rob in CT

      Individual premiums are about $375 per month.

      Total premium, or the amount you pay? My employer pays 70% of my health insurance premium.

      ETA: premium (my 30% share) is $179 every 2 weeks, so $4296/yr. That’s for me + my kids, but not my wife.

      My limited understanding is that the individual market was a total disaster before the ACA, and is now less of a disaster but still sucks for lots of people.

      I look around my office and see a range of young to old people in varying states of health. How can the risk pool for individuals be so dramatically different that people are paying double or triple what I do?

      Someone more knowledgeable about health insurance will probably answer this better, but my guesses are:

      Risk pool size: the more people in the risk pool, the easier it is to price;

      Bargaining power: how big is your employer? Mine is very large, so it has some leverage. Despite this, IIRC my deductible is $3k per person/$6k per family or thereabouts and that’s the PPO – the best coverage available, not the HDP.

      • vic rattlehead

        I need to find a new job apparently. My premium is just under a grand a month for my wife and me (it was 1300something for a decent silver plan on the exchange for both of us). Employer pays none of it. They pay half of the lowest tier one but none of the next two tiers up. Whatever. Deductible is something like 4-6 grand. Might as well be 100 grand because we don’t have much money sitting around.

    • Quaino

      Your employer is almost certainly paying substantially more than you are paying for a multitude of reasons. Five years ago the Fortune 500 company I worked at had a rate of about $12,000/head for health care costs and I paid something less than you reference above each month… and that’s a pool of people who are going to have a relatively positive profile in terms of external factors vs. say most people doing service jobs, etc.

      The individual market isn’t a cock up, health care costs are just that fucking high and employers would rather foot the bill than pay us more money up front, because they get to deduct it.

  • PunditusMaximus

    Is the thesis here that Republicans have ever spoken in anything other than Newspeak in any of our lifetimes?

  • Cheap Wino

    . . . tightening up rules for special enrollment periods, greater flexibility in product and benefit design and simplified administrative processes. . .

    Gawd, I really hate being so blatantly fed bullshit. And that’s some bullshit you don’t even have to unpack, it’s all right there.

  • kped

    I love that wording, “extend from”. If you don’t look at the dates, it almost sounds like they are extending the enrollment period, rather than chopping of 45 days, or half the enrollment period. How does this provide stability? Who knows.

  • Rudolph Schnaubelt

    Plaudits & kudos for Dick a l’Orange.