Commentary, News

Congress changes Trumpcare in dead of night to allow insurers to cap coverage and deny care

Shortly before 11 PM last night, the Republican House of Representatives amended their Trumpcare bill. Following the House’s delay of a planned floor vote on the American Health Care Act yesterday, Republican leadership made the change to persuade hardline conservatives in the Freedom Caucus to vote for the bill.

Zachary Tracer from Bloomberg explains how this last-minute, secretive amendment drastically alters the rules of the insurance market:

If healthy people can buy cheap, skimpy insurance plans, they don’t subsidize those who are sick — meaning that people who aren’t healthy have to pay more, or may not be able to get insurance. Cutting the rules could push insurers to offer only limited plans, resulting in less choice for consumers, particularly those who are sick or want more comprehensive coverage.

This change also opens the door for insurance companies to reintroduce lifetime limits and annual caps on coverage, yet it’s reported that Congress will vote on this bill less than 24 hours after making the change. After years of peddling alternative facts about how hastily and secretively Congress passed the Affordable Care Act seven years ago, Republican leadership in Congress aims to change the health care system under the cover of night to allow millions of Americans to be denied care and coverage.

After last night’s failed effort to bring Trumpcare to a vote on the House floor, President Trump delivered an ultimatum to the House—pass this bill or nothing at all. The candidate who promised that everyone would be covered under his plan seems to care more about the appearance of getting a bill done than he cares about what the bill does.

Commentary, public health, Trump Administration

Congress sneaking in last-minute change to make Trumpcare even worse

Ahead of a floor vote scheduled for later today, Republican leadership in the House has realized that they do not have enough votes right now to pass the American Health Care Act (AHCA), the Trump-Ryan proposal to repeal and replace the Affordable Care Act (ACA). As a result, Trump and others are trying to sneak in disastrous last-minute changes to an already terrible bill to win over conservative votes at the expense of millions of lives.

One such change that they are proposing is repealing the requirement that health insurance plans cover a core set of essential health benefits. This guarantees that plans provide coverage for core services, such as hospitalizations, maternity care, prescription drugs, as well as mental health and substance use disorder treatment.

If this provision is repealed, insurers could offer bare-bones plans that don’t cover services that North Carolinians need, meaning only the most expensive, premium plans would cover services like treatment for opioid addition, for example.

What’s more, other key consumer protections would fall apart. While the AHCA does not repeal the ACA’s prohibition on lifetime limits and annual caps on services, that protection is useless without the essential health benefits requirement. Current law only applies these protections to services considered essential health benefits. If this provision is repealed, insurers may be free once again to arbitrarily cut off coverage for patients because their treatment is too expensive.

The haste with which Congress and Trump are moving to repeal our health care is telling; why rush to change one-sixth of the U.S. economy and millions of lives unless you don’t want the public to see what you’re doing? After all, we still haven’t seen the bill language that the House will vote on today. It seems like the Republicans may have to pass the bill to find out what’s in it.

Commentary

New info: Blue Cross turned a $185 million profit in 2016, minimized ACA losses by 86%

On March 1, Blue Cross and Blue Shield of North Carolina provided a year-end financial report for its health insurance business in 2016. What we learned is telling: after turning a small profit the prior year, Blue Cross produced a profit of $185 million in 2016.

Much has been made in the past of the financial losses that Blue Cross has incurred on plans sold on the individual/nongroup market, to which the Affordable Care Act made critical reforms that became effective in 2014.

However, Blue Cross’ financial losses on its ACA business shrunk by 86% from 2015 to 2016.

The lesson: It has taken a little time for insurers to adapt and learn how to manage the costs and utilization patterns in this new line of business. But that’s not out of the ordinary for businesses adjusting to changing markets.

Despite any losses it incurs through what it calls its ACA line of business, Blue Cross has held steady reserves of around $2 billion. The company is healthy, and even if it experiences slightly larger losses on these lines of business, it can sustain them without having its solvency threatened and without passing the buck to consumers.

While conservatives throw out alternative facts about the ACA going into collapse, it’s clear that—in only the third year of the ACA’s health insurance marketplace—companies are figuring this thing out. As Blue Cross minimizes their losses and more than half a million North Carolinians continue to enroll each year, it’s easy to see that there is no imminent collapse here in our state, even with limited insurer competition.

Commentary

GOP health care proposal would hike premium costs for half a million North Carolinians

The Republican Congress’ plans to repeal and replace the Affordable Care Act (ACA) have started to come into focus following the release of a policy brief and the leak of draft legislative language. Their proposal would eliminate the ACA’s premium tax credits and replace them with flat tax credits, which would operate like a voucher, for people buying their own insurance. These changes are important for people in our state, as 499,178 North Carolinians enrolled in a plan with financial help from the ACA’s premium tax credits in 2016.

While the GOP tax credit proposal is similar in a few ways to the ACA’s premium tax credit, it differs significantly in how it determines how much financial help an individual can receive. The dollar-amount of the GOP tax credit is adjusted for age, but it is not adjusted for crucial factors, meaning it will fall short of helping the people who need it most.

  1. There is no income test for tax credit eligibility, nor does the size of the tax credit adjust for people with lower incomes. Under this proposal, Art Pope could get a larger tax credit than a 30-year-old teacher.
  2. Second, the tax credit does not adjust for the costs of plans available to the consumer.

As a result, North Carolinians who are older, have low-to-moderate incomes, and have high health care needs would face unaffordable costs under the GOP proposal.

For a Greensboro family of four—two 35-year-old parents with two young children—that earns $65,000 annually, premium costs for a Silver plan would jump by 73 percent. In order to afford a decent health care plan, this middle-income family would have to pay roughly 15% of their income toward premiums alone.

Young people with much lower incomes would also see higher costs. A 33-year-old single mother of two children who makes $26,000 a year in Orange County would see her premium increase by a whopping 490 percent. Read more

Commentary, Trump Administration

Speak bigly, carry a small pen: Trump’s executive order on the Affordable Care Act

Donald Trump speakingOn his first day in office, President Trump signed an executive order targeting the Affordable Care Act (ACA). Since then, much as been made about what the executive order might mean. Because Congress has failed to come up with a repeal-and-replace plan as expeditiously as promised during campaign season, it seems that the executive order seeks to say a lot without doing very much in the short term.

Unfortunately, media coverage of the executive order has served the President’s goals—to confuse the public and subvert confidence in the law. Much like the congressional votes earlier this month to pass a budget resolution starting the process of repeal, the executive order has no impact on policy and makes no immediate changes to the law. What’s more, while the order makes references to curbing “economic and regulatory burdens” of the law, it grants no new authority to executive agencies. Any proposed changes—such as eliminating the individual responsibility provision of the law and others—would have to come through normal regulatory or legislative channels.

But here’s what the order does do: it signals the administration’s commitment to dismantling the gains that we’ve seen under the ACA. What’s more, it irresponsibly signals an urgency to undo the ACA without first enacting a plan to replace the law.

That’s dangerous for not only millions of Americans who benefit from the law, but it causes chaos for the insurance market. Insurance companies will have to apply to sell 2018 Marketplace plans by May; why commit to selling plans for 2018 if the Trump administration is not committed to maintaining a stable market? That’s especially true if the GOP pursues a reckless repeal-and-run strategy, seeking to repeal the law, delay the effective date, and come up with a replacement plan later.

Therefore, while largely symbolic, the executive order jeopardizes market confidence, which will likely contribute to an exodus of insurers from both the Marketplace and the non-Marketplace individual market. Think having only Blue Cross plans in every county is bad? Wait until no one is willing to sell.

At the end of the day, the ACA is still the law of the land, and consumers can continue to sign up for 2017 coverage until Open Enrollment ends next week on Tuesday, January 31. Don’t let the administration’s distractions fool consumers into thinking that enrolling is futile—financial help is still available, and most people are still required to have coverage. North Carolinians should enroll while they still can.