Sunday, June 18, 2017

Is there going to be a Senate health bill?

Who says there's no diversity among the 13 white men on the Senate's Health Care Working Group? More at Yahoo! News.
I'm sure Steve and other good people are right in warning us to stay vigilant on the threat of TrumpCare, whatever that turns out to be (certainly including an end to the employer mandate requiring companies to buy health insurance for their workers, an end to the Ten Essential Benefits every health insurance policy is now required to cover without a copay and the community rating system that allows people with preexisting conditions to pay the same premiums as everybody else, and the transformation of Medicaid into a block-granted state-run boondoggle that will end up in red states in the general revenue, like TANF in the Gingrich "welfare reform" of 1998, reluctantly signed after two vetoes by Bill Clinton, covering none of the needs of the poor; and of course cutting some $660 billion off the taxes of very wealthy individuals and insurance and drug companies). And yet I have a harder and harder time believing that it really exists.

I mean the Senate bill in particular, said to be getting cooked up in absolute secrecy for a vote without hearings, public scrutiny, or CBO score, maybe next week, or whenever they're confident they have the 51 votes according to ThinkProgress,

They can hide, but they can't run. Sooner or later it's got to be unveiled and voted on, and then go to conference with the House. The Senate Republicans have the same kind of tension as the House ones do, too, between those who would like to pretend the bill does some good to the needy (Murkowski, Gardner, Portman, Moore Capito, and Collins) and those for whom total defeat over Obama is the prime directive (Paul, Lee, and Cruz), which means the drama of March through May, where the House leadership had to withdraw one bill without a vote before passing a bill for the Senate to ignore, will be repeated. The public approval of the bill as people understand it is now down to 29% nationwide (as opposed to 49% for Obamacare); there isn't a single state where it's above 35%.

Public approval of the AHCA by state, as of June 15, from New York Times.
And Donald Trump's own initial love for the House bill seems to have changed over the past five or six weeks to loathing...
"What we have is something very, very incredibly well-crafted," Trump said of the [House] bill. He added that he feels "confident" the bill will pass through the Senate and said it "will get even better." (May 4)
One source said Trump called the House bill “mean, mean, mean” and said, “We need to be more generous, more kind.” The other source said Trump used a vulgarity to describe the House bill and told the senators, “We need to be more generous.” (June 13)
Then Vox managed, I don't know how, to break through the Republican Senators' wall of silence and get eight of them to respond to some questions about the bill, and the results were somewhat disquieting.

The funniest answers were certainly from John McCain—

Tara Golshan, Vox

Generally, what are the big problems this bill is trying to solve?

John McCain

Almost all of them. They’re trying to get to 51 votes.

—and Chuck Grassley (these octogenarians could be getting trotted out just to allow observers to blame their double talk on dementia, but I'm pretty sure Grassley at least is not demented, more at LGM), but some of the younger folks like Boozman of Arkansas seem to be having a pretty hard time of their own:

Jeff Stein

What do you think this health care bill will accomplish? How will it help people in America with their health insurance?

John Boozman

Well, right now when I go back to Arkansas — we’ve got so many people in Arkansas, premiums have gone up 128 percent in the past four years. We have all kinds of people in a situation where if they’re fortunate enough to afford the premium, they’ve got $5[,000] to $10,000 deductibles. And so hopefully we’ll deal with some of those problems

Jeff Stein

How does this bill do that?

John Boozman

Well, it makes it such that it’s more affordable. So that’s really what we’re working through now. We don’t have a bill yet; we’re working hard to come to an agreement so we can solve some of those problems.

Jeff Stein

Why will this bill reduce premiums? How will it lead to the outcome you’re describing?

John Boozman

Well, again, like I said, that’s what we’re working through here. I’m not going to negotiate the bill now. We’re in a situation where that is the outcome.
I know that the course we’re going down is simply not sustainable. The other problem we’ve got is that premiums were held down through the election; the premiums, in my state, the increase will be at least 20 to 25 percent. That’s what the insurance commissioners are telling me. I think we’re on an unsustainable course.

Jeff Stein

But I’m curious why you believe this bill will fix that problem. What’s the mechanism for fixing it?

John Boozman

It’s working together and coming up with a bill that does do that. Because we’re in a situation with Obamacare that, again, we don’t have a sustainable product.
I'm not actually sure why Boozman agreed to the interview—unlike most of the Senators who contributed, he's not one of the 13 member of the "working group" that is supposed (in lieu of a normally constituted committee) to be writing the legislation—but I believe him when he suggests there isn't any bill.

I can't imagine what their game is—insurers really are dropping out of the individual market in many states and premium requests are going high (for the small percentage wealthy enough to have to pay full fare, and of couse for the government that subsidizes everybody else), basically because of insurers' insecurity as to what the market is going to be like next year, and things could get bad for their constituents if they don't decide soon whether to shit or go blind, as my dad would say. But their conduct is not the conduct of somebody who is trying to railroad legislation through against the popular will as much as it is of somebody who's pretending for some reason to do that. The obvious reason being, I'd think, the desires of Donald J. Trump, who wants them to come up with something and doesn't much care what's in it. They're pretending to have a bill, to keep him docile and manageable, and procrastinating.

I'd been thinking nobody is really afraid of Emperor Trump any more, but I'm not sure of that, and when you look at people like McConnell or McCain you see them as obsequious as ever. But they can't do this one job, however fearful of the consequences they might be.

Annals of Derp

Incidentally, those 128% rate increases might surprise Arkansans. For whom? As of last year in the Exchange,
For the three carriers that were already offering plans in the Arkansas exchange, the average rate changes were:
  • Arkansas BCBS = 7.15 percent increase
  • Celtic (Ambetter) = 0.08 percent increase
  • QualChoice/QCA Health Plan = 8.2 percent decrease
Arkansas BCBS had the bulk of the 2015 enrollees, with 79 percent of the state’s individual market share. But almost 9 percent of Arkansas’s individual market enrollees had a plan through one of the QualChoice Holdings carriers in 2015, and those policies had rates decrease of more than 8 percent in 2016.
The modest rate increase for 2016 comes on the heels of a decrease the year before; the Arkansas Insurance Department announced in October 2014 that premiums in 2015 would be two percent lower on average compared to 2014 rates.
And the increases for 2017 were higher, 15% for BCBS  and 25% for QualComm, which had gone too far in the other direction in the previous year, but nothing that's going to add up to 128.

Turns out that Boozman is using a very special kind of calculation, from the Arkansas Health and Human Services Department, in which the 2013 premiums are represented by one set of data from the calculations of the Medical Loss Ratio of all policies in the individual market (which were available only up through 2015), and the 2017 premiums by a different set, the CMS Multidimensional Information and Analytics System (MIDAS), considering only policies purchased on the Exchange (which were available only starting 2014), so that—

Via Arkansas HHS.

—according to this picture premiums rose 18% over the zero-year period from 2014 to 2014, from $289 to $341 a month, followed by a more modest 8% rise from 2015 to 2015, from $329 to $356. Also, the CMS 2017 data are fictional, "based on a weighted average of plan selections during the 2017 open enrollment period." Or, putting it another way, this number from the Arkansas Republican state government is totally bogus.

And the deductible for the second cheapest Silver plan in Arkansas this year is $2000. Just sayin.

Cross-posted at The Rectification of Names.

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