Near universal health coverage achieved in six states and DC

An article by Michael Rainey of The Fiscal Times (see link below), called “How six states achieved near universal coverage” noted the success of covering at least 95% of their people. These six states are Hawaii, Iowa, Massachusetts, Minnesota, Rhode Island and Vermont. The District of Columbia also fits the bill. Per the article:

“A half-dozen states and the District of Columbia have health care insurance rates of over 95%, achieving near-universal coverage. Three researchers at the University of Pennsylvania — including Ezekiel Emanuel, a key architect of Obamacare — said Monday that the Affordable Care Act has everything to do with those results.

Here’s how the states achieved such high insurance rates, according to the authors:

Expanding Medicaid: States that expanded their Medicaid programs as allowed under the ACA had about half the uninsured rate (6.6%) in 2018 as states that did not do so (12.4%). ‘Nearly 5 million people would gain health insurance if the remaining 14 states expanded Medicaid,’ they write.

Extending enrollment periods: High-coverage states countered the Trump administration’s efforts to shorten enrollment periods and reduce informational assistance.

Lowering premiums: States enacted additional subsidies and reinsurance programs to keep premiums low, a crucial factor in maintaining insurance coverage from year to year.

Simplifying options: Some states limited the number of options available to counteract “choice overload,” which can reduce signups through consumer paralysis.

Maintaining individual mandates: Five low uninsured states maintain some kind of individual and employer mandates, which may help persuade healthy people to sign up.

The lesson, the authors say, is that near-universal health coverage can be achieved without national legislation. ‘While it is easy to dismiss the ACA and focus on the promise of Medicare for All, there is a more straightforward path to universal coverage,’ they write, ‘adopting a handful of relatively simple policies and programs at the state level can ensure health insurance coverage for nearly all Americans.’”

This article echoes what can be achievable if Medicaid is expanded and the other above steps are taken. The three states who drag the results down for the country – Texas, Florida and Georgia – did not expand Medicaid nor run their own Healthcare exchanges. Of the six states over 95%, it should be noted Iowa and Hawaii use the federal Healthcare Exchange, while the other four run their own exchanges.

I have long said Medicare for All is something to be explored, but it requires detailed analyses (and time) of its costs and impact. In the interim, I have strongly advocated improving the Affordable Care Act. The goal is access to care, in my view. The employment paradigm has been changing for some time, where fewer full-time workers are being used than before. We are seeing several industries move to a largely part-time workforce, such as in the retail, restaurant, and hospitality industries. We have seen contractual employment continue as well as the growth of gig economies. Health care access needs to come from somewhere.

What I do not care for is the hyper-politicization of this topic. Republicans (including the president) have actively sabotaged the Affordable Care Act, cutting funding to insurers, not mentioning the negative talk about it. It has still survived. Some Democrats choose to throw progress out and go full bore with Medicare for All. Again, that is a detailed undertaking and no candidate can accomplish this without buy-in from both parties.

So, let’s improve what we have. States who have not expanded Medicaid have been economically short-sighted and harmed their citizens. I have argued for repaying insurers who were harmed by the reneging on funding commitments, inviting them back into markets. Where choice is not available, introduce a Medicare option. I would also lower the eligibility for Medicare to age 60 or 62.

These are practical options that may move the needle upward like in those six states. Let’s talk about that.

https://finance.yahoo.com/news/6-states-achieved-near-universal-224827646.html

Blue Cross Blue Shield of North Carolina ACA premium rate cut request

Earlier this week, Blue Cross Blue Shield of North Carolina (BCBSNC) has announced a request of a premium rate cut for the second year in a row under the Affordable Care Act. They announced a request of a 5.2% rate reduction for their 435,000 members and one of 3.3% for small businesses in the state. It would have been three years in a row, but as I mentioned in earlier blogs, the Trump decision to renege on paying insurers for absorbing co-pays and deductibles for people making less than 2 1/2 x poverty limit caused premiums to increase for all.

This shows the ACA is stabilizing for insurance carriers who have been at it a few years. It would be nice to get more carriers back in for members to have choices. Many left when the Senate, led by the GOP defunded the risk corrider payments to the tune of 89% of the adverse selection cost. These carriers left the markets with the US government owing them money.

These two efforts to dampen the ACA have gone largely unreported. But, there is one more which is critical that impacts premiums and threatens the entire ACA. The tax bill passed by the GOP led Congress eliminating an unpopular feature of the ACA, which required individual coverage. It was called the individual mandate. By obligating people to have coverage, it lessened the risk on the insurers which will keep premiums lower than they would be otherwise.

Here is what BCBSNC said in their announcement as reported by The Charlotte Observer.

“The rate of decrease requested for 2019 would have been larger, the company told the Observer in 201, if the GOP tax reform legislation signed by President Donald Trump hadn’t repealed the ACA’s individual health insurance mandate.”

Further, several GOP led-states are suing the federal government to rule the ACA unconstitutional due to the elimination of the mandate. The tax laws are complex, but it is going to end up at the Supreme Court. It is thought by experts this case is weak, but the Trump Justice Department has decided to not defend the law which helps so many. Ironically, this is happening as it stabilizes even more, the GOP lost seats because of their ham-handed efforts to repeal it and when some Democrats want Medicare-for-all.

Sunday summaries

I hope your weekend is going well. Several topics have toyed with me writing a full post, so I will resort to a brief summary of a few. In no particular order:

The royal family of Saudi Arabia has done a pretty inept job of lying to the world about what happened to Jamal Khashoggi. It is so unartful that even the US President, who is not known for truth and wants just to do transactions, is being forced to admit they must be lying. I applaud other world leaders and even more than a few US Senators for stepping up to cry foul. My guess is this will eventually lead to the fall of Crown Prince MSB as he is embarrassing the family and country and this is adds to a growing list of notorious screw-ups.

Heading north to Great Britain, there were an estimated 750,000 British folks that protested in the streets of London yesterday asking for a new Brexit vote with actual facts being disseminated. While I fully understand the rationale of those who want Brexit, from the outset, Brexit will be harmful financially to Great Britain. Many financial companies and EU headquarters have either moved or are planning to move to an EU site. Plus, Scotland and Northern Ireland continue to talk openly of votes to leave Great Britain should it occur. If that is not enough, it is believed that Vladimir Putin has had a hand in the disinformation as he did with the 2016 and current 2018 elections in the US.

Returning to the US, candidates of my old Republican Party are taking a lot of heat over their positions on healthcare over the years. They should. Not only has this party not tried to improve and stabilize the Affordable Care Act, they have sabotaged and made it worse. It should be noted politicians don’t seem to understand a lot about healthcare. Here is a letter I sent to my newspaper that will give you a sense of what has transpired.

It seems healthcare is a key issue this election. Surveys the last eighteen months have indicated the majority of Americans want the Affordable Care Act stabilized and improved. Yet, the GOP leadership has tried to repeal it and actually has sabotaged its success making premiums higher than they otherwise would have been. The Senate’s defunding by 89% of adverse selection payments to insurers, the President’s defunding of payments to insurers to help people in need with co-pays and deductibles and the fight in states like NC to not expand Medicaid have increased exchange premiums and driven more carriers out of markets. This retired actuary, benefits consultant and benefits manager believe these measures have harmed Americans and people should know this.

Finally, a story that should get even more airplay than it is relates to the voter suppression attempts by the Georgia gubernatorial candidate Brian Kemp in his role as State Secretary. Whereas an ethical person would recuse himself from overseeing elections, Kemp has been pretty blatant in his efforts to make it harder to vote. I do not like the voter ID laws, gerrymandering districts and aggressive voter suppression tactics being done in my own and other GOP led states. These are Jim Crow-like. Yes, Democrats have done similar tactics, but what is being done the last eight years has been an orchestrated effort by a group called ALEC, funded by the Koch Brothers.

I am pretty tired of this the “ends justifies the means” rhetoric. I see what can happen when people cheat. They cheat to get elected and cheat once they are there. The US President is not only enriching people who donated to his efforts, he is enriching himself by using his position to make more money. This self-dealing is actually illegal. And, when people cheat, it devalues our country and state governance.