Fight to protect health benefits

This is the text of a Letter to the Editor, which appeared in today's Baltimore Sun:

The intentional attack on the Affordable Care Act, which is playing out in Washington, is both cruel and immoral. It would undermine the progress in health care we have made while 23 million Americans would lose their coverage. In Maryland alone, based upon the new Congressional Budget Office score, 181,204 individuals in the private market would lose coverage, Medicaid would be eviscerated and premiums would rise even more. This is unacceptable ("House GOP's health bill would leave 23 million more uninsured, CBO analysis finds," May 24). 

Equally so is the enormous market anxiety being created by the Trump administration as it refuses to commit to continuing cost-sharing reduction payments. These are absolutely critical to making health care services affordable for lower-income people and keeping insurers in the marketplace. In Maryland, more than 83,000 individuals are projected to benefit from over $97 million in cost-sharing reduction payments in 2017. 

The administration recently sought a 90-day delay in a legal fight over the payments, adding to the uncertainty and the president's proposed budget for next year does not include funding for these subsidies. 

The action in Washington is already damaging the insurance marketplace. CareFirst, the state's largest insurer, is seeking rate increases of more than 50 percent for policies sold on the state's exchange. As if that wasn't alarming enough, CareFirst President and CEO Chet Burrell has said that if the federal subsidies are not made, the company will further increase its already staggering proposed rates, making coverage unaffordable for many more Marylanders.  

Fortunately, some Maryland leaders are working to preserve as much coverage as possible in the state. Attorney General Brian Frosh joined with 16 of his counterparts around the country to intervene in a lawsuit focused on the federal subsidies. Another step that could be considered is a reinsurance program, either through a 1332 waiver or with state funds, which could help protect Marylanders from premium increases.

There is much at stake as those opposed to the Affordable Care Act move to blow it up. Hundreds of thousands of Marylanders could lose their insurance and access to affordable health care. We are particularly concerned about the most vulnerable among us, but we are also concerned about the fiscal impact on our state's economy and on the well-being of our communities. 

Maryland has always been a leader on health care reform. Now is the time for our leaders to step up and refuse to allow the progress we have made in Maryland to be subverted by those in Washington who appear to have lost their moral compass

Congressional Budget Office Analysis of Revised AHCA

The Congressional Budget Office today released the much anticipated score updates for the House GOP bill, the American Health Care Act, which was passed by only a 2-vote majority on May 4.

The analysis shows that 23 million Americans will lose their healthcare coverage over 10 years, a small improvement over the 24 million projected under the previous version of the bill. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance under current law.

Other key points to note in the analysis. The legislation will:

  • Slash $834 billion dollars from Medicaid, leading to huge service and eligibility cuts for low-income people, seniors, and the disabled;
  • Shift billions in costs to state governments;
  • Significantly increase premiums for older adults; 
  • Allow states to waive the ACA's required essential health benefits; and,
  • Permit insurers to charge higher premiums for those with pre-existing conditions who don't maintain continuous coverage.

All of this to provide hundreds of billions of dollars in tax cuts for corporations and the wealthy.

In Maryland:

It is now up to the Senate to protect consumers from the devastating impacts of this bill.  

New CBO Scores Expected Tomorrow, Could Trigger Another House Vote on the AHCA

President's Trump draft budget proposal hit Capitol Hill today with a thud. Calling for enormous cuts in healthcare and social safety nets. Some of the biggest cuts?

— Medicaid by $610 billion over the next decade
— NIH by $6 billion next year
— CDC by $1.3 billion next year

Tomorrow, the updated Congressional Budget Office Scores are scheduled to be released on the American Health Care Act, the House GOP healthcare bill which passed by just a two-vote majority on May 4. The bill has not officially been sent to the Senate because it must include the CBO scores, and those scores must show that it meets the Senate budget requirements of at least a $2 billion deficit reduction over the next 10 years. A previous version of the AHCA saved $150 billion over 10 years, and some outside health experts expect the new scores to show sufficient savings. But there were major changes to the final version that add a degree of uncertainty to that outcome. If it fails that test, it would need to be revamped and revoted on in the House, which which may be challenging now that Rep. MacAuthur has resigned as co-chair of the moderate Tuesday Group.

Health Insurance Markets Facing Instability As Rate Deadlines Loom

Last Thursday, Attorneys General from 15 states and the District of Columbia, including Maryland's Attorney General Brian Froshfiled a motion to intervene in a long-running lawsuit between the Administration and House Republicans over the legality of the cost sharing reduction subsidies included in the Patient Protection and Affordable Care Act. The Attorneys General said that they can not trust the Administration, which appears to view healthcare as a political bargaining chip, to act in the best interests of the states. The subsidies, known as Cost Sharing Reductions (CSRs), help low-income consumers use their insurance, by making payments directly to insurers to offset the costs of deductibles and co-payments. Ending these payments would have serious consequences for insurers, some of whom are already considering leaving the markets in 2018.  

On Monday, the White House agreed to continue paying the subsidies while the House of Representatives and Department of Justice asked the District of Columbia federal appeals court to keep the lawsuit that questions their legality on hold for another 90 days.

This delay imposes further uncertainty on the healthcare insurance market, just as insurers are trying to set their rates for the coming year. In Maryland, CareFirst is asking for rate increases of an average 50.4% on its HMO plans in Maryland and a 58.8% increase on average on its PPO plans. CEO Chet Burrell warned earlier this month that if cost-sharing reduction payments were to end, rates could increase by another 10 to 15 percentage points.

Approximately 83,000 Maryland consumers qualify for CSRs and about $97 million was paid to insurers to help make their health care affordable last year. 

Maryland Insurance Administration Publishes Rate Filings

As if the House passage of the deeply flawed and irresponsible AHCA yesterday weren't enough, the Maryland Insurance Administration released the 2018 proposed premium rates for Maryland's insurance carriers, and they produced some sticker shock, to say the least.

Maryland's largest carrier, CareFirst, requested an average 50.4% increase on its HMO plans in Maryland and a 58.8% increase on average on its PPO plans.

Other carriers also requested large increases, although smaller than CareFirst's. Cigna Health and Life Insurance Co. requested an average 37.36% increase, while Kaiser Foundation Health Plan of the Mid-Atlantic States asked for an average 18.08% increase.

Evergreen Health, which was absent from the individual marketplace last year because it was waiting for approval to convert to a for-profit insurer, is seeking an average 27.8% increase in its rates.

Consumer Health First President, Leni Preston, was quoted in an article in today's Baltimore Sun:

"The company [CareFirst] set prices too low in the beginning and they should have realized there was going to be a rush of sick people trying to get care," said Leni Preston, president of the Maryland advocacy group Consumer Health First.

"These just seem uncomfortably high and out of sync with what one sees with the rest of the market," Preston said. "I'm almost speechless, really."

Carriers received large increases last year, saying it was a one-time market adjustment to reflect the fact that fewer healthier people were enrolling in the plans than anticipated. However, it may be creating a downward spiral as healthier individuals balk at the increasing premiums, leaving even fewer healthy people in the pool. 

So far, no carrier has indicated that they are considering leaving the market, but they are wary of continued losses.

These are initial rate requests. Historically, the MIA's independent analysis has resulted in adjustments to the rates before approval.

Press Release from Consumer Health First on Republican Repeal of the Affordable Care Act

The Republican-led House of Representatives voted with the slimmest of margins, to repeal the Affordable Care Act (ACA) and replace it with legislation that will likely strip coverage from millions of Americans, gut Medicaid and make care less affordable and accessible, especially for lower-income, older and sicker individuals and families. Jeananne Sciabarra, Executive Director of Consumer Health First, has issued the following statement:

“We are extremely disappointed in the outcome of the healthcare vote in the House of Representatives today. Without a score from the Congressional Budget Office, without any public input whatsoever, House Republicans have moved to strip coverage from millions of Americans, including hundreds of thousands of Marylanders, and make healthcare less affordable and less accessible, especially for our most vulnerable citizens. Congress has shown that it cares more about giving tax cuts to the ultra-wealthy than the well-being of everyday Americans.

“We are also very disappointed in Representative Andy Harris, the lone Maryland lawmaker to vote for this bill, for selling out the needs of his constituents and enabling the House to endanger Maryland’s Medicaid program. 

“We want to thank our Democratic representatives for standing up against this bill, and we call now on the Senate, including Maryland’s Chris Van Hollen and Ben Cardin, to do everything they can to stop this bill from moving any further. We also urge Governor Hogan to strongly oppose any federal attempts to undermine our healthcare system, including any rollbacks to Medicaid. 

“Consumer Health First will continue to speak out against any attacks to Marylanders’ healthcare and we remain steadfast in our commitment to achieving affordable, high-quality healthcare for all Marylanders.”