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Coffee CAHC policy round-up: December 15, 2017

Coffee CAHC is a twice-weekly newsletter where we round up and comment on the latest health coverage policy developments both nationally and here in Maine. We hope you find these updates helpful!

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Coffee CAHC

115th Congress, 1st session

128th Maine Legislature, adjourned


Friday, December 15, 2017


Folks, devoted readers among you will recall that I’m something of a happy geek. It will surprise none of you, then, to know that I am seeing Star Wars: The Last Jedi later today, and that I can’t wait for it. Unfortunately, however, the fact that some people saw it last night means that the internet is now a complete “daaaaaaaanger zoooooooone!”* for me. I’m absolutely terrified that I’m going to see some massive spoiler in a headline, like “6 QUESTIONS ABOUT HOW CHEWBACCA IS LUKE’S REAL DAD” or something. But the Coffee CAHC must be baked, so I’m braving the interwebz for you all, dear readers.

*First reader to write back to me correctly placing this reference gets bonus points and a Coffee CAHC shout-out next week.


National level

First things first: it’s the last day of open enrollment. If you think you might be eligible for coverage through the Marketplace, today’s your last day to get signed up for a plan. Do it! (and if you or somebody you know has questions or needs help, call our HelpLine at 1-800-965-7476!)

Interestingly, a CMS newsletter for Marketplace enrollment assisters that went out last night says that Maine residents who were impacted by the windstorm may qualify for some extra time to sign up, under what’s called an “exceptional circumstances special enrollment period”. But make no mistake: this is not automatic, and it is not a blanket extension for the entire state. You (or anybody else) should still sign up by the end of the day today.

That being said, people who were impacted by the windstorm in November may be able to get through the door if they call the Marketplace and “provide detailed information about their situation”. I couldn’t find an online version of the newsletter, so I can’t link to it, but anybody with questions or trouble accessing this SEP in the future should – of course! – call our HelpLine.

OK, on to politics.

In what’s becoming something of a common refrain, “Congress did nothing the past few days”.

Except actually, this time, that’s not entirely true. We now know the broad contours of both the tax bill, and the next “continuing resolution” budget agreement that will temporarily prevent the government from shutting down (I’m just going to call that “the CR” to make my morning a bit easier).

They’re both infuriating.

The tax reform bill that came out of the House and Senate conference committees will still repeal the individual mandate.

The CR does not contain Alexander-Murray or Collins-Nelson (the two bills that Senator Collins claims to be preconditions for her support for the tax bill), and does not fund FQHCs, and does not fund CHIP.

Let’s start with tax reform, and why people who care about health care need to be paying attention to this garbage bill, regardless of the individual mandate piece of it (which is bad enough as it is).

By bending over backwards to hurl massive, massive, massive bonuses at some hyperwealthy campaign donors and mega-corporations, the Republicans who are supporting this measure are adding a trillion dollars to the deficit. They’re paying for some of their billionaire bonanza by getting rid of the individual mandate (which saves the government money because it means fewer people getting health care and tax credits).

I want to point you toward one passage at the end of this article in USA Today, which I think really sums up the jaw-dropping insanity we’re talking about here:

Not having the mandate is expected to reduce the number of people buying coverage both voluntarily and because coverage becomes too expensive. Not covering them will reduce how much the government pays for subsidized coverage.

Brady said that change helped offset the cost of continuing to have the deduction for high medical expenses, provision the House would have eliminated but the Senate not only kept but expanded for two years.

“The individual mandate that came from the Senate also allowed them to maintain and really even provide a little more relief on the medical expense deduction,” Brady said. “That seems, it always seemed to me like an appropriate connection.”

Let us unpack this a bit.

What the good representative is saying here, and I mean spelling out for us in crystal-clear detail, is the following:

  1. We feel like we absolutely need to give billionaires a bonus;
  2. We used to pay for the billionaire bonus by screwing over sick people and seniors, by getting rid of the ability to deduct medical expenses;
  3. Then the Senate decided to pay for the billionaire bonus by screwing 13 million Americans out of their health care coverage, and we like that;
  4. So now we are all fine paying for the billionaire bonus by screwing 13 million Americans out of their health coverage, and I guess some of you can have your medical deductions back;
  5. Billionaires matter to us way, way more than you do.

The logic here is startlingly simple. They will starve the government of cash by forking over this colossal billionaire bonus, which will also jack up taxes on most of the middle class anyway, and then they’ll say “hey we have no money” and will come for your Medicare, your Medicaid, and your Social Security.

You don’t need to be a conspiracy theorist to believe this: they’re flat-out saying so, in press conferences and in tweets.

They believe that the role of government is to protect billionaires at any cost, even if that cost is paid in working-class health care, working-class savings, and working-class lives. Are you angry yet?

On the other hand, Speaker Paul Ryan said yesterday that maybe he’d be willing to spare Social Security the axe if women would just have more babies. So, you know, there’s always that.

(Side note: I wrote my masters thesis on pension systems. The Speaker is not entirely wrong about the inverted-pyramid dynamic in America, but hey, you know what’s a very efficient and effective way of compensating for some of the demographic challenges he highlights, particularly as a shorter-run solution to boosting your workforce-age population than waiting for babies to become workers? Immigration. Perhaps the Speaker should reconsider his position on immigration in light of his apparently vast concern over our demographic challenges…ok, I’m off my soapbox.)

Anyway, sounds like the tax package is coming up for a vote early next week, although that schedule may be somewhat in flux as the Senate Republicans currently have two members whose attendance is dependent on their current medical conditions.

Oh, and yes, I too have seen Senator Marco Rubio claim that he’s going to vote against the bill unless they make some changes to it. I don’t believe him and neither should you.

So, yes, of course, keep up the calls, keep up the e-mails, keep up the tweets to Senator Collins. Once again, my friends, I’m afraid that I have to ask you all to continue to beg and plead with your elected officials not to destroy your lives and the lives of your friends and families. Just be careful that if you try to drop a note off at her offices, you don’t end up going to jail. (And, as always, be nice to her staff.)


State level

The Appropriations committee met on Wednesday to begin discussing next year’s budget. A large part of that conversation was focused around Medicaid expansion. You can read more here.

Unfortunately, I wasn’t able to be in the room during their deliberations or even listen in, but the recap I got from others who were there is that the key question that needs answering is this: what is the actual, reasonable projection of the cost, in 2018, of expansion?

The Governor’s ongoing hysteria around the cost of expansion doesn’t seem to be based in anything realistic. And the fiscal note that was originally part of the expansion push assumed that it would take effect January 1 (it won’t), and assumes a 100% uptake on day 1 (which also won’t happen). We think that when those factors are taken into account, the figure for the budget will be drastically and dramatically lower.

So, for now, we’re waiting to get some more details. Stay tuned!

Meanwhile, don’t forget that the first meeting of the health care task force is next week. Joe Lawlor at the Press Herald wrote an interesting article about the group.

As a backdrop to both expansion and the health care task force, you may have seen news the other day about Maine’s overall health ranking on some metrics comparing states. The article I just linked to is worth checking out in its entirety, but here’s just one jaw-dropping stat: while Maine’s infant mortality rate dropped slightly (good) over the past few years, it has increased by 20% over the past 5 years.

There’s a really simple lesson and takeaway from the report, which is that Maine’s leaders and policymakers need to be paying dramatically more attention to public health than they have been, and need to take it much more seriously than they are. Let’s not forget that when a handful of obstinate legislators stubbornly forced the state into a completely unnecessary and ridiculous shutdown last year (don’t forget that we had a budget surplus), it was the Fund for a Healthy Maine that got raided to dig us out of it. In other words, when some legislators had a little fuss, public health was what paid the price.

That. Needs. To. Stop.


Would you like to know more?

Here’s the link to the actual state report, which includes the entire dataset, of that state health ranking. Some fascinating (and depressing) stuff in there.


Until next time, friends, I remain,


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