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Coffee CAHC policy round-up: July 14, 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, 1st session


Friday, July 14, 2017


I can’t believe I forgot to update everybody about this on Wednesday: I saw the new “Spider-man: Homecoming” movie on Friday, and it’s wonderful. I absolutely loved it. It gets the Steve seal of approval.

Don’t forget that CAHC is hiring! We’ve opened a search for a digital engagement specialist. This is a contract position to help us strategize and build up our online media presence and communications plan. Details at this link. Please share far and wide, and if you’re interested, send us your application materials!


National level

Hmm. The “new” Senate bill sure looks an awful lot like the “old” one

A slightly-tweaked edition of BCRA dropped yesterday, and somehow they’ve managed to make it even worse than it was before. While the vast majority of the bill stays exactly the same – it still guts Medicaid and destroys any chance that most people will be able to afford individual coverage – it also blithely waves “buh-bye” to protections for people with pre-existing conditions by adopting a version of the so-called “Cruz-Lee amendment”.

This is the amendment I have mentioned before that would allow insurers to sell any number of crappy barebones plans as long as they sell one “ACA-compliant” plan in a market. This is a surefire recipe for an individual market death spiral, as sick people flock to the plan that covers them and healthy people stick with the cheap plans that won’t actually cover anything.

And this, of course, is assuming that people with pre-existing conditions will even be able to afford the right plans: let’s not forget that BCRA allows insurers to price those folks right out of the market.

The “revised” plan still allows insurers to shut the door in your face if you try to sign up for a plan after a gap in coverage, by allowing them to lock you out of coverage for six months.

It seems to have a glaring and ominous math problem, apparently using the same $70 billion pot of money for three or four different purposes (and a tip of the cap to Maine’s own Senator Susan Collins, who was the one who, as far as I can tell, first flagged this ridiculous error).

Oh, and in the middle of all of this, Congress is once again attempting to exempt themselves from the destruction they’re perfectly happy to rain down on the rest of us.

In short, if you hated the Senate bill last week, you should probably loathe the Senate bill this week.

But that doesn’t mean that this thing is dead. Far from it. If anything, it’s closer than ever to passing. That’s because the annihilation of protections for people with pre-existing conditions seems to have been a key demand of some of the more conservative members of the Senate before they could even deign to consider voting for this bill. Now that Americans with health conditions are being hung out to dry, some of those wavering senators may finally come onboard.

It’s also time for Senate leadership to go on a spending spree (as Vox put it, “Christmas in July”). Remember a few weeks back, when the Senate bill was first unveiled and I said that there appeared to be several hundred billion dollars of savings in the bill that Senate Majority Leader Mitch McConnell could “play with”? Well, it’s playtime. Expect to see a slew of amendments coming up over the next few days to buy a senator here and a senator there with funding for pet projects that will get them in the “yes” column.

All that being said, we are once again passing our thanks along to Senator Collins and Senator King, both of whom very quickly declared their opposition to the bill after it was unveiled yesterday. We would encourage all of you, if you haven’t already done so, to reach out to both Senators, thank them for their opposition to the proposal, and urge them to stand strong against any version of this bad bill.

What happens next? Well, it’s gonna be a frenzy of action over the next week, apparently. Expect to see a lot of wheeling and dealing over the weekend. There may or may not be a CBO score next week – leadership may decide to charge ahead without one. And then the plan is to vote as early as next Thursday. Which makes it absolute critical that we keep the pressure on the Senate to kill this thing once and for all.

On a semi-related note, I wanted to flag a little tidbit in today’s edition of the “Vitals” newsletter from Axios (which, by the way, if you haven’t signed up for it, you should). One of their reporters looked through some financial analytics being released by large Wall Street investment firms, and found that they are all expecting increasing insurance industry profits. Why? Because of an ongoing decrease in “utilization” – that is, consumers are using their insurance less, largely because they are seeking less care (not going to the doctor, or the hospital, or filling prescriptions).

That’s almost certainly attributable to the growth in high deductible health plans, which (as Axios points out) started long before the ACA. But what’s especially alarming about this is that AHCA and BCRA would explode peoples’ out of pocket costs. Our friends at Families USA have a new analysis showing that deductibles in Maine alone would increase an average of 342% under the Senate bill (largely because it gets rid of the subsidies that lower out of pocket costs for consumers).

The other day, I had a chance to speak with somebody who works in hospital system finances (it was a private conversation, so I’m going to go light on details here). I asked this person if their hospital system had seen, or was seeing, the same trend that I’ve heard is impacting the health care industry as a whole: unpaid debt from insured patients. They told me that it was an interesting question, because they’d only recently developed the ability to separate “self-pay” (e.g. uninsured) debt from insured debt, but that once they ran the breakdown, the numbers weren’t even close: insured debt drastically outstripped self-pay.

Now, there are a few other likely reasons for this: people without insurance are less likely to go to the hospital at all (delaying care as long as possible), and quite a few uninsured consumers in Maine likely qualify for free hospital care under state and federal law. It’s still an alarming trend.

It also is yet another way in which AHCA/BCRA are so insidiously dangerous, and brutally indifferent to the real pain and suffering they will inflict on people.


State level

A slight correction from Wednesday’s edition: the Appropriations committee is meeting again on Monday, and the Legislative Council is meeting on Wednesday (not Monday, as I said in the last issue). Then the whole Legislature will be in on Thursday next week to deal with the bills that come out of the Appropriations table process. I’m hearing that they will then come back one more time, probably in the first week of August, to deal with any final veto override votes from the Governor related to this last slew of bills.

As for those bills, sounds like it was quite the time in the Appropriations committee earlier this week. My sources tell me that the Committee spent hours rehashing old policy debates and splitting along predictable caucus lines with their recommendations of which bills should or should not be funded, or carried over to next year.

I’ve been working in or around (or a member of) the Legislature going back a little over a decade now, and this is, by far, the weirdest, wackiest legislative session I can remember. It isn’t even close. It’s hard to describe, but the building has moods: there’s an ebb and flow to the action, and a session can take on a certain “flavor” over the months in which legislators are in Augusta. The tone of this session…I don’t even know what to say. A kind word might be “unpredictable”, or maybe “zany”; a less charitable assessment might be “madcap” or “chaos”.

I don’t really have any deep analysis for you here, just an observation.

It will be interesting to see how this continues, or if it changes, when we get to the short session. The Legislature is planning on conducting a lot of business next year. If you didn’t realize, over a two-year “biennial” legislature, the first year is the “long” year that goes until…well, typically goes until mid-late June, this year being a clear exception. But the second year is the short year, when they are only in until mid-April (…theoretically).

Carrying bills over from year 1 to year 2 isn’t uncommon, but it seems like an unusually high number (and some unusually important or controversial bills) are getting punted down the road this time around. It’s going to be a jam-packed three or four months.


Would you like to know more?

You can read Vox’s breakdown of what’s in BCRA 1.1 here.

And here is Tim Jost’s rundown.


Until next time, friends, I remain,


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