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Coffee CAHC policy round-up: July 26, 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

 

Wednesday, July 26, 2017

 

I keep hearing that “self-care is important!”. Last night, after a long week of insurance company rate hearings and a bananas afternoon and evening of Senate action, my self-care took the form of zoning out in front of some Netflix scarfing down what can only be described as a “reckless” amount of spicy chicken wings followed by some Ben and Jerry’s (Americone Dream, in case you were wondering). That has led to some regret today: let’s just say I did not feel super energetic when the alarm went off this morning. What’s y’all’s favorite self-care technique? Please share them – we’ll need a good solid list to get us through this week!

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

Here we go.

Unless you just woke up from a several-days-long sleep, then you know that the Senate voted yesterday to open debate on their version of the Destroy America’s Health System and Safety Net I mean Gut Medicaid to the Bone I mean Better Care Reconciliation Act I mean Obamacare Repeal Reconciliation Act I mean American Health Care Act I mean…the “TBD! ¯\_(ツ)_/¯”, uh, Act.

This was a razor thin margin. Of the 52 GOP Senators, all but two – Maine’s own Susan Collins, and Lisa Murkowski of Alaska – voted to start a short, 20-hour debate on some version of some bill that they haven’t even seen yet, and which (they were quite willing to point out) they had no idea what it would look like in the end. As predicted, Vice President Pence, executing one of his two official duties as VP (the other being to take over the presidency if required), broke the tie.

There was a bit of high drama as Senator John McCain, returning to the Senate just days after being diagnosed with an aggressive form of brain cancer, voted to move forward debating a bill to eliminate health care access for tens of millions of Americans. Right after he voted for the motion-to-proceed on a bill that has absolutely violated every precept of the Senate’s “regular order”, followed immediately by a fiery speech in which he demanded a return to regular order. Then he announced that he would not vote for the bill, just a few hours before he voted for the bill.

That’s the kind of day it was, really.

To recap, my understanding of what happened, procedurally speaking, is that McConnell moved the House bill (AHCA), with the intent to spend the 20 hours of allowed debate using that bill as a framework. Over the next few days, a ton of amendments will be offered to alter, or completely replace, AHCA with some alternative. The hope for Senate leadership is that they get something over the 50+1 threshold and move it to a “Committee of Conference” with the House to hash out any differences between the two bills as passed by each chamber. That conference committee would only be avoided if the Senate passed the House AHCA bill exactly as the House passed it.

Things got especially interesting late yesterday evening. Senator McConnell had his first key test on a vote to turn the bill into the latest version of the Senate’s “Better Care Reconciliation Act”, or BCRA. This version included Senator Ted Cruz’s amendment (insurers can sell crummy plans as long as they sell one ACA-compliant plan), and some amendment offered by Senator Rob Portman that tried to get at some of his concerns related to ending Medicaid expansion.

To be clear, there was no expectation that this would pass.

But I’m not sure anybody expected that they would lose nine GOP votes.

This amendment didn’t just lose, it went down in flames. Senators as far apart on the GOP ideological spectrum as Susan Collins (the moderate wing) and Tom Cotton (a staunch conservative who, as far as I can tell, was not on anybody’s radar for this process) voted against it.

What does that mean? …who knows?

The latest idea seems to be that McConnell is pleading with his members to at least accept something being called “skinny repeal”, which is a mildly “stripped-down” version of BCRA that “only” (sarcasm) throws 15 million people to the wolves. That way, they can get to a conference committee and keep some hope alive that they’ll agree to a version that can pass both chambers.

This is going to be a crazy, hectic couple of days. We’re hearing that the “final” vote will come sometime this Friday.

You know the drill. You’ve been following this with us since we launched Coffee CAHC way back in January. Maine’s two Senators are with us, but we need to keep calling and e-mailing them to thank them for that support and give them the backup they need to stay strong and vote against any version of this bill that comes up in the next few days.

As always, I’ll be watching the process and will keep you posted.

Consider this your “heads up” that Friday’s Coffee CAHC will probably drop later than usual. I may even delay it until Saturday, if it looks like the “final” vote is coming later that day. I’d rather delay by a few hours to give you all the most important update than stick to our schedule and send you something that will be out-of-date within the hour.

 

State level

I’ve been absorbed in rate hearings for the past week. It’s been quite the experience.

I hope that, next week, I’ll have the time and headspace to do a deeper dive for you all on these rate requests and the hearing process. For now, let me just say that I don’t envy any of the parties: not the insurers, not the Bureau of Insurance, and certainly not the consumers who are facing 20-30% premium increases and higher out of pocket costs, if the rates are approved.

The simple fact of the matter is that the ineptitude in Washington is doing real damage, right now, to insurance markets in Maine and across the country. Insurers have no idea what to expect tomorrow, let alone next year – and remember, this is an entire industry built on being risk-averse. They are trying to price that risk into their rate requests.

Our key message to the Bureau of Insurance at the hearings for all three carriers was simple: while we certainly understand that things are, to be charitable, “weird” right now, that political uncertainty alone cannot be used as an excuse to give insurance companies a blank check on premiums next year. They have to demonstrate clear, rational analysis of the underlying factors driving their requested increases.

 

Would you like to know more?

I might as well rename this section “yeah, what Tim Jost said.” Here he is breaking down yesterday’s Senate action for us.

An alternative name for this section could well be “Vox does the best explainers.” Here’s their cartoon (I seriously love, love, love these) on “skinny repeal” and why it, too, is a recipe for disaster.

 

Until next time, friends, I remain,

-Steve

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