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Coffee CAHC policy round-up: May 19, 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, May 19, 2017


Has anybody ever done a study on how long it takes the average Mainer to transition from “I’m so sick of winter!” to “whoa it is WAY. TOO. HOT.”? On this front, I’ve changed as I’ve gotten older: I’ll take the heat and the sun over the cold and the dark any day. These last few days of warm sunshine have done me some real good. I even enjoyed being awakened by that ripping thunderstorm that smashed over Augusta around 11 or so last night.


National level

Remember that time that the U.S. House of Representatives FINALLY voted on the AHCA and sent it to the Senate and that was that?

HA HA HA lol j/k yeah nope.

In a very weird bit of news that broke late yesterday, it turns out that the House is still “in possession” of the AHCA. They haven’t actually sent it over to the Senate yet. Why not? Because they are worried that the CBO score will show that it doesn’t actually save the government the $2b necessary for the Senate to consider under “reconciliation”. They had around a $130b cushion to play with, but apparently they are worried that that flurry of last-minute amendments they just went ahead and voted in without a score may have been a bit too much.

If the CBO score – which we now hear will land next Wednesday – shows that they didn’t hit the target, then they’ll have to revise the package and vote on it again in the House before sending it to the Senate.

To be clear, I’m not saying this is likely, but it’s interesting that they’re concerned enough about it to hold onto the bill, juuuuuuuuuust in case.

In other federal news, Sarah Kliff at Vox has described the current state of negotiations in the Senate as “kooky”. If Sarah says it is so, then it is so. Why is she saying this? Because some of the ideas that are being floated as part of the ongoing negotiations seem like unusual propositions to be coming from certain members – such as Orrin Hatch of Utah, who mused that the individual mandate may need to stick around in perpetuity. (Huh?!??)

As the official group of 13 (male) Senators does their thing, Senator Susan Collins is declaring the House version of AHCA dead in the water as she works to rally bipartisan support for a different compromise.

Meanwhile, the few insurers that have filed rate plans so far are asking for pretty significant rate increases, and it’s largely down to one reason: the Trump Administration and the Congressional GOP are not sending any of the signals that insurance companies need to make solid projections for next year. Remember, these are requested rate increases. State and federal regulators will get a crack at these before final rates are approved or set.


State level

At public hearings on Wednesday in Portland and yesterday in Augusta, DHHS got an earful from individuals and advocates from across the state who are furious about the Department’s proposed changes to the MaineCare program. Under the guise of an 1115 “demonstration waiver”, the Department is proposing some sweeping changes to MaineCare, such as (among other stuff):

  • work requirements (which don’t work);
  • emergency room copays (using a very silly standard of “if you’re admitted it was an ‘appropriate’ use of the ER so we won’t charge you then” – a broken leg, evidently, being an “inappropriate” use of the ER?);
  • charging premiums and examining assets for some Medicaid applicants.

Several of the changes they’re requesting actually violate state and federal law. Which is one of many reasons CAHC spoke against the proposal.

Meanwhile, the legislature is slowly but surely stabilizing a little bit after the chaotic pace of the past few weeks. Committees are winding down their work for this year, moving bills off their plates. All eyes now turn to the budget negotiations. What will happen there? Your guess is as good as mine. The Appropriations committee is plugging away, largely behind the scenes, but adjournment creeps ever closer.


What’s at stake

This week’s featured story highlights a piece of the ACA/AHCA debate that I fear may be getting missed: this is about way, way more than just the Marketplaces. Sara, a 38 year old cancer survivor, shares her story and her fears of what could happen to the millions of Americans (and hundreds of thousands of Mainers) with pre-existing conditions, even those who have employer-based coverage, if the AHCA passes and wipes out vital protections for Sara and others like her.


Would you like to know more?

Center on Budget and Policy Priorities took a look at how home and community-based services will suffer dramatically under the version of AHCA passed by the House. This is a particularly important issue for Maine.

We’ve said it before and we’ll say it again: high risk pools take money, and AHCA doesn’t have nearly enough cash in there to keep them afloat. Don’t believe us? There’s new research backing us up.


Until next time, friends, I remain,


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