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Coffee CAHC policy round-up: November 1, 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


Wednesday, November 1, 2017


Well, so this has been an interesting week so far, huh?

For any of our national readers (a small but dedicated crew), Maine got blasted by a strange storm from late Sunday night into mid-day Monday that left about half of the state without power. Communities are slowly but surely coming back online, but lots of folks are still without power.

Meanwhile, those of us who were lucky enough not to lose it at all have been opening our homes as warming/showering/charging stations. I think we’ve had more than a dozen friends and family members come by our place in the past few days to shower, move critical things to our freezer and fridge, charge phones and laptops, and even work from our kitchen while they wait for their own homes to get re-energized.

Hope all of you are hanging in and doing ok, and if any of you are in the Augusta area and need anything from me, just drop me a line!


National level

It’s open enrollment!!!

Yes, open enrollment 5 is upon us, and as of today, consumers can once again shop and sign up for plans. Because of the way that insurers reacted to ongoing attempts at sabotage from the Trump Administration – specifically, the elimination of CSR reimbursements to insurers – this year presents an odd quirk: increased tax credits that may, for some consumers, make some gold plans cheaper than some silver plans, and make bronze plans premium-free entirely. What strange times we live in.


Late last Friday, the 2019 Notice of Benefit and Payment Parameters dropped. This is the massive annual rule that provides one of the most important opportunities for the Administration to shape the malleable portions of the Affordable Care Act. These documents are incredibly important, and also ridiculously dense – like, this one is nearly 400 pages long, dense. But as a signal of how an Administration intends to shape the direction and future of the ACA, these matter enormously (and, once we get past “proposed” into “adopted”, they do set the direction and future of the ACA).

I will be straight-up honest with all of you, dear readers: despite my love for you and the ACA and how much I love and breathe this stuff, I confess that I did not elect to spend my weekend reading all 365 pages of the 2019 NBPP. This means that I don’t yet have a particularly nuanced take on what’s in there. But, hey, I’m happy to share my un-nuanced take based on what I’ve read in other experts’ nuanced takes!

The first thing that jumps out is how much authority and responsibility this NBPP tries to shift from the federal government to the states. Which, if you think about some of the Administration’s statements on the ACA and health care in general, makes sense: they seem to feel that states are better equipped to manage certain aspects of the health care system than the federal government is. For example, under this proposal, states would gain some significant flexibility over how essential health benefits packages are designed and defined (they could, for example, choose to use the EHB package designated by any other state as their own); states would also be given a significant expanded role in oversight of many of the regulatory requirements placed on insurance companies by the ACA (which means, of course, that states will also be shouldering pretty significant new burdens with managing these increased powers).

And speaking of the EHBs, the changes to EHB definitions that are proposed in the rule are so sweeping that, almost immediately, some experts opined that they may violate the law.

Another aspect of the proposal that caught my eye is the set of proposed changes to the navigator program. Right now, it’s a requirement that every state have at least two organizations serving as navigator grantees, and at least one of those organizations must be a community-based and community-focused nonprofit. The rule would change both of those requirements, to say that a state could have only one navigator grantee and remove the requirement that that grantee be a community-focused nonprofit.

I’ll have more thoughts on the NBPP in the days and weeks ahead as we unpack what’s in there, but for now, it’s a curious and troubling document that signals that the Trump Administration’s war on the ACA is far from over.

It’s time for an update on CHIP and health center funding!

So, there’s a bill kicking around in the House, and it’s causing headaches for everybody.

Long story short, Congress still (shamefully) has not restored funding for either CHIP or the federally qualified health centers, after letting funding for both programs lapse back in September.

Now there’s a bill in the House that would fund both, but it’s been tied to some truly ridiculous “pay-fors”, or offsets; basically, cutting over there to pay for this program over here. One lowlight, just as an example, is that the bill would gut over $6 billion from the Prevention and Public Health Fund in the ACA. In other words, the House (really, House Republicans) proposes to destroy public health funding in order to turn the lights back on for CHIP and the FQHCs.

It’s all ridiculous, and has led to a crazy situation where those who are in favor of funding these absolutely critical programs are now in a position of trying to slow down or stop a vote on this bill altogether, because of the damage it would do.

Complicating things even further is that the House bill would almost certainly be DOA in the Senate, where other bills to fund these programs have…so far, anyway…not been attached to the same kinds of nutty schemes as this House version.

So, stay tuned.


State level

At the moment, here at CAHC, we are pretty much all-open-enrollment, all-the-time. You may have seen or heard or even run into our own Kate Ende, who has been on an absolute media blitz across the state over the past few weeks pushing and promoting open enrollment.

Meanwhile, I’d say a lot – even most – of our partners have a laser focus on the election this coming Tuesday. Remember, question 2 is our chance to vote to expand Medicaid in Maine.

CAHC was one of the earliest endorsers of the yes-on-2 campaign. The campaign is looking for volunteers to fill get-out-the-vote shifts over the next few days between now and Tuesday. If you’re able to help, please visit the campaign’s website at and sign up to help get this campaign over the finish line.


Would you like to know more?

Overachievers can read the entire NBPP here (note that it’s still technically in draft format until it gets officially published later this week).

Huffington Post has an excellent and in-depth longform article on what contributed to the problems with Iowa’s exchange. Take a look, it’s an interesting read (and hat tip to Axios for pointing me at it).


Until next time, friends, I remain,


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