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Coffee CAHC policy round-up: November 22, 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 22, 2017


Readers, I do try to make sure that Coffee CAHC is as impartial and informative as possible, and keep my editorializing to a minimum. But while we are a nonpartisan nonprofit, we will take bold stances when it counts. So here, today, in this week’s Coffee CAHC, I’m declaring the following:

  • Stuffing is the best Thanksgiving side dish. Full stop.
  • Canned cranberry sauce is gross. Fruit “sauce” should not be a thing you can serve in ridged slices. And if you think otherwise, message me and I’ll get you some of my homemade stuff to change your mind.
  • Roast turkey is just not that good.
  • Mac ‘n cheese absolutely belongs on the Thanksgiving table.
  • Trendy or not, roasted brussels sprouts are faaaaantastic.

[Disclaimer: the above statements reflect only the views of the author and are not necessarily actual “bold stances” representative of the organizational views of Consumers for Affordable Health Care, nor do they necessarily represent consensus opinions of other CAHC staff. In fact, the author anticipates getting shouted at about at least some of these statements at the staff meeting this morning. Wish him luck, readers.]

From all of us here at CAHC, we wish you and yours a warm and wonderful Thanksgiving!


National level

Worrisome news late yesterday: Senator Lisa Murkowski of Alaska – who you’ll all recall was one of the three senators to consistently vote against other versions of ACA repeal this year – has announced that she’s fine voting for individual mandate repeal.

There’s this new thread percolating among some down in DC (including Senator Murkowski) that it’s fine to repeal the individual mandate as long as you also pass the Alexander-Murray bill at the same time.

Let’s be clear: nope. Not even a little bit.

Alexander-Murray is about limiting or containing damage already done by the Trump Administration related to cost sharing subsidies, whereas repealing the individual mandate destabilizes the entire risk pool and opens the individual market up to a death spiral scenario. Equating the two just doesn’t make any sense. It’s sort of like going camping and saying “it’s fine to dump out all of your water as long as you don’t forget your sleeping bag.” They may be two pieces of the puzzle, but they’re not equivalents.

Ultimately, the people who will literally pay the price for the GOP’s confused, wanton, and cavalier sabotage of insurance markets will be those individuals over 400% of the poverty limit, who get no tax credits or subsidies through the ACA and who have to pay for insurance entirely out of their own pockets. Those folks are gonna get hammered by this.

In other nationwide news, NBC and Kaiser Health News have a very good piece on confusion around “skinny health plans”. These are policies, typically sold through online brokers, that offer – at best – an extremely minimal amount of barebones catastrophic coverage. They don’t have to comply with many or most of the ACA’s consumer protections, so while the premiums may be low, they won’t get you out of paying the penalty and they generally won’t offer anything even close to the coverage from an ACA-compliant plan.

We’ve had callers to our HelpLine in the past who got burned by plans like these, thinking they caught a great deal. The old adage applies: if it seems too good to be true, it probably is. Remember, when in doubt, you can always call our HelpLine at 1-800-965-7476 to find out what you’re looking at.


State level

No news is good news, right? …right?


Would you like to know more?

We’ve got a few fascinating reads for you to tackle over the holiday break!

First, hat tip to CAHC friend DG for flagging this piece for me. Georgetown University’s Center for Children and Families dives into new research showing that, not only does Medicaid help lift people out of poverty, it’s among the most effective methods to do so. This is an important read.

These next two pieces were linked in yesterday’s Axios Vitals newsletter, so Sam Baker at Axios gets the credit for pointing me at both.

First, a completely fascinating article on the three people who are probably the only remaining iron lung users in the United States. It’s a compelling look at three tenacious survivors of a terrible epidemic, but those three survivors also pass on a sobering message about the critical importance of vaccines. I sometimes can’t believe that we still even need to talk about the efficacy and value of vaccines, but if you’re on the fence or anti-vaccine, please read this article.

Second, a completely upsetting article about the rising costs of ambulance rides. Ambulance companies are more and more commonly operated by private equity firms these days (as opposed to provided as a free or low-cost taxpayer-funded service under the umbrella of your local fire department, back in the day), and often charge by the mile. They’re also, often, not considered to be “in network”. We’ve dealt with cases on our HelpLine before where somebody’s transport, even from one hospital to another, was not covered by their insurance. Gets my blood boiling. You’re in a coma and you’re somehow expected to tell the ER doc “sorry, can’t medevac me on that ambulance, they aren’t in my network, can you call me a cab instead?” Grrrr!


Until next time, friends, I remain,


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The Open Enrollment period to get health insurance for 2018 ended on December 15, 2017. Open Enrollment is the time of year you can sign up for health insurance. If you don’t have any insurance, you might have to pay a fine when you file your taxes.

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