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Coffee CAHC policy round-up: September 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


Friday, September 1, 2017


Boy…it is DISTINCTLY autumnal out there today, ain’t it? I can’t say I’m looking forward to the cold and the dark, but I do enjoy fall and winter cooking – bring on the stews and casseroles! And I guess once I slip into a food-coma-hibernation, wake me up when spring hits, k? Thanks!


National level

Well, we figured that September was going to be a much more news-heavy month than August ended up being, and the Trump Administration was just SOOOOO excited about their plans to gleefully torpedo the ACA from the inside that they couldn’t even wait until September officially hit before pushing one of the big red buttons at their disposal.

Late yesterday afternoon, the Administration – after sending some worrying signals earlier in the week – announced that they will be slashing and burning federal spending on outreach and enrollment efforts around the ACA. They are cutting advertising by a staggering 90%, and cutting grants to navigator groups by about half. Their pathetic, laughably two-faced “rationale” for this decision is that people “already know” about the ACA. Which, to be fair, makes TOOOOOTAL sense from an advertising perspective, right? It’s like how, now that everybody knows about Coke, Coca-Cola doesn’t advertise anymore! That’s how this works, right? (sarcasm. That’s not how this works. That’s not how ANY of this works).

Cutting navigator grants is particularly insidious. Let me tell you, from my experience having been a part of ACA outreach and enrollment with CAHC for three years now*, it’s “easy” to get the bulk of people signed up right away; it’s much, much harder to reach those remaining unenrolled folks, and they tend to be people who need both the help, and the coverage, even more.

There are two points covered in the NY Times article in that link just above here that I want to touch on.

The first is that not everybody who meets with a navigator ends up enrolling WITH that navigator. Sometimes they get a ton of info, want to mull their choices and options (how unreasonable of them! [again, sarcasm]), and end up enrolling on their own later. This happens a lot. I am not a navigator (I’m a certified application counselor), and over the years, I’ve met with quite a few people who have done exactly this. They get the info, we help them sort through what can be, admittedly, a fairly confusing process and basket of options, and then they take some time and make their own decision later on. So for the Administration to say to a navigator grantee “well, you only hit 50% of your target for enrollments, so we’re slashing your funding in half” is to willfully ignore that not all of their work is delivered in the form of a direct enrollment.

The second is that the Administration is doing everything it can to convince people that the ACA is dead, and then – with this announcement – saying “oh people know it’s still around so they’ll just go enroll themselves.” They are screaming into America’s face that the ACA is toast (which, again, it soooooo isn’t) and then shrugging on enrollment and outreach to say “meh they’ll figure it out”. Again, going from our personal experience here at CAHC, worrying that people are going to think the law is gone is not a theoretical concern. Most consumers don’t follow these issues as closely as you and I do. They hear what is loudest, and what is loudest is usually the President howling his version of “the truth” at a microphone somewhere.

It’s also worth noting that the folks who are left to enroll are largely in what are called “hard to reach populations”, and they are hard to reach for a reason. Actually, they’re hard to reach for LOTS of reasons. You are, in many cases, working to overcome serious structural and social barriers that stand between folks and access to health care or coverage. I’m talking about people with lower incomes, racial and ethnic minorities, LGBTQ+ individuals, and rural communities. They deserve the same access to qualified, expert, impartial help as anybody else. The Administration choosing to cut and run on these efforts at this point isn’t just a sign of how much they despise the ACA and will do whatever they can to destroy it – it’s a sign of how little they care about these communities, these individuals. The Administration’s message is clear: we are zealots on a mission, and you are about to be collateral damage.

It’s also hard not to see this setting up an inevitable clash with Congress, where nods toward bipartisan stabilization, genuine stabilization, are growing. In fact, serious plans for Congress are being suggested by a bipartisan group of Governors (at least one of whom used to be a member of Congress). I don’t know exactly what options Congress has to mandate or better enforce actions by the Administration to execute and uphold the intent of the ACA’s programs related to outreach and education. But whatever powers they do have, we think they should take. This is important. It isn’t just important for the health and wellbeing of the ACA as a program: it’s crucial to making sure that some of their more vulnerable constituents get a chance to take advantage of a program that can help keep them safe and healthy. That’s worth Congress putting its foot down.

*Holy moley, as of October, I have been at CAHC for three years. Wowza!


State level

Not much news. One curious tidbit is that there is still some work being done on finalizing rates for Maine’s three individual market insurance carriers for next year. Anthem and the Bureau of Insurance seem to have agreed that Anthem gets a second crack at calculating their rates for next year, in a way that could lead the Bureau to authorizing higher rates than what they had initially signed off on from Anthem’s request. We’ll keep an eye on it.


Would you like to know more?

An interesting piece on the Health Affairs blog that looks at the relationship between state insurance commissioners and the federal government, vis a vis the ACA, and previews what to expect insurance commissioners to say when they testify before the Senate next week.

I thought this article in the Houston Chronicle looking at some of the public health threats from hurricane Harvey was sobering. It’s also a powerful reminder that, while we tend to get siloed into our own little “issue areas” in our lives, there is far less distance between those tackling climate change, and those working in public health, than we may think about on a day-to-day basis.


Until next time, friends, I remain,


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