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Coffee CAHC policy round-up: September 27, 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, September 27, 2017


Well, friends, it finally happened. After spending this entire year planning, plotting, reacting, begging, pleading, sweating the details, and tossing and turning through more sleepless nights than I care to admit, yesterday was the day…of the annual Health Care for Maine conference! And I think it went pretty well!

…oh, and ALSO…


National level

I have never been happier to say “this is probably going to be a short update”.

Yes, for really and for truly, hand on heart, the Graham-Cassidy bill is dead. And with it, the current version of Congress’ attempts to repeal and replace the ACA.

I am saying “current version” quite deliberately. No, it isn’t over, forever. Seven years of promises aren’t going to go away that easily (easily?!). But the reconciliation “instructions” (aka the “vehicle”) that was being used to get this thing done on a 50-vote rather than 60-vote margin in the Senate expire this Saturday. The next set of reconciliation instructions are going to focus on tax reform, although it’s possible that some health reform elements could make their way in there.

Still, that can be our problem next week. Today, we have earned and we all deserve to take a deep breath and relax…at least through the rest of the day.

Because here’s the thing. Congress has spent so long flailing their way to this repeal failure that they have missed their window to do some actual good for a change. CHIP reauthorization had to be done by this Saturday, and that now looks unlikely; the opportunity to pass a bipartisan ACA stabilization bill in time to have an effect on next year’s markets has slipped away as of today (more on this below); and the federally qualified health centers still face a dramatic fiscal cliff this Saturday as well.

So, if it feels weird to go a whole day without calling a member of Congress, you could mention how vital FQHCs are to Maine. I will say that Maine’s two Senators are already all-in on funding the FQHCs, and have both signed on to letters to that effect; Congresswoman Chellie Pingree is cosponsoring the House bill, called the “CHIME Act”, that would provide funding; Congressman Poliquin has not.


State level

There are two reasons for today’s late Coffee CAHC. The first is that, yes, we really did have our conference yesterday, and I’ve been in and out of meetings today related to that conference.

The other reason is that I was waiting for a bit more to develop on Maine’s individual insurance market offerings for next year.

As you probably know, for a few years now Maine has had individual market plans being offered by Anthem, Community Health Options, and Harvard Pilgrim. But – as I’ve covered in previous Coffee CAHCs – all three carriers indicated their concerns about the stability of the ACA in Maine next year. Not, to be clear, because of anything wrong with the ACA itself or anything that we’ve done, or not done, here in Maine: no, they are worried that the Trump Administration seems intent on sabotaging the law from the inside.

Today is the deadline for carriers to sign contracts to participate in the health insurance marketplace for next year, and one of our three carriers, Anthem, announced this morning that they are leaving the individual market in Maine almost entirely.

They will continue to sell one gold plan only in Aroostook, Washington, and Hancock counties. Why? Because if they leave the individual market entirely, it would trigger a five-year lockout where they would not be allowed to sell or market any individual market plans in the state. By offering one plan in one region, they can keep their options open for the future.

This is, to say the least, disappointing. We obviously want consumers to have as many choices as possible. It’s mostly disappointing because of how clear Anthem was in their reasoning for leaving, laying this at the feet of Congressional inaction and Trump administration sabotage.

No news yet from either of the other two carriers. While Harvard Pilgrim kept their options open to either stay-or-go (and was clear that it could go either way if Congress didn’t act to stabilize the marketplace), CHO has repeatedly signaled their commitment to staying in the individual market statewide.

We’ll know more by tomorrow.

On a happier note, the fifth annual Health Care for Maine conference was yesterday and I think it went really well. It’s hard for me to be objective, honestly, because planning this conference has been one of my primary duties this year. But if you were there, please drop me a line and let me know what you thought! We’ll be sending an official feedback survey tomorrow.


Coffee CAHC temporary schedule change

One little heads-up. For the first two weeks in October, we’ll be pulling back from our Wednesday-Friday schedule to send just one issue on Fridays.

Partially, this is because we anticipate (and hope!) that there will be a little lower volume of federal news for the next few weeks.

Mostly, however, it’s because I am taking a long-overdue vacation and will be traveling outside of the country from October 1st to 14th. And I want you to know, dear readers, that while Coffee CAHC is an absolute joy and something that I truly, truly treasure providing for you all, I am even more excited to leave my computer in a drawer for two weeks as I traipse around Colombia. I’m looking forward to visiting some old friends, spending some time on the Caribbean coast, and – because even on vacation, I just can’t quit y’all – visiting the “Zona Cafetera” coffee producing region! Expect a Coffee CAHC coffee plantation selfie when I get back.

In my absence, you’ll be in the more-than-capable hands of Emily Brostek, CAHC’s executive director. Be nice to her while I’m gone! (I know you will)


Would you like to know more?

Atul Gawande is one of those people who, when he speaks, I drop what I’m doing to listen. His latest is on a trip to his home region of Athens, Ohio, to see what folks there think about health care. You can check out an interview with him here.


Until next time, friends, I remain,


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