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Coffee CAHC policy round-up: September 6, 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 6, 2017


Last night, I learned that our cat is terrified – TERRIFIED – by thunderstorms. I learned this while he was cowering behind my legs as I texted with a friend who, having had their internet knocked out by the storm, was confronting a more technological fear: watching their evening plan of a good blast of junk TV on Netflix evaporate before their very eyes (sorry, LD, hope the DVDs worked in the end). I have trouble at this point imagining more than a few minutes without internet access. It got me thinking about what, exactly, my role will be in a “The Road”-esque post-technology apocalyptic wasteland. Cat-consoler-in-chief? Village jester? Important source of lamp oil? Here’s hoping we never find out!

Now that we’re out of the long Congressional recess, Coffee CAHC will be back to a Wednesday-Friday schedule. Apologies that today’s is more of a “Happy Hour CAHC” than a “Coffee CAHC”, but there was an afternoon meeting that I thought was worth waiting for, to share some details with you. What meeting is that? Read on to find out! (hint: it’s in the “state level” section).


National level

There are two topics dominating the national conversation on health care today: the Trump Administration’s crusade to blow up the ACA from within, and the contours of whatever action Congress takes (or attempts to take) to stabilize the exchanges. If it seems bizarre to watch these two contrary actions taking place simultaneously, well, welcome to The Upside Down*.

On the first point, we are still waiting to find out exactly how the slash-and-burn on navigator funding is going to play out. Which grantees will be cut by what amounts? Nobody seems to know. This probably has something to do with the fact that CMS staff only learned about the funding cuts at the same time that they were getting ready to send the checks for the full amounts for the coming year. Seems they’re scrambling a bit now to adjust to this abrupt decision.

(As an aside, the link above – to the website Bookmark that site. They do some tremendous in-depth work on health coverage topics and the exchanges.)

Here in Maine, this blow is cushioned somewhat by the news that Maine Health Access Foundation will be resurrecting Enroll207 this year, to help spread the word about open enrollment (sorry for linking to an article I’m quoted in; I generally try not to do that). We’re fortunate to have state partners like MeHAF stepping in to pick up the pieces.

Still, let’s not kid around. This is a hit job on the ACA, plain and simple. Carriers this year were worried about exactly this sort of sabotage – and it is sabotage – when they set their rates for next year. As I said on Friday, outreach and enrollment investments pay off for “hard-to-reach” populations, and one of those populations that I neglected to point out last week are the younger, healthier enrollees who are vital to making sure that the risk pools are stable and premium growth is manageable. Ugh.

This quote, from the Vox article linked in the previous paragraph, really hammers it home for me:

“If our legal responsibility was simply to enroll, I might cave and be a bit more sympathetic… But we have five different responsibilities, and enrolling is only one of them. Outreach and education is a huge piece. You don’t get enrollments from teaching people to use their insurance.”

At the same time that the Trump Administration continues to do real harm to consumers and the ACA, Congress is back and they’re gonna FIX EVERYTHING!



The Senate Health, Education, Labor, and Pensions (HELP) committee is holding hearings this week and next to seek some bipartisan consensus on ways to stabilize the exchanges. Obviously, CSR reimbursement funding tops that list (are you sick of hearing about that from me yet?), but there’s also a lot of discussion around doing something with 1332 waivers.

I’d say we are “nervous” about messing with 1332 waivers. As a refresher, 1332 waivers provide a path for states to ask the feds for permission to do something different than the way the ACA typically works (exchanges, tax credits, etc). But there are strict rules, or “guardrails”, on what states can and can’t do. Compared to “just sticking with the ACA”, the replacement plan can’t cost any more, it has to cover at least as many people, and the coverage has to be at least as good/comprehensive.

Our concern would be a bill that relaxes or removes those guardrails as a way of letting states just go ahead and implement all the crummy stuff that we just spent 8 months convincing Congress was a terrible idea – and before you say “yeah but surely no state would do that!”, well, *coughIOWAcough*.

Generally speaking, in order for any congressional action to actually make a difference for next year, they need to act…like…a few months ago. They have, really, days at this point before insurers have to make final decisions about their participation in 2018 markets. Generally speaking,

I’ve seen a lot of pessimism about the odds of Congress actually getting anything done, but then an interesting little tidbit was reported this morning that Representatives Meadows and MacArthur (the plucky duo that “cracked the code” on the House passing their health care bill waaaaaaaaay back in the spring) have come to some sort of agreement about a package. There aren’t a lot of details on this yet, but since these two would be key to anything passing the House, worth keeping an eye on.

And then there’s still the Cassidy-Graham bill (side note, Senator Cassidy has slapped, or tried to slap, his name on seemingly every single version of health care legislation in the Senate, no matter how different they were – which makes me wonder if he’s actually reading any of them…). This is the last remaining “repeal/replace” vehicle left standing after the debacle from a few weeks back. It got a boost today when Senator McCain, one of the three “no” votes that ultimately tanked the effort in the summer, said he’d support it. I have no idea what to make of his sudden support, but it’s worth remembering that Cassidy-Graham is a bill much closer to the types of bills that failed on much larger margins during “vote-a-rama” than the final bill – which was a narrow repeal bill designed to move the debate to a committee of conference with the House.


*Anybody else REALLY excited for Stranger Things season 2?


State level

One of the debates we were following very closely at the State House this year was over what Maine can do to tackle high prescription drug costs. We supported a few different bills that came at the problem in various ways.

Two of those bills looked at work being done in other states around price transparency and price gouging as action that may be available to states. The Judiciary Committee heard both of those bills, carried one over to next session, and invited some stakeholders to meet in the off-session to find areas of consensus. That stakeholder group met for the first time today.

Look, let’s not kid ourselves: getting drug manufacturers, and pharmacy benefit managers, and consumer advocacy groups, to all agree on how to “rein in” high drug costs? Tough lift. Very tough lift. But I was encouraged by the civil tone today, and the manner in which all of the stakeholders came with what I read as pretty open attitudes. We certainly didn’t come to any sort of broad agreement (not that I expected that to happen), but I think the shape of some areas of consensus is becoming a bit clearer, which is good progress.


Would you like to know more?

Over the past few months, health care has been one of the (if not the) “hottest topics” in the policy arena. That has shifted here and there, but one of the things that I think is worth remembering – especially for those of us who end up “siloed” into our own little issue areas – is that major debates almost always impact multiple policy areas. Kaiser Health News has a sobering case-in-point reminder of that with this article about how President Trump’s decision to unwind the DACA program has many young immigrants fearing for their health.


Until next time, friends, I remain,


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