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Coffee CAHC policy round-up: September 8, 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 8, 2017

 

Good morning, Coffee CAHCers! As much as I dread the long cold dark of an impending winter, even I have to admit that late summer/early fall in Maine is a great time. Warm sunny days, crisp cool nights. You can’t ask for a better start to a Friday than what I enjoyed this morning: a free weekend ahead, a pumpkin spice latte in my hand (don’t you dare judge me), and all the instructions I needed to sign up for a free identity theft protection service courtesy of Equifax, who cheerfully handed my date of birth and social security number off to the dark recesses of the internet, along with 142,999,999 others of you. Happy autumn!

 

National level

OK, sooooooo, nobody panic, but…Congress held what were, by most accounts, some mostly rational, mostly level-headed, bipartisan hearings this week on stabilizing the ACA and the individual market?

The shape of a potential agreement is looking clearer now: two years of funding for CSR reimbursements, some “increased flexibility” on 1332 waivers, and allowing “copper” (AKA “catastrophic”) plans for individuals over 30.

As always, of course, the devil is in the details. CSR funding is vital, but of course we’d prefer to see a permanent appropriation rather than a 2 year stopgap. We’re very keen on seeing the details of how “flexibility” is interpreted when it comes to 1332 waivers: speeding up the process seems ok, but we don’t want “flexibility” to be a euphemism for “letting states stick it to consumers and burn the ACA protections to the ground.”

As far as copper plans? Mixed feelings. For some very healthy consumers looking for peace-of-mind in an emergency, a catastrophic plan can be the right choice. But they are not a panacea. If (or when) something serious or unexpected (or seriously unexpected) happens, and you really need to use your coverage, you’ve got a massive deductible and out-of-pocket maximum to spend your way out of first.

We have been beating this drum for years: insurance costs more than your premiums. And when consumers don’t have thousands of extra dollars to spend meeting their deductibles every year, higher out of pocket obligations come with some serious consequences: consumers avoid getting care entirely (no seriously), or have trouble paying for it when they do.

(And, no, this is not an “ACA-only” problem: employers are running for high deductible plans, too, and the industry has been trending this way since before the ACA. Hat-tip to Axios for flagging this study in an issue of their Vitals newsletter earlier this week.)

All that being said, however, let’s take stock here for just a moment and recognize how far we have come. Ten months ago, it was DEFCON 1 as we crossed our fingers and suited up just to try and stave off ACA repeal; and here we are now talking about “well, this isn’t our favorite part of the plan to stabilize the individual markets, but we like this other bit…” Give yourselves a pat on the back for that. We’re only in this place because of the work all of you did this year.

We do have our own ideas on how best to strengthen the ACA, and you can read about them in an op-ed we wrote in the Bangor Daily.

 

State level

The Secretary of State, Matthew Dunlap, has released the final version of Question 2 for this November’s referendum ballot. Question 2, remember, is the question that, if it passes, will provide insurance coverage for about 70,000 Mainers who right now have no way of accessing affordable health coverage, because they don’t qualify for other programs.

After some frankly eye-rolling criticism from opponents who tried to say one of the biggest insurance programs in the country isn’t actually insurance (“there are FIVE lights!”*), Secretary Dunlap decided to go with the term “coverage” instead. We think insurance is insurance is insurance, but “coverage” works for us.

Don’t forget that comments to the federal Department of Health and Human Services on Maine’s 1115 Medicaid waiver are due next week (September 16th). Remember, this is the nightmarish attempt to blast MaineCare to pieces with a bunch of bad ideas (work requirements, e.g.) that have been proven not to work and, in some cases, are actually illegal. Every comment helps. You can add your voice here.

 

*Anyone who writes to me and correctly places this reference will get a special shout-out in next Wednesday’s Coffee CAHC, as well as my deep giddy love from one geek to another.

 

Would you like to know more?

Another h/t to Axios for flagging this very timely study on the “necessity” of ER visits, finding that only a very tiny fractional percentage of visits are “unnecessary”. Why timely? Because one of the (many) cruel and brutish bad ideas in Maine’s 1115 Medicaid waiver is charging MaineCare members copays for ER visits that “don’t result in inpatient admissions”. To be clear, you could go to the ER with a serious health problem, spend hours there, see appropriate doctors, get a battery of tests, be diagnosed with a serious problem that doesn’t necessitate admission, and be sent home with treatment plans and meds: but hey, they didn’t admit you, and obviously you should have known better right, so here’s a bill! Ugh. Come on, people: really?

 

Until next time, friends, I remain,

-Steve

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