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You are here: Home / Anderson On Health Insurance / The ACA and ineffective sabotage

The ACA and ineffective sabotage

by David Anderson|  November 10, 20176:56 am| 38 Comments

This post is in: Anderson On Health Insurance, Hail to the Hairpiece, Fucked-up-edness

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Right now the early data indicates that the ACA is chugging along. Ineffective sabotage may be the key factor. The decision to announce the termination of CSR payments was probably made at the second to worse time if the goal was to effectively damage or destroy the ACA individual market. All of this is against the counterfactual of either a permanent appropriation or the suit getting bounced in early 2017 for lack of standing.

What's really amazing to me about week 1 of open enrollment is that NEW enrollees were up 30% and 67% over 2015 and 2016 respectively on a per-day basis. This in spite of sabotage & thanks to a heroic effort from the health advocacy community. #GetCovered https://t.co/kukwO4g87u

— Dustin Pugel (@Dpugel) November 9, 2017

The optimal time to announce the non-payment of CSR obligations would have been between January 20th to early June. That would have stopped payments early enough in the year that insurers would have faced a choice: Eat a $5 to $7 billion dollar loss in a market that was improving but still not lucrative or exit mid-year. If there was a mid-year exit, chaos could have created a demand or a receptivity to “DO SOMETHING.”

The second optimal time for sabotage would have been this week or later. If payments were made through October and plans went to market on November 1st with a variety of pricing strategies in place, a mid-November CSR termination would have forced some plans to withdraw, more plans to temporarily pull plans as new pricing tables got loaded on Healthcare.gov. The minimal intervention scenario would have been mass chaos with some insurers pulling out.

A late summer (July/August/September payments) CSR termination would still put insurers on the hook for $2-$3 billion in losses. Most insurers would have built their 2018 rates to accommodate the changes. Some of the thinly capitalized insurers would have left the market as they would be experiencing capital shocks.

The actual termination of payments after the September payments were made and after the contracts were signed for 2018 but before open enrollment started was the second least effective time window if sabotage was the goal. Insurers had plenty of time to price no CSR into their rates for 2018. Most states had a plan in place. Insurers had enough time and friendly enough regulators to adjust from optimistic rates to realistic rates. These rates went in early enough (except for one insurer in New Mexico) to offer really good subsidized rates for Bronze and Gold plans in large chunks of the country.

The only time where pulling CSR funding would have been less effective would have been the ten days between the September CSR payment and the contract finalization due date. If that happened, there would have been less confusion and all insurers and states that had multiple plans in place would have filed their no CSR rate plan. The biggest gain is that I would have had a bit more sleep in the middle of October.

The rates are set so the following is true:

KFF is basically begging people to pay attention to this: Over half (54%) of the people eligible for financial help can purchase a bronze plan in 2018 for $0. https://t.co/hyJjOOZYIz

— Joshua Peck (@joshuafapeck) November 9, 2017

Ineffective sabotage and a lot of attention to the ACA might be helping enrollment. Right now, it does not seem to be hurting enrollment.

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Next Post: The Vultures are Circling »

Reader Interactions

38Comments

  1. 1.

    Amir Khalid

    November 10, 2017 at 7:17 am

    I fear for you guys. Trump is trying everything he can to undermine Obamacare, and one has to fear at some point he might by chance try something that turns out to work.

  2. 2.

    satby

    November 10, 2017 at 7:34 am

    @Amir Khalid: then we go back to the way it was before, but people will be furious and the blowback will be huge.

  3. 3.

    David Anderson

    November 10, 2017 at 7:59 am

    @satby: yep, to quote Senator Manchin:
    https://www.politico.com/story/2017/05/04/obamacare-repeal-vote-joe-manchin-trump-237979

    and while they may not believe Democrats’ 2010 health law gave them insurance, “they’re going to know who took it away from them.”

  4. 4.

    stinger

    November 10, 2017 at 8:29 am

    We’re lucky that the venal, corrupt monsters who rule us are ignorant and incompetent, I guess.

  5. 5.

    NobodySpecial

    November 10, 2017 at 8:43 am

    Was quite shocked doing my Obamacare shopping yesterday. Ended up picking up a Gold plan for 2018. Thanks to David’s posts here, I knew about Illinois’s Silver loading and went for a Gold – which was about $50/month cheaper than the Bronze I had for 2017. There was also a Silver for the grand total of 18 cents a month, but the Gold was still cheap and superior, so I’ll shell out the extra cash. Thanks, David, for all your work here!

  6. 6.

    WereBear

    November 10, 2017 at 8:45 am

    @stinger: I believe these are all DNA-linked traits, known as Asshole Syndrome.

  7. 7.

    Patricia Kayden

    November 10, 2017 at 8:45 am

    @satby: Yep. Democrats should be running on Trump’s sabotage of the ACA.

  8. 8.

    satby

    November 10, 2017 at 9:15 am

    @NobodySpecial: wow! You’re giving me hope. For complicated reasons, I still own my old Chicago home and keep IL residency, so maybe I can find an affordable plan too.

  9. 9.

    David Anderson

    November 10, 2017 at 9:17 am

    @Patricia Kayden: Not going to work. That is a post/series of posts starting next week.

  10. 10.

    Yarrow

    November 10, 2017 at 9:22 am

    David, will these rates hold for 2018 or can they–will they–change throughout the year? I know someone who is currently on COBRA that will expire in April. They will likely then have to go on to the exchange. I understand that the COBRA period expiring is a qualifying event.

    They are currently trying to decide whether or not to continue COBRA or use this open enrollment period to switch to an exchange plan for all of 2018. The COBRA plan is a good one but switching mid-year means they’ll have to start over with their 2018 deductible. I said I’d ask you to make sure that if they wait until April to jump on the exchange that they still can do that and that it’ll be okay as far as pricing, CSR, etc. That the only downside would be starting over with the deductible. Would that be your understanding? Or is that too risky and it’s best to lock in the 2018 plan now.

    Related question: Once someone has purchased insurance on the exchange, can the plan be canceled mid-year? Or the rates raised? Or are you and they locked in all year?

  11. 11.

    NobodySpecial

    November 10, 2017 at 9:54 am

    @satby: Well, I mean, there ARE tradeoffs, like probably making a quarter or less of the average BJ commenter. But, hey, cheap insurance.

  12. 12.

    Central Planning

    November 10, 2017 at 10:09 am

    Is there any demographic data on the sign ups? I wonder how many people are signing up because the president is a republican and also not near.

  13. 13.

    Patricia Kayden

    November 10, 2017 at 10:27 am

    @David Anderson: Looking forward to those posts.

  14. 14.

    Humboldtblue

    November 10, 2017 at 10:34 am

    David I have just erased a long expletive-filled rant against the scam that is medical insurance, particularly now that motherfucking Anthem BC has pulled out of California and the monthly rate for the shit insurance I was forced to buy (things changed pretty quickly after my giddiness in January when I thought I had found a great deal, and you can take your goddamn deductibles and go to hell and don’t even ask me about trying to find a goddamn doctor) will now rise from $180 per month to more than $900.

    Instead of allowing my blood pressure to rise any further and to calm my desire to punch a fucking underwriter in the fucking face am I correct in assuming that this plan is probably as good as it gets for a single guy with no ongoing medical issues?

  15. 15.

    randy khan

    November 10, 2017 at 11:07 am

    I constantly am amazed at the level of incompetence of this Administration and the Republicans in Congress – they can’t even sabotage Obama policies effectively.

  16. 16.

    Another Scott

    November 10, 2017 at 11:13 am

    @Humboldtblue: Nobody is going to be able to use that link to see what plan you’re talking about – it’s customized for your particular browser session.

    Have you tried the CoveredCalifornia help links?

    It’s horrible that insurance is still too expensive for you (and far too many others). Here’s hoping that someone can help you find the best possible plan for your situation.

    Good luck!

    Cheers,
    Scott.

  17. 17.

    Humboldtblue

    November 10, 2017 at 11:19 am

    @Another Scott: Thanks! and yes, I was on the site. The Covered Cali people are great and the service and help available are awesome

    Silver 73 PPO … $141 per month $220 deduct … Blue Shield is the provider

  18. 18.

    Matthew

    November 10, 2017 at 11:20 am

    I am happy that so many people are finding good deals. In central Virginia, I have only one provider available to me and my rates for a Bronze Plan just went from $287/mo with a $6000 deductible to $879/mo with a $7200 deductible. I am a self-employed attorney and have zero other ACA-compliant options. Right now I am looking at either closing my business and going back to work as a public defender so I can be eligible for the state health insurance program, or just going without insurance next year, paying the penalty, and hoping for a Democratic landslide in 2018 (which would still not help me in 2019, but maybe 2020?). Either way, the ACA will be losing at least one enrollee here!

    I am really surprised that more people are not in my situation and we are not hearing more about this. Most of my colleagues are on a spouse’s plan, so maybe that explains it. While I am happy for others that the subsidies are available and are making plans affordable (attractive, even!), I feel like part of a small and overlooked group for whom Trump really has sabotaged health care. Unless I close my firm, next year will be the first year I haven’t had health insurance in my life. Pretty depressing for a guy in my mid-40s who has worked hard his whole life.

    /end pity party

  19. 19.

    Yarrow

    November 10, 2017 at 11:25 am

    @Humboldtblue: You might be able to find a local person who can help you figure out the best choice for you. I think they used to be called navigators. Maybe still are.

    Also, did you check the Gold plans? It sounds like because of the crap that has happened those can sometimes be cheaper.

  20. 20.

    Humboldtblue

    November 10, 2017 at 11:33 am

    @Yarrow:

    Yeah, I’ll call CC again, they helped me immensely in January although I learned at a later date I wasn’t eligible for the plan I chose. My original comment was more just spit-balling because I have nothing other to offer in response to David’s work than complete and utter ignorance. Thanks, tho.

  21. 21.

    NobodySpecial

    November 10, 2017 at 11:33 am

    @Humboldtblue: Check your network hospital. They also usually have someone there for navigator purposes.

  22. 22.

    randy khan

    November 10, 2017 at 11:43 am

    David, is there a good place to point people to find information on plans that are available to them, or is Healthcare.gov the best general spot?

    Ideally, what I’d like is a site that aggregates sites for each state, but I don’t know if that exists. I’m asking because I’m planning to try to disseminate the information via Facebook to friends and others.

  23. 23.

    patrick II

    November 10, 2017 at 11:49 am

    I mentioned this the other night, but I am loving it so: I don’t know how much effect he is having, but Jimmy Kimmel has an audience of over 2 million people and he has been telling them every night this week about their opportunity to sign up for this wonderful government healthcare program with no lifetime caps and don’t worry about preexisting conditions — Trumpcare. He tells the audience to put his ad on facebook and twitter and to sign up at healthcare.gov. He has been getting nice twitter responses from Trump fans thanking him for finally being an open minded liberal. It is a world championship troll.
    The second night: https://www.youtube.com/watch?v=mlZNmtZdTlg

  24. 24.

    Enhanced Voting Techniques

    November 10, 2017 at 11:50 am

    @randy khan:

    I constantly am amazed at the level of incompetence of this Administration and the Republicans in Congress – they can’t even sabotage Obama policies effectively.

    It’s really not surprising – these are all retoric and emotion driven people and issues like health care policy coverage are quite dry and borning stuff.

  25. 25.

    Duane

    November 10, 2017 at 12:01 pm

    Jimmy Kimball has been promoting “Trumpcare” on his show the last two nights. Tells people to sign-up at Healthcare.gov. what’s funny is the messages he gets saying what a great deal it is, and how Trump fixed healthcare like he said. Watch it. Really says it all.

  26. 26.

    Duane

    November 10, 2017 at 12:12 pm

    @Duane: I see Patrick got there first. It is a classic trolling.

  27. 27.

    KithKanan

    November 10, 2017 at 12:44 pm

    @Humboldtblue: It’s going to depend on how often you see a doctor despite your lack of ongoing medical issues and how comfortable you are with risk.

    If you’re in the income range to qualify for a Silver 73, you could also get a bronze plan for only $1/month after subsidies, pocket the nearly $1700 difference, and come out ahead if you spend less than that much on medical bills for the year. If you’re unlucky though, you’re at the risk of the $4800 or $6300 deductible and $7000 out of pocket limit.

  28. 28.

    Humboldtblue

    November 10, 2017 at 1:15 pm

    @KithKanan:

    Thank you, I sorta understood that from some quick reading this morning. My issue is that even though I have no ongoing medical issues I am now over 50 and the next physical I get there are going to be some along with a few doctor visits. I look at the Bronze and the deductibles make me cringe. I think for the next year the Silver 73 is my best option. I’ll call me dad (he would think David is his actual son not me, what with his actuarial tables and shit, that was Pop’s career) and the Covered Cal folks (they are very helpful) and work it out.

  29. 29.

    Mnemosyne

    November 10, 2017 at 1:19 pm

    @Humboldtblue:

    Before you decide, make sure to check the list of things that are considered “preventive health care” and see how many of them will be free for you since you’re over 50. For example, a baseline colonoscopy would be free of charge because of your age.

  30. 30.

    KithKanan

    November 10, 2017 at 1:36 pm

    Also, it looks like I was right about what Blue Shield was up to in my county. Now that they’re the sole on-exchange carrier, they’ve added an HMO option to create a silver gap in a way that’s still permissible on Covered California.

  31. 31.

    Humboldtblue

    November 10, 2017 at 1:39 pm

    @Mnemosyne:

    Good point, thanks. (This administrative shit is what I am the worst at and it always drove my dad crazy, he lives for this shit)

  32. 32.

    Humboldtblue

    November 10, 2017 at 1:50 pm

    And thank you to all of you who helped out, I appreciate it, that was very kind of you.

  33. 33.

    David Anderson

    November 10, 2017 at 2:27 pm

    @Yarrow: It is 99% chance that things are locked in for the year.

  34. 34.

    David Anderson

    November 10, 2017 at 2:28 pm

    @Humboldtblue: That link does not work for me. E-mail instead
    BJDickMayhew Yah 00

  35. 35.

    Humboldtblue

    November 10, 2017 at 2:35 pm

    @David Anderson:Okey doke

  36. 36.

    Kitty

    November 10, 2017 at 3:44 pm

    If you’re receiving a subsidy, go through re-enrollment. My plan went up $200 per month, but when I re-enrolled, my subsidy increased as well.

  37. 37.

    Yarrow

    November 10, 2017 at 4:30 pm

    @David Anderson: Thank you. Appreciate your help.

  38. 38.

    Yet Another Scott

    November 11, 2017 at 10:25 am

    @David Anderson Do you think that the incessant drumbeat of “repeal and replace, of constantly telling us this thing is dead, playing chicken with the CSR, has actually been good advertising? That maybe it has helped to keep health insurance a top of mind topic for people? Seems that no matter how negative, insurance has constantly been in the press. Maybe that has actually helped?

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