1/ DEAR DEMOCRATS: Based on 21 states so far, I’ve concluded that you’re *sort of* overplaying your hand re. 2019 #ACA premium hikes. Let me explain. acasignups.net/18/07/03/updat…
2/ The talking point being spread among Dems is that “#ACA premiums will spike by double digits due to #ACASabotage!” The image which comes to mind is of rates increasing by ~20-25% with sabotage vs. perhaps ~5-10% without it, costing unsubsidized enrollees up to $1,000 more.
3/ Now the first part *is* accurate: #ACASabotage *is* causing premiums to increase an extra ~12% or so. However, the *specifics* are shaping up to be a bit different than I expected:
4/ Based on what I’m seeing across 20 states +DC (~40% of the total #ACA market), it looks like carriers are looking at roughly ~10% rate hikes *with* #ACASabotage…vs. perhaps a 1-2% *DROP* without it.
5/ Now, let me add some caveats: Both the with/without #ACASabotage nat’l averages will likely change as more states are added in; some rates will change after state regulators review them (see Oregon); and *some* carriers actually *are* seeking hikes of 30%, 40%, 50% or more.
6/ Having said that, assuming it ends up roughly where it is now (+10% with sabotage, -1% without), the fact STILL remains that unsubsidized enrollees will have to pay hundreds of dollars more each next year due specifically to #ACASabotage. Here’s how the $ figures look so far:
7/ If you pay $600/month this year and your premiums WOULD have gone DOWN $30/month in 2019 without #ACASabotage but are instead going UP $30/month due to it, guess what? The impact isn’t just $360 for the year, it’s $720.
8/ Messaging-wise, this is harder to frame. Not only is the math slightly more complex, but people are skeptical—“Oh, sure, rates would have gone down! We’ve heard that before!” etc etc. Well, here’s a good example out of Georgia:
9/ As you can see, they’re looking to raise rates by 5.7% next year. However, they’re also adjusting their 2019 premiums upwards by 15.5% due to increased morbidity (sicker enrollees). Why is that? “PRIMARILY DUE to the non-enforcement of the individual mandate”.
10/ In other words, perhaps 10% of that 15.5% morbidity adjustment is due to the mandate being repealed (which happens to be exactly what the CBO is projecting nationally). Remove that and their premiums would be DROPPING 4-5% instead.
11/ Here’s another example: Minnesota. Thanks to MN’s reinsurance program (every state should have one!), 2019 premiums are actually DROPPING about 8% next year even WITH #ACASabotage…but if you remove the sabotage factors, they’d likely drop even MORE: acasignups.net/18/06/15/minne…
12/ Now, the #ACASabotage factor ranges widely from state to state, carrier to carrier and even plan to plan for a variety of reasons. Rhode Island is looking at a pretty nominal impact: BCBSRI isn’t adding any sabotage hike, while Neighborhood Health is only tacking on 1.9%.
13/ Why is this? Hard to know. Every carrier has different internal factors. Some states are fighting back (for instance, DC, along with New Jersey, is restoring the mandate next year, so DC’s rates will probably be refiled later this summer…NJ hasn’t submitted theirs yet).
14/ Maryland should be interesting—they’re looking at nearly 30% hikes with #ACASabotage, likely 5-10 points lower without, but also expect to implement their own reinsurance program which *should* knock that down to mid-single digits in the end.
15/ Even WISCONSIN (yes, Scott Walker’s hard-GOP Wisconsin) is supposed to be launching a reinsurance program to chop rate hikes down to size. If so, that’s awesome…but that’s SEPARATE from #ACASabotage, which will STILL tacks hundreds of $ onto unsubsidized enrollee costs!
16/ Anyway, try to keep this thread in mind this fall when the FINAL, APPROVED 2019 rates are rolled out and Trump inevitably starts trying to make fun of Dems for “much ado about nothing” since rates are “only going up single digits for the first time” in some states, etc etc.
17/ Oh, one more thing: Remember, adding 10% to $600 is the same as adding 20% to $300 in terms of the extra dollars you have to pay, so don’t let “only going up by single digits!” fool you this fall. /END

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More from @charles_gaba

Aug 27, 2018
⚠️ GRAPHICS-HEAVY THREAD: Next week, the #TexasFoldEm lawsuit brought by 20 Republican Attorneys General against the #ACA goes to court. The Trump Administration is refusing to defend against it even though it EVERY legal expert says it’s a pile of steaming garbage. 1/
2/ If the #TexasFoldEm plaintiffs succeed, federal protections for those w/#PreExistingConditions would be gone. Not just on the individual market…people w/EMPLOYER coverage would be at risk as well, especially since most people are out of a job at least once in their lives.
3/ Here’s a reminder of the idiotic “argument” the #TexasFoldEm plaintiffs are using:
1. SCOTUS ruled the #ACA mandate is only Constitutional because it’s a tax.
2. The GOP repealed the mandate tax.
3. Therefore, they get to repeal the rest of the #ACA as well.
Really. That’s it.
Read 67 tweets
Aug 21, 2018
THREAD: For those who still don’t understand how important the #ACA #TexasFoldEm case is (along #StopKavanaugh), here’s a simple timeline of the ACA’s 3-Legged Stool:
1/ Here’s how the #ACA’s 3-Legged Stool was *supposed* to work when the law was passed. The blue leg includes the patient protections. The red leg is the part everyone hated but which served an important purpose. The green leg is the financial help for people to pay for it.
2/ This is what it ACTUALLY ended up looking like: There were two main problems. The financial assistance was cut off at 400% FPL income (& wasn’t generous enough), and the mandate penalty wasn’t strong enough to be fully effective. Both were EASILY fixable.
Read 13 tweets
Aug 13, 2018

Do you remember “Harry & Louise”?

Here’s a reminder. Watch both commercials, but especially the second one. There’s a LOT going on here:

2/ First of all, notice how in 1993, “community rating” (i.e., not being allowed to charge people more based on their health status) was considered a HORRIBLE thing.
3/ Cut to 2018: 8 yrs after the Affordable Care Act was signed into law, 89% of the public thinks it’s important NOT to charge people more for their health insurance based on their health status. EIGHTY-NINE PERCENT. This is the real legacy of the #ACA.

Read 19 tweets
Aug 10, 2018
ATTENTION MICHIGAN RESIDENTS: I’m trying to track down the Twitter handles for the following 2018 Democratic nominees; please help if you can, thanks!

HD001: Tenisha Yancey
HD003: Wendell Byrd
HD004: Isaac Robinson
HD005: Cynthia A. Johnson
HD006: Tyrone Carter
HD012: Alex Garza
HD013: Frank Liberati
HD014: Cara Clemente
HD016: Kevin Coleman
HD022: John Chirkun
HD024: Laura Winn
HD025: Nate Shannon
HD028: Lori M. Stone
HD030: John P. Spica
HD031: William J. Sowerby
HD032: Paul Manley
HD036: Robert Murphy
HD045: Kyle Cooper
HD048: Sheryl Y. Kennedy
HD049: John D. Cherry
(yes, THAT John Cherry…he doesn’t seem to be on Twitter?)
HD050: Tim Sneller
HD051: David E. Lossing
HD054: Ronnie D. Peterson
HD056: Ernie Whiteside
HD057: Amber Pedersen
HD058: Tamara C. Barnes
HD059: Dennis B. Smith
HD063: Jennifer Aniano
Read 5 tweets
Aug 10, 2018
THREAD: Yeah, I have insomnia, so here’s some wonky info re. single payer, M4A and the Michigan Gubernatorial primary. 1/
2/ Now that the #MIGov primary is over, since the most contentious debate between El-Sayed and Whitmer (besides 'dark money') was about single-payer healthcare, let's get a few things straight:
3/ 1. "Single Payer" refers to any healthcare system where the gov’t is the payment source for healthcare providers (doctors/hospitals/drug cos/etc).
Read 44 tweets
Aug 8, 2018
How Much More Will #ACASabotage Cost Unsubsidized Enrollees in YOUR Congressional District???
1/ Last year, I posted state-by-state infographics which broke out the estimated number of Americans who would lose healthcare coverage if each of the various #ACA repeal bills form the GOP were to become law.
2/ At first I used my own estimates, but then @EmilyG_DC and her colleagues from the Center for American Progress (@amprog) stepped up and started compiling their own projections. Their methodology was different but our estimates were generally in the same range.
Read 67 tweets

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