Guaranteed Issue

Michigan

Back in February, I posted an updated & overhauled version of my Michigan healthcare legislative wish list for the newly-elected Democratic majorities in my home states House and Senate.

The list includes 9 major items (some of which actually include a lot more than one provision within them). It really should include ten, since I forgot about implementing a Basic Health Plan program like New York and Minnesota have (and as Oregon is ramping up to do soon as well), but it's still a pretty full plate.

The second and third items on the list included:

Peterson / KFF

A few weeks ago, I wrote a piece reminding people that the Affordable Care Act explicitly prohibits insurance carriers from charging higher premiums for enrollees who voluntarily refuse to get vaccinated against COVID-19 (presumably not including those who can't do so due to being allergic, being immunocompromised, being under 12 years old, etc), and noting several reasons why this is the case.

I concluded, however, by noting that:

Having said that, those who don't get vaccinated will start facing more financial penalties soon anyway...a point which is included in the NY Times article above itself:

In 2020, before there were Covid-19 vaccines, most major private insurers waived patient payments — from coinsurance to deductibles — for Covid treatment. But many if not most have allowed that policy to lapse. Aetna, for example, ended that policy on Feb. 28; UnitedHealthcare began rolling back its waivers late last year and discontinued them by the end of March.

3-Legged Stool (original)

Over the past few weeks, as the Delta COVID-19 variant has surged across the country and COVID vaccination rates have plummeted, there's been a growing cry from many vaccinated Americans. Here's just a few examples:

Step up private sector. Mandate vaccinations for employees and consumers. Looking at you health insurance companies. Add insane premiums for those eligible yet refuse to be vaccinated. Deny hospital coverage for chosen unvaccinated hospital care.

— Ethan Embry (@EmbryEthan) August 3, 2021

It’s clear that new messaging—along with the obvious employer mandate—is having an impact.

Now’s a good time to require vaccines to fly.

Insurance companies should also raise premiums for the unvaccinated. Smokers pay more. Covid is more deadly than smoking—and it’s contagious. https://t.co/ob9d9ofoIn

— Angry Staffer (@Angry_Staffer) August 1, 2021

Republican Senator Cory Gardner is up for re-election this fall, and he's in major trouble. Various polling over the summer has him trailing his Democratic opponent, former CO Governor John Hickenlooper, by around 6 points on average.

Gardner is underwater for many reasons, many of which have to do with his repeated attempts to repeal the Affordable Care Act...most recently by voting for the "Skinny Repeal" bill the summer of 2017 which was nipped in the bud by a single vote thanks to John McCain's famous "thumbs down" vote.

There seems to be something in the air this week...or perhaps it just takes roughly 3 months from the time a new legislative session starts for the first legislation to work its way through the process. Whatever the reason, Washington, Connecticut and now Nevada have all made major moves towards codifying ACA patient protections at the state level in the even the ACA itself is repealed:

The Nevada Senate has passed a bill that would enact state-level health care protections for people with pre-existing conditions.

State Sen. Julia Ratti says the legislation aims to bring about protections that are already in place under the Affordable Care Act. The Democrat told lawmakers last month that people are worried about their health care access.

She says Nevada should make sure these protections are in place at the state level if the federal provisions are rolled back.

State senators approved the measure on Monday in a unanimous vote.

The measure stipulates that insurers cannot deny a person health care coverage due to a pre-existing condition.

Hot on the heels of Washington State locking in pretty much every "Blue Leg" ACA protection in a single bill today, the Connecticut state House of Representatives passed their own bill covering some ACA protections (via CT News Junkie):

Connecticut’s House of Representatives voted Wednesday to strengthen state health insurance laws by making sure residents with pre-existing conditions are protected.

House Bill 5521 passed unanimously by a 146-0 vote, and now goes to the Senate.

Well, now. I guess Connecticut Republicans are smarter than Congressional Republicans, anyway...

 

via Nicholas Bagley of The Incidental Economist:

Maryland files suit to protect health reform from Texas.

... the Maryland attorney general today filed a separate lawsuit in a Maryland district court. Among other things, he’s seeking an injunction requiring the continued enforcement of the law. Depending on how quickly the Maryland case moves, it’s possible we could see dueling injunctions—one ordering the Trump administration to stop enforcing the law, the other ordering it to keep enforcing.

That’s an unholy mess just waiting to happen. Now, it may not come to that. My best guess is that the Texas lawsuit will fizzle: any injunction will likely be stayed pending appeal, either by the Fifth Circuit or the Supreme Court, and the case is going nowhere on the merits. The Maryland lawsuit will likely prove unnecessary.

I don't have much to add to this other than to note how much this case underscores just how much power and importance state attorneys general have.

Reed O'Conner, the hard-right wing judge presiding over the idiotic #TexasFoldEm lawsuit which could potentially wipe out the Affordable Care Act as soon as January 1st, has been radio silent for the past week since he heard oral arguments over the case from the dueling bands of state Attorneys General.

However, if Tim Jost's description of how that hearing went is anything to go by, it's looking pretty ominous:

To enter the Fort Worth Courtroom of Judge Reed O’Connor on September 5, 2018, was to leave the real world.  The Affordable Care Act was once again on trial.  At stake was access to health care for the 20 million Americans who have gained coverage through the ACA, affordable coverage for 133 million Americans with preexisting conditions, and preventive services coverage for 44 million Medicare beneficiaries.

 

Welp. This doesn't look good. As I noted earlier this afternoon, the insane #TexasFoldEm lawsuit held their oral arguments today, and as expected, the Republican-appointed judge in the case, Reed O'Connor, isn't exactly a fan of the ACA. Paul Demko lays out the bottom line in Politico:

U.S. District Court Judge Reed O'Connor, a George W. Bush appointee, vigorously questioned attorneys during the three-hour hearing but gave no indication when he would rule.

Lawyers for the Trump administration partially agreed with the red states' argument, concluding that the removal of Obamacare's individual mandate requires striking down the law's insurance provisions, including protections for people with preexisting medical conditions.

But the administration disagreed on the need for immediate action, arguing that any remedies should not be applied until next year.

I noted this back in June, and the numbers are virtually identical today:

In June 2018, President Trump’s administration announced – as part of a lawsuit known as Texas v. United States, brought by 20 Republican state attorneys general – it will no longer defend the ACA’s protections for people with pre-existing medical conditions.

Yes, this is the #TexasFoldEm case which has oral arguments happening even as I'm typing this.

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