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Open Enrollment for 2019 coverage under Obamacare starts today, and despite all the Trump administration's attempts to kill it, the Affordable Care Act just keeps chugging along. Thanks to the constant efforts to undermine the program (and especially the Supreme Court's decision to let states opt out of Medicaid expansion), the ACA isn't covering as many people as it could have, but there's some definite good news to be found this year. For one thing, Obamacare is still alive and kicking, and most Americans have a far more positive opinion of it than of, say, the Big Fat Tax Cut for Rich Fuckwads. For another, thanks both to the ACA's built-in mechanisms to contain consumer costs, most people who qualify for premium subsidies are still able to find affordable insurance, and after a couple years of uncertainty, insurers are actually finding the marketplace plans still bringing in decent, steady business. So hooray, and make sure you update your coverage if you don't have insurance through work!


This will be the first year that there'll be no tax penalty for not having insurance, and it's not yet clear how that will ultimately affect the cost of plans offered on the exchanges. This will also be the first year in which people will be allowed to buy cheap shitty "alternatives" to plans that actually provide the level of coverage required under the ACA. For 2019 at least, the policies sold on the exchanges will all be real, full insurance. If you want the junk insurance, you have to buy it through an insurance broker or an insurance company's website. Starting as soon as next year, states can apply to Health and Human Services to allow such crappy insurance, which doesn't cover much and doesn't protect pre-existing conditions, on the state exchanges.

For this year, at least, premiums for ACA plans haven't increased dramatically, in part because many insurers actually raised their rates last year in in anticipation that Trump would dismantle Obamacare even more than he managed to. Even so, says WaPo,

An analysis by the Kaiser Family Foundation, a health policy organization, found that rates for the most popular level of ACA health plan are, on average, 16 percent higher than they would have been without the changes by the administration and Congress.

Predictions that insurers would flee the marketplace haven't turned out either; in fact, says the Wall Street Journal, the markets appear to be stabilizing because "consumer demand has remained unexpectedly steady, which in turn has helped insurers' bottom lines." As lots of Republicans found out at town halls last year, people really like having health insurance. Which is why Republicans keep lying about "protecting" preexisting conditions, even as the Trump administration fully supports a lawsuit by 20 red states that could completely gut the ACA's very real protections for patients. (You can stay on top of ongoing efforts to undermine the ACA at the Center on Budget and Policy Priorities' Sabotage Watch website.)

Despite all the fuckery, the good news is that Obamacare keeps working much the way it was supposed to, at least for most people of modest income who don't have insurance through work:

Roughly 85% of enrollees received a tax credit to help reduce their premiums. The average credit covered about 85% of the total premium cost, making the average premium after the subsidy $80 a month.

That can vary a lot by state: In mostly rural states where there are fewer insurers competing, NPR reports, the benchmark plans can get very pricey, like in Wyoming, where the average pre-subsidy premium is $709 a month, the nation's most expensive coverage. (And of course, once the subsidy kicks in, that would still be a low-ish $109 a month and change on average.) In more populous states with more competition, things are even better:

In New Jersey, for example, the monthly premium for a benchmark policy is $289 for 2019 — a decline of 15 percent from 2018's premiums.

But for people looking for help choosing a plan, Trumpfuckery continues. As was the case last year, the open enrollment period is only six weeks instead of the previous 12-week period, and HHS's publicity budget for open enrollment remains just a tenth of what it had been in 2016, the last year Obama was running things. Worse, the budget for "healthcare navigators" -- the groups that help people find the best plan for their needs and budget -- has been slashed, leaving many states with far less help for insurance shoppers. And the navigators who do get grants are now required to encourage people to consider junk insurance, because of course they are, and to steer people to insurance agents and brokers, who may -- unlike navigators -- get a commission for selling junk insurance. It's all about helping insurance providers make a buck, not so much helping people get healthcare.

The good news? As was the case last year, blue states are stepping in; several states that run their own exchanges will keep open enrollment going until the end of December. Some states have taken additional steps to shore up the ACA against the fuckery:

In May, New Jersey adopted its own individual mandate. And California banned the sale of short-term health policies that don't meet ACA standards. Maryland and Alaska have added other programs to stabilize the insurance marketplace.

The good news is that there's still a functional ACA in place; if voters reject the phony claims of Republicans and elect a Democratic Congress next week, it will be far harder for Trump to erode the law further, though lord knows he'll do all he can to try. If we elect a Democrat in 2020, there's a framework to rebuild on as we move toward eventual single-payer.

Speaking of which, here's the fun Halloween tweet from Seema Verma, the Trump appointee in charge of running both the ACA and Medicare/Medicaid. Her official account, at that:

Yup, that's the Medicare administrator saying Medicare for All would suck, haha, but for a VERY GOOD Trump-approved reason, you see:

This is, of course, bullshit from the administration that spends the ACA promotion budget producing videos about the nightmare of Obamacare. Sure would be nice to have a government where people tried to make the agencies work instead of dismantling them, huh?

[WaPo / WSJ (Paywalled? Try this Twitter linky!) / Axios / NPR / Sabotage Watch / Image: Remix of photo by Gage Skidmore (Creative Commons 2.0 license) with knife by transparentpng.com (CC 4.0)]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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