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Nurse Redheart is very happy for you all. Now Shhh.


Joni Mitchell was mostly right: Sometimes you don't know what you've got til its gone. But since lots of people paid attention to the damn song, they're also a bit less likely to give up on something good before it's taken away. Which might explain why, despite the many, many Trump efforts to kill off the Affordable Care Act, last year's enrollment for insurance on the exchanges was only slightly lower than during the 2017 plan year (i.e., signups from fall 2016), according to a report released yesterday by the Center for Medicare & Medicaid Services (CMS). Overall enrollment for 2018 was just under 11.8 million, down by just 400,000 from 2017. That's despite the open enrollment period being cut in half, a 90% funding cut for advertising, and the Trump administration doing everything it could to undermine Obamacare. The Trumpsters had been hoping ACA enrollment would drop by half, to about 6 million enrollees. Instead, people went out and signed up, because they realize that while Obamacare isn't perfect, it's better than no coverage at all.

Strangely, the predictable tweetstorm from CMS Administrator Seema Verma, who has lobbied Congress (and even tried to win insurance industry support for repeal) began with a hearty thank you to her team for "the most cost-effective and successful open enrollment to date!" Then she got to the serious business of bashing the exchange plans:

Boy, you people sure were excited about signing up for crap! She made certain to note that for people who don't qualify for subsidies, premiums were way up -- oddly, she didn't mention the main reason for those premium increases was the uncertainty and turmoil thrown into the market by Trump policies, as a Congressional Budget Office analysis determined last fall.

All that Trumpfuckery was cushioned, however, for the 83 percent of enrollees with subsidized plans, because the subsidies increase as premiums go up. That was meant to protect enrollees against market cost fluctuations, but it also turned out to be fairly effective at limiting the damage done by deliberate sabotage. As Axios points out, the chief result of Trump's attempt to kill the ACA has been to keep enrollment about the same while costing the government a hell of a lot more money. Such a great deal maker, our "president"! So instead of the ACA's original goal of getting Americans to pay for their own insurance as they were able to, Trump has actually shifted costs from policyholders to taxpayers. Unfortunately, this could well become part of future calls to kill Obamacare: As with so many GOP plans, the idea seems to be to deliberately fuck up a government program then call for it to be eliminated, because look how fucked up it is.

Andy Slavitt, who ran CMS for the final two years of the Obama administration, offered his own counter-tweetstorm, in which he exclaimed that in the face of all the attempts to derail the ACA, "It is amazing how well the law is working." Slavitt was very pleased by the enrollment numbers under the circumstances, but added that if the Obama crew were still in charge of CMS, 2018 enrollment would have been more like 14 million:

He also noted that because the Trumpfuckery was mostly aimed at raising premiums for the benchmark "silver" plans, many consumers shifted to the more basic bronze plans to save money -- about six percent. But a significant chunk of enrollees (three percent) chose the more generous gold plans, since in many cases they were only a little more expensive than the silver plans. The shift to cheaper plans and the increased subsidy amounts combined to actually decrease monthly costs for subsidized enrollees:

As for Verma's tweet claiming that "more affordable healthcare options are needed," Slavitt had a few ideas there as well:

All in all, the CMS report is reason for cautious optimism, at least as far as we can keep Trump and the GOP from further weakening the ACA. It's a surprisingly resilient program, and the chance to get to work and really fix it should be a hell of an incentive for Democrats to retake both houses of Congress this fall.

[WaPo / Center for Medicare & Medicaid Services / Axios / Andy Slavitt on Twitter / Topher Spiro on Twitter]

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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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