An insurance CEO says Trump has made Obamacare more expensive

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Legislators head back home this weekend for the Memorial Day recess — but don't expect to see much in the way of raucous town halls. Only six of the 217 Republicans who voted for the American Health Care Act will hold public meetings, according to data from the Town Hall Project. These brave legislators are:

• Rep. Darrell Issa (R-CA)
• Rep. Jim Sensenbrenner (R-WI)
• Rep. Francis Rooney (R-FL)
• Rep. Mike Conaway (R-TX)
• Rep. Mark Walker (R-NC)
• Rep. Tom Reed (R-NYC)

Rep. Issa's town hall will likely be the most lively. He represents a Southern California district that Hillary Clinton won in the 2016 election. Issa was on the fence about his AHCA vote right up until it actually happened. He then stood right by Trump during the Rose Garden ceremony to celebrate the AHCA's passage. If any town hall might get a bit heated, you would expect it to be Issa's, which is happening next Saturday, June 3.

Insurance executive: Trump is making Obamacare more expensive

Blue Cross Blue Shield North Carolina has requested a hefty 22.9 percent Obamacare rate increase for 2018. As Dylan wrote in yesterday's VoxCare, most of this increase is due to the fact that the health plan does not expect the Trump administration to keep paying the law's cost-sharing reduction subsidies.

This is one of the first tangible examples of Trump administration actions driving up Obamacare premiums. The North Carolina plan has said it would only raise premiums 8.8 percent if it had assurances that the Trump administration would keep funding that program. But the White House has been very ambiguous on this point, only committing to making this month's payment — leaving the rest of this year and 2018 in limbo. As a direct result, Blue Cross Blue Shield North Carolina is asking for a very big rate increase.

I caught up with the plan's chief executive, Brad Wilson, Friday afternoon. He told me a bit more about how they see the health care landscape — and how the Trump administration's uncertain approach to Obamacare is driving up prices:

The information we've seen coming from the administration actually creates more uncertainty rather than greater certainty. The last thing I saw was the president saying he intends to make the CSR money available through May 2017. That's good news and we're grateful for that assurance. But what he has not said is what about June through December, what about 2018. There's a big void. There is no assurance.

We try to deal with reality, what is being said right now, what can we reasonably rely on. We had to file a rate last week. If things change, or the money is made available, I'm sure we'd take that into account. But right now we cannot assume nor should we assume the money is going to be there. Not based on what we know today.

Blue Cross Blue Shield North Carolina has by no means had a great experience with Obamacare. It lost $450 million on the marketplaces in 2014 and 2015. But Wilson says he felt like the market was finally stabilizing this year. He expects the plan to "at least break even" looking at results from the first quarter of 2017. He doesn't feel like Obamacare is exploding in North Carolina — but it could, depending on what Trump and Congress decide to do next. "We will continue to work hard in North Carolina to try to stay in the marketplace until decisions are made by others that make it clear we can't anymore," Wilson says.

Stay tuned for my full interview with Wilson early next week on Vox.

A very long list of all the health care questions the Senate still needs to solve

Dylan has taken an exhaustive dive into the different issues that still divide Republican senators on health care — and has come up with a very long "to-do" list for their working group. In particular, he identifies nine questions they'll need to answer as work drafting the bill begins:

1. What’s more important: increasing coverage or reducing costs?
2. How quickly will they roll back Obamacare’s Medicaid expansion?
3. How much will they subsidize low-income Americans?
4. Should they adjust that financial aid based on geography?
5. Will they water down the tax relief in the House bill?
6. Or will they lower the Medicaid spending caps even further?
7. How much of Obamacare’s insurance regulations will they repeal or let states waive?
8. What are they willing to do to stabilize Obamacare’s markets in the next few years?
9. Should they automatically enroll uninsured people into catastrophic coverage?

This is … quite a list! Read Dylan's piece here.

Chart of the Day: When do Americans have babies? Depends on where they live.

Amber Thomas

The timing of baby-making. This new data visualization project digs deep into federal birth data and finds some interesting regional variations in when Americans tend to have babies. People in Northern states tend to have more babies in the fall than people in Southern states, suggesting more conceptions during those chilly winter months. Read more here.

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

News of the day

• "GOP turns gloomy over Obamacare repeal" "Sen. Susan Collins of Maine said the Senate 'absolutely' has to surpass the CBO’s assessment of the House effort. One of two true GOP moderates in the chamber, Collins is urging her colleagues to tilt the bill toward the center rather than to the right." —Burgess Everett and Jennifer Haberkorn, Politico
• "How Medicaid spending caps would hit the states" "This is what would have happened to these states in 2011 under the different kinds of caps. It's not a guarantee of what would happen in the future, since the state populations and health care costs are likely to change." —David Nather and Lazaro Gamio, Axios

​Analysis and longer reads

• "Shuttered mental hospital had history of trouble, government sanctions" "On the third floor, which had not yet undergone repairs, disturbing messages had been carved on windows. Floor tiles were chipped and cracking. In one room in the section of the hospital that once housed children, a toilet had been ripped from the floor and holes punched through walls." —Mike Hixenbaugh, Houston Chronicle
• "Trump's latest tantrum will hurt hundreds of thousands of people. Here's how." "The key point is that Blue Cross Blue Shield North Carolina is acting on the assumption that the CSRs will not be there. And in that scenario, the company has decided, massive premium hikes are necessary. So, if it comes to pass that the CSRs actually aren’t there, you will see similar premium hikes across the country." —Greg Sargent, The Washington Post
• "The people left behind when only the 'deserving poor' get help" "Maine dropped health coverage for an estimated 14,500 parents and 10,000 childless adults, with Medicaid enrollment declining by more than 70,000 over time. The food-stamp program shrank by more than 20 percent. The number of able-bodied adults without dependents on food stamps plummeted by more than 80 percent. The welfare program halved in size." —Annie Lowrey, The Atlantic

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