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How Nevada fixed Obamacare

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Mark your calendar: CBO score on Republican bill coming the week of May 22

The Congressional Budget Office announced Wednesday that it would release its score for the American Health Care Act early in the week of May 22. The agency has also promised to announce the exact time and date of the release — unlike the last AHCA score, where we all huddled around our computers at 4 pm as rumors spread that it could drop.

This was an unusual announcement: The CBO does not typically send out press releases about upcoming publications. But then again, it was unusual for the House to vote without a score at all. We are in unusual territory.

Why is this AHCA score taking longer than the last? It probably has a lot to do with the type of changes Republicans made to their health plan.

The big new thing in the bill that passed the House is waivers that states can apply for to opt out of key Obamacare regulations, like the requirement to charge sick and healthy people the same premiums or cover essential health benefits.

Waivers are a really tricky thing for the CBO to score. They require making assumptions about which states will or won't apply for the exemptions, which can be difficult when states themselves haven't developed clear plans.

State legislatures don't have to make up their minds about whether they'll take an option that exists in a bill that may never pass. But the CBO, to write this report, does need to estimate how many states will go for the waivers. And that is probably partly why getting a score is turning out to be a difficult and long process.

The surprisingly simple way Nevada recruited more Obamacare insurers

There are a lot of stories right now about the Obamacare marketplaces losing health plans and becoming less competitive.

In Nevada, though, the opposite is happening. The state is expected to have two new health plans join the marketplace this year, which would mean a total of five options for shoppers to choose from.

Nevada made one policy decision that made selling marketplace coverage way more financially appealing (kudos to Louise Norris at for reporting this first): It gave insurers that wanted to manage the state's Medicaid program an incentive to sell on the marketplaces too.

States often contract with multiple private health insurers to manage Medicaid, a public program. So Nevada had multiple insurers making bids for those contracts.

Medicaid is a way bigger program than the Obamacare marketplaces, with 74 million enrollees compared with Obamacare's 12 million. The Medicaid contracts are lucrative; Nevada had $30 million to spend on four-year contracts with private plans.

Nevada knew these were contracts insurers would want. So it told the health plans that Medicaid applications would get preferential treatment if the insurance plan committed to selling marketplace coverage in 2018.

And that is exactly what the Medicaid health plans did. Two insurance plans, Silver Summit and Aetna, bid for and won new Medicaid contracts. As a result, both are expected to join the marketplace next year.

I'm unaware of any other state that has taken this approach to its marketplace, but it certainly seems like one way to increase competition. It makes the Obamacare marketplaces financially appealing to insurers, even if the plans they sell on them aren't huge moneymakers.

Chart of the Day

This is a hand-cross-stitched chart from a very thoughtful reader! Mary Clare Peate mailed me a delightful version of my favorite Obamacare chart, which shows public opinion solidly split over time for seven years. It now hangs proudly in my office! If you're looking for a more interactive version, you can find that here.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • "Comey turmoil postpones Senate health care markup": “The Senate HELP Committee called off a health care markup this morning after Senate Minority Leader Chuck Schumer asked all Democrats to be in the Senate chamber at 9:30 a.m. to protest President Trump's firing of FBI Director James Comey.” —David Nather, Axios
  • "Cassidy: Medicaid expansion may not end": “Sen. Bill Cassidy said that if President Trump keeps his promise to the American people, there will be 'some sort of Medicaid expansion.' The Louisiana Republican told reporters Tuesday that Trump told voters last year during the presidential campaign that he wouldn't pull coverage for people who had it and that people with pre-existing conditions would continue to have coverage.” —Robert King, Washington Examiner
  • "Senators on Defensive Over All-Male Healthcare Panel": “Barely two days into crafting a new bill to roll back Obamacare, U.S. Senate Republicans were already on the defensive on Tuesday over the absence of any women in their core working group. After a meeting of the Senate healthcare group, lawmakers were bombarded with questions as to why no women were named to the 13-man panel. Senate Majority Leader Mitch McConnell tried to explain.” —Reuters
  • "Insurers in Connecticut request rate hikes of 15.2 to 33.8% on individual plans": “Ten health insurers in Connecticut have submitted rate increase requests between 3.6 and 33.8 percent for 14 filings for 2018 individual and small group plans. Two insurers filed rate increase requests for products to be sold on the state's health insurance marketplace under the Affordable Care Act.” —Susan Morse, Healthcare Finance
  • "Trump’s Approval Rating Drops Again After Health Care Vote": “President Donald Trump’s approval rating is at a new low following the House GOP’s passage of a bill that would overhaul Obamacare, according to a new Morning Consult/POLITICO survey.” —Cameron Easley, Morning Consult

Longer reads and analysis

  • "Parents Of Sick Children Fear Trap If States Have Say On ‘Preexisting Conditions'": “In a last-minute amendment proposed by Rep. Tom MacArthur (R-N.J.), a state could seek permission to allow insurance companies to charge patients more (based on their health history) if their coverage lapses for more than 63 days. That provision in the GOP bill would tremendously weaken the ACA protections, said Larry Levitt, senior vice president of the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.) 'This would guarantee access to insurance for people with preexisting conditions in theory, but not really in practice — because they could be charged astronomically high premiums,' said Levitt.” —Bram Sable-Smith, Kaiser Health News
  • "The ‘Medicaidization’ Of The Health Insurance Marketplaces: A Necessary Trend": “In short, we believe that the 'Medicaidization' of the Marketplaces is a necessary and positive trend, and we remind policy makers that regardless of legislation or regulatory change, health plans must employ the Medicaidization playbook to well-serve a population that both parties believe needs coverage.” —Margaret Murray and Mike Adelberg, Health Affairs

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