CBO, Qliance, Jim Capretta

As always, we have 5 Things We’re Watching ready for you – but candidly, this list could be 12 or 13 items long. There’s a great deal going on, certainly, but I can’t help but wonder if it’s all distraction.

Are we improving the system rapidly enough to be able to say to our communities we’re doing everything we can?  Or are we getting cornered by the “tyranny of now” in the form of the next RFP, next quarterly earnings, or next M&A deal?

Not that anyone has time for existential self-reflection these days, but if you did, and you also had time to send me your thoughts on the subject, I’d love to read them.


1.  ACA, CSRs, and the courts

AG Bob Ferguson joined 13 other states and the District of Columbia in a motion that would allow the states to intervene in the case House v. Price. Recall that in 2016, a federal district court ruled that cost sharing reductions (CSRs) in the ACA required annual appropriations to be funded. The Obama administration appealed the decision.

The Trump administration now represents the appeal to keep the CSRs, which is in conflict with its position of repealing the ACA. The House has said it won’t drop its case and that the onus for a decision is on Trump. Yesterday, the Court of Appeals issued a 90-day delay in its decision. Ferguson is trying to intervene to take the position of the appellant to argue that Washingtonians would be harmed if the CSRs go away. Jeff Sprung, a candidate for State Auditor last year and a very sharp legal advocate, is the Deputy Attorney General leading the effort.

If the CSRs aren’t funded, premiums could spike “at least 20%.” Molina, which has 9% of the exchange enrollment nationwide, has told federal and state officials it would leave. Premera tells me “the lack of clarity on this issue just adds to an already high degree of uncertainty as we prepare for our 2018 rate filings.”

2.  CBO score and a House re-vote on AHCA

The CBO will release their “score” of the AHCA on Wednesday, detailing the impacts of the bill on coverage and the federal budget. Interesting note:  though the bill passed the House, Speaker Ryan still hasn’t sent the bill to the Senate out of “an abundance of caution.”

Here’s why: because of the strategy of circumventing the fillibuster in the Senate, where Republicans have only a two-vote majority, they are using a reconciliation process. That means the AHCA has to implement or “reconcile” with a budget bill Congress passed in January.

That bill requires $2 billion in savings to be structured in a very specific way. Some think the CBO or the Senate parliamentarian may find the savings from the AHCA don’t accrue properly. That would require relatively minor changes in the bill – but it would force the House to vote a second time on the bill, something few are likely excited to do.

3.  Podcast: Jim Capretta from AEI

If you joined us for our January event in SeaTac, then you know Jim Capretta. He is the Milton Friedman Chair at the American Enterprise Institute, and a very savvy observer of health care policy and politics. He was also one of our keynote speakers at that event.

He joined the State of Reform Podcast last week to give us an update on the AHCA.  We get into the weeds a bit – meaning he corrects me a few times where I’m wrong. But he also provides important historical perspective, like that President George W. Bush included funds in his budget every year for a pathway via tax credits to a broader coverage model.  It’s a wonky and worthwhile episode if you’re a policy geek.

4.  Breakfast: Health reform in a time of Trump

We hold our next breakfast event on June 6th, which we co-produce with the Washington State Wire.  While our last event was focused on the Regular Legislative Session in general, this upcoming event will be entirely and specifically focused on health policy.

Our lineup includes three of the most important players in Washington State health policy today:  Sen. Ann Rivers, Chair of the Senate Healthcare Committee; Hon. Mike Kreidler, Insurance Commissioner; Pam MacEwan, CEO of the Washington Health Benefit Exchange.

We’ll be at the WAC downtown starting at 7:00 am.  Our program will start at 7:30, so there is plenty of time to network.  Come join us!

5.  Lessons from Qliance closing its doors

A few months back, we posted (with permission) an email solicitation for investment funds sent out by Erika Bliss, CEO of Qliance. It wasn’t a good sign:  last week, Qliance abruptly shut its doors citing a lack of cash flow to maintain operations.

The direct primary care model championed by Qliance held promise. However, the health care financing system presented a series of structural challenges too difficult to overcome. I pulled together four observations from Qliance that probably have resonance for all of us in health care today.