Thread by @charles_gaba

📣 HEADS UP: House @EnergyCommerce Committee to grill @SeemaCMS on #ACASabotage this morning starting at 10am: acasignups.net/19/10/23/house…

Here we go: Opening statement by @RepDianaDeGette; overview of Trump Admin actions attempting to sabotage the #ACA. Ironically, it sounds like she might have a bit of a cold herself.

Opening statement by GOP ranking member @RepGuthrie; needless to say he's gushing with praise for Verma. As I explained yesterday, the "4% drop in premiums" for 2020 is a) misleading and b) is basically just a correction of carriers overestimating costs in 2017 & 2018.

Now we're on to GOP Rep. @SusanWBrooks, who's Seema Verma's Congresswoman. Apparently they're old friends.

.@EnergyCommerce Chair @FrankPallone opening statement. Notes gaslighting by Trump Admin: Claiming to support pre-existing condition coverage protections & expanding coverage at same time they support a lawsuit to strip protections away & nearly 2M have lost coverage under them.

Pallone notes draconian & likely illegal Medicaid work requirements which are already causing tens of thousands to lose coverage; notes that some were so crappy even Verma refused to approve them.

Now it's ranking GOP E&C leader @repgregwalden "I don't want to get into a partisan back & forth"...then proceeds to dig into the partisan back & forth. Accuses Dems of not wanting to reduce prescription drug pricing (ROFL) or stop surprise billing.

Walden is now lying about the various Dem POTUS candidate healthcare proposals.

(I'm gonna have to step out for about 20 minutes...here's the direct link to the hearing):

I'm back. Verma again trying to take credit for premiums dropping slightly in 2020 even though they shot up by nearly 28% in 2018 due mostly to Trump cutting off CSR funding. She's also trying to take credit for ACA reinsurance waivers...which were developed by the states.

Now it's back to Dem @CongressmanRuiz. He's an ER Doc and is telling several stories about how much things sucked pre-ACA and how much better things are with the ACA. Now he's passionately shouting at Verma about the Trump Admin calling for SCOTUS to strike down the law.

Ruiz (and @RepDianaDeGette earlier) repeatedly pointed out that Trump/Verma have NO ACTUAL PLAN for protecting those w/pre-existing conditions, adult children under 26, etc etc if they're successful in striking down the law.

GOP Rep. Brooks is up now.

Verma is again pointing out--correctly, I admit--that for those who DON'T receive ACA financial subsidies--the premiums are mostly unaffordable. This is precisely why I'm pushing hard to pass the #ACA2.0 bill #HR1884 (or at least #HR1868), which would resolve this issue.

Now Dem @RepAnnieKuster is up...asking again what the Trump Admin gameplan is if the #ACA is struck down by the idiotic #TexasFoldEm lawsuit. Notes that the GOP Congress voted 50+ times to repeal & Trump wants it struck down, so it's hard to take them seriously.

Kuster digging into those w/pre-existing conditions & how Trump is pushing hard on #ShortAssPlans (noting that under Trump, they're neither short-term nor of limited duration)...which specifically DON'T have to cover those w/pre-existing conditions.

Kuster wants to know if Verma ran an analysis of the impact her Sec. 1332 changes would have on those w/pre-existing conditions. Verma stonewalls & clearly didn't do so (or refuses to provide the analysis).

Next up: GOP @RepJeffDuncan.

Verma again pushing #ShortAssPlans as a cheap alt for those who don't qualify for #ACA subsidies. Again: I agree that #Over400FPLSOL, but the solution (aside from reducing overall costs) is NOT to move them to #ShortAssPlans, it's to #KillTheCliff.

Next up: Dem @USRepKCastor. Challenging Verma re. claims that Trump has "stabilized costs"...notes that @KFF analysis states that 2019 premiums would be 16% lower *without* various Trump Admin actions (mostly CSR cut-off, #ShortAssPlan expansion, zeroing out mandate penalty).

Castor focusing again on #ShortAssPlans & the fact that they can cherry-pick & discriminate against those w/pre-existing conditions. Again: THAT'S WHY THEY'RE SO CHEAP IN THE FIRST PLACE. It's all about trade-offs, folks.

Back to Walden. I missed a bit...sounds like Verma is trying to defend slashing navigator funding, etc., by using "how many people navigators enrolled" as the benchmark, which is incredibly disingenuous. Navigators do TONS more than just enrolling people.

Now it's Dem @RepYvetteClarke, noting that uninsured rate for children specifically has gone from 3.6M to 4.3M uninsured under Trump Admin, up to 5.5% via Census Bureau.

Clarke notes that no, the kids who've lost Medicaid/CHIP coverage have NOT transitioned over to private coverage. Notes that a lot of kids are being kicked off of Medicaid without their families being notified...tens of thousands have lost coverage wrongly.

Next: @RepPaulTonko again focusing on #ShortAssPlans. Verma refuses to admit that they don't have to cover pre-existing conditions. Keeps using buzzword "flexibility". Notes that their premiums can be up to 60% lower than #ACA plans...which is true, because they can discriminate.

Verma finally admits that yes, #ShortAssPlans can include annual/lifetime limits on coverage, don't have to cover pre-existing conditions, can discriminate on pricing etc etc.

She goes back to defending them as an affordable alternative to #ACA plans for unsubsidized.

Next: GOP Rep. @cathymcmorris, yields time to let Verma to keep defending #ShortAssPlans. McMorris now gushing with praise over Verma & going all Rah-Rah-USA-USA.

As @greg_fann notes: One thing I should note is that whether #ShortAssPlans "can discriminate" isn't a blanket yes/no answer nationally because they're regulated differently by the states; a few states *don't* let them discriminate...which in turn means they tend to cost more.

Next up: @RepLBR of Delaware. I just learned that residents of Delaware are called "Delawarians". Notes various actions (open enrollment period being cut in half, navigator budget cuts, outreach/marketing budget cuts).

I should note that cutting the open enrollment period in half wasn't *necessarily* a bad idea, but doing it *at the same time* as slashing the marketing/outreach/navigator budgets by up to 90% was a dick move.

.@RepLBR notes @JoshuaFAPeck's study showing that slashing those budgets caused significant enrollment drops, wants Verma to turn over all documents related to impact of slashing the marketing/outreach budgets.

Next: GOP @RepLarryBucshon. Asking about DME fee setting proposed rules for Medicaid rates for medical devices. Some of these things aren't really about the main topic of the hearing, but anything re. to healthcare pricing/fee levels still impacts overall healthcare spending.

Verma now addressing decline in Medicaid enrollment, notes that if the economy is better it's natural to see Medicaid enrollment drop. Calls it the "Booming Trump Economy" which is vomit-inducing.

Next: Dem @RepCardenas focusing on #ACA Medicaid expansion & a bunch of studies proving that it has *substantially* improved health/reduced deaths nationally (19,000 fewer in the 1st year alone), helps w/treatment for opioid addiction, etc.

Re. Cardenas now turning to #TexasFoldEm; "if Trump Admin gets its way & the #ACA is struck down, what happens to the 12 million with Medicaid via expansion?" Shorter Verma: "Trump Admin promises we'll do...something".

Sidenote: I have the total Med expansion at closer to 15M.

Next: GOP Rep. Greg Gianforte. He's the guy who body-slammed a reporter & was elected the next day anyway. Asking about telehealth (he's from Montana, so this makes sense given it's such a large rural state).

Next: Dem @RepBobbyRush: Concerned about kidney disease in low-income (especially minority) communities. Wants Verma to expand on her response to a letter they sent to her recently.

Next: GOP @RepBuddyCarter, who's praising Verma, hates PBMs. Likes the 340B program but wants changes.

Annnnnd @RepDianaDeGette wraps things up. That's it.