#the fact they continue to work together despite it being years since hh

[ncutii-gatwa]

as a brit who grew up up with the og horrible histories, it makes my life that the six idiots still work together and can still make the funniest shows on tv whilst also being the best of friends. and no matter what they do separately they always manage to come back together for something. comedy is so lucky to have people like them my god

[licoriceblackaliceangel]

February 1st is the day I made this blog!

First making this blog, I’ve said it plenty of times when it was brought up, but I never intended to do much with it.

I made it for the purpose of not flooding my main blog with bat/im stuff, and having the idea of answering asks for Alice if any came by. I was RPing as Alice with someone on discord for at least four months prior to this blog, and soon this blog delved more into an RP blog more than an ask blog.

I’ve made plenty of friends, have so many memories and a lot of growth through this blog. And despite some of the hard times I faced and forces and situations where I almost deleted a few times.. I don’t regret a thing.

SO.

I decided to make a little follow forever under the cut! A few people (Going back. A lot of people did. Oops.) will get some special shoutouts solely because I have a lot of thoughts, but if I don’t write something for you, don’t think you mean any less to me! If I forget anyone, my DEEPEST APOLOGIES. I have the memory of a gold fish and trying to remember everyone is. Hard.

But just know if we are mutuals I LOVE AND CHERISH YOU.

This also got a lot longer than I expected OOPS

@inkdrenchedsmile: Tea, I tell you everyday and talk to you almost everyday. I love and cherish you so so so much. You’re the sweetest, cutest, most darling thing ever. You are the brightest little marshmallow peep~ And I have so grateful everyday to have met you and be able to write with you. I love your writing and stories and your ideas and art and YOU ARE SO TALENTED! You mean the world to me. I love you, honeybun <3

@kalamxs: GIO. BOY YOu know I told you plenty of times you’re one of the reasons I even went to making this blog. I followed you before I even had the thought in my mind (I don’t remember why, maybe from your AWESOME ART and your writing and rping made me stay) because YOU ARE SO FUCKING GOOD!! I remember laughing all the time and sharing with my friends in my discord even though they don’t exactly understand BUT-- Man I’m so happy I got to actually. Interact with you! And get to befriend you and man YOUR ART GIVES ME LIFE. I love seeing all your stuff and writing and I LOVE WRITING WITH YOU. Bendo and Alice are absolutely adorable as well; fucking dorks. I LOVE YOU BABEY!! NEVER GONNA STOP LOVIN AND SUPPORTIN YOU!!

@bendicethedaughterofthedevil: NICK. You know I been with you since the MERE START. And I told you watching your growth and Bendice’s story was. WOO. Man I sometimes see the old Baby Shower art thing I did for the twin’s baby shower like.. Gonna be almost a year with that too. And just. :(.. THINGS WERE SIMPLER THEN.. I love you Nick, you’re talented and sweet and so so ambitious and strong and I LOVE YOU BABEY!!

@devilswinging: Veemo, I am so glad to have been able to meet ya and interact with you. I love ya man and I love writing with you and your muses. I love the small chit chats we have and seeing you on my dash. I love Alice’s relationship with Bebe and Sammy and just. Man!! You know, no matter what, if you ever feel down and feel like no one likes your boys, know I !! Will always love and appreciate them. <3 And Alice does too.

@instrumentsofcyanide: STELLLAAAAAAA. I fucking love you Stella. You’re so funny and sweet and the little messages back and forth sometimes and you coming in my DMs like: WHAT THE FUCK IS WITH YOUR ANONS all the time is. So funny. All the damn fiascos Oreo manages to produce and just. Oreo in general. Always gets me laughing and smiling. I love you and your boy so much?? You’re so fun and creative and silly and just an OVERALL JOY TO TALK AND BE AROUND WITH!!! I’m so glad to be able to interact and talk with you <3 (Never forget the first time I think you actually said anyhting to me was about that one Alice Blog Foot Pics Fiasco and I’ll never forget being like; Man someone I look up to and I’s first interaction is over saying ‘wow fuck this girl’ over guilting me for foot pics-- DOFIHJGFD)

@inkwise: AVI I LOVE YOU SM. DFKGJ. You’re so sweet and creative and your muses are an absolute joy. I especially have so many feelings. For Henry. So much. I love this man so much and I thank you and him everyday for my life. He needs a break. I love getting to write with you and seeing you on my dash is?? A fucking delight. Thank you. <3

@lxgner: ALICE YOU CREATIVE SWEET PERSON. You have so many damn muses and I APPLAUD YOU. Your OCs are all pretty sweet imo? The ones I seen. And the ambition you have to write and work on all this?? I applaud. I love your Joey muses esp and they’re so interesting and I love the thought you put into them all you know?? It’s interesting and really brings life into them. Your writing is delicious and your humor is. Great. I love writing with you <3 Keep your head up darling.

@one-eyed-twin: LADY V I LOVE YA SWEETHEART. Your muses are a delight and I love the little threads we’ve had, either it with Phiona, Clyde or Vlad (here and on my other blog) I love peaking at your threads and seeing your writing. You’re an absolute delight and I love?? Your creativity and your ART!! You truly are a person with impeccable tastes ~ Love seeing you on the dash, love <3

@inkyencounters: Glowbun you. Are really a sweetheart. So creative and funny, you really are kind and try to look out for everyone and it’s Very nice. I’m very appreciative of how kind ya are and the creativity you have with your muses and just. It’s very refreshing. Thank you for everything.

@sillymuses: Where do I begin. I love writing with you either with Charlie or on this blog, both here and my OC blog of course. You really have such a creative spin in your writing and really? Feel your characters and paint them so!! Amazingly. I love the back and forth between you and you’re honestly. Adorable. I love seeing you and your creativity hun <3

@inkmachine: GLOOMY I LOVE YOU AND I HOPE THINGS ARE/WILL GET BETTER SOON LOVIE. God it’s always a treat when you’re online and on the dash it’s. Always hilarious. I love seeing what Bendy fucking gets up to this time and he’s so?? Awesome. I love him a lot. The little bastard PFF. He’s absolute adorable and cute and I love the dark shit with him honestly. And him and Alice’s lil Candi adventures are always. Tooth rottingly sweet. I love ya hun. <3

@taakos-troupe-of-threads: I hope you know the phrase “Snap would fight Chalk Jesus for Alice’s honor” is a thing that will NEVER leave my mind and tends to cross it once a day. PFF. I love writing with you and seeing you on the dash as well! Snap is a fucking DOLL and I LOVE HIM SO MUCH. (As does Alice, ofc) They’re absolutely adorable and poor girl is such a worrier PFF. Our DMs are always something funny as well, I think. I always know I’m in for something good when I see that fucking. Orange Danny Devito icon in my dms-- KSKJF

@dappcrdust: GLITTER!! Man. I remember first writing with you with your Bendy muse and honestly? Ever interaction from him to now has ALWAYS been a fun treat. I love your writing and love seeing you on and getting into whatever shenanigans that seem to pop up. Mostly with Angel it seems pfff.. Sweet Angel. I love what you have all done and cooked for him and his character he’s so?? three dimensional i love it. Him and Alice’s BFFship is honestly. Great and I love them SO MUCH. You’re creative and fun and just. A sweetheart. Love ya hun <3

@gamblxrhxsk: tbh I didn’t know what blog to @ YOU FUCKING MANIAC. Jk. I love you Echo. PFFF It’s funny to me that I feel I got closer with you via fucking. shit with CEO-Entity. LMAO. Echo where do I start. You are SO DAMN FUNNY. Like my GOD how many times have I laughed out loud to myself over some shit ya wrote and done?? Hell, even with your stuff with phil swift and entity and all that stuff got my SQUAD TO COME TO ME LAUGHING OVER IT!! I love also all your muses and the fact you got this whole arsenal and can?? Keep up with it for what it seems like. PROPS!! I love fucking around with you here and there and even though we don’t really write together too much (which, I would love to but I’m myself and even still lowkey anxious OIGJG) I just love putzing around and seeing you do your thing on the dash; from jokes to serious business. It’s always a treat. <3

@nctherchpter: Pai, I’m still lowkey so flattered you ever followed me back (and now mutuals with me on our mains like. WHAAA--) Your art is always. Bellissimo. Asriel was always a joy to see and honestly just. Stole my heart. I love him so much. Your writing is always a joy and man you just. Are skilled in The Arts(TM) Your self insert blog is also?? Awesome. I love the concept and idea and going through with a thing like? Honestly. Inspiration. All your self insert stuff really is just. Big big inspo. I’m so glad you seem to have? So much fun. Also I did say it in Nick’s stream many moons ago when they were going through BATIM again. Your voice is v cute <3

@clair-de-luna: WHERE DO I BEGIN WITH YOU!!! Man I remember following your main back for that SWEET MUFFETON ART. My cherished Muffeton mutual. And now here we both are with THIS. YOUR ART JUST CONTINUES TO INSPIRE AND GROW AND I LOVE!! SEEING IT!! And LUNA MELTS ALICE AND I’S HEART ALL THE TIME. God does she ADORE HER LITTLE STAR!! Ugh. I cry real tears. Always a delight to see you both here and your main. <3 I love ya DC!!

@lilithmagne: AC you. Are truly an artistic marvel. Your art is INCREDIBLE, your writing is BEAUTIFUL. And I love seeing you on my dashboard. You are so sweet and kind?? It’s so nice. I LOVE the love and work you put into Lilith and her story and your research and dedication? It’s amazing. Lilith is an absolute BEAUTY and God I LOVE HER. You do her SUCH A BEAUTIFUL JUSTICE!! So honored to be mutuals with you honestly. <3 Keep being amazing you beautiful person.

@lucifermagne: MARZI YOU ARE AN ABSOLUTE ANGEL. Working on all those HH icons for other rpers, working on your other RP blogs and pumping out that SWEET CONTENT. You are honestly a treasure. You are absolute sweet and a joy to see online. I love peaking at your threads and LOVE seeing your posts either for HCs or just IC shenanigans with Lucifer. You put so much through and care into your interpretation of him and I LOVE IT. He’s such a fun goof ball but at the same time presents himself as. THE KING OF HELL. Obviously. He’s an absolute Joy and just!! It’s amazing. We haven’t threaded together yet but even despite that?? I just love seeing you and him (and Alastor and Marx and the gang ofc) on the dash. Always a damn delight. <3

@thatscwewywabbit: we only just started interacting like. a week or so ago but AMANDA Man I have told you before how much I adore seeing you write for Bugs and how it’s ALWAYS SO FUN to see him and your posts for him on the dash. THE AMOUNT OF RESEARCH, CARE, LOVE, THOUGHT ALL PUT INTO HIM AND YOUR WRITING FOR HIM. It’s just so good. So refreshing. Ugh. MY CHILDHOOD!! It makes me so happy all the time. You really are. An inspiration. Writing with you and him is a DELIGHT and love peeking at your other threads just. It’s so nice. It’s almost uncanny how well you play him. My goodness! Keep being awesome lovely <3

@viennaxmuses​: Fuck you bitch. Yeah. You’re getting put here. Bitch. Fuck you. I LOVE YOU. BItch. You fucking fuck. You sweet cute funny fuck. You adorable loving supportive bitch. Ya uplifting comforting creative artistic thot. Fuck you.

Okay this went WAY LONGER THAN I INTENDED but sorry everyone else I didn’t write a lil blurb for. I wrote a lot and I STILL WANNA GIVE SHOUTOUTS CUS I LOVE!! ALL OF YOU!! Even non-mutuals like. I just wanna share all the love and appreciation I have here.

@hxllodolly @cvangclii @snxkeyes @ofinkdxmonsandxngels @brxkeninstrument / @butcherbrains @stupidcoffeeboy @strawberry-lemonade-muses @hazbinmuses @bornloscrs @black-jack-the-cat​ @bluescarfvivi @a-framed-rabbit​ @angelusvoce​ @ask-slender-and-gray​ @wrenchand-abone

[deadinsidedressage]

Anonymous Barn Drama #30

Oh, I’m Sorry. I Didn’t Realize It’s ILLEGAL to Be a Person.

Also known as, “That Time I Did That Schooling Show That Really, Really Sucked Because My Trainer Was A Verbally Abusive Piece of Shit AND I Never Knew My Weird Friend Had Apparently Reached Nirvana”

My first schooling show was not a positive experience.  I was talked into showing a horse that I didn’t think was ready (oh the perks of being a working student) and we never actually made it all the way down the centerline. 

 So, when I got the opportunity to take another horse to a schooling show that could actually make it around the ring, I took it. A week or so before we left for the show, the horse’s owner decided she was going to sell him but knew that a 4 year old that had never been off the property might be a tough sell so decided to let me take him to the show anyway.

  I was relieved, I loved working with this horse and was actually really looking forward to the show as I didn’t have any show experience at the time and could use the exposure. 

Of course, my high anxiety trainer got all worked up about the fact that he was now for sale and suddenly my relaxing schooling show experience was now a “score as high as you can so we can sell this horse or else” experience. Fuck me, amirite?

We get to the show with two four year olds, one for each working student, and a school master and his rider who had also never been to a show before. yikes.tumblr.com

 Thankfully, the other working student had a lot of show experience and was able to help me figure everything out because my trainer was completely focused on the student as she “forgot” how little show experience I had… I caught on pretty quickly that she didn’t think she needed to spend any extra energy on me as she predominately helped the other baby horse who was being naughty and the student who didn’t have a whole lot of experience and probably wasn’t really ready to be at the show anyway. Basically, my trainer thought that putting the immense pressure of insisting if I didn’t make that horse get 8s on everything ever he wouldn’t sell and I would ruin his life was not only FINE but probably meant that I didn’t need any attention at all. I get that my baby was being a Good Boy in comparison and that I knew way more about showing in comparison.... but, um... please help me?

We all ended up in the same classes, so my trainer was predominately by the show ring and really wasn’t helping any of us in the warmup since she was watching whoever was doing their test. Which was fine, at first. Then, right as the other working student was about to go down centerline with her baby, I was run into by a pony in the warm up which sent my horse bolting and bucking through the entire warmup arena. Like straight up, this little kid ran her black and white spotted pony up my baby horse’s ASS at the canter. No heads up either. Just all of a sudden a 12.2hh pinto pony has it’s nose as close to this 17+hh baby horse’s butt. He could feel the hot breath of unruly pony on his rectum and he noped out hard.

Feeling the breath of a Smol Santa on his asshole, the horse I’m on just decides to become a bucking bronc with these HUGE bucks across the arena. I sit most of them, but one particularly big one unseated me and just screwed my ability to stay on. I ended up dumped in the corner and he was loose, running around the warmup. My trainer had her back to the ring as she was focused on the test being ridden and missed the entire thing except she heard on the speakers that there was a loose horse. Thankfully, one of my friends who wasn’t with my barn happened to be at this same schooling show. She was salting her wounds after some particularly horrible tests earlier in the day and was waiting to watch my ride, so she actually saw what happened and rushed over to help. 

So of course my trainer waits until the test is finished to look around and see what happened when she noticed that some randos were holding the horse I was supposed to be riding. Thankfully they walked him to me and not to her, I took him out of the ring to be met by my VERY angry trainer. Not only was she mad that some randos were walking him, she was pissed that I could be bothered to come off of him at a show in front of potential buyers and if I had just ridden him better I could have stayed on. In between berating me for DARING to come off him and “probably dropping his worth by $15,000″, she snatches the reins from me. I admit, I’m a bit of a wreck at this point thanks to the adrenaline of coming off being mixed with someone then being livid with me for being a human being. 

 I have about 15 minutes before I supposed to be going down centerline for my test and I’m not entirely sure I’m going to be ready in time when she turns to me and asks if I can get myself together in order to ride my test like I’m supposed to or if I’m planning on calling the owner to let her know that I’m scratching all the classes and letting all her money go to waste. I tell her I need a moment to compose myself. She looks like she’s about to ignore that and whip out her cellphone to explain to the owner that I’m the worst, etc. when my friend just grabs the reins back from her. I think it might have been because she was dead inside from how truly, truly horrific her tests were (she had a “different horse” in the ring than she did in warm-up and looked positively suicidal when she saluted at the end), but she was being the zenist motherfucker in the world.  The balls on this bitch.  Anyway, she grabs the horse and says something like “It’s okay, I’ve got this” in a weird ass Buddhist intonation and just takes over? I need to get back on the horse but I’m trying to be calm and not frazzled and the idea of going over to the mountain block is just not working. So this ancient Indian guru spirit channeling bitch finds cinder-blocks from God knows where and stacks them into a makeshit mounting block and gets me on. Gives me some eerily placid, tranquil pep talk about how I am capable and worthy and far more talented than I am giving myself credit for and sees me off into the warmup. She was so fucking oddly calm it was almost unnerving.  I’m able to trot the baby horse around and sort of settle us both, but I never got to warmup my canter so my departs were “expressive”. YET, the test went really well. 

 As I was walking out of the ring my trainer tells me that she was glad people got to see the test because he is such an easy horse and she just didn’t want their view of him tarnished by me coming off. Insert Waka Flocka “okay” gif here smh.  For the rest of the day she continues grumbling about how I ruined any chance of selling the horse and how she should have had the other working student just show both horses. Again, need I reiterate that she is just having so much fun dragging me through the dirt for falling off a horse that spooked massively in a situation that, while unfortunate, wasn’t fully in my control.

Then the scores come in, I won the class. With over a 70%. The other working student didn’t even break out of the mid 60′s on the other baby.

Ahem, suck my mother fucking dick.

Throughout the day, I am approached by riders and trainers asking if the horse was for sale and what his price was.  One lady basically offered to buy him on the spot except then suddenly my trainer ups his price by 20k based on all the interest without consulting the owner at all,  of course not missing a beat in telling me he could go for even more if I hadn’t been bucked off. 

We had a second test in the afternoon which I requested we scratch because he was pretty body sore and I didn’t think he’d perform well.  I was told that it was not an option to waste somebody else’s money and that I was doing it or she’d find someone else to do it.  So I made it work with as short a warmup as possible but he definitely didn’t have a strong second test.   Oh and somewhere in the middle of being in pain and having to do a second test, my creepy friend wisps in like a balmy breeze with a bottle of champagne and tries to get me drunk so I don’t “feel” how sore I am. I don’t know if she was drunk the whole day or even at all or if this is just... how she gets when she makes a 20% look like a possible score to get without being removed from the test?

Even so, my trainer was convinced the second test was better than the first and that I would regret wanting to scratch him. When the scores came in and he got a 65 and was middle of the class, she  decides goes on a tirade about how horrible the judging was and that we’d never go to a schooling show there again, blah, blah, blah, the world is unfair, please care about my white tears. Of course she never takes responsibility for the fact that she pushed a baby horse to show twice in one day when he was regularly only ridden 4 days a week.

 Some other shit goes down at the barn after the show, one of the trainers that expressed interest in him came out to try him and then suddenly ended up hired as an assistant trainer to work all the sales horses instead of purchasing him and I lost the ride on him.  She showed him all summer, consistently getting lower and lower scores throughout the season before finishing with some low 60% scores at Championships.  

All the while, my trainer is complaining how all of this is just making it harder and harder to sell the horse and how she has to drop his price more and more. 

Except, my trainer NEVER listed him for sale anywhere despite how vocal the owner was about him needing to be sold.  He could have sold at any point but because he wasn’t her horse she spent no effort marketing him like she did her own horses.  At this point, the owner is so desperate to sell him that she almost offered him to me for free at one point but instead took a stupidly low price from another student in the barn. Oh and, my friend? Yeah she’s still fucking weird.

[coffinsahetrickjw10insuranc-blog]

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[deniseyallen]

Portman Opening Statement at PSI Hearing on Oversight of HHS & DHS Efforts to Protect Unaccompanied Minors from Human Trafficking & Abuse

WASHINGTON, D.C. – This morning, U.S. Senator Rob Portman (R-OH), the Chairman of the Permanent Subcommittee on Investigations (PSI), delivered remarks at a hearing to examine efforts by the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Homeland Security (DHS) to protect unaccompanied minors from human trafficking and other forms of abuse.  This hearing follows up on PSI’s hearing on January 28, 2016 at which the Subcommittee released a report detailing how HHS placed eight children with human traffickers who placed the children in forced labor on an egg farm in Marion, Ohio.  The Subcommittee found that HHS had failed to establish procedures to protect UACs, such as conducting sufficient background checks on sponsors and following up with sponsors and UACs to ensure UACs’ welfare. 

Following is a transcript of Portman’s opening statement and you can watch his opening statement here and below.

“In 2015, I learned the story of eight unaccompanied minors from Guatemala who crossed our southern border.  A ring of human traffickers lured them to the United States, they’d actually gone to Guatemala and told their parents they would provide them education in America.  To pay for the children’s smuggling debt, their parents gave the traffickers the deeds to their homes, which the traffickers then retained until the children could work off the debt because they weren’t interested in giving them an education, as it turn out, they were interested in trafficking them.

“When the children crossed our border, their status, as defined by federal immigration law, was that of “unaccompanied alien child,” or UACs, so you will hear the term UAC used today.  The Department of Homeland Security picked them up and, following protocol, transferred them to the Department of Health and Human Services.  HHS then was supposed to place these children with sponsors who would keep them safe until they could go through the appropriate immigration legal proceedings. That’s practice.

“That didn’t happen. 

“What did happen:  HHS released these children back into the custody of those human traffickers without vetting them.

“Let me repeat that:  HHS actually placed these children back in the hands of the traffickers. 

“The traffickers took them to an egg farm in Marion, Ohio, where the children lived in squalid conditions and were forced to work 12 hours a day, six-seven days a week, for more than a year.  The traffickers threatened the children and their families with physical harm—and even death—if the children didn’t perform these long hours.

“This Subcommittee investigated.  We found that HHS didn’t do background checks on those sponsors.  HHS also didn’t respond to red flags that should have alerted them to problems with the sponsors.  For example, HHS missed that a group of sponsors were collecting multiple UACs, not just one child but multiple children.  And HHS didn’t do anything when a social worker provided help to one of those children, or tried to at least, and the sponsor turned the social worker away.

“During our investigation, we held a hearing in January 2016, so this goes back a couple of years, where HHS committed to do better, understanding that this was a major problem in 2016. Of course that was during the Obama administration so this has gone on through two administrations now. HHS committed to clarifying the Department of Homeland Security and HHS responsibilities for protecting these children.  HHS and DHS entered into a three-page ‘Memorandum of Agreement,’ which said that the agencies recognized they should ensure these unaccompanied alien children aren’t abused or trafficked.

“The agreement said the agencies would enter into a detailed “Joint Concept of Operations” that would spell out what the agencies would do to fix the problems.  HHS and DHS gave themselves a deadline of February 2017 to have this ‘Joint Concept of Operations’ pulled together. That seemed like plenty of time to do it. It wasn’t done and that was over a year ago.

“It’s now April 2018.  We still don’t have that Joint Concept of Operations—the JCO – and despite repeated questions from Sen. Carper and me, as well as our staffs, over the past year, we don’t have any answers about why that is. 

“In fact, in a recent meeting, a DHS official asked our investigators why we even cared about the JCO. 

“Let me be clear.  We care about the JCO because we care that we have a plan in place to protect these kids while they’re in our government’s custody.  We care because the Government Accountability Office has said that DHS has sent children to the wrong facility because of miscommunications with HHS. 

“We care because the agencies themselves thought it was important enough to set a deadline for this JCO, but then blew by it.  And we care because these kids, regardless of their immigration status, deserve to be treated properly, not abused or trafficked.

“We learned at 4 pm yesterday that 13 days ago – there was an additional memorandum of agreement reached between the two agencies – we requested and finally received a copy of this new agreement at midnight last night.  It’s not the JCO that we’ve been waiting for – but it is a more general statement of how information will be shared between the two agenices.  Frankly, we had assumed that this information was already being shared – maybe it was. It’s positive that we have this additional memorandum, that’s great. It’s nice that this hearing motivated that to happen but it’s not the JCO we’ve all been waiting for.

“We called this hearing today for DHS and HHS to give us some answers about the JCO.

“Once DHS hands unaccompanied minors off to HHS, the law provides that “the care and custody of all unaccompanied alien children . . . shall be the responsibility of the Secretary of Health and Human Services.”  But HHS told this Subcommittee that once it places children with sponsors—even sponsors who are not related to the children— it no longer has legal responsibility for them.  Not if they’re abused.  Not if they miss their court hearings. No responsibility.  That’s of course not acceptable and not workable.

“HHS inherited responsibilities relating to these children when Congress dissolved Immigration and Naturalization Services, INS.  We continue to believe HHS has the authority and responsibility to care and keep track of these children.

“Since our 2016 hearing, we also have heard about other problems.  We’ve heard that sponsors frequently fail to ensure these children show up at their immigration court proceedings.  That undermines our rule of law and an effective immigration system.  And in almost all of those cases, the judge enters an in absentia removal order.  That means that even if the children are eligible for immigration relief, like asylum status, they don’t get it and are ordered removed—so it’s bad for the children, too.

“We also learned that HHS does not track these children once HHS releases them to sponsors.  Nor does HHS notify state or local governments when it places these children with sponsors in those communities.  HHS says they do plan to start notifying local law enforcement when it releases high-risk children, but hasn’t done so because it can’t figure out who to tell.  This seems like a straightforward step—we should at least be able to figure that out here today? 

“Since 2016, HHS has called sponsors and the children 30 days after placement with sponsors to check on the children.  That’s a good step in my view.  But in his testimony, Mr. Wagner says from October to December last year, ORR tried to reach 7,635 of these children.  Of those, he says “ORR was unable to determine with certainty the whereabouts of 1,475 UAC.”  That’s almost 1500 kids missing in just a three month period.  We’d like to know how HHS plans to track down these children.

“And we also heard about problems at the three secure facilities HHS uses to house UACs who are higher risks—those accused of crimes, who might harm themselves, or who present a flight risk.  The head of the Yolo County, California facility says that HHS does not give them enough money for the number of children they house—which means they cannot hire enough staff to take care of the children safely.  We have a witness from the facility in Shenandoah Valley here today who will explain to us why their facility simply isn’t equipped to handle some of the children the HHS Office of Refugee Resettlement places there and what can be done about that.

“Again, this is not an issue that just came up in this administration. This dates back to the Obama administration and now into the new Trump administration. The topic of unaccompanied alien children obviously continues to be a hot button issue.�� But today, I want to focus on two key issues related to them. 

“First:  Human decency.  Once these unaccompanied children are in the United States, we have a duty to ensure they are not trafficked or abused. 

“Second:  The rule of law.  Our immigration system is broken.  One problem is that half of these children are not showing up to their court hearings.  That’s not good for the kids or for our system.  We need to do better.

“I look forward to hearing from our witnesses today about how we can make that happen”.

###

from Rob Portman http://www.portman.senate.gov/public/index.cfm/press-releases?ContentRecord_id=5F278910-C98E-41D9-BC75-F7D823C09D13

[ascendingmatrix]

10 FALSE VACCINE SAFETY CLAIMS EXPOSED

NATURAL BLAZE

VACCINES CAN AND DO CAUSE INJURIES, INCLUDING AUTISM

We’re living in an age where parents increasingly report that their typically developing children declined cognitively and physically after receiving vaccines. Despite the sound science supporting these parent claims, government agencies and mainstream media continue issuing the now shopworn mantra that vaccines are “safe and effective” ignoring published research and even common sense that indicate otherwise.

World Mercury Project has put together a list of the most common misrepresentations in the vaccine safety debate and provided the facts and references that support the reality that vaccines can and do cause injuries including autism and many other adverse health outcomes.  

CLAIM 1. VACCINES SAVE LIVES.

This statement is debatable. There is a growing body of research that suggests vaccines may cause more injury and death than the diseases they were meant to protect us from.

Vaccines can also cause permanent disability and death in individuals who are more susceptible to injury from vaccines or vaccine ingredients. Physicians and vaccine-injured individuals are encouraged to report injuries to the Vaccine Adverse Event Reporting System (VAERS). It’s estimated that only 1% of injuries are ever reported to VAERS, yet payments totaling nearly $4 billion have been made since 1988. That taxpayer-funded payout amount continues to rise at an alarming rate.

Despite the trend in medicine to personalize treatments and medications, the current vaccine program is a “one size fits all” policy.

CLAIM 2. VACCINES DON’T CAUSE AUTISM.

The National Vaccine Injury Compensation Program has paid many vaccine induced autism claims. Even the industry-compromised mainstream media has covered vaccine-induced autism, including Dr. Sanjay Gupta and CNN with the widely-reported Hannah Poling case.

The CDC published studies claiming no link between thimerosal and autism are conflicted, fraudulent and manipulated to suppress the autism link. However, they still show that vaccines cause grave neurological injuries such as tics. (See Verstraeten 2003, Barile 2012, Tozzi 2009.)

CDC vaccine safety scientist turned whistleblower (and author of several of the CDC autism studies), Dr. William Thompson, claims senior CDC officials asked him and his colleagues to lie about scientific fraud and destruction of evidence in critical vaccine safety research regarding the causative relationship between childhood vaccines and autism.

World Mercury Project has collected over 80 studies connecting the dots between the vaccine preservative, thimerosal, and autism. Studies on other vaccine ingredients and links to disease are also accumulating.

The safety of combining vaccines, which include aborted fetal tissue, mercury, aluminum, formaldehyde, animal and human DNA, and more—in infants and young children has not been tested.CLAIM 3. ALL VACCINES HAVE BEEN RIGOROUSLY TESTED AND ARE COMPLETELY SAFE.

This is patently false. The reason Congress exempted vaccine makers from liability in 1986 was BECAUSE vaccines were causing harm. Since the National Vaccine Injury Compensation Act went into effect, the federal government program has paid out 3.8 billion dollars in vaccine injuries and death.

In 2011, the Supreme Court ruled that vaccines are “unavoidably unsafe.”

The current CDC pediatric schedule recommends children receive as many as nine vaccines all at the same office visit. The safety of combining vaccines, which include aborted fetal tissue, mercury, aluminum, formaldehyde, animal and human DNA, and more—in infants and young children has not been tested.

There are no large-scale studies comparing health outcomes in vaccinated children vs. those who haven’t received vaccines. However, a recent peer-reviewed studyfound that vaccinated children had an increased risk of autism (4.2 times), ADHD (4.2 times), learning disabilities (5.2 times), eczema (2.9 times) and an astounding 30 times the risk of allergic rhinitis compared to unvaccinated children.

In 2016, the Vaccine Injury Adverse Reporting System (VAERS) collected 59,117 reports of adverse events from vaccines, including 432 deaths, 1091 permanent disabilities, 4,132 hospitalizations and 10,284 emergency room visits. According to HHS, the reported events are only 1% of the actual number. Therefore, the U.S is likely experiencing millions of adverse reactions from vaccines per year.

CLAIM 4. VACCINATIONS PRODUCE HERD IMMUNITY AND PREVENT DANGEROUS, EVEN DEADLY, DISEASES. ANTI-VAXXERS ARE CAUSING EPIDEMICS AND ERODING THE PUBLIC TRUST.

Herd immunity cannot be achieved through vaccination if vaccines aren’t effective. The Measles-Mumps-Rubella (MMR) vaccine is just one that isn’t working. Mumps cases in the U.S. have been on the rise in recent years with over 5,000 cases reported in 2016, more than any year in the past decade, and they are occurring in highly vaccinated populations. Recent outbreaks of disease in vaccinated populations are proving that all vaccines are not efficacious. Additionally, immunity from vaccines is usually temporary unlike the lifelong immunity typically produced by experiencing a childhood illness.

In 2010, two former Merck virologists filed a federal lawsuit claiming that Merck committed fraud in lying about the efficacy of the mumps component of their MMR vaccine. The suit, now in the hands of a federal judge, charges that Merck was aware of the declining efficacy of the mumps vaccine but still claimed it was 95% effective.

As the CDC continues to deny that there is a vaccine safety problem, studies show that the biggest impediment to broad vaccine acceptance and coverage is public mistrust of government regulators.

Bernadine Healy, former director of the National Institutes of Health, said that public distrust is growing because of inaction on the part of agencies regarding vaccine safety.

The only polio that is diagnosed now in America is the vaccine strain and those cases are compensated in Vaccine Court.

Ironically, many of today’s vaccines don’t actually prevent the vaccinated individual from harboring and transmitting the disease in question. This is true of pertussis,  diphtheria, and as already noted, polio.

The death rate from measles as far back as 1922 was extremely low—4.3 in 100,000. Consider that this was nearly 100 years ago—before electric refrigerators, before washing machines, before antibiotics, and IV hydration, and the advances of modern medicine.

Eight years before the measles vaccine was introduced, children went to school, and even to Disneyland, which opened its doors in 1955, and mothers didn’t live in fear of routine illnesses like measles.

Not only has thimerosal never been completely taken out of vaccines, but much more aluminum was—and continues to be—added, again with no scientific research to support the safety of doing so.CLAIM 5. THIMEROSAL (ETHYL MERCURY) WAS TAKEN OUT OF VACCINES IN 1999 AND AUTISM RATES STILL CONTINUED TO RISE. ALSO, THE ETHYL MERCURY IN VACCINES IS LESS TOXIC THAN METHYL MERCURY.

Between 1999 and 2003, thimerosal was being gradually removed from the Hep B, Hib and DTaP vaccines. However, the exposure to thimerosal due to flu shots was simultaneously ramping up.  Flu shots were originally recommended for pregnant women in 1997 but, initially, uptake of these shots was low (only 12.4% by 2002).  In 2004, the CDC recommended flu shots for all pregnant women in any trimester.  By 2012-2013, uptake of flu shots during pregnancy had steadily increased to approximately 50%.  So, the children born after 2004 were increasingly likely to have been exposed to thimerosal in utero, and a lot of it.

Concurrently, in 2001, the CDC recommended flu vaccines for high-risk infants over six months of age.  In January 2003, the CDC recommended routine annual flu shots for all children starting at six months of age.  Coverage initially was very low.  In the 2002–2003 and 2003–2004 influenza seasons, only 4.4% and 8.4% of children, respectively, were fully vaccinated for flu.  In the 2004-2005 flu season, the childhood uptake rate had shot up to 48%.  In the years after the phase out of mercury in the Hep B, Hib, and DTaP, children were increasingly being exposed to thimerosal through flu shots.  In 2004, over 90% of the flu shot supply was preserved with thimerosal.

There is no justification for injecting mercury, a known neurotoxin, into anyone, but definitely not pregnant women and children. The developing fetus is especially vulnerable to mercury exposure because fetal cord blood mercury levels are typically about double the mother’s mercury blood levels. Approximately 36 million flu shots containing 25 mcg. of mercury are in the supply for the 2017-2018 flu season.

A 2017 CDC study reviewing data from the 2010-11 and 2011-2012 flu seasons linked spontaneous abortions to flu vaccines, finding that women vaccinated with the inactivated influenza vaccine had 3.7-fold greater odds of spontaneous abortion within 23 days than women not receiving the vaccine. For women who received the H1N1 vaccine in both seasons covered in the study, the odds of spontaneous abortion in the 28 days after receving a flu vaccine was 7.7 times greater. The vast majority of flu vaccines available during the seasons studied were multi-dose formulations containing 25 mcg. of mercury.

Meningococcal vaccines may still contain 25mcg of mercury from thimerosal. Using EPA guidelines for mercury exposure, an individual should weigh 550 lbs. to “safely” process this amount of mercury. Of course, this is based on the INGESTION of methyl mercury. No guidelines have been established for INJECTING any form of mercury. Thimerosal is still included in “trace amounts” in other vaccines.

Not only has thimerosal never been completely taken out of vaccines, but much more aluminum was—and continues to be—added, again with no scientific research to support the safety of doing so.

Despite claims made by vaccine pundits and repeated in the media, ethyl mercury found in vaccines is not safer than methyl mercury found in fish. A recent meta-analysis showed that inorganic mercury has a half-life in the brain of several years. This is concerning since we know infant primates exposed to equal amounts of ethyl mercury compared to methyl mercury were found to have more than double the amount of inorganic mercury deposited into their brain tissue.

While it’s true that ethyl mercury clears the blood more quickly than methyl mercury, the organs of toxicity are the brain and kidneys. Ethyl mercury rapidly crosses into the brain where it gets trapped and is not easily excreted. Clearing the blood does not mean that the ethyl mercury has left the body.

Curiously, one division of the FDA has labeled thimerosal as not being “Generally Recognized As being Safe and Effective (GRASE), while another branch continues to allow the use of thimerosal in vaccines and over 130 prescription drugs.

CLAIM 6. THE STUDY BY WAKEFIELD CLAIMING A LINK BETWEEN THE MMR VACCINE AND AUTISM HAS BEEN DISPROVEN. THIS STUDY WAS RETRACTED AND THE AUTHOR DISCREDITED. OTHER MMR STUDIES PROVE NO LINK AS WELL.

The Wakefield Lancet paper never claimed that the MMR causes autism. Wakefield presented case histories of 12 children with bowel disease and autistic regression their parents claimed occurred after the MMR shot. Wakefield called for more study. From the conclusion: We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described.

Since the paper’s retraction, senior level CDC scientist turned whistleblower Dr. William Thompson said that a 2004 CDC study found an association with the MMR and the onset of autism in African-American boys and in children with no other developmental concerns before the vaccine, a condition they termed “isolated autism.” Thompson submitted thousands of documents to Congressman Bill Posey of Florida in 2014 regarding his claims. Subsequently, Congressman Posey made a statement from the floor of the U.S. House of Representatives saying, in part:

“Regardless of the subject matter, parents making decisions about their children’s health deserve to have the best information available to them. They should be able to count on federal agencies to tell them the truth…In August 2014, Dr. William Thompson, a senior scientist at the Centers for Disease Control and Prevention, worked with a whistleblower attorney to provide my office with documents related to a 2004 CDC study that examinedthe possibility of a relationship between [the] mumps, measles, rubella vaccine and autism. In a statement released in August, 2014, Dr. Thompson stated, ‘I regret that my co-authors and I omitted statistically significant information in our 2004 article published in the journal Pediatrics.’ “          

Since 2014, requests to allow Dr. William Thompson to testify have been denied by the CDC.

CLAIM 7. AUTISM IS GENETIC, NOT ENVIRONMENTAL. THERE IS NO EPIDEMIC BECAUSE CHANGING DIAGNOSTIC CRITERIA EXPLAINS THE RISE.

There is no such thing as a genetic epidemic and diagnostic substitution cannot account for the skyrocketing numbers of children now diagnosed with autism.

What we can glean from the science is that autism requires an environmental triggerto cause the epidemic increases we’re seeing in not only autism, but ADHD, tics, allergies and a laundry list of other childhood disorders that we have not seen in past generations.

Researchers have been searching for the elusive autism gene for decades and still haven’t found it despite spending hundreds of millions of dollars in their pursuit. There may be as many as 1,000 genes involved in autism risk and many of the most promising genetic findings are acquired mutations that point to environmental factors as the cause of the mutations. The expansion of genetic studies has found that, in families who have two children diagnosed with autism, the siblings often don’t share the same gene changes, which has raised the possibility that the disorder isn’t inherited even when it runs in families. This begs the question of shared environmental factors or risk conditions.

One of the largest twin studies to date published in 2011 also found the role of the environment has been underestimated.  The study found that the children’s environment represents more than 1/2 the susceptibility: 55% in severe autism and 58% in the broader spectrum, while genetics was involved in 37% and 38% of the risk respectively.

We often hear that autism starts in utero because initial studies that looked at abnormal brain growth associated with autism reported the abnormalities occurred prenatally, but that work has been challenged by Harvard researchers who used advanced imaging techniques and reported that the brain overgrowth was being driven by the white matter of the brain.  The observed overgrowth of the white matter occurred after birth and may be related to the process of myelination. The white matter overgrowth was also seen in infants with developmental language disorders, which is often one of the first symptoms of autism in children.

CLAIM 8.  THE UNITED STATES ALREADY HAS A VACCINE SAFETY COMMISSION.

Any appearance of vaccine safety efforts made by the CDC and its pundits is a facade. A government agency charged with ensuring high vaccination uptake in the population should not be entrusted to ensure that vaccines are as safe as possible.

The CDC is in the vaccine business, a tremendous conflict of interest when that same agency is tasked with promoting mass-scale vaccination. According to a 2003 UPI Investigation, the CDC held 28 vaccine licensing agreements at that time. In 2017, another analysis found that the CDC now holds at least 57 patents related to vaccines.

Members of the Advisory Committee on Immunization Practices, who determine vaccine recommendations, are allowed to have financial conflicts, some even profiting from the vaccine decisions the committee recommends.

The revolving door between the CDC and the vaccine industry is blatant and has gone unchecked for decades.

CLAIM 9. ROBERT F. KENNEDY, JR. IS AN “ANTI-VAXXER”.

This type of bullying terminology is an attempt to censor opinion and silence debate. There are very real problems with vaccine safety, efficacy, pharmaceutical influence in public interest decision making and policy, and conflicts of interest among the regulators of our government agencies expected to protect Americans from harm. That is the story that needs to be covered. Name calling does nothing to advance the discussion of these critical issues.

Robert F. Kennedy, Jr. ensured that all of his six children were fully vaccinated. But when he read the independent, peer-reviewed research linking vaccines with serious health conditions and talked to pharmaceutical and government “experts”, he was convinced that mercury was driving the epidemic of neurological and immunological injuries impacting today’s children in numbers never before seen in history.

Kennedy was also concerned over the lack of true vaccine safety science. The few existing CDC safety studies are rife with errors and additionally, CDC whistleblower William Thompson claims some of them to be fraudulent.

Proclaiming that Mr. Kennedy is “anti-vaccine” effectively dismisses not only what tens of thousands of parents have witnessed but also what a growing amount of published, reputable science is bearing out. He wants trustworthy regulators who will actually do their jobs in protecting the health of our nation’s citizens.

When it comes to the safety and well-being of their children, parents and caregivers have every right to pose questionsCLAIM 10. UNVACCINATED PEOPLE MAKE OTHERS SICK. VACCINES SHOULD BE MANDATORY WITH NO PHILOSOPHICAL, MEDICAL OR RELIGIOUS EXEMPTIONS.

History shows us that vaccinated people can also spread diseases and infections. This is well illustrated by the 2016 Harvard mumps outbreak and the 2017 mumps outbreak at Syracuse University wherein all people diagnosed with mumps had received both recommended doses of the MMR vaccine. As mentioned above, according to two former Merck virologists who worked on the mumps portion of the MMR, the mumps vaccine is not effective.

In addition to the lack of efficacy in vaccines such as the MMR, vaccines made with live viruses such as MMR, chicken pox, rotavirus, influenza, and shingles can cause shedding of the viruses to the close contacts of  those vaccinated. When it comes to the safety and well-being of their children, parents and caregivers have every right to pose questions, no matter the topic. Parents research the safest car seats, cribs, strollers and everything else that involves their children. Vaccines should also be on the table for questioning, researching, discussing, or criticizing. And if parents decide to refuse vaccines for their children, those decisions should be respected.

“One size fits all” is a questionable policy when it comes to medical treatment. Knowledgeable doctors realize that there isn’t a single medical procedure that works well for the entire population—and that includes vaccines. Published science also supports the fact that some people with genetic predispositions or biological susceptibilities should not have vaccines.  We desperately need more research in this area so we can identify those likely to be harmed so we can modify their vaccine schedule. Have we traded acute childhood illness for lifelong chronic disease? The American public is become increasingly aware of the rapid decline in the health of our nation’s children and are worried that the ever-expanding childhood vaccine schedule—that has tripled since the 1980’s—may be responsible for the current epidemic of serious childhood health conditions.  These concerns are warranted given the fact that over half of the children in this country—54%–now have a chronic health condition.

Mandated vaccines are in direct opposition to informed consent, the number one tenet of the Nuremberg Code: The voluntary consent of the human subject is absolutely essential.

Ignoring facts, research and conflicts of interest within regulatory agencies has created a smoke screen to cover the obvious truth of the matter—vaccines are not as safe and effective as our government agencies and mainstream media would have us believe. Vaccines can and do cause serious injuries including autism and many other adverse health outcomes.

Photo by Jason Rosewell on Unsplash

[mikalajanie]

Four ways states are foiling Obamacare sabotage

Throughout 2017, the Trump Administration has taken brazen action to sabotage the ACA and the health insurance markets that operate under the ACA’s rules. Funding for HealthCare.gov’s marketing and outreach has been slashed (nevertheless, a record number of people purchased coverage on the first day of open enrollment), and funding for cost-sharing reductions has been eliminated. A new executive order instructs federal agencies to draft regulations that will ultimately undermine the stability of the ACA-qualified insurance market.

And all of this comes after Republican lawmakers and governors spent the previous seven years sabotaging the ACA, and concurrently with Republican lawmakers’ protracted efforts to repeal the ACA in 2017.

That’s a lot to withstand, and it’s left the individual health insurance market on somewhat shaky ground. Quite a few insurers have opted to exit the exchanges or the entire individual market at the end of 2017 (although quite a few others are expanding or joining the exchanges for the first time), and pre-subsidy premium increases for 2018 are substantial.

But while the Trump Administration has been working to thwart the ACA, quite a few states have been taking action to shore up their individual markets and protect access to health care. Let’s take a look at what they’re doing:

Extended open enrollment

The duration of open enrollment for 2018 coverage has been cut in half, although that can’t be blamed entirely on the Trump Administration — the Obama Administration had already planned to move to that schedule in the fall of 2018; the Trump Administration just moved it up a year.

Under the schedule set by HHS, open enrollment for 2018 coverage will run from November 1, 2017 to December 15, 2017, with all plans effective January 1, 2018.

But nine of the states that have their own enrollment platforms have opted to extend open enrollment for 2018 coverage. There were only 12 states that had this flexibility, as the rest of the states rely on HealthCare.gov and have to abide by the open enrollment schedule that HHS has established.

But nine state-run exchanges have decided to go with a longer open enrollment period this year, and transition to the shorter open enrollment as scheduled in the fall of 2018. Enrollment will begin on November 1 in all of them, but will end on the following dates:

Connecticut: December 22 (for coverage effective January 1)

Rhode Island: December 31 (for coverage effective January 1)

Colorado: January 12, 2018

Minnesota: January 14, 2018

Washington: January 15, 2018

Massachusetts: January 23, 2018

DC: January 31, 2018

California: January 31, 2018

New York: January 31, 2018

In those states, people have extra time to enroll. Data from previous open enrollment periods indicates that the people who enroll on the later end of the window tend to be younger and healthier than those who enroll at the start of the window. This makes sense, as sick people are not likely to procrastinate when it comes to securing health insurance coverage.

So the longer open enrollment periods in those nine states are an effort to ensure that enrollment assistance isn’t stretched too thin, that as many people as possible can enroll, and that the individual market risk pool will be as stable and healthy as possible.

Adding the cost of CSR to Silver plans

Premiums for 2018 are going to be significantly higher than they would have been if cost-sharing reduction (CSR) funding had been committed early in 2017. And after months of dithering on the issue, the Trump Administration announced three weeks before the start of open enrollment that funding for cost-sharing reductions would end immediately.

But regulators in many states had already anticipated that move, and had taken action to protect the majority of their individual market enrollees from the fallout.

David Anderson, Charles Gaba, Andrew Sprung and I have been putting together a spreadsheet and a map that show which strategy — if any — each state has taken, and more details are available for most states on healthinsurance.org’s pages about the exchanges.

In general, states that directed insurers to add the cost of CSR to Silver plans have protected most consumers from the impact of the elimination of federal funding for CSR. Many states, including California, Pennsylvania, and Florida, have taken that strategy even further, by ensuring that there are off-exchange-only Silver plans that won’t include the cost of CSR in their premiums.

When the cost of CSR is added to Silver plan premiums, the result is larger premium subsidies for all enrollees who are eligible for premium subsidies (nationwide, 84 percent of exchange enrollees receive premium subsidies in 2017). For people who don’t get CSR but who do get premium subsidies (ie, those with income between 250 percent and 400 percent of the poverty level), Gold and Bronze plans will end up being an even better value in states where the cost of CSR has been added to Silver plans. For people who buy off-exchange coverage, Bronze, Gold, and in some cases, “extended Bronze” plans are available in most states without the cost of CSR added to the premiums, and off-exchange-only Silver plans are also available in many states without the cost of CSR added to the premiums. (It’s essential to carefully comparison shop, though, especially if you’re considering a Silver plan and don’t get premium subsidies.)

In short, states had the option to take action to ensure that most consumers would be unharmed by the CSR funding cut. Many did so by late summer, and others made last-minute changes to rates after the Trump Administration clarified that CSR funding would not continue.

Establishing reinsurance programs

On President Trump’s first day in office, he weakened the ACA’s individual mandate with his first executive order, creating the perception that the individual mandate would no longer be enforced. (To the extent that it can be enforced, the enforcement has actually remained unchanged — but perception is key, and the uninsured rate has spiked upwards in Trump’s first several months in office.)

A perceived weakening of the individual mandate is destabilizing to insurance markets. But reinsurance is an effective means of stabilizing the individual market, and can provide a counterbalance to the Trump Administration’s efforts to undermine the ACA.

Nationwide, there are about 16.5 million people in the ACA-compliant individual market. But since each state’s individual market is separate from all the others, most of them have fairly low total populations. So it doesn’t take very many high claims to destabilize a state’s individual market, since the premium increases necessary to cover claims can result in coverage becoming unaffordable for healthy, unsubsidized enrollees, who then leave the market, further exacerbating the problem.

The ACA included a reinsurance program, but it was temporary and only lasted through 2016. So some states have set out to create their own reinsurance programs, using 1332 waivers so that they can fund reinsurance with the federal money that would have otherwise been spent on larger premium subsidies. The result is fairly minimal state spending and unchanged federal spending, but lower premiums that result in more people being able to afford coverage.

Alaska established a reinsurance program for 2017 with state funds, and received approval in July for five years of federal funding to keep it going. As a result, average premiums in Alaska are declining by more than 20 percent in 2018, despite the fact that the cost of CSR has to be added to the premiums.

Minnesota established a reinsurance program to take effect in 2018, and received approval for federal funding in September. (The situation in Minnesota is still somewhat uncertain, however, because the reinsurance funding approval came with a funding cut for MinnesotaCare, the state’s Basic Health Program.)

Oregon also established a reinsurance program, and their request for federal funding was approved in October 2017. The state credited the new reinsurance program with keeping rate hikes for 2018 in the single-digit range, but after the Trump Administration cut off CSR funding, the Oregon Division of Financial Regulation announced that Silver plan rates would have to increase by an additional 7.1 percent to cover the cost of CSR. However, rates for 2018 would have been 6 percentage points higher without the new reinsurance program.

Iowa also submitted a 1332 waiver proposal that would have created a reinsurance program along with a variety of other changes to revamp the individual health insurance system in the state and reduce premiums. Some of the provisions were controversial, and it was unclear whether HHS would approve the waiver — they had not done so as of late October. At that point, however, Iowa withdrew their waiver proposal. 

Oklahoma also tried to establish a reinsurance program, and calculated that rates for 2018 would have been 34 percent lower than 2017 rates. But they were relying on federal funding and the waiver approval process didn’t happen quickly enough for the program to be implemented by the time rates for 2018 had to be finalized, so Oklahoma also withdrew their waiver proposal. The state may try again in the future, and has far-reaching plans to overhaul their individual market using 1332 waivers.

Codifying contraceptive coverage

In October, the Trump Administration announced new regulations — effective immediately — that grant employers wide-ranging access to exemptions from the ACA’s requirement that health plans cover all FDA-approved contraceptives for women.

Throughout 2017, Republican lawmakers have tried to modify the ACA provision that requires all individual and small-group major medical plans to cover the essential health benefits. To varying degrees, they want to allow the sale of less robust coverage again, and put the onus on the consumer to choose well.

One of the ACA’s essential health benefits is preventive care, which includes full coverage for at least one form of every FDA-approved female contraceptive method. This requirement remains in force, as none of the 2017 legislative efforts to repeal or change the ACA have been successful. The Trump Administration implemented regulations in October 2017 that broaden the ability for employers and universities to obtain exemptions from the requirement that their health plans cover contraceptives, and Republican lawmakers have tried repeatedly to advance legislation that would allow individual market plans to be sold without contraceptive coverage.

But more than half the states have some sort of regulations in place that require contraceptive coverage, in some cases without a copay. Here are some examples of the steps states have taken to enhance and protect access to contraception, regardless of federal actions:

For nearly two decades, Hawaii has required state-regulated, employer-sponsored plans to cover contraceptives. And in 2017, the state implemented a new law that allows pharmacists to prescribe and dispense 12 months of birth control.

Oregon passed a law in 2017 (effective in 2019) that requires all state-regulated plans to cover contraceptives at no cost (including vasectomies, which are not required to be covered under the ACA), and also to cover abortions.

Nevada enacted a law in 2017 that requires Nevada Medicaid and all state-regulated plans to cover birth control with no copay, and authorizes pharmacists to dispense up to 12 months of birth control at a time.

New York’s Governor, Andrew Cuomo, took regulatory action in 2017 to require contraceptive coverage on all state-regulated plans, along with coverage for medically-necessary abortions.

A law that took effect in 2016 in Vermont requires insurers to cover FDA-approved contraceptives (including vasectomies) with no copays, and allows women to obtain up to 12 months worth of birth control at one time.

Maryland enacted legislation in 2016 (effective in 2018) that requires coverage for FDA-approved contraceptive (including vasectomies and emergency Plan B contraception) with no copays. It also eliminates prior authorization requirements for long-acting reversible contraceptives (IUDs and implants) and lets women obtain up to six months worth of birth control at one time.

Although the battle over the ACA is likely to be protracted and messy, states have the ability to protect their residents to some extent. Consumers can and should contact their federal representatives to have conversations about health care reform, but they can also reach out to their local leaders to express opinions about strengthening consumer protections at the state level.

from https://www.healthinsurance.org/blog/2017/11/07/four-ways-states-are-foiling-obamacare-sabotage/

[judithcsmith]

Four ways states are foiling Obamacare sabotage

Throughout 2017, the Trump Administration has taken brazen action to sabotage the ACA and the health insurance markets that operate under the ACA’s rules. Funding for HealthCare.gov’s marketing and outreach has been slashed (nevertheless, a record number of people purchased coverage on the first day of open enrollment), and funding for cost-sharing reductions has been eliminated. A new executive order instructs federal agencies to draft regulations that will ultimately undermine the stability of the ACA-qualified insurance market.

And all of this comes after Republican lawmakers and governors spent the previous seven years sabotaging the ACA, and concurrently with Republican lawmakers’ protracted efforts to repeal the ACA in 2017.

That’s a lot to withstand, and it’s left the individual health insurance market on somewhat shaky ground. Quite a few insurers have opted to exit the exchanges or the entire individual market at the end of 2017 (although quite a few others are expanding or joining the exchanges for the first time), and pre-subsidy premium increases for 2018 are substantial.

But while the Trump Administration has been working to thwart the ACA, quite a few states have been taking action to shore up their individual markets and protect access to health care. Let’s take a look at what they’re doing:

Extended open enrollment

The duration of open enrollment for 2018 coverage has been cut in half, although that can’t be blamed entirely on the Trump Administration — the Obama Administration had already planned to move to that schedule in the fall of 2018; the Trump Administration just moved it up a year.

Under the schedule set by HHS, open enrollment for 2018 coverage will run from November 1, 2017 to December 15, 2017, with all plans effective January 1, 2018.

But nine of the states that have their own enrollment platforms have opted to extend open enrollment for 2018 coverage. There were only 12 states that had this flexibility, as the rest of the states rely on HealthCare.gov and have to abide by the open enrollment schedule that HHS has established.

But nine state-run exchanges have decided to go with a longer open enrollment period this year, and transition to the shorter open enrollment as scheduled in the fall of 2018. Enrollment will begin on November 1 in all of them, but will end on the following dates:

Connecticut: December 22 (for coverage effective January 1)

Rhode Island: December 31 (for coverage effective January 1)

Colorado: January 12, 2018

Minnesota: January 14, 2018

Washington: January 15, 2018

Massachusetts: January 23, 2018

DC: January 31, 2018

California: January 31, 2018

New York: January 31, 2018

In those states, people have extra time to enroll. Data from previous open enrollment periods indicates that the people who enroll on the later end of the window tend to be younger and healthier than those who enroll at the start of the window. This makes sense, as sick people are not likely to procrastinate when it comes to securing health insurance coverage.

So the longer open enrollment periods in those nine states are an effort to ensure that enrollment assistance isn’t stretched too thin, that as many people as possible can enroll, and that the individual market risk pool will be as stable and healthy as possible.

Adding the cost of CSR to Silver plans

Premiums for 2018 are going to be significantly higher than they would have been if cost-sharing reduction (CSR) funding had been committed early in 2017. And after months of dithering on the issue, the Trump Administration announced three weeks before the start of open enrollment that funding for cost-sharing reductions would end immediately.

But regulators in many states had already anticipated that move, and had taken action to protect the majority of their individual market enrollees from the fallout.

David Anderson, Charles Gaba, Andrew Sprung and I have been putting together a spreadsheet and a map that show which strategy — if any — each state has taken, and more details are available for most states on healthinsurance.org’s pages about the exchanges.

In general, states that directed insurers to add the cost of CSR to Silver plans have protected most consumers from the impact of the elimination of federal funding for CSR. Many states, including California, Pennsylvania, and Florida, have taken that strategy even further, by ensuring that there are off-exchange-only Silver plans that won’t include the cost of CSR in their premiums.

When the cost of CSR is added to Silver plan premiums, the result is larger premium subsidies for all enrollees who are eligible for premium subsidies (nationwide, 84 percent of exchange enrollees receive premium subsidies in 2017). For people who don’t get CSR but who do get premium subsidies (ie, those with income between 250 percent and 400 percent of the poverty level), Gold and Bronze plans will end up being an even better value in states where the cost of CSR has been added to Silver plans. For people who buy off-exchange coverage, Bronze, Gold, and in some cases, “extended Bronze” plans are available in most states without the cost of CSR added to the premiums, and off-exchange-only Silver plans are also available in many states without the cost of CSR added to the premiums. (It’s essential to carefully comparison shop, though, especially if you’re considering a Silver plan and don’t get premium subsidies.)

In short, states had the option to take action to ensure that most consumers would be unharmed by the CSR funding cut. Many did so by late summer, and others made last-minute changes to rates after the Trump Administration clarified that CSR funding would not continue.

Establishing reinsurance programs

On President Trump’s first day in office, he weakened the ACA’s individual mandate with his first executive order, creating the perception that the individual mandate would no longer be enforced. (To the extent that it can be enforced, the enforcement has actually remained unchanged — but perception is key, and the uninsured rate has spiked upwards in Trump’s first several months in office.)

A perceived weakening of the individual mandate is destabilizing to insurance markets. But reinsurance is an effective means of stabilizing the individual market, and can provide a counterbalance to the Trump Administration’s efforts to undermine the ACA.

Nationwide, there are about 16.5 million people in the ACA-compliant individual market. But since each state’s individual market is separate from all the others, most of them have fairly low total populations. So it doesn’t take very many high claims to destabilize a state’s individual market, since the premium increases necessary to cover claims can result in coverage becoming unaffordable for healthy, unsubsidized enrollees, who then leave the market, further exacerbating the problem.

The ACA included a reinsurance program, but it was temporary and only lasted through 2016. So some states have set out to create their own reinsurance programs, using 1332 waivers so that they can fund reinsurance with the federal money that would have otherwise been spent on larger premium subsidies. The result is fairly minimal state spending and unchanged federal spending, but lower premiums that result in more people being able to afford coverage.

Alaska established a reinsurance program for 2017 with state funds, and received approval in July for five years of federal funding to keep it going. As a result, average premiums in Alaska are declining by more than 20 percent in 2018, despite the fact that the cost of CSR has to be added to the premiums.

Minnesota established a reinsurance program to take effect in 2018, and received approval for federal funding in September. (The situation in Minnesota is still somewhat uncertain, however, because the reinsurance funding approval came with a funding cut for MinnesotaCare, the state’s Basic Health Program.)

Oregon also established a reinsurance program, and their request for federal funding was approved in October 2017. The state credited the new reinsurance program with keeping rate hikes for 2018 in the single-digit range, but after the Trump Administration cut off CSR funding, the Oregon Division of Financial Regulation announced that Silver plan rates would have to increase by an additional 7.1 percent to cover the cost of CSR. However, rates for 2018 would have been 6 percentage points higher without the new reinsurance program.

Iowa also submitted a 1332 waiver proposal that would have created a reinsurance program along with a variety of other changes to revamp the individual health insurance system in the state and reduce premiums. Some of the provisions were controversial, and it was unclear whether HHS would approve the waiver — they had not done so as of late October. At that point, however, Iowa withdrew their waiver proposal. 

Oklahoma also tried to establish a reinsurance program, and calculated that rates for 2018 would have been 34 percent lower than 2017 rates. But they were relying on federal funding and the waiver approval process didn’t happen quickly enough for the program to be implemented by the time rates for 2018 had to be finalized, so Oklahoma also withdrew their waiver proposal. The state may try again in the future, and has far-reaching plans to overhaul their individual market using 1332 waivers.

Codifying contraceptive coverage

In October, the Trump Administration announced new regulations — effective immediately — that grant employers wide-ranging access to exemptions from the ACA’s requirement that health plans cover all FDA-approved contraceptives for women.

Throughout 2017, Republican lawmakers have tried to modify the ACA provision that requires all individual and small-group major medical plans to cover the essential health benefits. To varying degrees, they want to allow the sale of less robust coverage again, and put the onus on the consumer to choose well.

One of the ACA’s essential health benefits is preventive care, which includes full coverage for at least one form of every FDA-approved female contraceptive method. This requirement remains in force, as none of the 2017 legislative efforts to repeal or change the ACA have been successful. The Trump Administration implemented regulations in October 2017 that broaden the ability for employers and universities to obtain exemptions from the requirement that their health plans cover contraceptives, and Republican lawmakers have tried repeatedly to advance legislation that would allow individual market plans to be sold without contraceptive coverage.

But more than half the states have some sort of regulations in place that require contraceptive coverage, in some cases without a copay. Here are some examples of the steps states have taken to enhance and protect access to contraception, regardless of federal actions:

For nearly two decades, Hawaii has required state-regulated, employer-sponsored plans to cover contraceptives. And in 2017, the state implemented a new law that allows pharmacists to prescribe and dispense 12 months of birth control.

Oregon passed a law in 2017 (effective in 2019) that requires all state-regulated plans to cover contraceptives at no cost (including vasectomies, which are not required to be covered under the ACA), and also to cover abortions.

Nevada enacted a law in 2017 that requires Nevada Medicaid and all state-regulated plans to cover birth control with no copay, and authorizes pharmacists to dispense up to 12 months of birth control at a time.

New York’s Governor, Andrew Cuomo, took regulatory action in 2017 to require contraceptive coverage on all state-regulated plans, along with coverage for medically-necessary abortions.

A law that took effect in 2016 in Vermont requires insurers to cover FDA-approved contraceptives (including vasectomies) with no copays, and allows women to obtain up to 12 months worth of birth control at one time.

Maryland enacted legislation in 2016 (effective in 2018) that requires coverage for FDA-approved contraceptive (including vasectomies and emergency Plan B contraception) with no copays. It also eliminates prior authorization requirements for long-acting reversible contraceptives (IUDs and implants) and lets women obtain up to six months worth of birth control at one time.

Although the battle over the ACA is likely to be protracted and messy, states have the ability to protect their residents to some extent. Consumers can and should contact their federal representatives to have conversations about health care reform, but they can also reach out to their local leaders to express opinions about strengthening consumer protections at the state level.

from RSSMix.com Mix ID 8246807 http://ift.tt/2AiaMbD

[johndonohueus]

Four ways states are foiling Obamacare sabotage

Throughout 2017, the Trump Administration has taken brazen action to sabotage the ACA and the health insurance markets that operate under the ACA’s rules. Funding for HealthCare.gov’s marketing and outreach has been slashed (nevertheless, a record number of people purchased coverage on the first day of open enrollment), and funding for cost-sharing reductions has been eliminated. A new executive order instructs federal agencies to draft regulations that will ultimately undermine the stability of the ACA-qualified insurance market.

And all of this comes after Republican lawmakers and governors spent the previous seven years sabotaging the ACA, and concurrently with Republican lawmakers’ protracted efforts to repeal the ACA in 2017.

That’s a lot to withstand, and it’s left the individual health insurance market on somewhat shaky ground. Quite a few insurers have opted to exit the exchanges or the entire individual market at the end of 2017 (although quite a few others are expanding or joining the exchanges for the first time), and pre-subsidy premium increases for 2018 are substantial.

But while the Trump Administration has been working to thwart the ACA, quite a few states have been taking action to shore up their individual markets and protect access to health care. Let’s take a look at what they’re doing:

Extended open enrollment

The duration of open enrollment for 2018 coverage has been cut in half, although that can’t be blamed entirely on the Trump Administration — the Obama Administration had already planned to move to that schedule in the fall of 2018; the Trump Administration just moved it up a year.

Under the schedule set by HHS, open enrollment for 2018 coverage will run from November 1, 2017 to December 15, 2017, with all plans effective January 1, 2018.

But nine of the states that have their own enrollment platforms have opted to extend open enrollment for 2018 coverage. There were only 12 states that had this flexibility, as the rest of the states rely on HealthCare.gov and have to abide by the open enrollment schedule that HHS has established.

But nine state-run exchanges have decided to go with a longer open enrollment period this year, and transition to the shorter open enrollment as scheduled in the fall of 2018. Enrollment will begin on November 1 in all of them, but will end on the following dates:

Connecticut: December 22 (for coverage effective January 1)

Rhode Island: December 31 (for coverage effective January 1)

Colorado: January 12, 2018

Minnesota: January 14, 2018

Washington: January 15, 2018

Massachusetts: January 23, 2018

DC: January 31, 2018

California: January 31, 2018

New York: January 31, 2018

In those states, people have extra time to enroll. Data from previous open enrollment periods indicates that the people who enroll on the later end of the window tend to be younger and healthier than those who enroll at the start of the window. This makes sense, as sick people are not likely to procrastinate when it comes to securing health insurance coverage.

So the longer open enrollment periods in those nine states are an effort to ensure that enrollment assistance isn’t stretched too thin, that as many people as possible can enroll, and that the individual market risk pool will be as stable and healthy as possible.

Adding the cost of CSR to Silver plans

Premiums for 2018 are going to be significantly higher than they would have been if cost-sharing reduction (CSR) funding had been committed early in 2017. And after months of dithering on the issue, the Trump Administration announced three weeks before the start of open enrollment that funding for cost-sharing reductions would end immediately.

But regulators in many states had already anticipated that move, and had taken action to protect the majority of their individual market enrollees from the fallout.

David Anderson, Charles Gaba, Andrew Sprung and I have been putting together a spreadsheet and a map that show which strategy — if any — each state has taken, and more details are available for most states on healthinsurance.org’s pages about the exchanges.

In general, states that directed insurers to add the cost of CSR to Silver plans have protected most consumers from the impact of the elimination of federal funding for CSR. Many states, including California, Pennsylvania, and Florida, have taken that strategy even further, by ensuring that there are off-exchange-only Silver plans that won’t include the cost of CSR in their premiums.

When the cost of CSR is added to Silver plan premiums, the result is larger premium subsidies for all enrollees who are eligible for premium subsidies (nationwide, 84 percent of exchange enrollees receive premium subsidies in 2017). For people who don’t get CSR but who do get premium subsidies (ie, those with income between 250 percent and 400 percent of the poverty level), Gold and Bronze plans will end up being an even better value in states where the cost of CSR has been added to Silver plans. For people who buy off-exchange coverage, Bronze, Gold, and in some cases, “extended Bronze” plans are available in most states without the cost of CSR added to the premiums, and off-exchange-only Silver plans are also available in many states without the cost of CSR added to the premiums. (It’s essential to carefully comparison shop, though, especially if you’re considering a Silver plan and don’t get premium subsidies.)

In short, states had the option to take action to ensure that most consumers would be unharmed by the CSR funding cut. Many did so by late summer, and others made last-minute changes to rates after the Trump Administration clarified that CSR funding would not continue.

Establishing reinsurance programs

On President Trump’s first day in office, he weakened the ACA’s individual mandate with his first executive order, creating the perception that the individual mandate would no longer be enforced. (To the extent that it can be enforced, the enforcement has actually remained unchanged — but perception is key, and the uninsured rate has spiked upwards in Trump’s first several months in office.)

A perceived weakening of the individual mandate is destabilizing to insurance markets. But reinsurance is an effective means of stabilizing the individual market, and can provide a counterbalance to the Trump Administration’s efforts to undermine the ACA.

Nationwide, there are about 16.5 million people in the ACA-compliant individual market. But since each state’s individual market is separate from all the others, most of them have fairly low total populations. So it doesn’t take very many high claims to destabilize a state’s individual market, since the premium increases necessary to cover claims can result in coverage becoming unaffordable for healthy, unsubsidized enrollees, who then leave the market, further exacerbating the problem.

The ACA included a reinsurance program, but it was temporary and only lasted through 2016. So some states have set out to create their own reinsurance programs, using 1332 waivers so that they can fund reinsurance with the federal money that would have otherwise been spent on larger premium subsidies. The result is fairly minimal state spending and unchanged federal spending, but lower premiums that result in more people being able to afford coverage.

Alaska established a reinsurance program for 2017 with state funds, and received approval in July for five years of federal funding to keep it going. As a result, average premiums in Alaska are declining by more than 20 percent in 2018, despite the fact that the cost of CSR has to be added to the premiums.

Minnesota established a reinsurance program to take effect in 2018, and received approval for federal funding in September. (The situation in Minnesota is still somewhat uncertain, however, because the reinsurance funding approval came with a funding cut for MinnesotaCare, the state’s Basic Health Program.)

Oregon also established a reinsurance program, and their request for federal funding was approved in October 2017. The state credited the new reinsurance program with keeping rate hikes for 2018 in the single-digit range, but after the Trump Administration cut off CSR funding, the Oregon Division of Financial Regulation announced that Silver plan rates would have to increase by an additional 7.1 percent to cover the cost of CSR. However, rates for 2018 would have been 6 percentage points higher without the new reinsurance program.

Iowa also submitted a 1332 waiver proposal that would have created a reinsurance program along with a variety of other changes to revamp the individual health insurance system in the state and reduce premiums. Some of the provisions were controversial, and it was unclear whether HHS would approve the waiver — they had not done so as of late October. At that point, however, Iowa withdrew their waiver proposal. 

Oklahoma also tried to establish a reinsurance program, and calculated that rates for 2018 would have been 34 percent lower than 2017 rates. But they were relying on federal funding and the waiver approval process didn’t happen quickly enough for the program to be implemented by the time rates for 2018 had to be finalized, so Oklahoma also withdrew their waiver proposal. The state may try again in the future, and has far-reaching plans to overhaul their individual market using 1332 waivers.

Codifying contraceptive coverage

In October, the Trump Administration announced new regulations — effective immediately — that grant employers wide-ranging access to exemptions from the ACA’s requirement that health plans cover all FDA-approved contraceptives for women.

Throughout 2017, Republican lawmakers have tried to modify the ACA provision that requires all individual and small-group major medical plans to cover the essential health benefits. To varying degrees, they want to allow the sale of less robust coverage again, and put the onus on the consumer to choose well.

One of the ACA’s essential health benefits is preventive care, which includes full coverage for at least one form of every FDA-approved female contraceptive method. This requirement remains in force, as none of the 2017 legislative efforts to repeal or change the ACA have been successful. The Trump Administration implemented regulations in October 2017 that broaden the ability for employers and universities to obtain exemptions from the requirement that their health plans cover contraceptives, and Republican lawmakers have tried repeatedly to advance legislation that would allow individual market plans to be sold without contraceptive coverage.

But more than half the states have some sort of regulations in place that require contraceptive coverage, in some cases without a copay. Here are some examples of the steps states have taken to enhance and protect access to contraception, regardless of federal actions:

For nearly two decades, Hawaii has required state-regulated, employer-sponsored plans to cover contraceptives. And in 2017, the state implemented a new law that allows pharmacists to prescribe and dispense 12 months of birth control.

Oregon passed a law in 2017 (effective in 2019) that requires all state-regulated plans to cover contraceptives at no cost (including vasectomies, which are not required to be covered under the ACA), and also to cover abortions.

Nevada enacted a law in 2017 that requires Nevada Medicaid and all state-regulated plans to cover birth control with no copay, and authorizes pharmacists to dispense up to 12 months of birth control at a time.

New York’s Governor, Andrew Cuomo, took regulatory action in 2017 to require contraceptive coverage on all state-regulated plans, along with coverage for medically-necessary abortions.

A law that took effect in 2016 in Vermont requires insurers to cover FDA-approved contraceptives (including vasectomies) with no copays, and allows women to obtain up to 12 months worth of birth control at one time.

Maryland enacted legislation in 2016 (effective in 2018) that requires coverage for FDA-approved contraceptive (including vasectomies and emergency Plan B contraception) with no copays. It also eliminates prior authorization requirements for long-acting reversible contraceptives (IUDs and implants) and lets women obtain up to six months worth of birth control at one time.

Although the battle over the ACA is likely to be protracted and messy, states have the ability to protect their residents to some extent. Consumers can and should contact their federal representatives to have conversations about health care reform, but they can also reach out to their local leaders to express opinions about strengthening consumer protections at the state level.

from RSSMix.com Mix ID 8246807 https://www.healthinsurance.org/blog/2017/11/07/four-ways-states-are-foiling-obamacare-sabotage/

[janekira2]

Four ways states are foiling Obamacare sabotage

Throughout 2017, the Trump Administration has taken brazen action to sabotage the ACA and the health insurance markets that operate under the ACA’s rules. Funding for HealthCare.gov’s marketing and outreach has been slashed (nevertheless, a record number of people purchased coverage on the first day of open enrollment), and funding for cost-sharing reductions has been eliminated. A new executive order instructs federal agencies to draft regulations that will ultimately undermine the stability of the ACA-qualified insurance market.

And all of this comes after Republican lawmakers and governors spent the previous seven years sabotaging the ACA, and concurrently with Republican lawmakers’ protracted efforts to repeal the ACA in 2017.

That’s a lot to withstand, and it’s left the individual health insurance market on somewhat shaky ground. Quite a few insurers have opted to exit the exchanges or the entire individual market at the end of 2017 (although quite a few others are expanding or joining the exchanges for the first time), and pre-subsidy premium increases for 2018 are substantial.

But while the Trump Administration has been working to thwart the ACA, quite a few states have been taking action to shore up their individual markets and protect access to health care. Let’s take a look at what they’re doing:

Extended open enrollment

The duration of open enrollment for 2018 coverage has been cut in half, although that can’t be blamed entirely on the Trump Administration — the Obama Administration had already planned to move to that schedule in the fall of 2018; the Trump Administration just moved it up a year.

Under the schedule set by HHS, open enrollment for 2018 coverage will run from November 1, 2017 to December 15, 2017, with all plans effective January 1, 2018.

But nine of the states that have their own enrollment platforms have opted to extend open enrollment for 2018 coverage. There were only 12 states that had this flexibility, as the rest of the states rely on HealthCare.gov and have to abide by the open enrollment schedule that HHS has established.

But nine state-run exchanges have decided to go with a longer open enrollment period this year, and transition to the shorter open enrollment as scheduled in the fall of 2018. Enrollment will begin on November 1 in all of them, but will end on the following dates:

Connecticut: December 22 (for coverage effective January 1)

Rhode Island: December 31 (for coverage effective January 1)

Colorado: January 12, 2018

Minnesota: January 14, 2018

Washington: January 15, 2018

Massachusetts: January 23, 2018

DC: January 31, 2018

California: January 31, 2018

New York: January 31, 2018

In those states, people have extra time to enroll. Data from previous open enrollment periods indicates that the people who enroll on the later end of the window tend to be younger and healthier than those who enroll at the start of the window. This makes sense, as sick people are not likely to procrastinate when it comes to securing health insurance coverage.

So the longer open enrollment periods in those nine states are an effort to ensure that enrollment assistance isn’t stretched too thin, that as many people as possible can enroll, and that the individual market risk pool will be as stable and healthy as possible.

Adding the cost of CSR to Silver plans

Premiums for 2018 are going to be significantly higher than they would have been if cost-sharing reduction (CSR) funding had been committed early in 2017. And after months of dithering on the issue, the Trump Administration announced three weeks before the start of open enrollment that funding for cost-sharing reductions would end immediately.

But regulators in many states had already anticipated that move, and had taken action to protect the majority of their individual market enrollees from the fallout.

David Anderson, Charles Gaba, Andrew Sprung and I have been putting together a spreadsheet and a map that show which strategy — if any — each state has taken, and more details are available for most states on healthinsurance.org’s pages about the exchanges.

In general, states that directed insurers to add the cost of CSR to Silver plans have protected most consumers from the impact of the elimination of federal funding for CSR. Many states, including California, Pennsylvania, and Florida, have taken that strategy even further, by ensuring that there are off-exchange-only Silver plans that won’t include the cost of CSR in their premiums.

When the cost of CSR is added to Silver plan premiums, the result is larger premium subsidies for all enrollees who are eligible for premium subsidies (nationwide, 84 percent of exchange enrollees receive premium subsidies in 2017). For people who don’t get CSR but who do get premium subsidies (ie, those with income between 250 percent and 400 percent of the poverty level), Gold and Bronze plans will end up being an even better value in states where the cost of CSR has been added to Silver plans. For people who buy off-exchange coverage, Bronze, Gold, and in some cases, “extended Bronze” plans are available in most states without the cost of CSR added to the premiums, and off-exchange-only Silver plans are also available in many states without the cost of CSR added to the premiums. (It’s essential to carefully comparison shop, though, especially if you’re considering a Silver plan and don’t get premium subsidies.)

In short, states had the option to take action to ensure that most consumers would be unharmed by the CSR funding cut. Many did so by late summer, and others made last-minute changes to rates after the Trump Administration clarified that CSR funding would not continue.

Establishing reinsurance programs

On President Trump’s first day in office, he weakened the ACA’s individual mandate with his first executive order, creating the perception that the individual mandate would no longer be enforced. (To the extent that it can be enforced, the enforcement has actually remained unchanged — but perception is key, and the uninsured rate has spiked upwards in Trump’s first several months in office.)

A perceived weakening of the individual mandate is destabilizing to insurance markets. But reinsurance is an effective means of stabilizing the individual market, and can provide a counterbalance to the Trump Administration’s efforts to undermine the ACA.

Nationwide, there are about 16.5 million people in the ACA-compliant individual market. But since each state’s individual market is separate from all the others, most of them have fairly low total populations. So it doesn’t take very many high claims to destabilize a state’s individual market, since the premium increases necessary to cover claims can result in coverage becoming unaffordable for healthy, unsubsidized enrollees, who then leave the market, further exacerbating the problem.

The ACA included a reinsurance program, but it was temporary and only lasted through 2016. So some states have set out to create their own reinsurance programs, using 1332 waivers so that they can fund reinsurance with the federal money that would have otherwise been spent on larger premium subsidies. The result is fairly minimal state spending and unchanged federal spending, but lower premiums that result in more people being able to afford coverage.

Alaska established a reinsurance program for 2017 with state funds, and received approval in July for five years of federal funding to keep it going. As a result, average premiums in Alaska are declining by more than 20 percent in 2018, despite the fact that the cost of CSR has to be added to the premiums.

Minnesota established a reinsurance program to take effect in 2018, and received approval for federal funding in September. (The situation in Minnesota is still somewhat uncertain, however, because the reinsurance funding approval came with a funding cut for MinnesotaCare, the state’s Basic Health Program.)

Oregon also established a reinsurance program, and their request for federal funding was approved in October 2017. The state credited the new reinsurance program with keeping rate hikes for 2018 in the single-digit range, but after the Trump Administration cut off CSR funding, the Oregon Division of Financial Regulation announced that Silver plan rates would have to increase by an additional 7.1 percent to cover the cost of CSR. However, rates for 2018 would have been 6 percentage points higher without the new reinsurance program.

Iowa also submitted a 1332 waiver proposal that would have created a reinsurance program along with a variety of other changes to revamp the individual health insurance system in the state and reduce premiums. Some of the provisions were controversial, and it was unclear whether HHS would approve the waiver — they had not done so as of late October. At that point, however, Iowa withdrew their waiver proposal. 

Oklahoma also tried to establish a reinsurance program, and calculated that rates for 2018 would have been 34 percent lower than 2017 rates. But they were relying on federal funding and the waiver approval process didn’t happen quickly enough for the program to be implemented by the time rates for 2018 had to be finalized, so Oklahoma also withdrew their waiver proposal. The state may try again in the future, and has far-reaching plans to overhaul their individual market using 1332 waivers.

Codifying contraceptive coverage

In October, the Trump Administration announced new regulations — effective immediately — that grant employers wide-ranging access to exemptions from the ACA’s requirement that health plans cover all FDA-approved contraceptives for women.

Throughout 2017, Republican lawmakers have tried to modify the ACA provision that requires all individual and small-group major medical plans to cover the essential health benefits. To varying degrees, they want to allow the sale of less robust coverage again, and put the onus on the consumer to choose well.

One of the ACA’s essential health benefits is preventive care, which includes full coverage for at least one form of every FDA-approved female contraceptive method. This requirement remains in force, as none of the 2017 legislative efforts to repeal or change the ACA have been successful. The Trump Administration implemented regulations in October 2017 that broaden the ability for employers and universities to obtain exemptions from the requirement that their health plans cover contraceptives, and Republican lawmakers have tried repeatedly to advance legislation that would allow individual market plans to be sold without contraceptive coverage.

But more than half the states have some sort of regulations in place that require contraceptive coverage, in some cases without a copay. Here are some examples of the steps states have taken to enhance and protect access to contraception, regardless of federal actions:

For nearly two decades, Hawaii has required state-regulated, employer-sponsored plans to cover contraceptives. And in 2017, the state implemented a new law that allows pharmacists to prescribe and dispense 12 months of birth control.

Oregon passed a law in 2017 (effective in 2019) that requires all state-regulated plans to cover contraceptives at no cost (including vasectomies, which are not required to be covered under the ACA), and also to cover abortions.

Nevada enacted a law in 2017 that requires Nevada Medicaid and all state-regulated plans to cover birth control with no copay, and authorizes pharmacists to dispense up to 12 months of birth control at a time.

New York’s Governor, Andrew Cuomo, took regulatory action in 2017 to require contraceptive coverage on all state-regulated plans, along with coverage for medically-necessary abortions.

A law that took effect in 2016 in Vermont requires insurers to cover FDA-approved contraceptives (including vasectomies) with no copays, and allows women to obtain up to 12 months worth of birth control at one time.

Maryland enacted legislation in 2016 (effective in 2018) that requires coverage for FDA-approved contraceptive (including vasectomies and emergency Plan B contraception) with no copays. It also eliminates prior authorization requirements for long-acting reversible contraceptives (IUDs and implants) and lets women obtain up to six months worth of birth control at one time.

Although the battle over the ACA is likely to be protracted and messy, states have the ability to protect their residents to some extent. Consumers can and should contact their federal representatives to have conversations about health care reform, but they can also reach out to their local leaders to express opinions about strengthening consumer protections at the state level.

from RSSMix.com Mix ID 8246807 https://www.healthinsurance.org/blog/2017/11/07/four-ways-states-are-foiling-obamacare-sabotage/