Thread by @charles_gaba

📣 PREPARE THYSELF: #ACA2.0 IS HAPPENING (Part 1):
acasignups.net/21/03/17/prepa…

Short version: The expanded subsidies in the #AmRescuePlan are fantastic, but are only for 2 yrs & only reduce premiums, not deductibles/co-pays. if @SenatorShaheen's #S499 becomes law, not only would that expansion be made *permanent*...

...but it would also accomplish the SECOND major provision of @POTUS Biden's healthcare vision by *upgrading the benchmark #ACA plan* from SILVER to GOLD *and* upgrade *CSR* subsidies as well. Combined, this would dramatically cut down deductibles/other out of pocket expenses.

Here's the best part: Much of the cost of doing all of this would also be paid for without raising taxes one dime...by also formally *funding* CSR subsidies, as confusing as that may sound. This would eliminate #SilverLoading, which would no longer be needed anyway.

Here's a summary of how #ACA subsidies work under the original law, temporarily under the #AmRescuePlan and how they'd work permanently under #S499 if it gets passed/signed into law:

📣 P.S. BE ON THE LOOKOUT FOR PART 2 TOMORROW...in which I tackle *EIGHTEEN* different ACA/healthcare-related House bills at once!

📣🎉 PART TWO: Prepare Thyself: ACA 2.0 is happening! acasignups.net/21/03/17/prepa…

In Part 1 I talked about 3 *Senate* bills to upgrade the ACA; 2 of them would also add a Public Option, but it's the third which I suspect will be more likely to pass.

In Part 2 I look at *9* bills to be part of a *House* hearing next week in the @EnergyCommerce Committee.

(The E&C hearing will actually hold hearings on *eighteen* ACA/healthcare bills total, but I'm breaking them into 2 separate posts...the other 9 will be in Part 3 tomorrow).

Let's dig in!

#HR1790 would reverse the Trump Admin's decision to modify how ACA subsidies & maximum out of pocket expenses are calculated. The Trump version made subsidies weaker/costs higher; reversing it would make subsides stronger/costs lower.

#HR1796 would provide several hundred million dollars in grants for states to streamline their data sharing, set up auto-enrollment & pre-populated applications for enrollment, and help states establish their own state-based individual mandate requirements/penalties.

That last one is more important than it sounds. If #HR1796 passes, it basically officially declares one of the biggest open secrets of the ACA since the *federal* mandate was repealed: It ain't coming back at the federal level (the pending SCOTUS decision could impact this).

#HR1872 would reverse the gutting of HealthCare.Gov's marketing/outreach budget by codifying $100M/yr to be used specifically for promoting enrollment in ACA plans. It would also *prevent* promotion of junk plans, & would require language- & audience-specific outreach.

#HR1874 would reverse the Trump Admin's gutting of HC.gov's Navigator/Counselor program budget by codifying $100M/yr for it as well as stopping grants from going to profit-based orgs which promote junk plans.

#HR1875 is an eyebrow-raiser. An Obama exec. order allowed "Short-Term, Limited Duration" plans (#ShortAssPlans) to keep being offered, but restricted them to 90 days & said they couldn't be renewed within the same year (i.e., they had to be short-term & of limited duration).

A *Trump* XO *reversed* Obama's, allowing #ShortAssPlans to be kept all year & letting them be renewed (which, aside from everything else, means they're no longer "short-term" or of "limited duration"). These are the *exact* type of junk plans the ACA was designed to discourage.

Several prior bills would have reset #ShortAssPlan restrictions back to the Obama Admin policy & codified them as such...but #HR1875, which is just 1 sentence long, does something quite different:

It legally categorizes STLDs as INDIVIDUAL HEALTH INSURANCE. This is a Big Deal.

Right now, "short-term, limited duration" plans aren't technically considered "individual health insurance coverage"...which also means they're not subject to a lot of ACA regulations. Like guaranteed issue. Or community rating. Or essential health benefits...get the picture?

.@USRepKCastor's #HR1875 doesn't ban #ShortAssPlans. It doesn't even restrict them to 90 days. What it *does* do is require them to meet the same minimum standards of #ACA policies...

...which basically means they'd no longer have any reason to exist in the first place.

The *only* "advantage" #ShortAssPlans have over #ACA plans (amidst a laundry list of shortcomings) is that they have cheaper premiums...*because* of those shortcomings. Make them stop being junk & that advantage goes away.

However, if #S499 passes into law as well, there'd be no further need for #ShortAssPlans anyway, since #ACA-compliant coverage would be affordable for *everyone*, even those who haven't qualified for subsidies until now.

Sign #S499 & I'm fully onboard w/#H1875.

#HR1878's heart is in the right place, but could make wonks like @bjdickmayhew, @jgmcglamery & I very *unhappy* depending how it's implemented.

It would provide $10 BILLION/yr for EITHER reinstating a federal *reinsurance* program *or* for direct out-of-pocket assistance.

Direct assistance would be awesome, but reinsurance can be awkward. I'll be writing up my own post soon, but here's @bjdickmayhew's explainer. Basically, reinsurance can be helpful in some circumstances but *harmful* in others: balloon-juice.com/2021/03/10/the…

#HR1890, from @RepSchakowsky, tackles the #SkinnyNetwork problem many #ACA plans have by making the HHS Sec. develop minimum network adequacy standards. It also gives the HHS Sec. the power to step in & regulate rates in states where regulators are asleep at the switch.

I support both of these, but don't be surprised if a bunch of state insurance commissioners cry foul over the second one and sue over States Rights for what they'd see as HHS stepping on their turf.

#HR1896 would provide $200M in grants for states to establish their own #ACA exchanges. Some states like Oregon & Hawaii flushed a ton of grant money down the toilet in the early days of the ACA, but these days states like NV, PA & NJ are setting them up with (relative) ease.

#HR1896 is interesting because it's a genuinely BIPARTISAN bill to expand the #ACA. It was introduced by @RepAndyKimNJ (D) & @RepBrianFitz (R), both of whom introduced the same bill 2 years ago.

Finally, #HR340 would effectively bribe the 12 states which haven't expanded Medicaid yet with even MORE money to do so than the $16 billion they're already being offered under the #AmRescuePlan.

The #AmRescuePlan would increase the federal share of Medicaid spending by 5 points for 2 years if these states stop being assholes & expand Medicaid under the #ACA. That 5 point bump is *more* than the 10% expansion cost they'd have to pay, so they'd actually come out ahead.

#HR340 would have the feds *also* cover that 10% of expansion cost for 3 years, +5-9% for a few years after that, which means if all 12 states took the offer, they'd walk away with the full $16 billion in *pure gains* just for doing something they should've done 7 years ago.

WHEW! There you have it: 9 House bills. In Part 3 (tomorrow) I'll be covering the *other* 8 House bills set to be discussed at next week's @EnergyCommerce hearing. Stay tuned!
acasignups.net/21/03/17/prepa…

📣 PART 3 OF 3: Prepare Thyself: #ACA2.0 is happening!
acasignups.net/21/03/20/prepa…

(not all 18 bills are directly #ACA related, but all of them have some overlap with it)

(noteworthy: several of the bills have bipartisan sponsorship in this final batch)

Here's the *other* 9 bills to be discussed this Tuesday by the @EnergyCommerce Health subcommittee:

#HR1738: Right now, depending on the state/status, Medicaid/CHIP enrollees have to verify eligibility *every month* which is a royal pain in the ass for them & a massive amount of red tape/admin overhead for the state. This would make them eligible for 12 mo. after starting.

#HR1784: This is another way to pressure the remaining non-expansion to FINALLY expand Medicaid: It would require detailed annual reports on the uninsured who they're screwing over, and would penalize them by up to 1.5 pts of federal funding if they don't issue those reports.

#HR1025: Another bipartisan bill! This would require Medicaid to keep paying at least Medicare rates to primary care physicians. I think it'd make this permanent; could be wrong about that.

#HR66 & #HR1791: Both appear to do the same thing: They'd MAKE CHIP FUNDING PERMANENT instead of letting the GOP hold it hostage every few years. Interestingly, HR66 is *bipartisan*, w/GOP Rep. Vern Buchanan joining Rep. Lucy McBath. The other one is from Rep. Barragan.

#HR1888: This would require 100% FMAP funding for Indian healthcare providers. I kind of assumed the INS was already fully federally funded, but apparently not? There's no legislative text or description available so I'm fuzzy on the details. Perhaps @RepRaulRuizMD can clarify?

#HR1717: This would make the "spousal impoverishment" Medicaid provision *permanent*, which it really should've been all along. Another bipartisan bill from MI @RepFredUpton & @RepDebDingell.

#HR1880: This is also from @RepDebDingell: It would permanently codify the "Money Follows the Person" program, which requires Medicaid funding to follow enrollees as they move from nursing homes/etc. to home/community-based services.

FINALLY, there's #HR1390 from @RepSusanWild, which has no text *or* description, just a title: "The Children's Health Insurance Program Pandemic Enhancement & Relief Act" (CHIPPER), which I assume would...provide more $ for CHIP during the COVID pandemic?

SO THERE YOU HAVE IT: 18 bills to be discussed in a day-long marathon session by the @EnergyCommerce Health subcommittee this Tuesday:
energycommerce.house.gov/committee-acti…

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