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Charles Gaba @charles_gaba
, 13 tweets, 5 min read Read on Twitter
THREAD: For those who still don’t understand how important the #ACA #TexasFoldEm case is (along #StopKavanaugh), here’s a simple timeline of the ACA’s 3-Legged Stool:
1/ Here’s how the #ACA’s 3-Legged Stool was *supposed* to work when the law was passed. The blue leg includes the patient protections. The red leg is the part everyone hated but which served an important purpose. The green leg is the financial help for people to pay for it.
2/ This is what it ACTUALLY ended up looking like: There were two main problems. The financial assistance was cut off at 400% FPL income (& wasn’t generous enough), and the mandate penalty wasn’t strong enough to be fully effective. Both were EASILY fixable.
3/ The GOP-held Congress refused to help fix these problems, allowing them to fester, along w/other issues…some via flaws in the original law, others via deliberate undermining efforts. Then, last year, Trump killed off CSR reimbursement payments.
4/ The CSR cut-off was *mostly* mitigated by a clever workaround called #SilverLoading. This solved the issue for subsidized enrollees & in many cases IMPROVED their situation. However, it also meant that many UNSUBSIDIZED enrollees were even WORSE off.
5/ Then, last December, the GOP passed the $1.5 TRILLION DEFICIT tax bill…which included repealing the federal #ACA individual mandate penalty, effectively cutting off the red leg.
6/ Starting in 2019, this will lead to the world’s most expensive shim: The feds will have to spend BILLIONS MORE in tax credits to cover the additional subsidies needed to make up for the rate hikes needed to account for adverse selection due to the mandate being repealed.
7/ For *subsidized* enrollees, the mandate being repealed shouldn’t make much of a difference since subsidies will also increase to match. HOWEVER, for UNSUBSIDIZED enrollees, their problems are about to get even WORSE due to premiums increasing even MORE because of it.
8/ Then, in February, a bunch of GOP attorneys general demonstrated the ultimate in chutzpah by filing the #TexasFoldEm lawsuit. This is LITERALLY their argument, which Trump’s own DoJ is actually SIDING with:
9/ I’m quite serious: Their entire argument is that BECAUSE they cut off the red leg, that means they get to off the blue leg as well, and while they’re at it, they also get to cut off the green leg.
10/ IF they win their case and IF that ruling is upheld by SCOTUS, this is what it’ll look like.

Oral arguments to happen the first week of September…the same time as the Kavanaugh hearings.
11/ In fact, now that I think of it, even the SEAT of the stool would be gone, as there would no longer be any minimum network adequacy requirement (which isn’t robust enough as it stands).
12/ This video is a real-life example of EXACTLY what I’m talking about:
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