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Not only is @SeemaCMS going after Medicaid, she's debating a regulatory change to the marketplaces that will ban states from autoenrolling policyholders and allowing insurers to pack premium increases into silver plans — two methods states use to cancel out Trump's ACA sabotage.
This needs a bit of explanation: when Trump cut off cost sharing payments to insurers, you might have noticed premiums didn't rise as much as people feared they would. That's because insurers in many states took advantage of a loophole in the ACA to effectively keep the payments.
Basically, the ACA calculates the size of tax credits to buy insurance based on the cost of the mid-tier, or "silver" plans. So insurers raised prices *just on those plans*, causing subsidies to rise *for every plan* by as much as the CSR payments. It's called "silver loading."
Now the Trump admin is taking notice that their sabotage isn't working and insurers figured out how to get the money they tried to cut off. So they're thinking of a rule to ban insurers from packing all their premium hikes into silver plans. Result: everyone's rates will go up.
