Here's my deep dive into #HR1425, the Patient Protection & Affordable Care *Enhancement* Act (#ACEA), which I've dubbed simply "#ACA2.0": 2/ acasignups.net/20/06/24/aca20…
Sec. 101: Currently, if you earn >400% FPL (~$50K if you're single, ~$104K for a family of 4), you have to pay full price for an exchange plan.
Under #HR1425, you'd pay no more than 8.5% of your income, & those receiving subsidies now would see them made far more generous. 4/
Under #HR1425, you'd pay no more than 8.5% of your income, & those receiving subsidies now would see them made far more generous. 4/
Depending on where you live, how much you earn and your age/household makeup, you could save up to $20,000/year. That's not a typo.
Also, anyone earning <150% FPL would pay *$0* in premiums for an #ACA benchmark plan (and nominal other cost sharing thanks to the CSR program). 5/
Also, anyone earning <150% FPL would pay *$0* in premiums for an #ACA benchmark plan (and nominal other cost sharing thanks to the CSR program). 5/
Sec. 102: The Trump Admin tweaked the ACA's subsidy formula to make it less generous while also raising the maximum out of pocket cost for enrollees. This would reverse that tweak and codify it so it can't be messed with again in the future. 6/
Sec. 103: This fixes the FAMILY GLITCH, a drafting error in the original #ACA which inadvertently cut several million Americans out of subsidy eligibility if a single member of the household has employer coverage. Dems have been trying to fix this error since 2014. 7/
Sec. 104: Right now, if someone receives a lump-sum Social Security disability payment this year which was *supposed* to be paid the prior year, it gets counted against subsidy eligibility. This section fixes that issue. 8/
Sec. 105: The #ACA provided grants for states to establish their own exchanges, but most chose to stick w/HealthCareGov & the money was time-limited. Recently some states have expressed interest in splitting off from HCgov after all; this would provide more $ to do so. 9/
Sec. 106: Health Insurance Affordability Fund. The ACA included a federal reinsurance program from 2014-2016 to keep unsubsidized premiums lower. This would reestablish that fund, but the $ could also be used for certain other cost reduction programs as well. 10/
Sec. 107: Under the ACA, #ShortAssPlans (non-ACA compliant plans which can discriminate vs. those w/pre-existing conditions) could still be offered but were discouraged. Pres. Obama issued an XO which restricted them further. Trump reversed that XO & is pushing them *hard*... 11/
...Sec. 107 would reverse Trump's reversal, restricting #ShortAssPlans to 90 days/nonrenewable, which fits w/their original purpose (they're literally called "Short Term, Limited Duration" plans).
Via Sec. 101, there'd be very little "need" for #ShortAssPlans anymore anyway. 12/
Via Sec. 101, there'd be very little "need" for #ShortAssPlans anymore anyway. 12/
Sec. 108: The ACA includes a provision ("Sec. 1332") which allows states to modify *some* ACA rules *as long as they can prove that doing so would result in at least as many people being covered, at least as comprehensively, w/out raising the federal deficit*. 13/
The Trump Admin issued new Sec. 1332 "guidance" which seriously messes w/the original intent of this provision.
Sec. 108 would, like 107, simply revert this back to prior Obama-era guidance.
acasignups.net/18/10/27/red-a…
Sec. 108 would, like 107, simply revert this back to prior Obama-era guidance.
acasignups.net/18/10/27/red-a…
Sec. 109: The Trump Administration slashed the ACA's Navigator grant program, which helps educate/explain/assist enrollees in both ACA plans & Medicaid/CHIP, by ~90%. This would restore that funding to $100M/yr. 15/
Sec. 110: There's been claims that the Trump Admin is deliberately timing "maintenance periods" of HCgov in such a way as to discourage enrollment. I actually *don't* think this is the case, but this would require the Comptroller General to investigate & report on that. 16/
Sec. 111: Like the navigator program, Trump's CMS Dept. has slashed the *marketing & outreach budget* by 90% while using some of the remaining $ to produce ANTI-ACA propaganda. This would codify $100M/yr for marketing & outreach while requiring that it be used properly. 17/
Sec. 112: This would require increased transparency in how CMS uses its budget (see "propaganda videos" above), while also mandating an audit of how they've used it in the past (I wrote about this issue over 2 years ago). 18/
acasignups.net/18/02/13/updat…
acasignups.net/18/02/13/updat…
Sec. 113: This would require the Labor Dept. to more prominently display/educate employees about their options if/when they lose employer coverage (COBRA as well as ACA exchange special enrollment periods, subsidies, etc.), which is particularly relevant at the moment. 19/
Sec. 114: This would provide $200M/yr for 3 years to help states develop programs to boost/encourage enrollment, improve data sharing, etc.
It would also help states implement a state-based INDIVIDUAL MANDATE PENALTY (as 5 have done already), which is VERY interesting... 20/
It would also help states implement a state-based INDIVIDUAL MANDATE PENALTY (as 5 have done already), which is VERY interesting... 20/
Sec. 115: Strengthening Network Adequacy: This would apparently raise the bar for how many doctors, hospitals, clinics, prescription drugs etc. have to be included in a given plans network. How this would be done is outside my scope of expertise. 21/
Sec. 116: This would provide additional federal oversight (or at least additional *state regulator* oversight) over rate hikes deemed excessive (the ACA already has some regulations on this front). 22/
(Thread continued after lunch)...
Sec. 201: Under the ACA, the feds paid 100% of the cost of Medicaid expansion for the first 3 years; after that it gradually drops to 90% (where it stays). This was time-limited, so any state which hasn't expanded Medicaid by now has to pay 10% out of the gate... 24/
...Sec. 201 would reset the clock on the 100% funding so that the 3-year period would start whenever the state agrees to expansion. This SHOULD strongly encourage Texas, Florida, Georgia etc. to stop being douchenozzles and do the right thing for 2.3 million Americans. 25/
Sec. 202: Right now some states make you fill out a bunch of paperwork proving you're still eligible for Medicaid/CHIP *every month* which can be a royal PITA & results in many eligible people being kicked off. This would make Medicaid eligibility good for 12 months. 26/
Sec. 203: Right now, many women who give birth are only eligible for Medicaid for 60 days after delivery. This extends that to a full 12 months to help mitigate postpartum medical/healthcare issues.. 27/
Sec. 204: As noted above, Sec. 201 would give non-expansion states a second chance to get 100% federal funding for 3 years (the carrot). This is the stick: If they CONTINUE to blow off Medicaid expansion, that 100% match would eventually dwindle away to nothing again. 28/
Sec. 205: I think this would crack down on non-expansion states by requiring that they providemore detailed info about their uninsured population/etc. 29/
Sec. 206: PRIMARY CARE PAY INCREASE: This would beef up federal Medicaid/CHIP compensation for primary care physicians (the details get wonky). 30/
Sec. 207: Right now the CHIP program (which covers 9 million low-income children) has to have funding renewed every few years. This would make CHIP funding permanently appropriated. 31/
Sec. 208: Permanent extension of CHIP enrollment & quality measures (connected to Sec. 207). Apparently some related CHIP functions also have to be renewed every few years; this would make those permanent as well. 32/
Sec. 209: I *think* this has to do w/how states decide which kids are eligible; apparently right now they have to choose 1 of 2 different criteria...this appears to say *either* criteria suffices. I think. 33/
Sec. 210: This expands Medicaid coverge to residents of Micronesia, the Marshall Islands and Palau who live in the U.S.; apparently they aren't currently eligible. 34/
Sec. 211: Requires full payment parity to healthcare providers providing services to Native Americans & Native Hawaiians via the Indian Health Service, Medicaid, CHIP, etc...apparently they've been getting shortchanged all this time. 35/
SO HOW WILL THIS ALL BE PAID FOR?
Well, the CBO says all the ACA exchange stuff would cost $295B over a decade, while the Medicaid stuff would cost *another* $295B...or around $590B over a decade... 36/
acasignups.net/20/06/24/cbo-h…
Well, the CBO says all the ACA exchange stuff would cost $295B over a decade, while the Medicaid stuff would cost *another* $295B...or around $590B over a decade... 36/
acasignups.net/20/06/24/cbo-h…
So there you go. It's a great bill which massively improves & expands the ACA while protecting it from sabotage, expanding coverage to millions, reducing costs for tens of millions more and *saving* taxpayers $15B to boot. 38/
Naturally, it's DOA in the Senate as long as Mitch McConnell is in charge. Let's change that, shall we?
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