Thread by @charles_gaba

THREAD: @dylanlscott's latest raises an important point about the catch-22 of resolving the #MedicaidGap.

HOWEVER, it also notes that the #AmRescuePlan DOES include two OTHER vitally important #ACA 2.0 upgrades:

#KillTheCliff
#UpTheSubs 1/

https://twitter.com/dylanlscott/status/1357062980286963717

I've posted graphs showing how much households would save if the #ACA subsidy cliff was killed & subsidies beefed up, but those were based on an earlier subsidy table.

#HR1425, #HR369 and, I'm certain, the #AmRescuePlan use the NEW subsidy table: 2/

acasignups.net/21/02/03/aca-2…

Assuming the #ACA survives SCOTUS *and* the #AmRescuePlan becomes law w/#KillTheCliff & #UpTheSubs, here's how much you could save based on the *average* benchmark premium price nationally. Depending on where you live, your household & income, this could vary widely. 3/

A 26-yr old Single Adult would save up to $122/month or $1,466/year:

A 64-yr old Single Adult would save up to $700/month or over $8,300/year:

How about families? A 40-yr old couple w/2 children would save up to $610/month or over $7,300/year:

Finally, this one will blow your mind: A 60-yr old couple would go from paying as much as 33% of their total income to paying just 8.5%...saving up to $1,430/month or over $17,000/year:

As @dylanlscott notes in his piece...and as I've written about before...while this would be a HUGE upgrade for the middle class, resolving the #MedicaidGap is a trickier problem.

38 states +DC have expanded Medicaid.
12 states still haven't done so.

Dems have several options:

1. Hope more state expansion ballot proposals are successful.
2. Sweeten the pot to encourage more states to expand.
3. Remove the LOWER-end subsidy cliff & offer ACA subsidies to those earning 0 - 100% FPL as well.
4. Federalize Medicaid.

Ballot initiative campaigns have been successful in getting a bunch of states to expand Medicaid over the past few years, including Maine and even red states like NE, UT, ID, MO & OK.

Advocates are working to do the same in MS, SD & FL:
acasignups.net/21/01/27/are-m…

HOWEVER...there's no guarantee that these 3 campaigns will work, and even if they do, the other 9 states apparently have laws which make it next to impossible to do similar campaigns. Even if they did, it could take many years to get expansion through all 12 of them.

Sweetening the pot would mean feds covering 100% of expansion instead of 90%, either for a limited time or permanently...but if they did that, they'd have to offer the same deal to states which already expanded. That'd cost a lot...and there's still no guarantee they'd do it.

How do we know this? Easy: Under Scott Walker, Wisconsin could have covered ~250K people and only paid 10% of the cost. Instead, the GOP chose to cover just ~220K people & pay 40% of the cost.

https://twitter.com/charles_gaba/status/1354565426185957376

In Utah, the GOP governor/legislature tried to do something similar: Even *after* Medicaid expansion passed, they wanted to 50,000 *fewer* residents while paying $50 million/year *more* to do so:
acasignups.net/19/03/29/utah-…

In other words, while there's a legitimate budget-based argument to be made for not expanding Medicaid (not a very good one, but an argument), THAT'S NOT THE PRIMARY REASON WHY GOP OFFICIALS REFUSE TO EXPAND IT. The main reason is purely ideologocial ("lazy deadbeats!" etc).

Of course there's also the fact that it was President Obama, a Black Democrat, who signed the ACA in the first place. Something tells me if President Romney had made this offer a lot more red states would have jumped onboard by now...but I digress...

Then we come to Option 3: #KillTheLowerBoundCliff: Offer #ACA subsidies to those earning LESS than 100% FPL as well.

This is a solution I've debated for several years...and at first it even *looked* like the #AmRescuePlan was going to do just that...
acasignups.net/21/02/01/aca-2…

...however, it turns out that I was misunderstanding the legislative text; #HR369, #HR1425 and, I presume, the #AmRescuePlan *don't* appear to tackle the #MedicaidGap after all.

So why WOULDN'T they kill the lower subsidy cliff? Three reasons:

--1. Doing so would guarantee that NONE of the 12 non-expansion states would expand Medicaid.

--2. doing so would mean many expansion states would REVERSE themselves & let it expire

--3. While a 100% premium-subsidized #ACA exchange plan would be a huge improvement on the status quo for those currently caught in the #MedicaidGap, it would be a significant step DOWN for those currently covered by Medicaid in terms of co-pays, deductibles & scope of coverage.

That leaves #4, which is to simply federalize Medicaid, period, which @JonWalkerDC is a fan of doing (and which I'd love as well).

Of course THAT would open up a whole other can of worms.

The #MedicaidGap is a real problem which will also have to be addressed soon. /END