🚨 REMINDER: The U.S. Supreme Court is scheduled to release one or more opinions TOMORROW MORNING. This may include the fate of the Affordable Care Act. 1/
acasignups.net/21/02/05/democ…
Oral argument *seemed* to go well for the #ACA last November, and the consensus opinion is that #SCOTUS will either throw the case out or, at worst, order the mandate language stricken while leaving the rest intact...which would be mildly irritating but otherwise fine. 2/
HOWEVER, there's 4 *other* possible rulings:
1. They kick it back down to the district court again.
2. They strike down guaranteed issue & community rating only.
3. They strike down most of the law but leave oddball provisions in place.
4. They kill the entire law. 3/
#1 is very unlikely, but if it did happen the case could bounce around the courts for another couple of years.

#2 would be a surreal mixed bag, but also a logistical nightmare to implement.

#3 or #4 would be an utter and complete disaster. 4/
#1 would be annoying but it would leave everything as is, giving Congress ample time to #MootTheSuit (or to pass #ACA2wPO, which would presumably *include*language to #MootTheSuit).

It would keep the Sword of Damocles dangling over everyone's head for awhile longer. 5/
#2 would leave many important #ACA provisions in place, including Medicaid expansion, closing the Medicare Part D donut hole, keeping kids on their parents plan up to age 26, etc. and it would leave the ACA exchanges *and APTC/CSR subsidies* in place, which is all good... 6/
...HOWEVER, #2 would also strip away protections for ~135 million Americans w/pre-existing conditions, and would create a logistical nightmare for the exchanges & subsidy calculations.

ACA subsidies are based on the price of the "benchmark Silver plan" in your area... 7/
...but if you kill Guaranteed Issue, Community Rating & EHB requirements, suddenly there IS no longer a "benchmark Silver plan" to hang the ACA subsidy hat on. We'd go back to *individual enrollee underwriting*, which means a separate "benchmark Silver" plan for each enrollee. 8/
In that scenario, someone with, say, hemophilia who racks up $18,000/month in medical expenses could be offered a "benchmark Silver plan" for $20,000/month...but with $19,500/month in ACA subsidies, assuming the carrier doesn't just deny them coverage outright. 9/
#3 would mean leaving a few scraps of the ACA in place like "mandatory calorie counts posted at restaurants" or whatever, which amounts to the same thing as #4: Striking down the entire law "root & branch" as Mitch McConnell used to gleefully say. 10/
If #3 or #4 happens--again, there's still a chance of that happening--and no legislation is passed to resolve the issue before the ACA is actually dismantled--the odds are that the devastation would happen QUICKLY...potentially as soon as April or May: 11/ acasignups.net/21/02/19/if-ac…
Here's a PARTIAL list of what would happen...and remember, this is from 2019, long before the #COVID19 pandemic hit. 12/
healthinsurance.org/blog/2019/03/2…
Medicaid expansion for 16 million+: GONE.
Premium subsidies for 9 million: GONE.
Cost Sharing subsidies for 6 million: GONE.
BHP coverage for over 800,000: GONE.
Pre-existing Condition protections for up to 130 million? GONE. 13/
Charging women more for their gender? BACK.
Requiring policies to cover at least 60% of expenses? GONE.
Requiring policies to cover maternity care, mental health & prescription drugs? GONE.
Letting kids up to age 26 stay on their parents policy? GONE. 14/
Limits on out of pocket expenses? GONE.
Annual/lifetime limits on healthcare claims? BACK.
Free preventative care services? GONE.
Medicare Part D Donut Hole? REOPENED. 15/
Here's a state-by-state (and district by district!) breakout of the estimated healthcare coverage losses *if* SCOTUS strikes down the entire ACA w/immediate effect & there's nothing immediately in place to deal with it: 16/
acasignups.net/20/11/11/how-m…
Short version: An estimated 23 million Americans would lose healthcare coverage (around 2/3 in Medicaid via ACA expansion, ~1/3 in subsidized ACA exchange plans).

In the middle of a pandemic. /END

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More from @charles_gaba

25 Feb
Happy to report I’ve raised $10,000 to elect Dems up & down the ballot in 2021-2022 so far. Image
It’s a good day to help keep the #HouseBlueIn22. Donate now! secure.actblue.com/donate/housebl…
It’s a good day to help keep #VABlueIn21. Donate now!
secure.actblue.com/donate/vablue21
Read 5 tweets
24 Feb
As a mainstream Dem who raised over $5 million to help flip the Senate *including* over $56,000 for Paula Jean Swearengin in WV, I think I have a right to chime in on this. 1/
I raised money for a total of over 600 Democratic candidates last cycle, including around 30 Senate races, over 150 House races, several hundred state legislative races and a couple dozen statewide races for Governor, SoS, AG, etc. Grand total raised: $6 million. 2/
In contested primaries, I usually didn't favor a specific Dem, but raised money for whoever the eventual nominee ended up being (ActBlue lets you do that for federal and statewide races). For legislative races I usually raised $ for the state party until the primary. 3/
Read 15 tweets
24 Feb
📣 How many *additional* #ACA enrollees are signing up during the ongoing #COVID19 Enrollment Period? If @HealthSherpas data so far is indicative, quite a few:
acasignups.net/21/02/23/how-m…
Using their Week 1 data, it seems likely that between 160K - 250K people enrolled in #ACA exchange plans nationally from 2/15 - 2/21. Assuming that's accurate *and* the pace holds steady for the full 3-mo period (unlikely), the potential ceiling would be 2.1 - 3.3 million.
Normally you'd expect around 700,000 people to enroll via traditional Special Enrollment Periods nationally during that same period, so that would mean 1.4 - 2.6 million *more* enrollees than you'd normally expect without a COVID SEP.
Read 5 tweets
24 Feb
“DON’T TRACK COVID ALONG PARTISAN LINES! IT’S NONPARTISAN!” —criticism I’ve repeatedly received over the past year
Meanwhile, #COVID19 deaths are now 3.3% *higher* in the red counties than the blue counties.
Meanwhile, the 100 counties w/the highest #COVID19 death rate voted for Donald Trump by *TWENTY-ONE POINTS*.
Read 5 tweets
23 Feb
📣"more than triple the volume in a typical SEP week"

I have no idea whether this is representative nationally or if it'll continue, but if so (and if it keeps at this pace), that's potentially huge.
Last month I projected that a 60-day national "no reason needed" COVID Enrollment Period would bring in perhaps 400,000 additional exchange enrollees (beyond normal Special Enrollment Period rates).

Typically, ~7K enroll via SEPs every day during the off-season nationally.
Tripling that nationally would mean ~14K *more* per day, or ~840K during a 60-day period...more than double my rough projection.

Of course the federal COVID Enrollment Period is *90* days, but it's only 30 for some state exchanges, and that 3x rate may not be representative.
Read 4 tweets
23 Feb
Cannon and I strongly disagree about his framing of CA banning #ShortAssPlans, but I agree that asking about actual healthcare POLICY decisions would make a hell of a lot more sense than whether or not Becerra is a doctor or not.

Tom Price is a doctor and he was a disaster.
As for #ShortAssPlans in California, what Cannon is really talking about is availability of affordable individual market plans for those who earn too much to be eligible for #ACA subsidies.
This is a real problem, I agree. It's expected to be addressed in the short term by the #AmRescuePlan, and hopefully on a permanent basis via #HR369.

In California, they *partly* addressed the issue by adding their own ACA subsidies for those earning 400 - 600% FPL...
Read 6 tweets

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