Short version: The expanded subsidies in the #AmRescuePlan are fantastic, but are only for 2 yrs & only reduce premiums, not deductibles/co-pays. if @SenatorShaheen's #S499 becomes law, not only would that expansion be made *permanent*...
...but it would also accomplish the SECOND major provision of @POTUS Biden's healthcare vision by *upgrading the benchmark #ACA plan* from SILVER to GOLD *and* upgrade *CSR* subsidies as well. Combined, this would dramatically cut down deductibles/other out of pocket expenses.
Here's the best part: Much of the cost of doing all of this would also be paid for without raising taxes one dime...by also formally *funding* CSR subsidies, as confusing as that may sound. This would eliminate #SilverLoading, which would no longer be needed anyway.
Here's a summary of how #ACA subsidies work under the original law, temporarily under the #AmRescuePlan and how they'd work permanently under #S499 if it gets passed/signed into law:
📣 P.S. BE ON THE LOOKOUT FOR PART 2 TOMORROW...in which I tackle *EIGHTEEN* different ACA/healthcare-related House bills at once!
In Part 1 I talked about 3 *Senate* bills to upgrade the ACA; 2 of them would also add a Public Option, but it's the third which I suspect will be more likely to pass.
In Part 2 I look at *9* bills to be part of a *House* hearing next week in the @EnergyCommerce Committee.
(The E&C hearing will actually hold hearings on *eighteen* ACA/healthcare bills total, but I'm breaking them into 2 separate posts...the other 9 will be in Part 3 tomorrow).
Let's dig in!
#HR1790 would reverse the Trump Admin's decision to modify how ACA subsidies & maximum out of pocket expenses are calculated. The Trump version made subsidies weaker/costs higher; reversing it would make subsides stronger/costs lower.
#HR1796 would provide several hundred million dollars in grants for states to streamline their data sharing, set up auto-enrollment & pre-populated applications for enrollment, and help states establish their own state-based individual mandate requirements/penalties.
That last one is more important than it sounds. If #HR1796 passes, it basically officially declares one of the biggest open secrets of the ACA since the *federal* mandate was repealed: It ain't coming back at the federal level (the pending SCOTUS decision could impact this).
#HR1872 would reverse the gutting of HealthCare.Gov's marketing/outreach budget by codifying $100M/yr to be used specifically for promoting enrollment in ACA plans. It would also *prevent* promotion of junk plans, & would require language- & audience-specific outreach.
#HR1874 would reverse the Trump Admin's gutting of HC.gov's Navigator/Counselor program budget by codifying $100M/yr for it as well as stopping grants from going to profit-based orgs which promote junk plans.
#HR1875 is an eyebrow-raiser. An Obama exec. order allowed "Short-Term, Limited Duration" plans (#ShortAssPlans) to keep being offered, but restricted them to 90 days & said they couldn't be renewed within the same year (i.e., they had to be short-term & of limited duration).
A *Trump* XO *reversed* Obama's, allowing #ShortAssPlans to be kept all year & letting them be renewed (which, aside from everything else, means they're no longer "short-term" or of "limited duration"). These are the *exact* type of junk plans the ACA was designed to discourage.
Several prior bills would have reset #ShortAssPlan restrictions back to the Obama Admin policy & codified them as such...but #HR1875, which is just 1 sentence long, does something quite different:
It legally categorizes STLDs as INDIVIDUAL HEALTH INSURANCE. This is a Big Deal.
Right now, "short-term, limited duration" plans aren't technically considered "individual health insurance coverage"...which also means they're not subject to a lot of ACA regulations. Like guaranteed issue. Or community rating. Or essential health benefits...get the picture?
.@USRepKCastor's #HR1875 doesn't ban #ShortAssPlans. It doesn't even restrict them to 90 days. What it *does* do is require them to meet the same minimum standards of #ACA policies...
...which basically means they'd no longer have any reason to exist in the first place.
The *only* "advantage" #ShortAssPlans have over #ACA plans (amidst a laundry list of shortcomings) is that they have cheaper premiums...*because* of those shortcomings. Make them stop being junk & that advantage goes away.
However, if #S499 passes into law as well, there'd be no further need for #ShortAssPlans anyway, since #ACA-compliant coverage would be affordable for *everyone*, even those who haven't qualified for subsidies until now.
#HR1878's heart is in the right place, but could make wonks like @bjdickmayhew, @jgmcglamery & I very *unhappy* depending how it's implemented.
It would provide $10 BILLION/yr for EITHER reinstating a federal *reinsurance* program *or* for direct out-of-pocket assistance.
Direct assistance would be awesome, but reinsurance can be awkward. I'll be writing up my own post soon, but here's @bjdickmayhew's explainer. Basically, reinsurance can be helpful in some circumstances but *harmful* in others: balloon-juice.com/2021/03/10/the…
#HR1890, from @RepSchakowsky, tackles the #SkinnyNetwork problem many #ACA plans have by making the HHS Sec. develop minimum network adequacy standards. It also gives the HHS Sec. the power to step in & regulate rates in states where regulators are asleep at the switch.
I support both of these, but don't be surprised if a bunch of state insurance commissioners cry foul over the second one and sue over States Rights for what they'd see as HHS stepping on their turf.
#HR1896 would provide $200M in grants for states to establish their own #ACA exchanges. Some states like Oregon & Hawaii flushed a ton of grant money down the toilet in the early days of the ACA, but these days states like NV, PA & NJ are setting them up with (relative) ease.
#HR1896 is interesting because it's a genuinely BIPARTISAN bill to expand the #ACA. It was introduced by @RepAndyKimNJ (D) & @RepBrianFitz (R), both of whom introduced the same bill 2 years ago.
Finally, #HR340 would effectively bribe the 12 states which haven't expanded Medicaid yet with even MORE money to do so than the $16 billion they're already being offered under the #AmRescuePlan.
The #AmRescuePlan would increase the federal share of Medicaid spending by 5 points for 2 years if these states stop being assholes & expand Medicaid under the #ACA. That 5 point bump is *more* than the 10% expansion cost they'd have to pay, so they'd actually come out ahead.
#HR340 would have the feds *also* cover that 10% of expansion cost for 3 years, +5-9% for a few years after that, which means if all 12 states took the offer, they'd walk away with the full $16 billion in *pure gains* just for doing something they should've done 7 years ago.
WHEW! There you have it: 9 House bills. In Part 3 (tomorrow) I'll be covering the *other* 8 House bills set to be discussed at next week's @EnergyCommerce hearing. Stay tuned! acasignups.net/21/03/17/prepa…
(not all 18 bills are directly #ACA related, but all of them have some overlap with it)
(noteworthy: several of the bills have bipartisan sponsorship in this final batch)
Here's the *other* 9 bills to be discussed this Tuesday by the @EnergyCommerce Health subcommittee:
#HR1738: Right now, depending on the state/status, Medicaid/CHIP enrollees have to verify eligibility *every month* which is a royal pain in the ass for them & a massive amount of red tape/admin overhead for the state. This would make them eligible for 12 mo. after starting.
#HR1784: This is another way to pressure the remaining non-expansion to FINALLY expand Medicaid: It would require detailed annual reports on the uninsured who they're screwing over, and would penalize them by up to 1.5 pts of federal funding if they don't issue those reports.
#HR1025: Another bipartisan bill! This would require Medicaid to keep paying at least Medicare rates to primary care physicians. I think it'd make this permanent; could be wrong about that.
#HR66 & #HR1791: Both appear to do the same thing: They'd MAKE CHIP FUNDING PERMANENT instead of letting the GOP hold it hostage every few years. Interestingly, HR66 is *bipartisan*, w/GOP Rep. Vern Buchanan joining Rep. Lucy McBath. The other one is from Rep. Barragan.
#HR1888: This would require 100% FMAP funding for Indian healthcare providers. I kind of assumed the INS was already fully federally funded, but apparently not? There's no legislative text or description available so I'm fuzzy on the details. Perhaps @RepRaulRuizMD can clarify?
#HR1717: This would make the "spousal impoverishment" Medicaid provision *permanent*, which it really should've been all along. Another bipartisan bill from MI @RepFredUpton & @RepDebDingell.
#HR1880: This is also from @RepDebDingell: It would permanently codify the "Money Follows the Person" program, which requires Medicaid funding to follow enrollees as they move from nursing homes/etc. to home/community-based services.
FINALLY, there's #HR1390 from @RepSusanWild, which has no text *or* description, just a title: "The Children's Health Insurance Program Pandemic Enhancement & Relief Act" (CHIPPER), which I assume would...provide more $ for CHIP during the COVID pandemic?
🧵 People have asked me why I started an organized project to raise money *directly* for Democratic candidates up & down the ballot when there's already so many other organizations out there doing this. There's a couple of reasons. 1/
The first is that most of the existing organizations/PACs/etc seem to (in my view) *either* focus ONLY on the true swing districts *or* they raise money for races which are clearly unwinnable without being up front about how long the odds in those races are. 2/
I try to walk the line between these--for district-level races I cast my net wider than most "tossup only!" advocates, but not absurdly wide; for statewide races I *do* include deep red states but also make it absolutely clear that those races are *very* long shots. 3/
A little fun Die Hard trivia for those who don’t know:
The first Die Hard was based on a 1979 novel called Nothing Lasts Forever by Roderick Thorp. In the novel McClain’s character was named Joe Leland. This was a sequel to a 1966 novel by Thorp called The Detective. 1/
The Detective had been made into a film starring Frank Sinatra as Joe Leland in 1968.
This means Bruce Willis plays the same character as Frank Sinatra.
In fact, the studio was contractually required to offer the role to Sinatra if he wanted it. Sinatra was 73 at the time.
As for the novel Nothing Lasts Forever (title since changed to “Die Hard”), it follows most of the same storyline and characters, but with a few VERY important differences…
How does the @nytimes know that these are actual federal officials who actually signed it if they did so “anonymously?”
Does that mean the Times is redacting their names? Or does it just say “signed, 400 officials” at the bottom of the letter?
@nytimes I’m not being snarky here—I can’t read the original NY Times article without a subscription; do they clarify how they verified that these 400 people actually are federal officials and that they did in fact sign off on the letter in it?
1. DON'T DELAY; #GETCOVERED BY *DECEMBER 15th* IF POSSIBLE!
#ACA Open Enrollment officially runs from 11/01/23 - 1/16/24, but if you want your coverage to start in JANUARY you only have until December 15th in most states!
Here's a table of the deadlines & when coverage starts for every state +DC (some may be extended at the last minute):