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Charles Ghoul-ba 👻 Profile picture
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28 Oct, 10 tweets, 4 min read
Deleted a tweet about the BBB ACA subsidy extension provision until I get more clarity, because the figures cited didn’t make much sense to me if taken literally.
OK, here's the official (for the moment, anyway) "framework" via the White House itself:
whitehouse.gov/briefing-room/…
The healthcare provisions would include:
--Extend expanded #AmRescuePlan subsidies thru 2025 (3 more years)
--Close Medicaid Gap via expanding ACA subsidies <100% FPL thru 2025 (4 yrs)
--Add hearing aid coverage to Medicare
--Repeal Trump Admin prescription drug rebate rule Image
There's been a big debate about whether to do fewer things permanently or more things for a shorter period. I've come down on the latter side, figuring that a) it's harder to take away benefits than to add them and b) if we don't have a democracy by 2025 none of this will matter.
Having said that, I admit I'd be a lot more comfortable if the first two were made permanent instead of cutting off in 2025...but that would require another ~$400 billion in offsets via the CBO's 10-year score, give or take.
As an aside, I wish people would frame it as "how much in offsets would be required" instead of "how much more would it cost" when talking about this stuff.
In any event, the upside of doing "more for shorter periods" is that they can make the 2022 theme "Help us finish the job."
FYI: My original, deleted tweet was in response to @ThePlumLineGS's piece which cited the numbers here... 1/
whitehouse.gov/briefing-room/… Image
...however, the CBO score of the enhanced ACA subsidy expansion + Medicaid Gap workaround *thru 2025* comes in at roughly the same total that the WH is ballparking ($141B vs. $130B), so it does indeed sound like the #AmRescuePlan's formula would be kept.
energycommerce.house.gov/sites/democrat… Image
The White House framework numbers are the part that don't make sense if taken literally: 9 million people x $600/year x 3 years would only be $16.2 billion total. I'm not sure where they got those figures but the numbers add up elsewhere, so (shrug).

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More from @charles_gaba

Charles Ghoul-ba 👻 Profile picture
30 Oct
In 2018, Bernie acolyte Paula Swearengin ran against Manchin in the primary & was crushed by 40 points.

In 2020, Swearengin ran against Caputo in the general and was crushed by 43 points.

Oh, and I personally raised over $50,000 for Paula Jean Swearengin last cycle.
(For those wondering: I raised money for EVERY federal race last cycle, no matter how absurd of a long shot it was.)
Swearengin is a perfect test case for Our Revolution's "We need to run far-left progressives instead of moderate/centrist Dems in deep red areas to win" theory.

1st time she was crushed by one in the primary.

2nd time she won the primary & was then crushed by the Republican.
Read 6 tweets
Charles Ghoul-ba 👻 Profile picture
30 Oct
📣📣📣
QUESTION: What healthcare policies are included in the #BuildBackBetter framework?

ANSWER: A hell of a lot more than you probably thought!

There's *77* sections on healthcare policy improvements. Here's an overview of all of them.
acasignups.net/21/10/30/detai…
There's 4 sections devoted to closing the Medicaid Gap; 9 sections on expanding/extending ACA health insurance subsidies & affordability; 6 on Home & Community-Based Services; 1 which adds Hearing Aid coverage to Medicare; 5 on various Hospice/Palliative Care programs...
...3 sections re. beefing up the CDC, FDA & other departments to head off the NEXT global pandemic; 18 sections (!) on prenatal, perinatal, maternal & postpartum health programs; 4 sections funding SAMHSA programs; 3 devoted to Native Hawaiian health programs...
Read 4 tweets
Charles Ghoul-ba 👻 Profile picture
29 Oct
📣 THE 2022 #ACA OPEN ENROLLMENT PERIOD STARTS ON MONDAY.

Once again, the #ACA can be best described as a #3LeggedStool:

1. Insurer Responsibilities
2. Government Responsibilities
3. Enrollee Responsibilities

Let's review, shall we?
1st Leg: INSURER RESPONSIBILITIES:
--Guaranteed Issue
--Community Rating
--Essential Health Benefits
--Minimum Actuarial Value
--No Annual/Lifetime Limits
--Maximum Out of Pocket Costs
--Free Preventative Services
--Can Stay on Parents Plan until Age 26
2nd Leg: ENROLLEE RESPONSIBILITIES:
--Limited-Time Open Enrollment Period
--Shared Responsibility Penalty*
*(no longer applies in 46 states...replaced by the World's Most Expensive Shim®)
Read 5 tweets
Charles Ghoul-ba 👻 Profile picture
28 Oct
We’ll have to see what actually passes (if anything) of course, but it’s a fuckload more than “scraps” even now.
Universal Pre-K isn’t “scraps.”

Affordable childcare isn’t “scraps.”

Another full year of expanded child tax credits isn’t “scraps.”

$550 Billion in climate change/green energy development isn’t “scraps.”

Closing the Medicaid Gap for 2.2 million Americans isn’t “scraps.”
Extending the #AmRescuePlan’s expanded ACA tax credits another 3 years isn’t “scraps.”

There’s a whole mess of other stuff still included. It’s not perfect and I’m pissed as hell at Manchinema for dragging it down & the ENTIRE GOP for rejecting ALL of it, but it’s not “scraps.”
Read 4 tweets
Charles Ghoul-ba 👻 Profile picture
28 Oct
This is just a quick overview for my readers; I don't see the point of doing a deep dive until I know whether this is the final cut or not:
acasignups.net/21/10/28/biden…
UPDATE: The text of the updated House version of the bill is already out! That was fast...
rules.house.gov/sites/democrat…

Re. healthcare stuff, here's some of the relevant portions:

1. ACA Subsidy Cliff killed for another 3 years: Image
2. Extension of the more generous #AmRescuePlan subsidy table for another 3 years: Image
Read 8 tweets
Charles Ghoul-ba 👻 Profile picture
25 Oct
Deleted a tweet because some folks who should know better thought I was *siding* with Manchin on this.

To be clear: Yes, it *could* technically end up "rewarding" the non-expansion states *depending on how it's done* by letting them off the hook for their share. HOWEVER...
1. The way the bill is currently written, those states would be required to pay the same 10% of the cost as if they expanded Medicaid anyway, making it moot--the only way they'd be "rewarded" is, ironically, if the "Fedicaid" portion is removed by, say, MANCHIN;
2. Even if it does "reward" them, as @FishmanEliot correctly notes, it's STILL far more important to get those caught in the Medicaid Gap covered than to "refuse to cave" to non-expansion state GOP leadership.
Read 5 tweets

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