Thread by @cynthiaccox

Curious how the Medicaid expansion works in Build Back Better? Here's a quick thread.
In short, BBB would close the Medicaid coverage gap in states like FL and TX that haven't expanded the program by allowing people living under poverty in those states to access ACA subsidies 🧵

2/ People in states that have already expanded Medicaid with incomes under 138% of poverty would still have Medicaid.
Starting in 2022, if BBB passes, 2.2 million uninsured people living in 12 Medicaid non-expansion states could get heavily subsidized coverage through ACA markets

3/ If BBB passes: In states that do not expand Medicaid, people with incomes under 138% of poverty would get free ($0 premium silver plans) that, in 2022, have an actuarial value of 94% (very low deductible) and from 2023-2025 have an actuarial value of 99% (maybe no deductible)

4/ People in non-expansion states with incomes between 100-138% of poverty were already eligible for ACA subsidies, but the BBB would make the generosity of plans for that group look more like Medicaid with no premium and very little out-of-pocket costs

5/ Eventually, there would be other enhancements to the ACA plans for low-income people in non-expansion states that would make the plans look more like Medicaid. And, as is the case for Medicaid, people who have employer offers would not be barred from accessing these subsidies

6/ Basically, in non-expansion states, BBB attempts to make the ACA Marketplace function as much as possible like Medicaid would have for people with incomes below 138% of poverty. But, it's only temporary. If BBB isn't extended by Congress, the Medicaid coverage gap will return