Thread by @charles_gaba

(sigh) Over 7,500 people have "liked" her first tweet and over 1,200 have shared her misinformation. Worse yet, she's apparently an MD.

It's time once again for...The Three-Legged Stool®!

I can't believe I have to explain this over 10 years later, but under the Patient Protection & Affordable Care Act (the #ACA), INSURANCE CARRIERS CAN'T CHARGE HIGHER PREMIUMS TO PEOPLE BASED ON THEIR MEDICAL OR HEALTH CONDITIONS.

Here's how the #ACA's "3-legged stool" was designed (it's gone through a few changes over the years, most notably the federal individual mandate penalty being cut off & replaced with the World's Most Expensive Shim®):

"Guaranteed Issue:" Insurers have to offer major medical insurance policies to anyone regardless of their medical history/condition.

"Community Rating:" Insurers can't charge higher premiums for the same policy to one person vs. another for anything other than 3 exceptions:

1. Age (w/in a 3:1 ratio; a 64-yr old can be charged up to 3x as much as a 21-yr old, down from 5x or 6x as much pre-ACA)

2. Location (most states have multiple geographic rating areas)

3. Smoking (this is the ONLY medical/behavioral exception allowed...up to 50% surcharge).

"Essential Health Benefits:" Every #ACA-compliant major medical policy MUST cover the following 10 benefits, though the specific drug formulary & some other details vary from state to state. Believe it or not, pre-ACA, many policies didn't cover maternity, mental health, etc.

"Minimum Actuarial Value:" #ACA plans are required to cover roughly 60% - 90% of their average enrollees medical expenses (that's an aggregate average, not your individual costs) depending on the metal level of the plan.

Non-ACA plans often don't have to require dick.

"No Annual/Lifetime Caps:" Pre-ACA, many plans would limit your annual or even LIFETIME benefits to perhaps $1 million...which sounds like a lot of money, but ask anyone whose undergone chemotherapy or who's had a premature infant in the NICU for a few weeks about that.

"Maximum Out of Pocket Ceiling:" (aka MOOP)
As long as your providers/prescription drugs are all in-network, ACA plans have a hard ceiling on how much you have to pay out of pocket (deductible, co-pays, coinsurance).

⚠️ I should take a moment to note that the MOOP rule, while important for preventing medical bankruptcy from a one-time catastrophic situation (hit by a car, etc), still needs major improvements for those for whom catastrophic costs are NOT a "one-time" thing.

If you're in a hit-by-car scenario *once*, that hard MOOP ceiling ($8,550 in 2022) can save you from wiping out your life savings...but if you have chronic medical problems w/OOP costs that level or higher *every year*, being hit for $8,550 *each year* can still be devastating.

"No-Cost Preventative Services:" All #ACA plans require a long list of services to be covered at NO COST (no deductible, no co-pays, etc) as long as they're done by an in-network provider, including physicals, mammograms, blood screenings etc...oh, and VACCINATIONS.

"Stay on Parents Plan until 26:" This one's pretty simple--parents can keep their adult children on their policy until they turn 26, at which point the kids have to move to their own policy.

This is actually one ACA provision that most states had their own version of pre-ACA.

As I mentioned above, the 3-Legged Stool as it actually looks today is somewhat different from how it was envisioned.

Some of this is due to shortcomings in the law itself; some is due to deliberate GOP sabotage; some is due to other weird stuff which has happened along the way:

Opinions vary, of course, but for me there are 4 major flaws in the ACA:

1. Premiums subsidies not generous enough (temporarily fixed by the #AmRescuePlan; hopefully to be permanently fixed by #BuildBackBetter)

2. Cost Sharing subsidies not generous enough (sort-of fixed by #SilverLoading; hopefully permanently fixed by @SenatorShaheen's #S499 bill at some point...)

3. MOOP still too high for those w/chronic conditions

4. Network adequacy requirements far too weak

As noted above, the first issue (premium subsidies not generous enough) has been TEMPORARILY resolved thanks to the #AmRescuePlan, which DRAMATICALLY expanded & strengthened the subsidy formula...but only thru the end of 2022.

Before the #AmRescuePlan, subsidies made ACA policies pretty affordable for those earning up to around ~200% of the Federal Poverty Level (~$26K if you're single, ~$51K for a family of 4), but it was only so-so for those earning 200-400% and those >400% received NO help.

Thanks to the #AmRescuePlan, NO ONE has to pay more than 8.5% of their income in premiums for an #ACA Silver plan & subsidies have been dramatically improved for those earning <400% FPL. Millions are eligible for $0-premium plans, even $0-premium Gold plans in some cases.

📣 SPEAKING OF WHICH, you STILL HAVE TIME to #GetCovered during the 2022 #ACA Open Enrollment Period, which runs thru January 15th in most states (& as late as January 31st in some):
acasignups.net/21/12/23/getco…

As for those who think that @dremilyportermd's words were simply misinterpreted, I thought that might be the case myself until I saw this:

https://twitter.com/dremilyportermd/status/1478786714982404104

She's correct: The #ACA *could* still be repealed at some point in the future. So could Medicare. Or Medicaid. Or the CHIP program. Or, dare I say it, a theoretical #M4All law.

Laws against murder "could be" repealed. Or against rape. Or against slavery...if we allow it.

Some people still think her tweets are being "misinterpreted" but it looks like that's not the case at all. BOTH of these screen-shotted tweets are BS. If the second is true then either she's enrolled in a junk plan or her carrier is breaking the law.

https://twitter.com/databaird/status/1478824191944183810