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Larry Levitt

@larry_levitt

Dec 22, 2021

A record 13.6 million people have signed up for ACA coverage.

This enrollment growth is being driven by increased premium assistance in the American Rescue Plan, a reversal of cuts in outreach, and an administration touting rather than trashing the ACA.

cms.gov/newsroom/press…

These ACA enrollment gains are at risk if Build Back Better does not pass and extend the American Rescue Plan's enhanced premium assistance beyond next year.

Enrollees would get notice of big premium increases right before the midterm election if premium help isn't extended.

President Biden has not accomplished everything he set out to do in health care, but you have to credit him with fulfilling his promise to reinvigorate the Affordable Care Act.

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Larry Levitt

@larry_levitt

Dec 21, 2021

The Biden Administration will be distributing 500 million rapid at-home COVID tests for free.

We don't want to be hermits, so we'll want to be using more tests than that to continue gathering safely during the winter wave. This sends an important signal about how to do so.

The Biden Administration previously announced that insurers will be required to reimburse for rapid at-home tests people buy. While cumbersome, that will help make tests more affordable for people, supplementing the distribution of 500 million free tests.

Unfortunately, right now, in the lead-up to the holidays, rapid tests are sold out in many stores and the cost is out of reach for many.

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Larry Levitt

@larry_levitt

Nov 23, 2021

CBO estimates that capping cost-sharing for insulin at $35 per month in the Build Back Better Act would decrease federal revenue by $4.6 billion over a decade, which is an indication of how much people who use insulin would save.

cbo.gov/publication/57…

There are two ways capping insulin cost-sharing leads to lower federal revenues:

1. It raises premiums in ACA marketplace plans, which increases the premium tax credits paid by the federal government.

2. It raises premiums in employer plans, which are not taxed as income.

Economists generally assume that when premiums for employer-provided health insurance rise, wages fall.

Since wages are taxed as income and health insurance premiums are not, a shift from wages to premiums will lead to a decrease in federal revenue.

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Larry Levitt

@larry_levitt

Oct 26, 2021

Filling the Medicaid coverage gap has become a contentious political issue. How many people know what it is and how it originated?

The ACA originally envisioned a seamless system of health coverage eligibility.

States were required to expand Medicaid to everyone with incomes up to 138% of the poverty level.

People with incomes 138-400% of the poverty level were eligible for premium subsidies.

In 2012 the Supreme Court threw a massive curveball at the ACA's seamless coverage system.

Even though the federal government was initially covering 100% of the cost of the Medicaid expansion, phasing down to 90%, the court ruled that it had to be voluntary.

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Larry Levitt

@larry_levitt

Oct 12, 2021

New: 83% of the public supports having the federal government negotiate drug prices, even after hearing arguments for and against the idea.

We didn't poll on baseball, motherhood, and apple pie, but I'm not sure they would score much higher.

kff.org/health-costs/p…

A big reason why the public overwhelmingly supports government negotiation of drug prices is that they don't buy the drug industry's arguments against it.

93% of people believe drug companies would still make enough to invest in research, even if prices in the U.S. were lower.

So much of the debate over the Build Back Better package has been on new spending and the overall price tag.

The provision that could prove to be among the most popular -- negotiation of drug prices -- saves money for both the government and patients.

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Larry Levitt

@larry_levitt

Sep 20, 2021

As sweeping as the Democrats' budget measure is, its goal in health care is to fill in gaps, not overhaul the system.

Cover poor people in 12 states not expanding Medicaid.

Expand community-based care.

Address ACA affordability.

Add dental, hearing, and vision to Medicare.

Filling in these health care gaps would be paid for primarily by negotiating drug prices in Medicare and limiting price increases to inflation.

While that would be a big deal, Medicare has for years controlled prices for hospital and physician care.

The more unprecedented part of the Democrats' health agenda is giving privately-insured patients access to government-negotiated drug prices. That's quite common in other countries, but does not happen here for drug prices or any other type of health care.

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