Thread by @charles_gaba

⚠️⚠️⚠️ DEMS: CAMPAIGN ON ACA2.0/MEFA!! ⚠️⚠️⚠️

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For those wondering: Here’s my initial takes on both #ACA2 and #MEFA. ACA2 stabilizes/repairs/expands the ACA itself *in order to clear the way* for MEFA as the next phase:
acasignups.net/18/03/13/updat…

acasignups.net/18/02/24/updat…

As silly as this sounds, the biggest problem I have with the #ACA2 bill is the official title. “Undo Sabotage & Expand Affordability of Health Insurance Act”, or #USEAHIA. Really, guys?

Since this has turned into a thread, here’s how healthcare coverage would likely evolve under CAP’s #MEFA proposal over time. First, here’s where things stand today (roughly):

2 years after becoming law, the individual market should be fully stabilized and MEFA should have snapped up a good 10 million or so people, mostly among those currently uninsured, underinsured & unsubsidized, while stabilizing things for everyone else.

4 years after taking effect, MEFA should have completely replaced the ENTIRE individual market, while also eating into the remaining uninsured as well as all newborns & those newly-turned 65.

6 years after taking effect, MEFA would have absorbed the *ENTIRE* Medicaid & CHIP population, as well as starting to eat away at small group enrollees. At this point the vast majority of the country should be on either ESI, Medicare or MEFA.

8 years after taking effect, large employers would be able to buy in as well, and a significant chunk of the “traditional” Medicare population should be phased over to MEFA.

Finally, a decade after taking effect, this is likely where things would have settled in: Around 99% of the country having comprehensive healthcare coverage, w/roughly 60% on MEFA, 10% on “traditional” Medicare & 30% on ESI. Eventually it would probably end up ~75/25 MEFA/ESI.

It’s important to keep in mind that unless we somehow end up with President Pelosi before then, NEITHER MEFA NOR M4A NOR ANY OTHER *COMPLETE* HEALTHCARE OVERHAUL is going to actually go into effect until ~2022 at the *very* earliest (even if it’s *passed/signed* in 2021)…

…which is why Dems should ALSO be promoting #ACA2 to stabilize/repair/strengthen the ACA *in the meantime*, as introduced a week or so ago by the House Dems: acasignups.net/18/03/13/updat…

Of course THAT has no chance of being signed into law until 2019 at the earliest either (believe it or not, I *could* see Trump signing ACA2 if it was bundled in with a larger must-pass bill the way he signed CHIP expansion/etc). Still a long shot but (shrug)…

So the best-case scenario would be: #ACA2 (or similar) passes House/Senate in 2019, stabilizes things for 2019 - 2021. In 2021, a (hopefully) all-D fed. gov’t passes #MEFA (or similar), which goes into effect starting in 2022.

Alternately, the half-sabotaged current ACA markets hobble along thru 2021. D’s pass short-term ACA2 (2021-2022 only) with MEFA taking effect starting in 2023.

I can already hear the backlash from “SP NOW!!” folks: “Under your scenario, we wouldn’t achieve the final stage until 2032!” Yep. That’s what I’m saying. That’s the best remotely realistic scenario I can foresee. I could be wrong, of course, and I’ll happily eat my words if so.

Also, keep in mind that it’s not like everyone would be twiddling their thumbs *until* year 10; the vast majority of the problems would have already been resolved in the first couple of years.

I *hope* to be able to continue analyzing, writing & explaining WTF is going on (& the GOP’s attempts to sabotage it every step of the way), but I’ll need help to do so: acasignups.net/18/03/07/help-…

I didn’t intend this to be a full thread but it turned into one.

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