ACA 2.0

 

As I'm typing this, the House Energy & Commerce Health Subcommittee is holding markup hearings regarding twelve different healthcare-related bills. The first six relate to prescription drug pricing and regulation, and some of them appear to have genuine bipartisan support.

The other six are directly related to the ACA...these are the six "mini ACA 2.0" bills which cover six of the eleven ACA repairs & improvement provisions included the the larger ACA 2.0 bill introduced yesterday. Here's summaries of all twelve bills being debated today:

 

Most people know that over the past three years, I've gone from being a fan of Vermont U.S. Senator Bernie Sanders to...well, not being a fan; let's just leave it at that. They also know that while I support an eventual move towards a single payer-based healthcare system, I simply feel that it will have to be achieved via incremental steps (preferably large steps, not baby ones).

However, for the past year, I've repeatedly made sure to temper my concerns and criticisms of Sen. Sanders views by making sure to note that Bernie himself cosponsored the Senate version of ACA 2.0 introduced by Sen. Elizabeth Warren, aka the Consumer Health Insurance Protection Act, or CHIPA.

I addressed this point at the time in response to earlier attacks on me by MFA purists:

I need to take a moment here to call out progressives who badmouthed and scolded me last week for promoting the House ACA 2.0 bill by insisting that ONLY Bernie's M4A bill will do, and ANYTHING short of that--even in the short term--is unacceptable.

OK, the House Democrats just wrapped up their press conference at which they officially introduced...The Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act, or #PPECMHMAA.

Just rolls off the tongue, huh?

(sigh) Naming-wise, this is actually worse than the title of last year's ACA upgrade bill ("The Undo Sabotage and Expand Affordability of Health Insurance Act", or #USEAHIA), H.R.5155, which I didn't think was possible.

In any event, last year I went with simply calling it "ACA 2.0", which seems even more appropriate today. Others seem to agree:

The bill Democrats are rolling out to shore up Obamacare is called the Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act. I think @charles_gaba calling it ACA 2.0 is going to catch on pretty quickly.

— Kimberly Leonard (@leonardkl) March 26, 2019

On Saturday, the 9th Anniversary of the Patient Protection and Affordable Care Act being signed into law, the news broke that on Tuesday, House Speaker Nancy Pelosi and other House Democratic leaders will be formally rolling out some sort of major "ACA 2.0" legislation:

Pelosi, House Democrats to Unveil Sweeping Legislation to Protect People with Pre-Existing Conditions and Lower Health Costs

Marking the 9th anniversary of the Affordable Care Act being signed into law in 2010 this weekend, Speaker Nancy Pelosi, Majority Leader Steney Hoyer, Chairman Frank Pallone, Chairman Richard Neal, Chairman Bobby Scott and Freshmen House Democrats will hold a press event Tuesday, March 26, at 2:30pm ET in the Rayburn Room to unveil legislation to protect people with pre-existing conditions, reverse the Trump Administration's health care sabotage, and take new measures to lower health premiums and out-of-pocket costs for families.

UPDATE 3/26/19: I'm watching the actual press conference right now. I just wanted to note that there will likely be a few changes/tweaks in the bill/bills introduced today vs. last year's H.R.5155, but it sounds like it'll be about 95% the same. More details this evening.

Back in early January, in an MSNBC interview with Joy Reid, House Speaker Nancy Pelosi noted that she did indeed intend on moving on legislation to, at the very least, raise or remove the ACA subsidy income threshold to allow financial assistance to be available to more people:

The new Speaker of the U.S. House of Representatives said this weekend she wants changes in the income threshold to allow more Americans to gain subsidies so they can buy individual coverage known as Obamacare. Helping more people get subsides are among the "couple of things" she would like to do to improve the ACA and expand health coverage to more Americans, Pelosi, a California Democrat, told MSNBC Friday night.

With useful healthcare legislation extremely unlikely to pass the U.S. Senate until at least 2021, state-based public options will be all the rage for the next couple of years...

Connecticut lawmakers are joining other states that have unveiled proposals to expand government-run health coverage, with plans to extend state health benefits to small businesses and nonprofits, and to explore a public option for individuals.

Under two measures announced Thursday, officials would open the state health plan to nonprofits and small companies – those with 50 or fewer employees – and form an advisory council to guide the development of a public option. The legislation would allow the state to create a program, dubbed “ConnectHealth,” that offers low-cost coverage to people who don’t have employer-sponsored insurance.

Regular readers know that I've been calling for Congress to #KillTheCliff for years:

Once again: Under the ACA, if you earn between 100-400% FPL (between $12,140 and $48,560 for a single person), you're eligible for APTC assistance on a sliding scale. The formula is based on the premium for the Silver "benchmark" plan available in your area, which averages around $611/month in 2019.

Here's how the formula works under the current ACA wording:

...Here's the problem: If they earn exactly 400% FPL ($48,560), they'll also only have to pay 9.86% ($4,802), receiving $2,530 in subsidies for the year....

 

I don't know what the status is of H.R. 5155 (the House Democrats catch-all "ACA 2.0" bill which I've been pushing for awhile now), but it looks like individual elements of it are also in the works as standalone bills:

HEARING ON “STRENGTHENING OUR HEALTH CARE SYSTEM: LEGISLATION TO LOWER CONSUMER COSTS AND EXPAND ACCESS”

Date: Wednesday, March 6, 2019 - 10:00am
Location: 2123 Rayburn House Office Building
Subcommittees: Health (116th Congress)

The Health Subcommittee with hold a legislative hearing on Wednesday, March 6, at 10 am in the John D. Dingell Room, 2123 Rayburn House Office Building. The hearing is entitled, “Strengthening Our Health Care System: Legislation to Lower Consumer Costs and Expand Access.” The bills to be the subject of the legislative hearing are as follows.

Over at Balloon Juice, David Anderson notes that the Blue Cross & Blue Shield Association has released their own "ACA 2.0" proposal...and many elements line up pretty closely to my own vision of what ACA 2.0 should look like as well as both the House (H.R. 5155) and Senate (S.2582) Dem versions. Here's Anderson's summary of the BCBSA proposal:

  • Younger adults pay a lower percentage of their income (at a given level) for the benchmark plan
  • Older adults are held harmless
  • All individuals, regardless of income, are eligible for subsidy assistance
  • CSRs appropriated
  • CSRs expanded
  • Full advertising and outreach funded
  • Health insurance premium tax suspended

...It looks like the insurers are trying to lay markers for where they want to see things in 2021 or 2022. They are looking at a fix and expansion of the current paradigm instead of a complete replacement of the system.

I visited DC last month for the Families USA healthcare conference. While I was there, I managed to arrange to meet with staffers for four U.S. Senators and two House members (in fact, the House members themselves stopped by to talk for awhile as well. None of the Senators did, but they were a bit busy dealing with Donald Trump's idiotic temper tantrum government shutdown at the time).

In my meetings, we discussed a variety of healthcare policy-related issues, but the two most important ones I focused on were:

Last year I briefly attempted to keep track off the dozens of various state-based "ACA 2.0" protection/improvement bills flying around various state legislatures. I eventually abandoned this project since it became too difficult to keep up with, but I'm still reporting case studies as they come to my attention...and Louise Norris has just alerted me to some pretty big changes going into effect in Colorado this April.

First up: Short-term plans are being heavily neutered. In addition to being limited to 6 months per year (which is still longer than the Obama Administration's 3-month cut-off)...

Short-term plans will have to charge older adults no more than three times as much as they charge younger adults. Short-term plans are generally not available after a person is 64, but a quick check of plans currently available in Colorado show that some insurers are charging a 64-year-old up to seven times as much as a 21-year-old. That will have to stop as of April.

A couple of weeks ago, I noted that Speaker of the House Nancy Pelosi, in an interview airing on MSNBC, stated that two of the major pieces of healthcare legislation she intends on pushing through this session are raising the ACA's tax credit eligibility threshold and "replacing" the now-repealed ACA individual mandate (i was never sure whether "replacing" meant reinstating it or actually replacing it with some other enrollment incentive).

I realize that the odds of any useful healthcare legislation managing to pass the Senate and become law under the Trump Administration is pretty slim, but hey, it's still good news, right!

Well, that news just got a whole lot better! via Richard Alonso-Zaldivar of the AP:

As part of her proposed 2020 annual budget, Rhode Island Governor Gina Raimondo has included an item of particular interest to those following the ACA:

Health Care Access and Affordability

State government plays a critical role in today’s health care system. Every policy decision we make has an impact on the individuals, children and families who need care. The Governor’s FY20 budget proposal builds on this momentum, preserving vital ACA protections that promote market stability and help to keep uninsured rates low. There are no eligibility cuts or broad-based benefit impacts proposed.

...Market Stability and Reinsurance Initiative

Back in April 2017, I compiled a 20-itme "ACA 2.0 wish list" which I titled "If I Ran the Zoo", which gained some amount of attention from the healthcare policy wonk community. To be clear, I wasn't the first one to come up with most of these ideas; it was mainly just pulling together a bunch of proposals to protect, repair and strengthen the ACA from various sources into a single, comprehensive collection.

Since then, several bills have been introduced by Democrats in either the House or the Senate which addressed one or more of these recommendations, and last spring there were two bills (one in the House, one in the Senate) which tackled over a half-dozen of them in a package deal. None of these bills have gone anywhere since then, of course; with the Dems having retaken the House, it's a lot more viable that one or more will do so this year, although getting any of them through the Senate is obviously a much tougher climb.

However, some of the items on the list haven't even made it that far, including #5 on my list:

This Just In from Covered California...

California’s Open Enrollment for Individuals Ends Jan. 15; Consumers Have One Week to Sign Up for Health Care Coverage

  • Consumers have through Jan. 15 to sign up and select a plan through Covered California or directly with health plans for coverage that will begin on Feb. 1.
  • The final week of open enrollment comes on the heels of Gov. Newsom’s announcing sweeping proposals, including a new requirement for having coverage and expanded subsidies.
  • While open enrollment ended for much of the nation in December, California’s final deadline is about two weeks earlier than it was in previous years, when open enrollment ran through the end of the month.
  • More than 238,000 consumers had selected a plan through Dec. 31.

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