ACA

Pennsylvania Democratic Representative Brendon Boyle, on MSNBC last night:

Rep. Boyle: The one thing I would point out, though, is this bill is actually significantly worse [than the GOP's ACA repeal attempt in 2017], because this piece of legislation will throw 13.5 million, almost 14 million Americans off their healthcare.

First, you're cutting people off Medicaid. But second, this does include very deep cuts to Obamacare as well. And finally, I have breaking news for you tonight, that literally just came out in the last few minutes as I've been sitting here: The nonpartisan Congressional Budget Office, the official authority on these figures, has now confirmed that this bill, in addition to Medicaid cuts, in addition to Obamacare cuts, includes $500 BILLION WORTH OF CUTS TO MEDICARE that is now in this bill as well.

via the Maine Dept. of Health & Human Services:

With potential Federal cuts to Medicaid on the horizon, renewing enhanced premium tax credits to ensure affordable insurance through the marketplace takes on greater significance

AUGUSTA— The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) today announced its support for renewing the enhanced premium tax credits for consumers of the health insurance marketplace. 

The enhanced premium tax credits, which were first implemented in 2021 through the American Rescue Act and extended in the Inflation Reduction Act are set to expire at the end of this year unless Congress acts. Allowing these federal tax credits to expire will result in higher health insurance premiums for Maine consumers, potentially putting health coverage out of reach for thousands of Mainers. Overall, the enhanced tax credits are saving Mainers a conservative estimate of nearly $90 million in health care premium savings this year.

UPDATED 5/22/25: Welp. House Republicans did indeed follow through with passing their horrific (and disgustingly-titled) "One Big Beautiful Bill" Act which will effectively repeal the bulk of the ACA without officially repealing it, and that's just for starters.

The final vote was 215 - 214, with every Republican except a handful voting for it (and the two who voted against it openly admitted to the NY Times that they would have voted for it if their votes had been needed), and every Democrat voting against it. There were 2 Republican "no" votes...but both of those were only because they wanted the final bill to be even more draconian.

The Congressional Budget Office projected the bill, if enacted, will result in at least 13.7 million more Americans losing healthcare coverage (and that was based on a prior version of the bill; the new version is considered even more extreme).

SEE IMPORTANT UPDATES BELOW.

With all the understandable focus on Congressional Republicans efforts to effectively end Medicaid coverage for nearly 21 million Americans enrolled via ACA expansion, there's been much less attention paid to the other looming threat to healthcare coverage: The expiration of the upgraded financial subsidies for ~24.2 million ACA exchange enrollees, which are currently scheduled to end this New Year's Eve.

As I've explained numerous times before, the ACA's original premium subsidy formula was always far too stingy to make individual market policies affordable for many people...and worse yet, the subsidies cut off entirely for households making more than 4 times the Federal Poverty Level (FPL).

As regular readers know, I've been a bit obsessed over the past month or so with generating pie charts which break out the total healthcare program enrollment for the entire population of all 435 U.S. Congressional Districts as well as all 50 states +DC.

As you can imagine, this has been a monumental task; not only did I have to crunch a lot of data to break out the statewide numbers into House district-level estimates, I also had to convert that data into nearly 480 easy-to-read graphics...and then I doubled my workload by going one step further and adding high-res PDF versions for folks to print out in large format for town halls, rallies and #HandsOff protests nationally.

Now that I've finally completed this project, it's time to turn back to the main reason for it in the first place: The imminent threat to healthcare coverage for literally tens of millions of Americans being posed by the budget resolution recently passed by House Republicans, which (fortunately) still has a number of points where it can potentially be stopped.

Originally posted 10/18/20.

RE-UPPED 1/31/22: It was announced this morning that John James, who lost not one but two statewide U.S. Senate races back to back in 2018 & 2020, is taking a third swing at elected office in 2022. This time he's setting his sights lower, going for Michigan's new open 10th Congressional district, which is still competitive but which definitely has more of a GOP-tilt to it. In light of that, I decided to dust off this post again.

RE-UPPED 4/9/25: It was announced yesterday that John James, who finally made it into elected office as a U.S. Representative in Michigan's 10th Congressional District (only to essentially abandon his district the moment he got re-elected in 2024) is now running for statewide office again, this time for Governor. In light of that, I decided to dust off this post again (again).

A month ago, incumbent Democratic Senator Gary Peters of Michigan and his Republican challenger John James were both interviewed as part of a Detroit Regional Chamber series on several issues, including healthcare policy and the ACA.

This was actually announced a few weeks ago, but I was knee-deep in my Congressional District-level Enrollment Breakout Pie Chart project so I didn't get around to posting about it until now.

Via the Musk/Trump Admin's Centers for Medicare & Medicaid Services (CMS):

Today, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to address the troubling amount of improper enrollments impacting Affordable Care Act (ACA) Health Insurance Marketplaces across the country. CMS’ 2025 Marketplace Integrity and Affordability Proposed Rule includes proposals that take critical and necessary steps to protect people from being enrolled in Marketplace coverage without their knowledge or consent, promote stable and affordable health insurance markets, and ensure taxpayer dollars fund financial assistance only for the people the ACA set out to support.

via Meredith Lee Hill of Politico:

Vulnerable House Republicans warn leaders against cutting Obamacare

The group of centrists also said the party needed to be careful about deep cuts to social safety net programs.

House Republicans in competitive districts warned GOP leaders Thursday: We could lose our seats if you gut Obamacare to pay for a massive border, energy and tax bill.

A group of about a dozen centrist Republicans...worry GOP efforts to pare back the Affordable Care Act could pour fuel on the fire.

...Instead, they argued, Republicans needed to embrace the GOP’s role as the working class party. Leaders would counter that message by slashing programs working Americans rely on, they said. GOP lawmakers in the room included Rep. Brian Fitzpatrick (Pa.), Young Kim (Calif.), David Valadao (Calif.), Andrew Garbarino (N.Y.), Tom Barrett (Mich.) and Don Bacon (Neb.).

On his first day in office, Donald Trump issued dozens of Executive Orders. Some of these are mostly symbolic; some won't have any effect without legislative action; some are blatantly unconstitutional & are already being challenged in court. Many, however, are terrifying and will have horrific consequences for thousands or potentially millions of Americans and non-Americans alike.

I already noted that one such order would withdraw the United States from the World Health Organization, which we curently provide 20% of the funding for.

Along with issuing his own new ones, Trump has also already rescinded over 60 XOs issued by President Biden. In this post I'm going to focus on three of them which pertain specifically to healthcare policy.

Again, all three of the following have now been RESCINDED BY DONALD TRUMP:

Many voices including mine have been warning of this for months, so it shouldn't come as a surprise to anyone, but here it is regardless: Last week Politico got ahold of a "menu" of draconian cuts to a wide variety of federal programs, mostly regarding healthcare policy, which House Republicans plan on implementing with their new trifecta:

The early list of potential spending offsets obtained by POLITICO includes changes to Medicare and ending Biden administration climate programs, along with slashing welfare and “reimagining” the Affordable Care Act.

The biggest program on the hit list, however, is Medicaid, which would make up nearly half of the $5 TRILLION in budget cuts Republicans have in mind in order to pay for...massive tax cuts for corporations & the wealthy, of course.