If I Ran the Zoo: How do the House and Senate ACA 2.0 bills stack up?


Time: D H M S

A year ago I wrote up my own "wish list" of 22 recommendations for fixing, improving, strengthening and expanding the Affordable Care Act (it's officially 20 items but two of them really should have been split into two entries apiece). I called it "If I Ran the Zoo", and it received quite a bit of praise, even though I didn't come up with most of them myself; it was mostly a compilation of ideas which had been floating around progressive healthcare wonk circles for awhile.

In any event, now that the Republican "ACA stabilization bill" (Alexander-Collins) appears to be dead and buried, I figured it might be helpful to line up both the House and Senate versions of the ACA 2.0 bills to see how they compare to each other as well as to my own list of recommendations.

There are some diffrences between the two bills even in areas where they both check off the box (the new proposed CSR formulas are different, for instance), but I tried keeping it as simple as I could. I threw in Alexander-Collins as well for the hell of it. Pink cells are either deal-breakers or a net negative in the case of how Alexander-Collins would handle CSR funding. There's still confusion in my head as to whether the A-C language about Short-Term plans would have allowed states to override Trump's expansion of them or to codify Trump's expansion of them. The only item I'm not sure whether I think is helpful or harmful is the "Copper Plan" expansion, so I left that in white.

It's important to note that 7 of the 20 additional items listed weren't on my own list last year because, frankly, they weren't an issue at the time. It's also worth noting that two of the items on my own list (merging rating areas statewide and merging the individual and small group markets) may not be feasible at the federal level--that might be under the strict pervue of the states. Then again, Warren's Senate bill would give the HHS Secretary the ability to veto excessive rate hikes, so perhaps that could be done here as well.