2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

BREAKING: House Dems Roll Out Fantastic #ACA2 Bill With Terrible Official Title

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

ANYWAY...what's actually in the bill that differs from last year's H.R.5155? Well, on the surface it sounds pretty similar, which I was expecting. However, it sounds like they're taking a two-tier approach: A single omnibus bill including all of the provisions along with "about six" smaller, "bite size" bills each of which tackles one of the main bullet points. I had a heads up on this strategy a few weeks ago when the House Energy & Commerce Committee held three separate hearings for three different bills:

  • H.R.1425 reinstates the ACA's federal reinsurance program (it originally sunsetted at the end of 2016...which was a big part of the ~25% avg. rate hike in 2017)
  • H.R.1386 reinstates $100 million in mandatory funding for the federal navigator program and requires HHS to utilize it properly
  • H.R.1385 opens back up $200 million in federal funding to establish state-based ACA exchanges. State exchange funding originally dried up in 2015, I believe.

One interesting side note: The third of these bills ($200M for state exchanges) is a bipartisan bill. It was introduced standalone by Rep. Andy Kim (D-NJ) and Rep. Brian Fitzpatrick (R-PA), which I find very interesting. Fitzpatrick (PA-01) barely won his race last year (51.3% to 48.7%), and Pennsylvania doesn't have their own exchange yet...but I know Democratic Governor Tom Wolf has expressed interest in doing so before, so there's a lot going on here.

All three of those bills are part of the official, larger ACA 2.0 bill. They also mentioned cracking down on "junk plans" referring to reinstating Obama-era restrictions on short-term and association plans. I'm not sure what the other two standalone bills are, but I'm sure those will be discussed very soon.

Here's the one-page explainer of the NEW, full ACA 2.0 bill:

From day one, the House Democratic Majority has been fighting against the Republican war on affordable health care and people with pre-existing conditions by working to advance new legislation to lower health costs and prescription drug prices for all Americans.

On the first day of the 116th Congress, House Democrats voted to throw the full legal weight of the House of Representatives against Republicans’ Texas v. U.S. lawsuit to repeal protections for people with pre-existing conditions and every other benefit and protection the Affordable Care Act provides. House Democrats are continuing to develop and advance bold legislation to lower out-of-control prescription drug prices. And with the Protecting Pre-Existing Conditions & Making Health Care More Affordable Act of 2019, House Democrats are taking another step forward to deliver on our promise to reverse the GOP’s health care sabotage and update and improve the Affordable Care Act. This legislation:

Lowers health insurance premiums with strengthened and expanded affordability assistance

  • Strengthens tax credits in the Marketplace to lower Americans’ health insurance premiums and allows more middle-class individuals and families to qualify for subsidies;
  • Ensures that families who don’t have an offer of affordable coverage from an employer can still qualify for subsidies in the Marketplace; and,
  • Provides funding for reinsurance, to help with high cost claims, improve Marketplace stability, and prevent the Trump Administration’s sabotage from raising premiums.

Strengthens protections for people with pre-existing conditions

  • Curtails the Trump Administration’s efforts to give states waivers to undermine protections for people with pre-existing conditions and weaken standards for essential health benefits, which would leave consumers with less comprehensive plans that do not cover needed services, such as prescription drugs, maternity care, and substance use disorder treatment.

Stops insurance companies from selling junk health insurance plans

  • Stops the Trump Administration’s efforts to push Americans into junk health insurance plans that do not provide coverage for essential medical treatments and drugs, and that are allowed to discriminate against people with pre-existing medical conditions.

Reverses the GOP’s health care sabotage that has needlessly driven up premiums and uninsured rates, and empowers states to innovate and invest in enrolling more people in affordable health coverage

  • Reverses the Trump Administration’s sabotage by requiring open enrollment outreach, education, and funding for navigators;
  • Invests in state efforts to conduct outreach to increase enrollment, educate consumers of their rights, and help individuals navigate the health insurance system;
  • Empowers states to implement new approaches to increasing enrollment and allows states to set up their own Marketplaces; and
  • Holds the Administration accountable for its use of federal dollars dedicated to increasing enrollment, outreach and running the federal exchange.

Here's a 3-page summary which goes into further detail, and here's the actual legislative text itself.

So how does this compare with the 2018 House Dems ACA 2.0 bill? Well, it looks like 11 of the 15 improvements made the cut:

  • Fix the ACA's "Family Glitch"
  • Remove the 400% FPL income APTC subsidy cap
  • Restore CSR reimbursement payments
  • Beef up the APTC subsidy formula
  • Raise the 250% FPL income CSR cap/beef up CSR formula
  • Fix/improve the ACA's "Silver Spam" loophole
  • Improve the ACA's "standardized plan" provision
  • Restore HC.gov marketing/advertising budget
  • Restore HC.gov navigator/outreach budge
  • "Further codify" Essential Health Benefit regulations
  • Crack down on #ShortAssPlans
  • Reinstate ACA national Reinsurance program
  • Add additional funding for state-level innovation programs
  • Restore funding for states to establish their own ACA exchanges
  • Audit HealthCare.Gov's budget

I'm not sure why they scrapped the two plan design items ("silver spamming" and "standardized plans"), although those aren't that big of a deal. Cutting the CSR provisions out of the loop is a bigger deal, but there's a very good reason for that: Thanks to Silver Loading, reinstating CSR funding by itself would actually hurt more people than it helps now. That leaves the omission of expanding/beefing up CSR subsidies as the only real disappointment--but given how messy and delicate the CSR situation is already, I can understand setting that one aside for the moment.

There’s also one other noteworthy omission: It doesn’t reinstate the ACA’s individual mandate penalty at the federal level. Whether they did this due to the delicate status of the #TexasFoldEm lawsuit (reinstating it in this bill could be used by the plaintiffs as an admission that their case has merit) or simply due to the mandate being so hated the first time around, I don’t know, but again, I completely understand taking a pass on it here.

Otherwise, this is an extremely robust bill which would cancel out some of the Trump Administration's worst sabotage efforts while protecting the ACA from further sabotage and significantly lowering premium costs for up to 15 million people, including those who don't currently qualify for any assistance at all.