Late last night, the U.S. Senate finally voted to approve a massive $2 TRILLION bailout/recovery bill in response to the Coronavirus pandemic. After a lot of haggling and drama, the final bill ended up passing unanimously, 96 - 0 (four Republican Senators weren't able to vote at all...due to being in self-isolation because of Coronavirus). It's expected to be quickly passed by unanimous consent in the House today and will presumably be signed by Donald Trump before nightfall.
And like that, the largest emergency economic influx bill in history is done.
There's a lot of explainers and thinkpieces being written about the bill as a whole...which elements are good, which are bad, which are flat-out offensive (especially the ~$500 billion in corporate giveaways, which still ended up in the final bill although they supposedly have some sort of oversight over which companies receive them and under what conditions), but my focus is of course on the healthcare aspects, and especially what it means for enrollment in ACA exchange plans and Medicaid via ACA expansion.
I live around half an hour from both the hospitals she refers to (one is in Novi, the other in Southfield). Michigan has the fifth-highest number of confirmed cases and the eighth-highest per capita (as of this writing, we have around 2,300 confirmed cases of COVID-19), at 1 confirmed case per 4,300 residents.As of this writing, 43 Michigan coronavirus patients have died.
The video is about 7 minutes long, but I implore you to watch the entire thing. For those who can't view or hear it, i've transcribed it verbatim below.
For several years now, I've been urging Congress to upgrade the Affordable Care Act via a series of major improvements. Most notable among these is the need to #KillTheCliff...that is, to eliminate the so-called "Subsidy Cliff" which kicks in for ACA individual market enrollees who earn more than 400% of the Federal Poverty Line (roughly $50,000 for a single adult or $103,000 for a family of four).
As I've explained many tmes, the ACA's subsidy structure works pretty well for those earning between 100 - 200% FPL, and is at least acceptable for those earning 200 - 400% FPL (in fact, thanks to #SilverLoading, it works quite well for most of that population as well). The real problem kicks in above 400% FPL (and to a lesser extent below 138% FPL for those living in the 14 states which still haven't expanded Medicaid). In addition, the subsidy formula still doesn't make policies truly affordable for many of those receiving them.
In short, both the upper- & lower-bound Subsidy Cliffs need to be eliminated, and the underlying formula needs to be strengthened as well.
For a couple of weeks now, I've been posting constant updates as one state-based ACA exchange after another has announced a COVID-19-specific Special Enrollment Period in light of the ongoing pandemic crisis. Until now, though, there's been two ACA exchanges which haven't made such an announcement. One is the Big One, HealthCare.Gov, which hosts a whopping 38 states and which is facing increasing pressure to do so.
The other...is Idaho. Specifically, Your Health Idaho, the state's ACA exchange.
If you scroll allllllllll the way down to Pages 1,088 - 1,090, there are two provisions which relate directly to the Affordable Care Act's Advance Premium Tax Credits for exchange enrollees:
SEC. 103. RESTORATION OF LIMITATIONS ON RECONCILIATION OF TAX CREDITS FOR COVERAGE UNDER A QUALIFIED HEALTH PLAN WITH ADVANCE PAYMENTS OF SUCH CREDIT.
(a) IN GENERAL.—Section 36B(f)(2)(B)(i) of the Internal Revenue Code of 1986 is amended to read as follows:
Today is the 10th Anniversary of the signing of the Patient Protection & Affordable Care Act. On March 23rd, 2010, President Barack Obama signed the bill into law, although it would be another 3 years and 9 months before most of the major provisions would go into effect: ACA exchange policies, Advance Premium Tax Credits and Cost Sharing Reduction subsidies, Medicaid expansion in most states (although a few got an early start via special waivers and conversion of existing programs), and so forth.
You may notice that I referred to it as the Patient Protection & Affordable Care Act. I, like most people, tend to shorthand the name as simply "the Affordable Care Act" or "the ACA", but the truth is that it's the patient protection part which received the most attention during the Great ACA Repeal Debacle of 2017...and which has once again come front & center in the spring of 2020.
Even so, the 10th Anniversary of the signing of the Patient Protection & Affordable Care Act is coming up this Monday, so I figured I should take a moment to note the continuing trendline between the Federally Facilitated Marketplace (FFM) (HealthCare.Gov) and the State-based Marketplaces (SBMs). There have been as many as 15 or as few as 12 depending on the year.
The first table below lists the official number of Qualified Health Plans which were selected by Americans during the official Open Enrollment Periods for the first seven years they've occured. The blue cells represent states which operated their own full SBMs that year. This has changed over the years as follows:
There's only two reasons why limited-time Open Enrollment Periods exist in the first place:
1. To help prevent people from gaming the system & causing premiums to skyrocket by waiting until they're sick/injured to sign up
2. To help goad/spur people into action (deadlines are proven to be very effective at getting people off their butts)
The thing is, this is a pandemic. "Ensuring a stable risk pool" isn't exactly a top priority for anyone at this particular moment, and the economic consequences of this disaster are going to be rampant for quite awhile no matter what anyway. Right now the top priority should be making certain as many people are covered as possible. And "deadly global pandemic" is likely to be pretty "inspirational", I'd imagine.
