Last March I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

via the AP:

Nevada’s most influential union is sending a subtle message to its members discouraging support for Bernie Sanders and Elizabeth Warren over their health care stances even though the union has not yet decided if it will endorse a candidate in the Democratic presidential race.

The casino workers’ Culinary Union, a 60,000-member group made up of housekeepers, porters, bartenders and more who work in Las Vegas’ famed casinos, began distributing leaflets in employee dining rooms this week that push back against “Medicare For All,” the plan from Sanders and Warren to move to a government-run health insurance system.

The leaflet said “presidential candidates suggesting forcing millions of hard working people to give up their healthcare creates unnecessary division between workers, and will give us four more years of Trump.

Health care is one of the biggest issues for the union, whose members have fought and negotiated for robust plans.

A handful of readers may have a vague memory of my attending a healthcare forum here in Oakland County, Michigan last November:

HEALTHCARE TOWN HALL: A PLAN FOR OAKLAND COUNTY

Please join us for a Health Care Forum with Andy Meisner. We will be focusing on the issues and proposed solutions for Oakland County.

November 12th, 6:30pm in Room 218 at West Bloomfield High School, 4925 Orchard Lake Road, West Bloomfield

The larger point of the forum was to highlight a plan which Oakland County Treasurer and County Executive candidate Andy Meisner has been working on for a year now, the "Meisner Plan for Oakland County’s Health, Wellness and Happiness”:

When I listen to people in every part of Oakland County, more than anything I hear concerns about people struggling to afford healthcare and prescription drugs. That’s why I’m proposing the “Meisner Plan” to make healthcare and prescription drugs more affordable and accessible in Oakland County.

Back in November, Georgia Governor Brian Kemp released a proposed ACA Section 1332 Waiver proposal which, if it were to be fully approved, would completely transform the ACA individual marketplace into something entirely different:

On November 4, 2019, Governor Brian Kemp of Georgia released a new draft waiver application under Section 1332 of the Affordable Care Act (ACA) that, if approved, would reshape the state’s insurance market. The application reflects a two-phase approach: a state-based reinsurance program to begin in plan year 2021, followed by a transition to the “Georgia Access” model beginning in plan year 2022. Both components of the waiver application would extend through plan year 2025.

NOTE: This is a joint post by three of my colleagues and myself:
David M. Anderson, Charles Gaba, Louise Norris and Andrew Sprung

State policymakers have been prolific and creative in putting forward measures to strengthen their ACA marketplaces. Measures enacted since 2017 or in progress now include reinsurance programs, which reduced base premiums by an average of 20% in their first year in the first seven states to implement such programs; new or renewed state-based exchanges, which capture insurance user fees that can be used for advertising and outreach; state premium subsidies to supplement federal subsidies; and state-based individual mandates, which can provide funding for all of the above.

via MNsure:

Though open enrollment through MNsure has ended, there are still opportunities to enroll through a special enrollment period (SEP). Minnesotans who experience a qualifying life event, like aging off a parent's health insurance (turning 26), getting married, or losing other health coverage, may be eligible to apply. See a complete list of qualifying life events, including coverage start dates.

Four days ago, from Trump Administration Centers for Medicare & Medicaid Administrator, Seema Verma:

No, the Trump administration is not cutting Medicaid. https://t.co/bk5uMMKof4

— Administrator Seema Verma (@SeemaCMS) February 6, 2020

(sigh) Honestly not sure why I'm bothering posting this. Anyone who doesn't understand that the only promises Trump keeps are the racist, xenophobic, homophobic, misogynistic, antisemitic and corrupt ones by this point is either a complete idiot or willfully ignorant:

The Trump administration wants to slash billions of dollars in federal support from Medicaid, food stamps and other safety net programs for the poor, while largely sparing the Medicare program that benefits seniors.

via the University of Michigan's Health Policy Student Association:

Feb. 13 Panel on ‘What’s Next in U.S. Health Care?’

The Health Policy Student Association (an IPE student organization) invites all to register for a free  Feb. 13 panel at 4:30 in School of Public Health Room 1755. Panelists include Marianne Udow-Phillips of the Center for Health Research & Transformation, HuffPost correspondent Jonathan Cohn, and ACA analyst Charles Gaba. RSVP requested.

If you're going to be in the Ann Arbor, Michigan area on Thursday, check it out!

For nearly three years now, the Trump Administration and Republican politicians across dozens of states have been claiming that expanding Medicaid to "able-bodied adults" encourages them to be lazy couch potatoes, lying around on their butts just soaking up all that sweet, sweet free healthcare coverage. That's the main excuse they've used to tack on draconian work requirements for Medicaid expansion enrollees: Supposedly doing so goads them into getting off their rumps, pulling themselves up by their bootstraps and becoming a Productive Member of Society, etc etc.

Of course, the reality is that most Medicaid expansion enrollees already work, and of those who don't most are already either in school, caring for a child or a medically frail relative, etc etc...meaning that work requirements impose a mountain of burdensome paperwork and reporting requirements in order to "catch" a tiny handful of people who supposedly match the "lazy bum" stereotype...but instead end up kicking thousands of people who are working/in school/etc. off of their coverage because they aren't able to keep up with the reporting requirements.

From this evening's CNN Town Hall:

QUESTION: Hello, Senator. Are you willing to compromise on your position on Medicare for all, free college, and eliminating student debt in order to pass meaningful legislation?

SANDERS: Well, Medicare for all, the proposal that we have, Ron, is in a sense a compromise because we don't do it all at once. We do it over a four-year period. And the first year, what we do is we expand Medicare.

Medicare is a strong program right now. It's the most popular health insurance program out there. But it is not as good as it should be. So what we do in the first year, Ron, is we expand it to cover dental care, which last I heard oral health was a health care issue, hearing aids, eyeglasses, and home health care. And in year one of a four- year transition period, we lower the eligibility age from 65 down to 55. Year two, 45, year three, 35. Year four, everybody's in. So that's kind of a compromise. There are some people who say, hey, let's do it. You know, other countries have done it all instantaneously. We do a four-year period...

Note: This isn't limited to Michigan...many of the items listed here could/should be applied in other states as well.

Dear Governor Whitmer & Michigan State House and Senate Members:

If you're familiar with me and this site, you probably know two things about me:

  • 2. Having said that, until universal coverage is feasible at the federal level in one way or another, I strongly believe that it is vitally important to protect, repair and strengthen the Affordable Care Act even if it ends up being replaced by something else in the near future.

One more reminder from the New York State of Health ACA exchange:

Press Release: NY State of Health Urges New Yorkers: Don’t Miss this Opportunity to Enroll in Health Coverage!

  • Open Enrollment Ends February 7
  • Thousands of Free, In-Person Assistors Available to Help Consumers

ALBANY, N.Y. (February 5, 2020) – NY State of Health, the state’s official health plan Marketplace, is encouraging New Yorkers who need health coverage to enroll in a 2020 Qualified Health Plan (QHP) by this Friday, February 7. The Open Enrollment deadline was extended an additional week to give consumers more time to find the health plan that fits their needs and enroll in coverage for 2020. Already, enrollment through NY State of Health is at its highest point ever, with more than 4.8 million New Yorkers enrolled in a health plan.

A few minutes ago I noted that the Supreme Court has announced that they'll be considering whether or not to expedite a review of the Texas vs. Azar (#TexasFoldEm) lawsuit at a private conference on February 21st.

What's that mean? Well, when we last checked in on the status of the case, the 20 Democratic state Attorneys General, led by California AG Xavier Becerra, had requested that the Supreme Court intervene in the ongoing federal court process and fast-track the case from where it is right now (bouncing around within the 5th Federal Circuit Court of Appeals) to instead hear the case directly and issue a final ruling on whether or not the Affordable Care Act will be struck down before the November election.

Speaking of the Texas Fold'em lawsuit (officially Texas vs. U.S. or Texas vs. Azar) which, if ultimately upheld, could result in the entire ACA being struck down, there's been a small but important development this morning:

Supreme Court to consider taking ObamaCare case

The Supreme Court on Wednesday listed a closely watched case seeking to strike down the Affordable Care Act for discussion at the justices’ private conference on Feb. 21. 

The justices will consider whether to take up the case and on what schedule. 

There is at least some possibility they could decide to take the case this term, meaning a ruling would be issued by June. But most observers expect a ruling will not come until after the 2020 election, either because the court waits until the next term to hear it, or because it decides not to take up the case at all until lower courts have finished considering it. 

I couldn't stomach watching most of Trump's Hate Rally Lie Fest State of the Union last night, but I did catch the healthcare portion. As usual, Trump blatantly lied through his teeth about almost everything, which is pretty standard these days. Still, I figured I should go through them point by point:

A good life for American families also requires the most affordable, innovative, and high-quality health system on Earth. I moved quickly to provide affordable alternatives. Our new plans are up to 60% less expensive, and better.

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