ACA 2.0

It's very clear that the name of the game for healthcare policy this year seems to be "What comes after the ACA?"

For over a year now, I've been strongly urging the passage of some sort of "ACA 2.0" upgrade package, primarily based on my own wish list entitled "If I Ran the Zoo", a collection of about 20 assorted ACA fixes. The reality is that a couple of the items on my list start to move away from an "upgraded ACA" and drift over into what I've mentally compartmentalized as the next phase in achieving Universal Healthcare Coverage.

Since I first posted my wish list just over a year ago, several new proposals have been released by various Democratic politicians and 3rd-party organizations such as the Center for American Progress, some of which are revised versions of other long-proposed systems. These include:

Last month I urged Democrats to go strongly on offense re. campaigning on healthcare policy in 2018 given the general landscape but especially the exit polling out of the special Congressional election in Pennsylvania:

  • Health care was a top issue to voters. Health care was ranked as a top issue for 52% of voters (15% saying it was the most important issue and another 37% saying it was very important). Only 19% said it was not that important or not important at all.
  • Conor Lamb won big especially among voters for whom health care was a top priority. Among voters who said health care was the most important issue for them, Lamb beat Rick Saccone 64-36 and among the broader group of voters who said it was either the most important or a very important issue Lamb beat Saccone 62-38.
  • On health care, voters said Lamb better reflected their views by 7 points (45% to 38%) over Saccone. With independents, that gap widened to 16 points with 50% saying Lamb’s health care views were more in line with theirs to only 34% for Saccone.

I was originally just planning on comparing the various provisions of the House and Senate Democratic versions of their "ACA 2.0" bills against my own, year-old "If I Ran the Zoo" wish list.

Then I wrote a post about a whole bunch of stand-alone bills in California which Louise Norris alerted me to and decided to throw those into the comparison table as well.

And now, with quick state-level action in both Maryland and New Jersey in recent days, I decided to expand this project across every state. I've started color-coding the status of each bill and am even adding some recent/past bills and/or waivers which have failed as I go (i.e., the failed/delayed mandate penalty restoration efforts in Connecticut and Maryland).

This is a work in progress, so the table is probably pretty incomplete for now and will likely be changing constantly as various bills are introduced, moved to committee, voted on, pass/fail, signed/vetoed by governors and actually implemented (or legally challenged).

UPDATE 4/20/18: Whew! OK, I've incorporated a bunch of Louise Norris' links for several states and have moved it to a full Google Docs spreadsheet. Be warned, it's pretty big now...

A note about the headline: I originally referred to "ACA 2.0 vs. Trumpcare", but the more I thought about it, the more I realized that as of this moment, Donald Trump and the GOP have only partially mutated the Affordable Care Act into their own warped vision. They've managed to scare off carriers, confuse enrollees, cause unsubsidized premiums to shoot up an extra 18%, and with the repeal of the individual mandate (and potentially the massive expansion of #ShortAssPlans via #RegulatorySabotage) starting next year are about to cause those same premiums to jump another 16% or so on average.

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.

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