ACA 2.0

Welp. That didn't take long...just a week ago, Connecticut Governor Ned Lamont announced that he and the state legislative leaders had put together a robust package of impressive healthcare reform bills, including:

  • expanding subsidies to at least some of those eanring more than 400% of the Federal Poverty Level (like California is in the process of doing)
  • expanding Medicaid up to 170% FPL (it used to be 201% FPL but was dropped down to 155% a couple of years ago)
  • reinstating the ACA's individual mandate penalty (similar to what Massachusetts, New Jersey and DC have done and what California is in the process of doing)
  • implementing a state-level reinsurance program (as over a half-dozen states, including several GOP-controlled ones, have done)

Holy Smokes! Right on top of my post earlier today about nearly twenty healthcare/ACA bills being pushed through the California legislature, here's a similar story about another batch of ACA improvement/protection bills being pushed through the New Jersey state assembly! via Lilo Stainton of NJ Spotlight:

Democratic lawmakers introduced a dozen bills late last week to create the infrastructure, funding, and regulatory structure for a state-based system that would enable New Jersey officials to create, market, and sell health insurance policies to low-income individuals and small businesses with fewer than 50 employees.

Last October, shortly before the midterm election, Democratic gubernatorial nominee Ned Lamont of Connecticut announced that if elected, he'd push hard for a robust reinsurance program along the lines of other states which have successfully implemented reinsurance 1332 waivers under the ACA:

HARTFORD, CT — Democratic gubernatorial candidate Ned Lamont has much lower expectations for what he’s going to be able to do to improve the health of Connecticut residents than one might expect from a Democratic candidate this year.

Sounds like Lamont would not push for CT to reinstate the ACA individual mandate penalty:

...Does he believe everyone in Connecticut has to purchase health insurance now that it’s not mandated by the federal government?

I didn't write about this yesterday because I was both swamped and a little confused about how the various bills were being packaged and voted on, but I think I have it straightened out now.

Back on March 26th, the House Democrats formally rolled out H.R. 1884. The official title of this bill is the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019", or PPECMHCMAA, which is terrible, so I've simply shorthanded it as "ACA 2.0".

HR 1884 is actually more of a catch-all collection of a dozen or so smaller, standalone ACA improvement bills, each of which either repairs an ACA provision which has been damaged or sabotaged in the past; protects an existing ACA provision from future sabotage; or strengthens & enhances the ACA going forward.

A little over a year ago, on March 21, 2018, Sen. Elizabeth Warren introduced a robust ACA 2.0 upgrade bill in the U.S. Senate called the "Consumer Health Insurance Protection Act", or CHIPA. It was largely a companion bill to a House version which had been introduced a couple of weeks earlier by Reps. Frank Pallone, Bobby Scott and Richard Neal, although there were some significant differences as well.

At the time, I noted that besides both bills including many "wish list" items which I've been hoping would be added to the ACA for several years now, Warren's Senate CHIPA bill was also noteworthy for one other reason: The list of cosponsors:

...Sanders is actually a co-sponsor of the Warren bill, as are Democratic Sens. Kamala Harris (Calif.), Maggie Hassan (N.H.), Kirsten Gillibrand (N.Y.) and Tammy Baldwin (Wis.).

Saturday, May 18th, 9:00am: Fems for Change: Healthcare, Who Knew It Could Be So Complicated?

  • Birmingham First United Methodist Church, 1589 W. Maple Rd., Birmingham, MI 48009

Turn on the TV, open a newspaper, browse social media: everyone is talking about new ideas for expanding American healthcare coverage. As consumers and voters, it can be hard to know which option is best for our families, our neighbors, and our nation.

This timely forum will help you make sense of Medicare for All; Medicare and Medicaid Buy-Ins; adding public plan features to private insurance; improving the Affordable Care Act (ACA); and other options discussed in the media.

 

As I'm typing this, the House Energy & Commerce Health Subcommittee is holding markup hearings regarding twelve different healthcare-related bills. The first six relate to prescription drug pricing and regulation, and some of them appear to have genuine bipartisan support.

The other six are directly related to the ACA...these are the six "mini ACA 2.0" bills which cover six of the eleven ACA repairs & improvement provisions included the the larger ACA 2.0 bill introduced yesterday. Here's summaries of all twelve bills being debated today:

 

Most people know that over the past three years, I've gone from being a fan of Vermont U.S. Senator Bernie Sanders to...well, not being a fan; let's just leave it at that. They also know that while I support an eventual move towards a single payer-based healthcare system, I simply feel that it will have to be achieved via incremental steps (preferably large steps, not baby ones).

However, for the past year, I've repeatedly made sure to temper my concerns and criticisms of Sen. Sanders views by making sure to note that Bernie himself cosponsored the Senate version of ACA 2.0 introduced by Sen. Elizabeth Warren, aka the Consumer Health Insurance Protection Act, or CHIPA.

I addressed this point at the time in response to earlier attacks on me by MFA purists:

I need to take a moment here to call out progressives who badmouthed and scolded me last week for promoting the House ACA 2.0 bill by insisting that ONLY Bernie's M4A bill will do, and ANYTHING short of that--even in the short term--is unacceptable.

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

NOTE: This was originally posted just before H.R. 1868 was introduced, and was based on a prior version of the legislation from 2018 called H.R.5155. Everything below has been updated to reflect the 2019 version of the legislation in question.

On Saturday, the 9th Anniversary of the Patient Protection and Affordable Care Act being signed into law, the news broke that on Tuesday, House Speaker Nancy Pelosi and other House Democratic leaders will be formally rolling out some sort of major "ACA 2.0" legislation:

Pelosi, House Democrats to Unveil Sweeping Legislation to Protect People with Pre-Existing Conditions and Lower Health Costs

UPDATE 3/26/19: I'm watching the actual press conference right now. I just wanted to note that there will likely be a few changes/tweaks in the bill/bills introduced today vs. last year's H.R.5155, but it sounds like it'll be about 95% the same. More details this evening.

Back in early January, in an MSNBC interview with Joy Reid, House Speaker Nancy Pelosi noted that she did indeed intend on moving on legislation to, at the very least, raise or remove the ACA subsidy income threshold to allow financial assistance to be available to more people:

The new Speaker of the U.S. House of Representatives said this weekend she wants changes in the income threshold to allow more Americans to gain subsidies so they can buy individual coverage known as Obamacare. Helping more people get subsides are among the "couple of things" she would like to do to improve the ACA and expand health coverage to more Americans, Pelosi, a California Democrat, told MSNBC Friday night.

With useful healthcare legislation extremely unlikely to pass the U.S. Senate until at least 2021, state-based public options will be all the rage for the next couple of years...

Connecticut lawmakers are joining other states that have unveiled proposals to expand government-run health coverage, with plans to extend state health benefits to small businesses and nonprofits, and to explore a public option for individuals.

Under two measures announced Thursday, officials would open the state health plan to nonprofits and small companies – those with 50 or fewer employees – and form an advisory council to guide the development of a public option. The legislation would allow the state to create a program, dubbed “ConnectHealth,” that offers low-cost coverage to people who don’t have employer-sponsored insurance.

Regular readers know that I've been calling for Congress to #KillTheCliff for years:

Once again: Under the ACA, if you earn between 100-400% FPL (between $12,140 and $48,560 for a single person), you're eligible for APTC assistance on a sliding scale. The formula is based on the premium for the Silver "benchmark" plan available in your area, which averages around $611/month in 2019.

Here's how the formula works under the current ACA wording:

...Here's the problem: If they earn exactly 400% FPL ($48,560), they'll also only have to pay 9.86% ($4,802), receiving $2,530 in subsidies for the year....

 

I don't know what the status is of H.R. 5155 (the House Democrats catch-all "ACA 2.0" bill which I've been pushing for awhile now), but it looks like individual elements of it are also in the works as standalone bills:

HEARING ON “STRENGTHENING OUR HEALTH CARE SYSTEM: LEGISLATION TO LOWER CONSUMER COSTS AND EXPAND ACCESS”

Date: Wednesday, March 6, 2019 - 10:00am
Location: 2123 Rayburn House Office Building
Subcommittees: Health (116th Congress)

The Health Subcommittee with hold a legislative hearing on Wednesday, March 6, at 10 am in the John D. Dingell Room, 2123 Rayburn House Office Building. The hearing is entitled, “Strengthening Our Health Care System: Legislation to Lower Consumer Costs and Expand Access.” The bills to be the subject of the legislative hearing are as follows.

Over at Balloon Juice, David Anderson notes that the Blue Cross & Blue Shield Association has released their own "ACA 2.0" proposal...and many elements line up pretty closely to my own vision of what ACA 2.0 should look like as well as both the House (H.R. 5155) and Senate (S.2582) Dem versions. Here's Anderson's summary of the BCBSA proposal:

  • Younger adults pay a lower percentage of their income (at a given level) for the benchmark plan
  • Older adults are held harmless
  • All individuals, regardless of income, are eligible for subsidy assistance
  • CSRs appropriated
  • CSRs expanded
  • Full advertising and outreach funded
  • Health insurance premium tax suspended

...It looks like the insurers are trying to lay markers for where they want to see things in 2021 or 2022. They are looking at a fix and expansion of the current paradigm instead of a complete replacement of the system.

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