Urban Institute

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

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:

In 2018, unsubsidized premiums for ACA-compliant individual healthcare policies have shot up by around 30% on average nationally. Around 18 points of this (60% of the total) is due specifically to policy decisions by the Trump Administration and Congressional Republicans, primarily the cut-off of Cost Sharing Reduction reimbursement payments and the (accurate, as it would later develop) anticipation, by some carriers, of the ACA's individual mandate being repealed.

What about 2019, however? The 2-3 points tacked on out of concern for the mandate being repealed was only a small portion of the full impact insurance carriers expect it to have, and of course there's the further undermining of the ACA via Donald Trump's "Short Term" and "Association Plan" executive orders. Finally, there's the impact of what is assumed to be another year of the advertising/outreach budget being starved by the Centers for Medicare & Medicaid.