One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).
I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):
A couple of weeks ago I wrote about how the Georgia state government, which for years has been among the more ACA-hostile GOP states, and which has spent the past several years actively attempting to get out of having any official ACA exchange platform whatsoever, has seemingly done a complete 180 and now supposedly wants to go the other way:
Georgia GOP leaders have proposed a bill that they hope will lead to a state takeover of the health insurance exchange marketplace for Affordable Care Act plans.
...Traditionally a majority of Georgians shop for ACA plans on the federally run marketplace website, healthcare.gov. Eighteen states use their own marketplace website, according to the Kaiser Family Foundation. The key feature of these sites is they allow shoppers to objectively compare their options for price and coverage.
It’s unclear exactly what the state’s replacement would be.
Georgia GOP leaders have proposed a bill that they hope will lead to a state takeover of the health insurance exchange marketplace for Affordable Care Act plans.
...Traditionally a majority of Georgians shop for ACA plans on the federally run marketplace website, healthcare.gov. Eighteen states use their own marketplace website, according to the Kaiser Family Foundation. The key feature of these sites is they allow shoppers to objectively compare their options for price and coverage.
It’s unclear exactly what the state’s replacement would be.
The Georgia Access model would eliminate the use of HealthCare.gov, transitioning consumers to decentralized enrollment through private web-brokers and insurers. The state would establish its own subsidy structure to allow for 1) the subsidization of plans that do not comply with all the ACA’s requirements; and 2) enrollment caps if subsidy costs exceed federal and state funds.
There's not a single part of the paragraph above which shouldn't be setting off major alarms:
The Georgia Access model would eliminate the use of HealthCare.gov, transitioning consumers to decentralized enrollment through private web-brokers and insurers. The state would establish its own subsidy structure to allow for 1) the subsidization of plans that do not comply with all the ACA’s requirements; and 2) enrollment caps if subsidy costs exceed federal and state funds.
There's not a single part of the paragraph above which shouldn't be setting off major alarms:
The Georgia Access model would eliminate the use of HealthCare.gov, transitioning consumers to decentralized enrollment through private web-brokers and insurers. The state would establish its own subsidy structure to allow for 1) the subsidization of plans that do not comply with all the ACA’s requirements; and 2) enrollment caps if subsidy costs exceed federal and state funds.
There's not a single part of the paragraph above which shouldn't be setting off major alarms:
One of the most inane restrictions of the ACA in my view, as I noted in my "If I Ran the Zoo" wish list back in 2017, is that it doesn't allow undocumented immigrants to enroll in ACA marketplace health plans ("Qualified Health Plans" or QHPs).
I don't just mean that they aren't eligible for federal financial subsidies--that's a prohibition which I can at least understand, even if I don't agree with it. I mean that they aren't allowed to enroll in ACA exchange-based QHPs even at full price, as noted in Section 1312(f)(3):
(3) Access limited to lawful residents.--If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange.
About 2 years ago, GOP Georgia Governor Brian Kemp submitted an ACA Section 1332 Waiver request to the Centers for Medicare & Medicaid Services. As Katie Keith of Health Affairs explained at the time, it consisted of two parts...the first of which was fairly noncontroversial, the second of which was...well, not good:
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.
UPDATE 12/17/21: I've already submitted my comment to the Health & Human Services Dept. Now, the National Health Law Program’s My Care Counts project has created an easy-to-use public comment tool for you to submit your own. PLEASE DO SO before January 9th!
MAKE SURE *NOT* TO USE THE GENERIC DEFAULT LANGUAGE IN THE FORM, HOWEVER; MAKE IT YOUR OWN.
See the rest of the post below for the background/details on this issue.
About 2 years ago, GOP Georgia Governor Brian Kemp submitted an ACA Section 1332 Waiver request to the Centers for Medicare & Medicaid Services. As Katie Keith of Health Affairs explained at the time, it consisted of two parts...the first of which was fairly noncontroversial, the second of which was...well, not good:
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.
