WHOA. Pelosi to move forward with House ACA 2.0 bill?

A couple of weeks ago, I noted that Speaker of the House Nancy Pelosi, in an interview airing on MSNBC, stated that two of the major pieces of healthcare legislation she intends on pushing through this session are raising the ACA's tax credit eligibility threshold and "replacing" the now-repealed ACA individual mandate (i was never sure whether "replacing" meant reinstating it or actually replacing it with some other enrollment incentive).

I realize that the odds of any useful healthcare legislation managing to pass the Senate and become law under the Trump Administration is pretty slim, but hey, it's still good news, right!

Well, that news just got a whole lot better! via Richard Alonso-Zaldivar of the AP:

Pushing her agenda, Pelosi is working from the ground up through major House committees. Her relationships with powerful chairmen and subcommittee chairs stretch back years. She's "playing chess on three boards at once," said Jim McDermott, a former Democratic congressman from Washington state, who predicts Pelosi's most difficult challenge will be "herding new members" impatient for sweeping changes.

Responding to written questions from The Associated Press, Pelosi called the ACA "a pillar of health and financial security," comparing it to Medicare, Medicaid and Social Security. "Democrats have the opportunity not only to reverse the years of Republicans' health care sabotage, but to update and improve the Affordable Care Act to further lower families' premiums and out-of-pocket costs, and expand coverage."

Legislation from Energy and Commerce Chairman Frank Pallone, D-N.J., Ways and Means Chairman Richard Neal, D-Mass., and Workforce and Education Chairman Bobby Scott, D-Va., would broaden the number of people who can get financial assistance with their premiums under the Obama health law, and undo the "family glitch" that prevents some from qualifying for subsidies. It would also restore the HealthCare.gov advertising budget slashed by Trump and block some of his administration's health insurance alternatives.

Those issues are separate from legal questions raised by ongoing Republican litigation to overturn the health law. The Democratic-led House has voted to intervene in the court case to defend the law.

The last bit is about the idiotic #TexasFoldEm court case, of course, but I'm gonna ignore that for the moment. Instead, let's focus on the "Legislation from Reps. Pallone, Neal & Scott.

Here's the bill which this is referring to...and in addition to "broadening the number of people who get financial assistance", "undoing the 'family glitch', restoring the HC.gov marketing budget and blocking #ShortAssPlans, it would do a lot more if it was passed and signed into law as is:

  • Restore CSR reimbursement payments (which by itself would help unsubsidized enrollees but hurt subsidized enrollees)
  • Fix the ACA's "Family Glitch"
  • Remove the 400% FPL income APTC subsidy cap (one of the most important measures to improve the ACA IMO)
  • Beef up the APTC subsidy formula (which, when done in coordination with restoring CSR payments would resolve the other half of the problem)
  • Raise the 250% FPL income CSR cap
  • Beef up the CSR subsidy formula
  • Fix/improve the ACA's "Silver Spam" loophole
  • Improve the ACA's "standardized plan" provision
  • Restore HealthCare.Gov's slashed marketing/advertising budget to pre-Trump levels
  • Restore HealthCare.Gov's slashed navigator/outreach budget to pre-Trump levels
  • "Further codify" Essential Health Benefit regulations which are being weakened around the edges by Trump's HHS Dept.
  • Restore Short-Term and Association Health Plan regulations to pre-Trump standards
  • Reinstate the ACA's national reinsurance program (it lasted 3 years originally, sunsetting at the end of 2016)
  • Add additional funding for state-level innovation programs
  • Restore federal funding to help states move off of HC.gov onto their own state-based exchanges
  • Audit HealthCare.Gov to see just how they're using the exchange user fees, which is something I've recommended for awhile now

That's a ton of awesome stuff in a single bill, and it would check off around half the items on my "If I Ran the Zoo" wish list from a couple of years back.

There's still a bunch of other stuff not included in the House bill which is included in the Senate ACA 2.0 bill from last year introduced by Senators Warren, Harris, Gillibrand, Hassan, Baldwin and (wait for it)...Sanders, including...

  • Tie Medicare Advantage contracts to ACA exchange participation in at-risk regions
  • Institute a $250/month cap on prescription drug costs for enrollees
  • Bump up the Medical Loss Ratio from 80% to 85% for the individual and small group markets, to match the large group market
  • Stop "bait-n-switch" of drug formularies in the middle of the year
  • Allow people to switch plans mid-year if their carrier cuts off their treatment mid-year
  • Require ample enrollee notification if a carrier changes their doctor/hospital network participation mid-year
  • Grant HHS the authority to veto excessive rate hikes (above/beyond the state regulator authority)
  • Tighten up network adequacy requirements
  • Make it easier for enrollees to opt out of auto-renewal
  • Eliminate the 50% smoker premium surcharge
  • Require more prominent insurance policy information
  • Outlaw "surprise" and "balance billing"

...but hey, you can't have everything, right?

Anyway, stay tuned...