AmRescuePlan

(sigh) The Sword of Damocles continues to dangle over the head of the Affordable Care Act. This time it isn't about an existential threat to the PPACA, at least...but the expanded/enhanced subsidies which were put into place temporarily by the American Rescue Plan (ARP) are definitely at risk.

Just a week or so ago, things were looking promising...

Conversations are underway between Joe Manchin III, D-W.Va., and Senate Majority Leader Charles E. Schumer to negotiate a budget reconciliation bill, which would require only a simple majority for passage, that would meet Manchin’s demands without losing support from other Democrats.

...Another Manchin condition is that the measure avoid any “cliffs” that sunset new programs early to keep the price tag down, something Manchin argues artificially hides the true costs since programs will prove too popular not to extend.

via John Wilkerson of Inside Health Policy:

House Speaker Nancy Pelosi (D-CA) said Thursday (June 16) that budget reconciliation legislation might not extend an increase in subsidies for health exchange insurance premiums; the subsidies are needed to avert a spike in Obamacare insurance rates right before the midterm elections.

...When a Punchbowl News reporter asked Thursday about that meeting and whether a reconciliation deal is expected soon, Pelosi’s response was, “It’s alive.”

“There are certain concerns we have about subsidies in the health care bill and the rest, which may or may not be in the negotiations,” she said.

...President Joe Biden included drug pricing reform in an inflation-fighting proposal released over the weekend -- but his plan did not mention the enhanced ACA credits, raising some eyebrows.

..Democrats had counted on drug price controls to pay for the enhanced ACA subsidies, but Manchin recently said the subsidies did not come up in his talks with the White House.

I haven't written about the ACA's Medical Loss Ratio (MLR) rule in awhile. I was pretty obsessed with it a few years ago, and I still check in on it from time to time, but otherwise I've mostly moved on to other things.

HOWEVER, the MLR rule is still pretty important...and while the dollar amounts I'm about to discuss aren't much more than a rounding error in terms of federal budget numbers, it's possible that the could play a small role in helping get a much larger project moving forward.

Before I begin, here's a short refresher on how the MLR rule works:

ACA Signups Logo

Last week the Centers for Medicare & Medicaid posted a new press release about a new report from the HHS's Assistant Secretary for Planning & Evaluation (ASPE) which has updated ACA-specific enrollment data current as of October 2021 - March 2022:

New Reports Show Record 35 Million People Enrolled in Coverage Related to the Affordable Care Act, with Historic 21 Million People Enrolled in Medicaid Expansion Coverage

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Last June, the U.S. Health & Human Services Dept. confirmed my estimate that total enrollment in healthcare policies either specifically created by (or expanded to more people by) the Affordable Care Act had broken 31 million Americans:

Today, the U.S. Department of Health and Human Services (HHS) released a new report that shows 31 million Americans have health coverage through the Affordable Care Act – a record. The report also shows that there have been reductions in uninsurance rates in every state in the country since the law’s coverage expansions took effect. People served by the health Marketplaces and Medicaid expansion have reached record highs.

HHS's breakout was fairly close to mine, though they had enrollment a bit higher in some categories and a bit lower in others:

And there it is:

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via MNsure:

ST. PAUL, Minn.—New data released by the Minnesota Department of Health shows actions taken by state officials and the Biden administration helped drop the state’s uninsured rate in 2021 to 4.0%, the lowest level ever measured.

“The Minnesota Heath Access Survey shows that more Minnesota families have been able to access and maintain their health insurance during this critical time,” said MNsure CEO Nate Clark. “Minnesota has been able to reduce the uninsured rate thanks in part to targeted, effective policies, including the expansion of premium tax credits that lower the cost of monthly premiums for private health plans available through MNsure.”

Way back in the summer of 2020, then-Presidential candidate Joe Biden rolled out his official healthcare policy proposal. Part of the plan included the following:

Expanding coverage to low-income Americans. Access to affordable health insurance shouldn’t depend on your state’s politics. But today, state politics is getting in the way of coverage for millions of low-income Americans. Governors and state legislatures in 14 states have refused to take up the Affordable Care Act’s expansion of Medicaid eligibility, denying access to Medicaid for an estimated 4.9 million adults.

Biden’s plan will ensure these individuals get covered by offering premium-free access to the public option for those 4.9 million individuals who would be eligible for Medicaid but for their state’s inaction, and making sure their public option covers the full scope of Medicaid benefits. States that have already expanded Medicaid will have the choice of moving the expansion population to the premium-free public option as long as the states continue to pay their current share of the cost of covering those individuals.

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via Access Health CT:

  • More than 65,000 Access Health CT enrollees would be impacted

HARTFORD, Conn. (March 16, 2022) — Access Health CT (AHCT) today announced that more than 65,000 Connecticut residents would be negatively impacted by reduced or eliminated financial help for health insurance if the increased financial assistance from the American Rescue Plan Act (ARPA) expires at the end of 2022.

The $178 million per year ($14.8 million per month) of assistance residents receive through ARPA will end unless the enhanced premium tax credits continue past 2022 through federal legislation.

“Ending increased financial help would have a significant impact on Connecticut residents,” said James Michel, Access Health CT Chief Executive Officer, “including progress made toward addressing health disparities. The American Rescue Plan Act makes health insurance coverage more affordable and accessible – greatly reducing the impact of social determinants of health.” 

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January 10th was the last time that the Centers for Medicare & Medicaid Services (CMS) issued a detailed 2022 Open Enrollment Snapshot report which broke out 2022 ACA enrollment across every state.

As of 1/10/22, it had already reached an all-time record of nearly 14.9 million people (13.8 million via Qualified Health Plans, or QHPs, and another million or so who have enrolled in Basic Health Plans (BHPs) in Minnesota and New York specifically).

A few days later, CMS issued another update just ahead of the official January 15th OEP deadline (in most states) which updated the top line QHP tally to over 14.2 million. They broke this out by "over 10 million" enrollees on the federal exchange (HealthCare.Gov), plus another 4.2 million or more in the 18 states which operate their own ACA exchanges.

Tack on the 1.0M BHPs and that's at least 15.2 million nationally.

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