Charles Gaba's blog

Ever since the MAGA Murder Bill (officially H.R. 1, the so-called "One Big Beautiful Bill Act") was passed by Republicans in the U.S. Senate & House and signed into law by Donald Trump a few days ago, I've seen a growing conventional wisdom taking hold on social media: People keep claiming that either all, "nearly all" or at least "most of" the budget cuts & other gutting of various programs and departments won't actually kick in until after the November 2026 midterms.

Now, don't get me wrong--most of those making these claims are well-intentioned; they're saying this cynically, to underscore how disingenuous Congressional Republicans are by back-loading the pain until the midterms are safely in their rearview mirrors. And, to be fair, much of the damage won't being until well after next November.

Over at The New Republic, Greg Sargent has taken this thinking one step further, noting that by delaying so much of the ugliness of the new law until 2027 or beyond...

Originally posted 2/26/25

Political battles are usually won based on appealing to emotion, not to facts, policy or logic.

However, you should still have those facts at your disposal for two reasons: First, they still help you craft appeals to emotion. Second, they also help you craft the actual policy. Besides, I'm a data guy; my primary job is to help put facts & policy into easily-understandable context.

Over the past couple of months I've compiled a master spreadsheet breaking out enrollment in ACA plans (Qualified Health Plans & Basic Health Plans), Medicaid/CHIP coverage (both traditional & via ACA expansion) and Medicare (both Fee-for-Services & Advantage) at the Congressional District levels.

Every year, I spend months painstakingly tracking every insurance carrier rate filing (nearly 400 for 2025!) for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.

Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need.

I really only need three pieces of information for each carrier:

USE THE DROPDOWN MENU ABOVE TO PICK A STATE.

It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.

In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.

Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:

Originally posted 1/01/25

Louisiana has around ~293,000 residents enrolled in ACA exchange plans, 96% of whom are currently subsidized. I estimate they also have another ~13,000 unsubsidized off-exchange enrollees.

Combined, that's 306,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 286,000 statewide.

Originally posted 12/06/24

Maryland has around 247,000 residents enrolled in ACA exchange plans, 76% of whom are currently subsidized. I estimate they also have another ~73,000 unsubsidized off-exchange enrollees.

Combined, that's 320,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 300,000 statewide.

Originally posted 12/13/24

Michigan has around 531,000 residents enrolled in ACA exchange plans, 91% of whom are currently subsidized. I estimate they also have another ~64,000 unsubsidized off-exchange enrollees.

Combined, that's 595,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 556,000 statewide.

Originally posted 12/04/24

Massachusetts has around 390,000 residents enrolled in ACA exchange plans, 83% of whom are currently subsidized. I estimate they also have another ~27,000 unsubsidized off-exchange enrollees.

Combined, that's ~417,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to perhaps ~400,000.

Originally posted 1/09/25

Maine has around 64,000 residents enrolled in ACA exchange plans, 85% of whom are currently subsidized. I estimate they also have another ~4,500 unsubsidized off-exchange enrollees.

Combined, that's around 70,000 people, although it could be somewhat lower due to net enrollment attrition since January.

Originally posted 12/03/24

Minnesota has around 151,000 residents enrolled in ACA exchange plans, 61% of whom are currently subsidized. I estimate they also have another ~62,000 unsubsidized off-exchange enrollees.

Combined, that's ~213,000 people, although assuming the national average 6.6% net enrollment attrition rate applies, current enrollment would be back down to more like 200,000 statewide.

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