Charles Gaba's blog

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, by default, 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.

via the NJ Dept. of Banking & Insurance:

Governor Murphy and Acting Commissioner Zimmerman Announce Record-Breaking 397K People Signed Up for Health Insurance Through Get Covered New Jersey During Open Enrollment

  • Enrollment Up 61% Since the Murphy Administration Assumed Operation of the Health Insurance Exchange
  • Residents with a Qualifying Life Event or Who Meet Certain Income Levels Still Have Options to Get Covered

TRENTON —Governor Phil Murphy and Department of Banking and Insurance Acting Commissioner Justin Zimmerman today announced that more than 397,000 New Jerseyans signed up for health coverage through Get Covered New Jersey during the Affordable Care Act Open Enrollment Period, marking another year of historic enrollment in New Jersey.

The headline says 397K but it's actually just shy of 398K.

Just a week ago, I posted...

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

And just a few hours ago, I posted a piece headlined, "Which Holdout State Will Be Next To Finally Expand Medicaid??"

Well, it looks like we may have our answer already. Via Ashton Pittman of the Mississippi Free Press:

A Medicaid expansion bill will arrive in the Mississippi Senate by Monday, beginning a process that could provide health care to about 230,000 working Mississippians, Lt. Gov. Delbert Hosemann says.

I've butted heads with California Democratic Congressman Ro Khanna a few times, most notably nearly four years ago over his misrepresentation of the role private health insurance would play under a theoretical Bernie Sanders-style "Medicare for All" system.

However, I also believe in giving credit where its due, and a new bill introduced by Rep. Khanna (with 29 cosponsors, most of whom seem to be members of the Progressive Caucus, as you'd expect) seems petty damned reasonable to me:

State-Based Universal Health Care Act of 2023

via the North Carolina Dept. of Health & Human Services:

NC Medicaid Expansion Continues to Bring Health Care to More North Carolinians

PRESS RELEASE — As of Feb. 1, 2024, 346,408 newly eligible North Carolinians are enrolled in Medicaid and now have access to comprehensive health care, according to the North Carolina Department of Health and Human Services’ Medicaid Expansion Enrollment Dashboard. NCDHHS released an updated the dashboard today, and it includes enrollment data as of Feb. 1, 2024. This number is more than half of the anticipated 600,000 people who are newly eligible for coverage, expected to enroll in Medicaid expansion over the next two years.

"In the first two months we have already enrolled over half of the eligible people," said NC Health and Human Services Secretary Kody H. Kinsley. "These individuals and families are seeing providers, utilizing preventative and specialty care, and getting life-saving prescriptions."

via Covered California:

La versión en español de este Comunicado puede ser descargada en este enlace.

SACRAMENTO, Calif. — Covered California has opened the application process for its Navigator Program, with up to $33.9 million to be granted over the next three years to community organizations that help individuals and families become aware of and enroll in health insurance, with a focus on diverse and underserved communities.

The application process will run until March 15. For this Navigator Program funding cycle, the total annual budget has nearly doubled, increasing from $6.5 million to up to $11.3 million per year.

“Covered California’s success over the past decade is due in great part to the tremendous Navigator Program grantees that have helped Californians understand their health care options and get the coverage they need,” Executive Director Jessica Altman said. “The increased funding this year is a testament to the effectiveness of this program and will help strengthen our efforts to reach the most vulnerable Californians where they are.”

I've only written about the ACA's Affordability Threshold a few times before, usually regarding the so-called "Family Glitch." As explained by the always brilliant Louise Norris:

We still get calls on a regular basis from people who are shopping for individual insurance because adding dependents to their employer plan is prohibitively expensive. We estimate that roughly 20 percent of the people who contact us are in this situation.

Unfortunately, due to a “glitch” in the ACA, they are not eligible for premium subsidies in the exchange if the amount the employee has to pay for employee-only coverage on the group plan is deemed “affordable” – defined as less than 9.78 percent of household income in 2020.

Not content to let Georgia hog all of the state-sues-feds-over-low-income-healthcare-coverage-policy headlines, the state of Florida has also recently gotten into the act with their own federal lawsuit, this time over the Children's Health Insurance Program, or CHIP. Via Health News Florida:

Gov. Ron DeSantis’ administration has filed suit to challenge a new federal requirement that specifies when children can be removed from the state’s Children’s Health Insurance Program.

...At issue is a Biden administration rule that took effect Jan. 1 requiring states to provide 12 months of continuous eligibility for enrollees ages 18 and younger under Medicaid and CHIP, even if monthly premiums are not paid.

Georgia is one of just ten remaining states which is still holding out on fully expanding Medicaid to all legal residents earning up to 138% of the federal poverty level under the Affordable Care Act. Instead, back in 2019, GOP Georgia Governor Brian Kemp submitted a Section 1115 waiver which included a plan to partially expand Medicaid to some uninsured Georgia residents...except with a work reporting requirement for enrollees attached to it.

The program was called "Georgia Pathways," it was approved by the Trump Administration, and unlike several other states which had work requirement provisions shot down by various judges, Georgia's managed to slip through. It was scheduled to go into effect in 2021 and was supposed to be valid until September 30, 2025 before having to be resubmitted for renewal.

The incoming Biden Administration's HHS Dept. put the kibosh on the work requirement provisions of the program. Georgia successfully challenged the administration and Georgia Pathways went into effect last summer...but is still currently scheduled to sunset next September.