18 State-Based #ACA exchange send blistering letter denouncing the House GOP budget bill

The following letter was just sent to both Republican House Speaker Mike Johnson and Democratic House Minority Leader Hakeem Jeffries:

Dear Speaker Johnson and Leader Jeffries:

For over a decade, State-Based Marketplaces have provided private health coverage to tens of millions of Americans, ensuring their health, well-being, and economic security. The Americans who depend on the Marketplaces include working parents, small business owners, farmers, gig workers, early retirees, and lower and middle-class individuals of all ages, political views, and backgrounds who drive our local economies and make both our rural and urban communities thrive.

The legislation under consideration in the House will severely impact the ability of these millions of Americans to continue to access this coverage and the health and financial security they depend on today. This will make for a sicker, less financially secure American public and strain hospitals and health care providers by increasing uncompensated care.

The stability of the American health care system and the economic security of millions of Americans are on the line due to the proposed changes to Marketplaces, and this risk is further compounded by proposed cuts to Medicaid and the impending expiration of Enhanced Premium Tax Credits.

The current House bill:

• Restricts eligibility for affordable health coverage for millions of Americans in Marketplace coverage today, moving them from being insured to uninsured.

• Imposes unprecedented red tape on private health insurance, making it virtually impossible to enroll and stay covered. Of particular concern, people losing jobs will be forced to wait months for coverage to begin while the government processes paperwork.

• Significantly reduces support to lower Americans’ health care costs at a time when Americans are facing high and rising prices at the grocery store and for other essential household goods.

• Removes state flexibility and autonomy, including top-down, federally mandated restrictions on when people can enroll.

• Exposes Marketplace consumers to higher costs and unexpected financial burdens when income changes.

• Makes Marketplace coverage, which covers 7 percent of the American public, the most costly, onerous, and volatile source of health coverage compared with all other coverage types including Medicare, Medicaid, and employer-sponsored coverage.

These proposals, in total, will drastically diminish the progress on health coverage that the United States has made in the last decade via Marketplaces. Only the sickest patients may remain in the Marketplaces, skyrocketing costs for everyone. Millions of Americans will lose their health coverage, local hospital systems will face unprecedented financial strain, state operational costs will spike in order to implement burdensome new federal rules, and all of this is likely to result in insurance carriers pulling out of local insurance markets. Some states may even be forced to walk away from State-Based Marketplaces entirely.

We are available to answer any questions you have about the vital concerns we share on behalf of the millions of Americans to whom we collectively provide health coverage and financial security, and also the rest of the nation that will be affected by the health system instability, increased cost, and worsened health outcomes this could instigate.

(signed, the Directors/CEOs/Administrators of Covered California, MNsure, Maryland Health Benefit Exchange, Oregon Health Insurance Marketplace, MA Health Connector, BeWellNM, NY State of Health, Your Health Idaho, DC Health Benefit Exchange Authority, HealthSource RI, Access Health CT, Virginia Health Benefit Exchange, Connect for Health Colorado, Office of the Health Insurance Marketplace (CoverME), Dept. of Vermont Health Access, Pennsylvania Health Insurance Exchange Authority (Pennie), Washington Health Benefit Exchange and the New Jersey Dept. of Banking & Insurance (GetCovered NJ))

Aside from the letter itself, which is pretty self-explanatory, it's also mildly interesting to note which of the 20 state-based ACA marketplaces (SBMs) are listed as signatories...as well as which ones aren't.

Seventeen out of twenty are listed; the three missing are Georgia, Kentucky and Nevada. Georgia not being listed may not seem surprising considering that it's a GOP-run state...except that Idaho's exchange is listed, and the Gem State is far deeper red than the Peach State. Also, neither Kentucky (red state, Democratic governor) nor Nevada (purple state, Republican governor) signed it either, so I don't think there's anything ideological going on here.

It's also interesting to see Oregon listed, even though they aren't even a state-based exchange yet (OR isn't transitioning off the federal marketplace until the 2027 Open Enrollment Period), while Illinois isn't, even though they're moving to full SBM status this fall.

My guess is that none of that means much; it's possible that there was just a communications error & the heads of the remaining exchanges just didn't manage to give their official approval to be added as signatories before the letter had to be sent out.