Back in late January, Senator Mark Warner of Virginia announced the introduction of a new-ish bill called the Health Care Improvement Act of 2021. Tell me if any of the major provisions look familiar:

  • Capping health care costs on the ACA exchanges
  • Establishing a low-cost public health care option
  • Authorizing the federal government to negotiate prescription drug prices
  • Allowing insurers to offer health care coverage across state boundaries
  • Supporting state-run reinsurance programs
  • Incentivizing states to expand Medicaid
  • Expanding Medicaid eligibility for new moms
  • Simplifying enrollment
  • Increasing Medicaid funding for states with high levels of unemployment
  • Reducing burdens on small businesses

NOTE: SEE SUMMARY TABLE IN UPDATE ALL THE WAY AT THE END.

I'm doing my best to stop myself from putting my head through a wall this weekend.

You may have seen this viral tweet making the rounds over the past day or so:

The Democrats just spent $52 billion to subsidize COBRA for 1.3 million people until September. That’s $40k per person for less than 6 months of health insurance. Most countries spend about $5-6k per person per year for universal healthcare.

— cabral (@axcomrade) March 12, 2021

This was posted at 12:22pm on Friday, March 12th, 2021. It's still live as of 11:00am on Sunday the 14th, has over 32,700 Likes and has been retweeted over 7,300 times as of this writing, but in case it's deleted by the time you read this, here's a screen shot:

HealthCare.Gov Logo

The Centers for Medicare & Medicaid Services (CMS) has just sent out guidance about how the newly-expanded & enhanced subsidies will work for those currently enrolled in (or newly enrolling in) healthcare policies via the federal ACA exchange, HealthCare.Gov.

It's important to note that the following guidelines only apply to residents of the 36 states hosted via HC.gov. The timing, policy and procedures for the new/expanded subsidies for residents of the 15 states which operate their own ACA exchanges may vary.

With that in mind, here's how CMS says things will work via HealthCare.Gov.

The first section is mostly just an overview of the ARP and a refresher on how ACA subsidies are calculated...

American Rescue Plan and the Marketplace

The New Law

President Biden

Yesterday I wrote a long, wonky post about an unusual case involving a legally-present (green card), unemployed Nigerian immigrant.

The short version is that because his income is so low, he normally wouldn't be eligible for ACA subsidies...except because he lives in Maryland, a Medicaid expansion state, he would normally be eligible for Medicaid...except that because he's an immigrant who's been in the United States for less than five years, he isn't eligible for Medicaid...except that, thanks to an obscure provision baked into the Affordable Care Act, he is eligible for ACA subsidies after all!

‘(B) SPECIAL RULE FOR CERTAIN INDIVIDUALS LAWFULLY PRESENT IN THE UNITED STATES.—If—

‘‘(i) a taxpayer has a household income which is not greater than 100 percent of an amount equal to the poverty line for a family of the size involved, and

The data below comes from the GitHub data repositories of Johns Hopkins University, except for Utah, which comes from the GitHub data of the New York Times due to JHU not breaking the state out by county but by "region" for some reason.

Important:

  • Every county except those in Alaska lists the 2020 Biden/Trump partisan lean; Alaska still uses the 2016 Clinton/Trump results (the 2020 Alaska results are only available by state legislative district, not by county/borough for some reason...if anyone has that info let me know)
  • I define a "Swing District" as one where the difference between Biden & Trump was less than 6.0%. FWIW, there's just 187 swing districts (out of over 3,100 total), with around 33.7 million Americans out of 332 million total, or roughly 10.2% of the U.S. population.
  • For the U.S. territories, Puerto Rico only includes the case breakout, not deaths, which are unavailable by county equivalent for some reason.

With those caveats in mind, here's the top 100 counties ranked by per capita COVID-19 cases as of Thursday, March 11th, 2021 (click image for high-res version).

  • Blue = Joe Biden won by more than 6 points
  • Orange = Donald Trump won by more than 6 points
  • Yellow = Swing District (Biden or Trump won by less than 6 points)

My biggest takeaway from the press releases below is that everyone will be made whole (that is, those eligible for additional subsidies or newly-eligible for subsidies at all will receive them in full), but that it may take anywhere from a few weeks to several months for that to happen, so cool your jets.

Covered California:

Covered California Hails the Signing of the American Rescue Plan Which Will Benefit Millions

SACRAMENTO, Calif. — Covered California’s executive director, Peter V. Lee, issued this statement following President Joe Biden’s signing of the American Rescue Plan. The landmark legislation provides new financial help to people who receive their health insurance through Affordable Care Act marketplaces like Covered California. The measure will lower health care costs by providing new and expanded subsidies to more Americans than ever before.

 

During the early days of the Affordable Care Act (and again during the insane "Repeal/Replace" saga of 2017), one of the dumbest and most disingenuous talking points of Republicans was to attack the ACA for being "too long."

I'm quite serious...many Very Serious Conservatives stroked their beards and wrung their hands over the sheer length of the ACA's legislative text (officially around 2,700 pages, though if you includ the mountain of regulations which are included with any major bill impacting hundreds of millions of people it could theoretically be tracked at 20,000 pages or so).

This silliness was most clearly expressed by Donald "Who?" Trump's first press secretary, Sean Spicer, who infamously put a copy of the House Republican's "replacement plan" (the AHCA) next to a copy of the ACA itself and cited the difference in pages between the two as some sort of "proof" that the AHCA was "better" for reasons unknown.

Anyway, the AHCA, Sean Spicer and Donald Trump are now gone, good riddance.

via MNsure:

Over 2,200 Minnesotans have signed up for health coverage through MNsure's special enrollment period so far

  • Special enrollment runs through May 17

ST. PAUL, Minn.—2,285 Minnesotans have signed up for private health insurance coverage since the start of MNsure's special enrollment period on February 16. This three-month special enrollment period, which runs through Monday, May 17, is available to any Minnesotan who is uninsured or who is not currently enrolled in a qualified health plan through MNsure. 

Minnesotans who want coverage to start on April 1 must enroll by 11:59 p.m. on Wednesday, March 31. Plans selected during the month of April will have an effective date of May 1, and plans selected by the May 17 deadline will have an effective date of June 1.

In early February, I posted a deep dive into HR 369, the Health Care Affordability Act, and how it would reduce net ACA premiums by permanently eliminating the income "subsidy eligibility cliff" (#KillTheCliff) and making the underlying subsidy formula more generous for all enrollees (#UpTheSubs).

I'm re-posting an updated, modified version of this analysis for two reasons:

  • First, because HR 1319, the American Rescue Plan, is about to actually pass and be signed into law, with a slightly different formula from HR 369 embedded within it (if only for two years).
  • Second, because my earlier analysis also threw in two other subsidy enhancement tables which confused the issue (California's state-based subsidies, and the predecessor to HR 369, both of which are/were less generous)

In this version I'm using the actual Advanced Premium Tax Credit (APTC) table under the American Rescue Plan, and I'm cutting out all references to the other two tables to avoid confusion.

Get Covered 2021!

 

Nearly every state (+DC) has re-opened enrollment on their respective ACA exchanges in response to both the ongoing COVID-19 pandemic and the American Rescue Plan (ARP), which substantially expands and enhances premium subsidies to millions of people!

If you've never enrolled in an ACA healthcare policy before, or if you looked into it years ago but weren't impressed, please give it another shot now. Thanks to the ARP (and some other reasons), it's a whole different ballgame this spring & summer.

Here's 10 important things to understand when you #GetCovered:

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