Last fall I wrote about Yet Another Sabotage Attack® on the ACA by the Trump administration, this time in the form of CMS Administrator Seema Verma completely warping the entire point behind the 1332 Waiver provision. Here's the backstory:

One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

Last September I noted that North Dakota was considering going one of two ways when it comes to making a major change in their individual insurance market: EIther joining over a half-dozen other states in pushing for a reinsurance program (which I strongly support doing), or going the other way and starting to offer weaker policies without some ACA protections the way states like Idaho, Tennessee, Iowa and Kansas either already do or are in the process of doing.

Fortunately, it looks like they ultimately decided to go the former route after all:

The bill started out on the right track...

Florida lawmakers approved a health insurance bill Wednesday that would require insurers keep covering pre-existing conditions if the Affordable Care Act disappears, though the bill would not keep protections in the federal law to control how much those patients can be charged.

...but quickly went off the rails after that:

The bill, Senate Bill 322, which the House approved by a 70-42 vote after the Senate passed it last week, would also expand short-term and association health plans and change requirements for “essential health benefits” covered by insurers, regardless of the status of the Affordable Care Act. It must be approved again by the Senate before it heads to Gov. Ron DeSantis for his signature.

A few minutes ago the Congressional Budget Office released a new report on a national, universal single payer healthcare system (commonly known as "Medicare for All" these days, although that's a bit of a misnomer since the proposed "Medicare for All" bills are quite different from today's definition of Medicare).

It's important to note that while this report came from the CBO, it is not a budget analysis of either the House or Senate MFA bills; it instead lays out the structural components which would be required to be in place in order to put such a system together and, I presume, in order to run such a budget analysis.

I'm swamped today between the rollouts of both the Choose Medicare Act and the revised Medicare for America Act as well as this new CBO report, so for the moment I'll just repost the summary and link to the report itself, along with a few notes as I'm able to add them:

NOTE: Back in January, I wrote up an extensive explainer about the "Medicare for America" (Med4Am) universal healthcare coverage bill introduced in December by Democratic Representatives (and Progressive Caucus members, I might add) Rosa DeLauro and Jan Schakowsky.

Regular readers know that I've been a fan of the basic #Med4Am framework for over a year, dating back to the "Medicare Extra for All" proposal introduced by the Center for American Progress (CAP) back in April 2018.

Yesterday, DeLauro & Schakowsky have introduced a modified, improved version of Medicare for America, with some important changes. I'm therefore posting an updated version of my January explainer of the bill, with notes about what's changed since the December version.

A little over a year ago, on March 21, 2018, Sen. Elizabeth Warren introduced a robust ACA 2.0 upgrade bill in the U.S. Senate called the "Consumer Health Insurance Protection Act", or CHIPA. It was largely a companion bill to a House version which had been introduced a couple of weeks earlier by Reps. Frank Pallone, Bobby Scott and Richard Neal, although there were some significant differences as well.

At the time, I noted that besides both bills including many "wish list" items which I've been hoping would be added to the ACA for several years now, Warren's Senate CHIPA bill was also noteworthy for one other reason: The list of cosponsors:

...Sanders is actually a co-sponsor of the Warren bill, as are Democratic Sens. Kamala Harris (Calif.), Maggie Hassan (N.H.), Kirsten Gillibrand (N.Y.) and Tammy Baldwin (Wis.).

NOTE: I'm adding some additional commentary to this post throughout the day, so reload it later on if you're curious about my thoughts, but I wanted to at least get the main info out there early.

Regular readers of this site know that I'm a big fan of Reps Rosa DeLauro & Jan Schakowsky's "Medicare for America" universal coverage bill, which is scheduled to be officialy re-introduced later on today (with some significant changes from the original version introduced back in December).

However, "Medicare for America" and "Medicare for All" are not the only "major healthcare reform" bills being tossed around DC these days. There's actually eight of them total (technically nine, but two of those are the House & Senate MFA versions, which are nearly identical). Of the eight, only two of them actually guarantee 100% universal healthcare coverage, which is part of the reason #MFA and #Med4Am receive so much attention.

Back in February, I issued a strong warning to House Democrats to proceed with caution when it comes to the prospect of agreeing to reinstate the Cost Sharing Reduction (CSR) reimbursement payments which Donald Trump cut off back in October 2017:

  • Had CSR reimbursement payments continued to be paid over the next decade, the CBO projected that it would have cost the federal government $118 billion between 2018 - 2026, or around $13 billion per year on average.
  • Cutting off CSR reimbursement payments saves the federal government that $118 billion over 9 years. HOWEVER...

 

Regular readers know that I'm a strong supporter of going with the "Medicare for America"-style approach to achieving universal heatlhcare coverage as opposed to the "Medicare for All" proposal. Regardless, this is still an historic moment in U.S. history:

Chairman McGovern, Congresswoman Jayapal, and Congresswoman Dingell Announce Historic Rules Committee Hearing on the Medicare for All Act

WASHINGTON, DC — Rules Committee Chairman James P. McGovern (D-MA), Congresswoman Pramila Jayapal (D-WA), and Congresswoman Debbie Dingell (D-MI) announced today that the House Rules Committee will hold an original jurisdiction hearing on the Medicare for All Act of 2019 on Tuesday, April 30th at 10am ET in H-313, The Capitol. It marks the first time Congress has ever held a hearing on Medicare for All. Witnesses will be announced later this week. 

Last week, Joan Alker of the Georgetown University Center for Children and Families noted that a whopping 840,000 children lost Medicaid or CHIP coverage in 2018:

We've taken a closer look at these #'s - check out your state below.
The net national # is 840k kids losing Medicaid/CHIP in 2018 not 860k as we said initially
But in the 39 states losing kids on Medicaid the net total # is worse -- 920,000

https://t.co/dOOD4gyAOw https://t.co/jhs22mNc0w

— Joan Alker (@JoanAlker1) April 26, 2019

There's a link to a whole analysis which breaks the numbers out by state:

We’ve been anxiously awaiting the release of final Medicaid and CHIP enrollment data for 2018, which was expected to be posted almost a month ago. The wait is finally over but not our concerns about what’s happening.

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