ACA 2.0

Earlier this evening, the House Ways & Means Committee formally published the markup of nine legislative provisions which, if they all survive the process, will make up roughly half of President Biden's proposed $1.9 trillion COVID-19 relief package, aka the American Rescue Plan:

The Ways and Means’ proposals comprise half of the $1.9 trillion Democratic COVID-19 relief package

SPRINGFIELD, MA – Today, House Ways and Means Committee Chairman Richard E. Neal (D-MA) announced the Committee will consider nine legislative proposals under the budget reconciliation instructions this week as the next step in delivering COVID-19 relief to the American people. Beginning on Wednesday, February 10, 2021 at 10:00 a.m. through Friday, February 12, 2021, the Committee will markup proposals spanning from extending unemployment insurance to expanding the child tax credit to delivering another round of direct assistance to struggling Americans.

The other day I posted a detailed look at just how much various households could save in premiums if H.R. 369, Rep. Lauren Underwood's Health Care Affordability Act of 2021, were to be passed and signed into law by President Biden. I used 8 different household examples, and based the savings on the national average 2021 benchmark premium for a single 40-year old, according to the Kaiser Family Foundation.

The households I used include:

UPDATE: Everything below refers to HR 369, but the American Rescue Plan, HR 1319, contains a virtually identical expansion of ACA subsidies...if only for two years.

Note that under HR 1319 (AmRescuePlan), the first year would be retroactive, meaning that current ACA enrollees should receive additional subsidies dating back to January 2021, though I don't know what form that will take...rebate checks, credit towards future premiums or an extra tax refund next spring.

Over the past couple of years, one of the things I've become known for is my obsessive fixation on visually displaying how much various households would save on healthcare premiums if various ACA subsidy-boosting bills were passed compared with the current ACA subsidy structure.

Back on January 14th, I noted that President Biden's proposed $1.9 trillion American Rescue Plan includes a couple of interesting ACA-specific provisions:

Roughly two to three million people lost employer sponsored health insurance between March and September, and even families who have maintained coverage may struggle to pay premiums and afford care. Further, going into this crisis, 30 million people were without coverage, limiting their access to the health care system in the middle of a pandemic. To ensure access to health coverage, President-elect Biden is calling on Congress to subsidize continuation health coverage (COBRA) through the end of September. He is also asking Congress to expand and increase the value of the Premium Tax Credit to lower or eliminate health insurance premiums and ensure enrollees - including those who never had coverage through their jobs - will not pay more than 8.5 percent of their income for coverage.

Together, these policies would reduce premiums for more than ten million people and reduce the ranks of the uninsured by millions more.

Note: This is the second or third time that I'm cribbing a bit from my friend & colleague Andrew Sprung over at Xpostfactoid. If you like my healthcare policy analysis/writing style and follow me on Twitter, you should follow him at @xpostfactoid as well.

Over at Xpostfactoid, Andrew Sprung beat me to the punch by several days with an excellent two-part look at the "ACA 2.0 Hunger Games" scenario.

During the Democratic primary season, I posted a simple graph which boiled down the four major types of healthcare policy overhaul favored by the various Democratic Presidential candidates...which also largely cover the gamut of systems preferred by various Democratic members of the House and Senate.

As I noted a year and a half ago in my analysis of Joe Biden's healthcare policy proposal, two major chunks of his plan are taken straight out of the House Democrats ACA 2.0 bills from 2018 & 2019 and from the Elizabeth Warren's ACA 2.0 bill in the Senate (CHIP, or the Consumer Health Insurance Protection Act). In fact, these two particular proposals were even part of Hillary Clinton's 2016 health plan, and originated way back in 2015 under a proposal by the Urban Institute:

It's been a solid year since Joe Biden rolled out his own official healthcare policy proposal. I did a fairly in-depth writeup on it last summer, but it's the understatement of the year to say that "a lot has changed since then".

The two most obvious developments on this front are 1. Biden has gone from one candidate of two dozen to being the presumptive Democratic Nominee; and 2. The COVID-19 pandemic has completely upended not only the Presidential race but the economy and the entire U.S. healthcare system. A third important (if less consequential) development is that the House has actually passed their own "ACA 2.0" bill in the form of H.R. 1425, the Affordable Care Enhancement Act, which partially overlaps Biden's healthcare plan.

Last evening, over three years after I posted my "If I Ran the Zoo" wish list of recommended improvements for the ACA, the U.S. House of Representatives finally passed H.R. 1425, the Patient Protection & Affordable Care Enhancement Act (#AHEA), which I simply dub "ACA 2.0":

House Democrats on Monday passed a bill that would bolster the Affordable Care Act by hiking premium subsidies and incentivizing states to expand Medicaid.

I wrote up a detailed, step-by-step explainer of all 30 provisions of the ACEA last week, and couldn't be happier to see it finally pass through at least one Congressional body.

Unfortunately...

OK, this surprised me a bit: #HR1425, the Patient Protection & Affordable Care Enhancement Act, has already received a 10-year budgetary impact score from the Congressional Budget Office. I don't think this is a formal score--the whole thing is only five pages and includes minimal text accompanying it, so it might be just a "draft" score or something. I presume that if Mitch McConnell were to shock everyone and actually give it a vote in the Senate (which won't happen), there would likely have to be a second, more elaborate scoring process done by the CBO first. Then again, perhaps not.

Anyway, in a nutshell, the CBO report on the House version of H.R. 1425 comes to the following conclusions regarding the budget impact and other, related results of the bill being implemented nationally. Keep in mind that this assumes that the bill became law and was implemented starting in 2021; the score includes the 10 year period from 2021 - 2030:

TITLE I: Lowering Healthcare Costs & Protecting People w/Pre-Existing Conditions:

OK, I don't know if I "scooped" everyone with my H.R. 1425 explainer yesterday or what, but the House Energy & Commerce Committee just now sent out an official press release announcing the bill, along with a one-page summary, more detailed explainer and the link to the text itself. It's kind of interesting to see what language they use and which sections they emphasize, espeically as compared & contrasted with my own write-up:

Health Committee Chairs Unveil Legislative Package to Make Health Care & Prescription Drugs More Affordable

Legislation Also Expands Access to Health Care, Protects People with Pre-Existing Conditions & Reverses Administration’s Ongoing Sabotage of the ACA

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