All 50 states + DC have 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:
Note:A few weeks ago, I ran a rough back-of-the-envelope extrapolation of partial data from the first 2 weeks of the ongoing COVID Special Enrollment Period and concluded that IF enrollment via the 36 HealthCare.Gov states was representative nationally, and IF the pace of the last 2 weeks of February held perfectly steady, it would mean around 666,000 new enrollees via HC.gov and 832,000 nationally by the end of March. Those were two pretty big caveats, of course, and as you'll see below, the reality wasn't quite as eyebrow-raising, though it's still pretty impressive.
The bottom line is that a whole lot of people got both the numerator and denominator wrong: Instead of being ~$53 billion to cover ~1.3 million people (which would be an insane $40,000 per person for just six months), it's actually more like ~$61 billion to help cover ~18.6 million people (roughly $3,300 per person per year on average).
When the $1.9 trillion American Rescue Plan (ARP) achieved final passage on March 10th, it did so almost exclusively along party lines. I say "almost" because there was a single Democratic House member who voted against it: Representative Jared Golden (ME-02).
I fully understand the tightrope that some swing district Dems have to walk. To his credit, Rep. Golden voted to impeach Donald Trump not once, but twice (though he only voted in favor of one of the 2 articles of impeachment against him the first time around). I certainly don't expect every single Democrat to vote the party line on every single bill.
In the end, the bill passed anyway, if only by a handful of votes; my guess is that he even received Speaker Pelosi's unofficial blessing to vote against it, as long as she knew for sure it would pass regardless.
Everyone who spread this disinformation was getting both the numerator and the denominator wrong. In short, they were claiming that the federal government was going to spend up to $53 billion to provide healthcare coverage to a mere 1.3 million people for as little as a six-month period (which would amount to an insane $80,000 per year apiece if true...which it isn't).
As I explained in painstaking detail, the actual amount being spent per person is more like $3,300 apiece for anywhere from 14.2 million to 18.6 million people depending on whether you're going by the House or Senate CBO score (and the final version of the ARP was the Senate version).
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.
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:
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.
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
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).
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.
In 2019, CMS (2020b) began publishing its Quality Rating System (QRS) for incumbent insurers who sell qualified health plans in the individual market. This information includes scores for medical care, member experience, and plan administration which are then rolled up into an overall, global quality rating (GQR). Recent research has shown notable variation by plan characteristics for behavioral health quality (Abraham, et al., 2021) and plan administration scores (Anderson, et al., 2020). CMS hopes this information is used by consumers to make enrollment decisions.
This afternoon, the Congressional Budget Office released their 10-year "score" report of the largest single chunk of the House Democrats version of the American Rescue Plan from the Ways & Means Committee:
S. Con. Res. 5, the Concurrent Resolution on the Budget for Fiscal Year 2021, instructed several committees of the House of Representatives to recommend legislative changes that would increase deficits up to a specified amount over the 2021-2030 period. As part of this reconciliation process, the House Committee on Ways and Means approved legislation on February 10 and 11, 2021, with a number of provisions that would increase deficits. The legislation would extend unemployment benefits, establish a pandemic emergency fund, increase subsidies for health insurance, provide cash payments to eligible people, expand several tax credits, and modify rules for pensions, among other provisions designed to mitigate the impact of the COVID-19 pandemic caused by the coronavirus.
When President Biden announced that HealthCare.Gov would be re-launching an extended Special Enrollment Period in light of the ongoing COVID-19 pandemic, I wasn't surprised at all; in fact, I would have been shocked if he hadn't ordered the HHS Dept. to do so. I was surprised by how long the new COVID Enrollment Period would be: A full 3 months (I had been expecting either 30, 45 or perhaps 60 days at the outside).
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.
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.
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.
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.
CMS tells Inside Health Policy that Affordable Care Act enrollees who have reconciled their 2019 advanced premium tax credits (APTCs) as required can keep their 2021 subsidies, even if they were notified that they’re at risk of losing them, by checking a box on their exchange application. But Sen. Mark Warner (D-VA) tells IHP he wants the government to do more to help enrollees.
...The ACA requires exchange enrollees to estimate their next year’s income to determine their eligibility for tax credits and then reconcile that prediction with actual income during tax filing season. Regulations also require CMS to cut off future year tax credits if IRS data show that an applicant filed a return yet failed to reconcile their APTCs.
Amid a pandemic-stricken nation struggling to find ways to reopen, massive unemployment and employees lucky enough to have jobs hanging onto them as tightly as possible, New York health care strategists are floating a plan to offer health insurance tax credits assistance to loan-saddled college graduates who have no overage or fear of losing what they do have.
As envisioned in a new report released last week by the United Hospital Fund, recent college graduates could be allowed to deduct the monthly costs of their student loan payments from their total adjusted income as calculated under the Affordable Care Act.
Late last night, the U.S. Senate finally voted to approve a massive $2 TRILLION bailout/recovery bill in response to the Coronavirus pandemic. After a lot of haggling and drama, the final bill ended up passing unanimously, 96 - 0 (four Republican Senators weren't able to vote at all...due to being in self-isolation because of Coronavirus). It's expected to be quickly passed by unanimous consent in the House today and will presumably be signed by Donald Trump before nightfall.
And like that, the largest emergency economic influx bill in history is done.
There's a lot of explainers and thinkpieces being written about the bill as a whole...which elements are good, which are bad, which are flat-out offensive (especially the ~$500 billion in corporate giveaways, which still ended up in the final bill although they supposedly have some sort of oversight over which companies receive them and under what conditions), but my focus is of course on the healthcare aspects, and especially what it means for enrollment in ACA exchange plans and Medicaid via ACA expansion.
With the 2020 Open Enrollment Period rapidly approaching (it actually kicks off on October 15th in California, and on November 1st in every other state + DC), it's important to keep in mind that many people who didn't qualify for financial assistance in 2019 may qualify in 2020...and in some cases that could mean a difference of thousands of dollars due to how the ACA subsidy formula works and other factors.
First, a refresher on how the ACA formula works for Individual Market enrollees (that is, people who are looking to buy health insurance for themselves and/or their family who don't receive it through their employer, Medicare, Medicaid, CHIP or some other source).
Earlier this week, a picture of a letter sent to a patient needing a heart transplant recommending that they find a way to raise $10,000 to cover some costs went viral on Twitter and Facebook, with various celebrities, politicians etc. reposting it.
I'm sure you've seen it already, but just for the record, here's one of the most viral variants, from freshman Congresswoman-elect Alexandra Ocasio-Cortz. It's important to clarify that the letter was not sent by the insurance carrier, and the $10K in question would not be going to pay an insurance company...or, in fact, even "Spectrum Health" aka the "Heart & Lung Specialized Care Clinics" noted in the letterhead.
Insurance groups are recommending GoFundMe as official policy - where customers can die if they can’t raise the goal in time - but sure, single payer healthcare is unreasonable.
I just received the following from a healthcare broker, who I trust from past communication exchanges, who wishes to remain anonymous. I'm presenting it as sent, with the only changes being breaking it out into paragraphs for readability & with their state's identifying information removed.
Senate Democrats, led by Sen. Patty Murray, are pushing to increase the Affordable Care Act's subsidies as part of a stabilization bill being renegotiated with Sen. Lamar Alexander. This would mean increasing the amount of financial assistance people receive, as well as making it available to more people.
...“We’re interested in both expanding access to subsidies and increasing their value. You’ve got two different sets of populations that will be impacted in different ways depending on how cost sharing” is structured, a Democratic aide told me.