APTC

American Rescue Plan Subsidies

For years now, I've been a tireless advocate for dramatically expanding & improving the Affordable Care Act's Advance Premium Tax Credit (APTC) formula. This is the table which determines a) just how generous the ACA's health insurance premium tax credits are at different income levels and b) how far up the income ladder those financial subsidies extend.

Just over a year ago, the American Rescue Plan (ARP), passed by Democrats in Congress and signed into law by President Biden, did exactly what I've been clamouring for all this time: It made ACA subsidies far more generous while also removing the completely arbitrary income eligibility cut-off threshold (otherwise known as the "Subsidy Cliff."

As a refresher, the way the ACA subsidies work is as follows:

Access Health CT Logo

via Access Health CT:

  • More than 65,000 Access Health CT enrollees would be impacted

HARTFORD, Conn. (March 16, 2022) — Access Health CT (AHCT) today announced that more than 65,000 Connecticut residents would be negatively impacted by reduced or eliminated financial help for health insurance if the increased financial assistance from the American Rescue Plan Act (ARPA) expires at the end of 2022.

The $178 million per year ($14.8 million per month) of assistance residents receive through ARPA will end unless the enhanced premium tax credits continue past 2022 through federal legislation.

“Ending increased financial help would have a significant impact on Connecticut residents,” said James Michel, Access Health CT Chief Executive Officer, “including progress made toward addressing health disparities. The American Rescue Plan Act makes health insurance coverage more affordable and accessible – greatly reducing the impact of social determinants of health.” 

Open Enrollment 2022

IMPORTANT: The official 2022 Open Enrollment Period has now ended in most of the country, but there's 8 states where residents still have time to #GetCovered, with their new healthcare policies going into effect starting either February 1st or March 1st.

The 2022 OEP is by far the best ever for the ACA coverage, with dramatically expanded financial help for millions more people (including many who weren't eligible last year), reinvigorated expert, unbiased assistance, more choices in many states and counties, and FREE policies for more people than ever before.

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 American Rescue Plan (ARP), it's a whole different ballgame.

Here's some important things to know when you #GetCovered for 2022:

Open Enrollment 2022

Monday, November 1st was the start of the official 2022 #ACA Open Enrollment Period (OEP) for anyone who needs quality, affordable healthcare coverage. The 2022 OEP is by far the best ever for the ACA coverage, with dramatically expanded financial help for millions more people (including many who weren't eligible last year), reinvigorated expert, unbiased assistance, more choices in many states and counties, and FREE policies for more people than ever before.

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 American Rescue Plan (ARP), it's a whole different ballgame.

Here's some important things to know when you #GetCovered for 2022:


1. RESIDENTS OF MOST STATES HAVE MORE TIME, BUT YOU STILL SHOULDN'T DELAY!

Get Covered 2021!

As of midnight on August 15th, the Big Deadline for the 2021 "No Excuse Needed" ACA Special Enrollment Period has come and gone in most states.

HOWEVER, you can still #GetCovered for the rest of 2021 in a few states (including two of the largest ones), and there are still millions of uninsured Americans nationally who are eligible for ACA-compliant coverage for the rest of this year via other options. Let's review!

2021 ACA Special Enrollment Period (SEP): If you live in California, Connecticut, the District of Columbia, New Jersey, New York or Vermont, the deadline for the "no questions asked" SEP goes beyond 8/15. In CA, DC & NY it actually runs through the end of the year!

CMS Logo

 

Thanks to Amy Lotven of Inside Health Politics for the heads up:

CMS Thursday (July 15) announced a new advertising campaign that will run in the final 30 days of the special enrollment period slated to end Aug. 15, and the agency also confirmed Inside Health Policy’sreport that the agency plans to auto-adjust tax credits for consumers who do not return to the federal marketplace starting Sept. 1.

Sure enough, this press release was put out by CMS earlier today:

ACA Logo

Earlier today, Greg Fann asked a fair question:

Any data on % of exchange enrollees receiving subsidies after ARP? It was ~87% pre-ARP. Also suspect many off-exchange enrollees are moving on-exchange mid-year 2021. @charles_gaba @xpostfactoid @bjdickmayhew @LouiseNorris @larry_levitt @cynthiaccox

— Greg Fann (@greg_fann) May 12, 2021

Several fellow health wonks have chimed in. I spitballed perhaps 95%. Fann puts it at 96-97%. Cynthia Cox of the Kaiser Family Foundation thinks it could be even higher:

A few weeks ago, I noted that one of the numerous ACA-related provisions of the American Rescue Plan was this one:

Put simply, subsidized enrollees last year received around $6.3 billion in "excess subsidies"...they underestimated their income for the year 2020 and would normally be required to pay them back, but the ARP is waiving that "clawback" of overpayments for one year only in response to the pandemic.

Again, these are subsidies which were already paid out in 2020. The money is already in the hands of the enrollees (well, technically it's in the hands of the insurance carriers, but that in turn freed up an equal amount in the bank accounts of the enrollees, anyway). This provision simply says that the enrollees don't have to pay it back.

Back in January, I posted a story about the ACA subsidy improvements to be included in the then-pending American Rescue Plan (ARP). At the time, I noted what seemed to be a pretty big scoop:

...there's also another small but critical detail included in the table above which escaped my attention last summer in H.R. 1425.

Take a look at the first line of Rep. Underwood's 2019 version (H.R 1868):

  • Over 100.0 percent up to 133.0 percent

Now take a look at the first line under both H.R. 1425 and H.R. 369:

  • Up to 150.0 percent

Notice the difference? I'm not talking about the "up to 150%" part. I'm talking about the removal of the "Over 100.0 percent" part.

If this were to pass the House & Senate and be signed into law by President Biden using this exact language, it would apparently eliminate the Medicaid Gap...albeit with a couple of major caveats.

The Kaiser Family Foundation has updated their estimated breakout of the entire uninsured population of the United States as of 2019, and what sort of healthcare coverage they're eligible for thanks to the Affordable Care Act and the American Rescue Plan's expanded/enhanced subsidies.

Obviously a lot has changed since then, primarily due to the COVID-19 pandemic, but I presume this is the most recent comprehensive, reliable data they've been able to compile:

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