Medicaid Expansion

I've written several times about how Republican Senator Cory Gardner of Colorado has repeatedly shown sickening levels of chutzpah and gaslighting when it comes to the Affordable Care Act:

In a pathetic attempt to gaslight Colorado voters, Gardner is now trying to paint himself as supporting healthcare expansion, going so far as to try to claim credit for passage and approval of last year's Section 1332 Reinsurance Waiver program which dramatically reduced premiums for unsubsidized individual market enrollees throughout Colorado...even though a) he didn't have a damned thing to do with it and b) the reinsurance program was only able to be developed thanks to the Affordable Care Act...which Gardner has repeatedly voted to repeal.

Five states held their primary elections for non-Presidential races yesterday, including Missouri...and Missouri also had another important measure on the statewide ballot:

On Tuesday, August 4, all Missourians will have the chance to vote Yes On 2 to bring more than a billion of our tax dollars home from Washington every year – money that’s now going to places like California and New York instead.

By bringing our tax dollars home, we can protect thousands of frontline healthcare jobs, help keep rural hospitals open, and deliver healthcare to Missourians who earn less than $18,000 a year. That includes thousands of veterans and their families, those nearing retirement, working women who don’t have access to preventive care, and other hardworking Missourians whose jobs don’t provide health insurance.

Back in 2018, I was all over the trend of deep red states putting ACA Medicaid expansion on the ballot after getting fed up with years of their elected leaders refusing to do so. Idaho, Utah and Nebraska voters all did exactly that, passing it by solid margins. Unfortunately, state Republicans got in the way (or at least tried to) in all three states, adding hurdles, barriers and caveats which have either delayed or partly weakened them.

Nonetheless, Utah and Idaho have both implemented Medicaid expansion to low-income residents (and thank God, given the current ongoing COVID-19 pandemic), while as far as I can tell, Nebraska is scheduled to launch their expansion program (called "Heritage Health") starting this October.

I wrote about this several times last year, but I'm a bit embarrassed to say that I haven't revisited the status of Oklahoma's Medicaid expansion ballot proposal since November:

In Red State Oklahoma, Medicaid Expansion Nears 2020 Ballot

A campaign in Oklahoma to expand Medicaid via the ballot box far eclipsed the necessary number of signatures needed to put the measure before voters next November 2020, supporters said Thursday.

The submission of 313,000 signatures to put a constitutional amendment on next year’s general election ballot shattered the required 178,000 needed by the Oklahoma Secretary of State’s office, organizers said. Media reports in Oklahoma said supporters of Medicaid expansion broke a state record when it comes to signatures needed for a statewide ballot initiative.

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

Back in early March (a lifetime ago given the events of the past few months), House Democrats were on the verge of finally voting on a suite of important ACA protections, repairs and improvements which I've long dubbed "ACA 2.0" (the actual title of the first version of the "upgrade suite" bill was ridiculous when it was first introduced in 2018, and the slightly modified version re-introduced in 2019 was somehow even worse, no matter how good the bill itself was).

The game plan was to hold a full floor vote in the House on H.R. 1884 (or possibly a slightly different variant) the week of March 23rd, 2020 to coincide with the 10th Anniversary of the Affordable Care Act itself. This would have made perfect sense both symbolically as well as policywise, as the ACA desperately needs a major upgrade (and it would've needed one even without years of Trump/GOP sabotage, I should note).

Regular readers may have noticed that after a 3-4 month hiatus, I've recently started writing several stories touting "ACA 2.0"-type bills again over the past week or so.

First, last Tuesday, I dusted off my "How much would H.R. 1868 lower YOUR premiums?" series, in which I look at real-world examples of the impact of killing the ACA subsidy cliff (i.e. the 400% FPL income eligibility threshold) and beefing up the underlying subsidy formula in specific parts of the country. Then, on Monday, I wrote an updated explainer of a newer bill, H.R. 6545, an Age-Based subsidy enhancer, which I'm touting as a perfect companion bill to go alongside H.R. 1868.

One by one, the dozen or so states which had either already implemented work requirement programs for Medicaid expansion enrollees or which were planning on doing so have either "delayed" or dropped those requirements entirely, either by force due to a federal judge ruling against them, or "voluntarily" due to them seeing the writing on the wall and realizing that a federal judge was going to rule against them in the near future.

Every state except one, that is: Utah.

Utah passed ACA Medicaid expansion solidly back in 2018...and they passed a "clean" version, which was supposed to mean anyone earning up to 138% of the Federal Poverty Line would be eligible, and the program wouldn't have any barriers or hurdles like work requirements and so forth.

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