Last week, David Anderson, Louise Norris and I looked at how many more Americans would be uninsured if the Republican effort in 2017 to "repeal and replace" the ACA's core programs had succeeded, as it very nearly did (90% of Republicans in Congress voted for the main House or Senate bills).
"Repeal and replace" was a misnomer: the Republican bills would have established an inadequate replacement for the marketplace -- but simply ended the ACA Medicaid expansion, which has had more impact. According to CBO projections, the repeal bills would have reduced Medicaid enrollment by 8 to 9 by this year, and by 14-15 million as of 2024, when the phase-out of enhanced federal funding for the expansion population would be complete. With the expansion intact, Medicaid enrollment has increased by about 8 million during the pandemic. Enrollment by those specifically rendered eligible by the ACA has increased by about 20% since February.
We also prepared several state-specific versions, as frankly we were apparently caught in a pre-election op-ed tsunami and couldn't quickly place the original. Below, I've pasted state-specific outtakes.
Subscribe to xpostfactoidPennsylvania
In
Pennsylvania, as the repeal bills were being voted on, 754,000 Medicaid enrollees owed their eligibility to ACA expansion criteria. All
would likely have lost Medicaid coverage had repeal passed...
...in
February 2020, just before the pandemic caused economic havoc, 12 million adult
Medicaid enrollees were rendered eligible by the ACA, and 9.2 million enrollees
in the ACA private plan marketplace received federal subsidies that paid for an
average of 76% of their premiums. In Pennsylvania, 267,000 marketplace
enrollees were subsidized as of February...
[Re Medicaid enrollment during the pandemic] By June, according to the Center for Medicare and Medicaid Services, Medicaid enrollment had grown to 75 million — an increase of 4 million since February. Enrollment growth has continued throughout this pandemic. It is likely now stands at 78 million. In Pennsylvania, enrollment increased by 178,000 from February through July.
Michigan
Both the AHCA and the BCRA would have sharply reduced the ACA's premium subsidies in the individual market for health insurance and would have rendered the available coverage virtually unusable for millions of low-income enrollees by eliminating the ACA's Cost Sharing Reduction subsidies – currently accessed by 96,000 Michiganders, while 212,000 receive federal premium subsidies that pay for an average of 76% of their premiums...
In Michigan, 800,000 current Medicaid enrollees owe their eligibility to ACA expansion criteria. All would likely have lost Medicaid coverage had repeal passed. Since the pandemic started triggering massive job loss, Medicaid enrollment enabled by the ACA expansion has increased by 20 percent. None of the 130,000 “expansion” enrollees who have gained coverage in Michigan since this past February would have been eligible had the 2017 repeal effort succeeded.
Illinois
In Illinois, 273,000 marketplace enrollees were subsidized as of February 2020, while more than 631,000 current Medicaid enrollees owe their eligibility to ACA expansion criteria. More than 500,000 of them would likely have lost Medicaid coverage had repeal passed...
Both the AHCA and the
BCRA would have sharply reduced the ACA's premium subsidies in the individual
market for health insurance and would have rendered the available coverage
virtually unusable for millions of low-income enrollees by eliminating the
ACA's Cost Sharing Reduction subsidies, currently received by 118,000 enrollees in Illinois.
* * *
Complete nullification of the ACA via the patently fraudulent Texas v. California suit, brought by 20 Republican attorneys general and governors and now before the Supreme Court, is current Republican policy, urged by the Trump administration (at Trump's insistence). Success would increase the ranks of the uninsured by 23 million, according to an estimate by the Center for American Progress. Charles Gaba, who assisted in the analysis, has broken out projected losses by Congressional district.
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One of the things I noticed about PA, which expanded late under Republican resistance, is that it does not have the estate recovery issue on expanded Medicaid and other non-long-term-care Medicaids. (That is, it is not one of the states that exercises its Federally-granted option to estate recover all medical expenses paid out for people 55 and over. In fact, it never did estate recover on non-long-term-care Medicaids, so unlike MN, OR, WA, CA, NY, CT, and CO, it had no law to correct.)
ReplyDeleteAnyway, I note that my own always-boasting-about-health-care MA does still estate recover ACA expanded Medicaid and other Medicaids. (It's "insured" rate is 93%, not the 97% they report, when you stop counting the people who have a loan until death for medical expenses, rather than actual insurance.)
Although we apparently have to go with trying to hold and correct the ACA (for this even, we need Biden and maybe 60+? votes in the Senate today, and a sensible Supreme Court), it's still a shame that we have to go with such a clunky, mistake-prone Rube Goldberg system as our own, with the ACA. (Even with Biden's proposed improvements, some of the fundamental problems stay.)
As I've pointed, some state governments apparently have trouble handling the complicated system to the point of causing coverage gaps for people. (To me 4 or 5 times in MA!)
The states, when using their own exchange, often can't even handle simple billing and autopay issues. (At the moment, I applied for next year's plan last Sunday. I have an erroneous status on the web-site neglecting the autopay that I scheduled, which an exchange agent told me yesterday would self-correct in 24 hours. It did not self-correct.
I have sought out the more able "exchange ombudsman" staff to help me, as they were able to fix similar problems in the past. However, when I submitted my form online, there was no message received back saying "we got it".
So, did they get it? I've had to post messages on the exchange's facebook page to try and find out. (No answer after a few hours.)
(This kind of thing happens every year. Between November and January I have to keep checking to see if the scheduled autopay was made due to strange indications from the computer system, and often connect with the ombudsman office. My worry, of course, is that if I am in the hospital, in a coma or something, I won't be able to do this necessary checking and following up. No such worries for people in Canada or UK, and I suspect most of the rest of the developed world.)
(Yes, the state governments often don't have the skill, but insist on creating employment by setting up their own exchanges. It's inefficient, and causes actual coverage gaps. And state-level newspapers don't have the resource or skill to report on the problems and have them fixed.)