Saturday, June 26, 2021

Elsewhere: the ACA survives and thrives

 For BlueWaveNJ, I've overviewed the legal threats to the ACA -- just overcome and still pending; the subsidy boosts enacted in the American Rescue Plan and their effects so far; and likely and unlikely next steps.  I covered similar ground at, with more attention to the remaining subsidy-eligible uninsured and measures to smooth and encourage enrollment.

Subscribe to xpostfactoid

1 comment:

  1. Your article on estate recovery of ACA expanded Medicaid ( ) was so sharp that I thought I'd check out these other articles as well.

    Good job, Andrew, for both quality and doing good.

    I see you didn't omit the "family glitch"--a remaining defect. Good. Let all the defects be made public so they can be fixed despite Republican attempts to block fixing them.

    For those looking for more information on that defect, Health Affairs' Katie Keith has a comprehensive post, exploring the genesis of that defect, and with a possible administrative-action-only solution here: .

    You didn't mention another defect: the estate recovery of ACA expanded Medicaid in at least a dozen states for people 55-64, but I'll give you a pass because you covered it a few days ago. (But I'm also putting it here in the comments so that anyone looking to find comprehensive coverage of defects in the current ACA can get them from this blog post.)

    Let me throw in also a very obscure defect that happens depending on how each state handles the decision on who gets expanded Medicaid and who gets on-exchange plans.

    Apparently, not all states synchronize expanded Medicaid eligibility periods and income-determination periods with the annual eligibility period and income-determination period of subsidized on-exchange ACA plans.

    Thus, twice to me in Massachusetts (owing to my early-retiree finances) I was switched from subsidized on-exchange to expanded Medicaid with little notice (about 6 days), and unpredictably to me. (In one case the cause was the Massachusetts Medicaid agency decided to reassess expanded Medicaid eligibility mid-year using updated income cutpoints a few percent higher, and I and about 1000 other Massachusetts residents got knocked to expanded Medicaid on short notice.)

    (The problem is that, had any of us been in the hospital with approved procedures and providers, this all would have been nullified. Along with causing a lot of planning problems and delayed care during the switch.) (When this happened to me, I contacted a Massachusetts Health Connector Ombudsman, who told me the system was so complex that they would not be able to stop this from happening to me in the future, and suggested I could avoid the problem by paying full price for on-exchange, which avoids the income determinations. I did this, especially because as well, at the time (2019), I discovered Massachusetts estate recovers expanded Medicaid for people 55-64, and I couldn't risk being thrown onto that possible estate liability for all medical bills paid out, even briefly.)

    This last problem, of course, arises from our byzantine-complexity health insurance system, the ACA being just a complex add-on to that.

    Aah, to be in a place like Canada or UK, in the sense that everybody just has insurance--the insurance--automatically!

    But, of course, as you point out, we'll be lucky to have our kludge more-or-less- adequately working, given, as you correctly put it "We will never be done with Republican efforts to undermine effective government action, especially in healthcare."