...not entirely, as they still refuse to enact the ACA Medicaid expansion, which would have the largest impact. But still, remarkably, the Texas legislature unanimously passed a bipartisan bill designed to improve the state's ACA marketplace. I have told the political tale in The American Prospect.
Specifically, the enacted bill directs the Texas Department of Insurance to undertake 'focused rate review' of plans offered in the marketplace -- a decade after ceding that function to CMS. It directs the Department to “focus its rate review in a manner that uniformly maximizes the benefits of silver loading, making coverage more affordable.” That is, to make gold plans cheaper than silver, and increase discounts in bronze plans.
The rub-your-eyes aspect of this, to my mind, is that the bill's Republican sponsor in the Texas House, Tom Oliverson, now talks about the ACA marketplace in terms that Max Baucus might have envisioned certain Republican senators using in 2009, when he and other Democratic old bulls of the Senate dreamed of a bipartisan bill:
Why would a staunch conservative co-sponsor a bill to increase government subsidies in the ACA marketplace? Oliverson told me that he sees it as a worthy goal to “make the marketplace work as well as it can.” (He understands the competitive underpricing of silver plans as a market distortion.) He sees his current attitude toward the marketplace as “not a change per se, but thinking about it in a new way. I think we’re all strongly opposed to single-payer, see it as a dead-end street. We need a competitive, robust marketplace and want those options to be as attractive and competitive as it can be.”
After outlining various forms of ACA non-compliant health coverage, Oliverson added:
“I want all of the above. I’m not praying for the ACA to fail just so I can say it’s a bad idea. It is what it is, and it’s not going anywhere. It is a good tool in the toolbox.”
Texas Senator Nathan Johnson, a Democrat, wrote this bill and shepherded it to passage. His account of how he won Republican consent is also remarkable (to me, anyway). I hope you'll give the tale a read.
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