A small refuge from the Trump administration's public charge cruelty

The Trump administration's proposed new rule jeopardizing the immigration status of legally present noncitiizens who tap non-cash benefits like Medicaid or food stamps is a travesty -- of public health, economics and human rights. If finalized, it will kill people by denying them medical care, harm the life prospects of millions of children, and put us one more long step down the road toward discriminatory treatment of a class of people demonized by the federal government. About 27 million people who are noncitizens themselves or live in a family including a noncitizen could be subject to the vastly expanded "public charge" rule.

There is one class of benefits left out of the demerit dragnet: ACA marketplace subsidies.  And ironically, a previous immigrant-bashing provision in federal law insulates a few hundred thousand immigrants from the proposed expansion of the public charge rule.

Mysteries of the Maryland ACA Marketplace, cont.

As I noted on Oct. 3, Maryland Health Connection, the state's ACA exchange, sent me enrollment data indicating that Maryland may have the highest "CSR takeup rate" in the country. That is, in 2015, Maryland private plan buyers whose incomes qualify them for Cost Sharing Reduction (CSR) subsidies, which are available only with silver plans, chose silver and access the benefit at market leading rates. In Maryland, 86% of CSR-eligible buyers chose silver, compared to a national average of about 76%. That's doubtless in large part because Maryland cloned the web interface of the Connecticut exchange, which does an excellent job steering CSR-eligibles toward silver.

There are some peculiarities in the Maryland data, though, and they're thrown into sharper relief by the raw numbers of silver plan enrollees at each income level, which I did not have when I posted last week. Chief among them is a relatively huge number of buyers, 22%, with incomes low enough to qualify them for Medicaid, unless they're lawfully present non-citizens not yet eligible for Medicaid because they've been in the country less than five years.