ACA 2.0

2018 MIDTERM ELECTION

Time: D H M S

 

NOTE: I'll be expanding on explainers for some of the items below over time, but I wanted to make sure this got out well before the August 7th primary.

Dear Democratic candidates for Michigan State House, State Senate or Governor this November:

If you're familiar with me and this site, you probably know three things about me:

  • 1. I strongly support achieving Universal Healthcare coverage, and I'd ideally prefer to utilize some sort of Single Payer system as the payment mechanism to do so.

This Just In...

State’s Market Stability Workgroup Recommends Immediate Action to Protect Rhode Islanders from Federal Threats to Health Insurance Access and Affordability

Posted on June 27, 2018 | By HealthSource RI

EAST PROVIDENCE, R.I. (June 27, 2018) – Rhode Island must act “without delay” to protect consumers from rising health coverage costs brought on by federal policy changes according to a report issued to Governor Raimondo by the state’s Market Stability Workgroup.

“People representing a wide variety of viewpoints engaged in lively discussions over the course of 8 weeks,” said Workgroup co-chair Bill Wray, Chief Risk Officer at the Washington Trust. “The fruits of those discussions are in this report. All of us – consumer advocates, business groups, health insurers and providers – were able to broadly agree on how best to protect Rhode Island’s insurance markets.”

Over the past few weeks I've noted that a half-dozen states or so (Maryland, New Jersey, Vermont, Hawaii, California and Illinois) have been pushing through a long list of bills/laws at the state level to either protect the ACA from sabotage or even strengthen it. Meanwhile, other states have either expanded Medicaid under the ACA (Virginia, of course) or have locked in ballot measures to do so this fall (Utah, Idaho). Finally, several states have announced they're joining dozens of others to take advantage of "Silver Loading" or full-on "Silver Switching".

Well, things haven't slowed down. Just a few days after eight different ACA/healthcare bills passed out of either the state Senate or Assembly, California legislators have passed several more:

UPDATE: Thanks to Anthony Wright, Executive Director of Health Access California, for clarifying a few things on some of these bills.

A couple of months ago Louise Norris of healthinsurance.org gave me a heads up about a half-dozen or so healthcare bills, mostly ACA-related, pending in the California state legislature. Some were in the state Senate, some in the state Assembly; some were more along the lines of protecting the ACA from sabotage efforts while others were about expanding upon the law.

Well, today a whole bunch of those bills (as well as a few I didn't even know about earlier) made it a major step further along the line to becoming law. Courtesy of the Health Access CA Twitter feed:

For a couple of months now, I've been attempting to track a slew of state-based "ACA 2.0" bills slowly winding their way through various state legislatures. However, this is really a bit of a misnomer, since some of these bills aren't so much about expanding the ACA as they are about protecting it from various types of undermining or sabotage from the Trump Administration and Congressional Republicans.

In fact, as far as I'm concerned, they really fall into three categories, which line up nicely with my color-coded "3-Legged Stool" metaphor: Blue, Green and Red Leg bills.

Once again: The "Blue Leg" of the Stool covers everything which ACA-compliant individual health insurance carriers are required to include: Guaranteed Issue, Community Rating, 10 Essential Health Benefits, a Minimum 60% Actuarial Value rating, no Annual or Lifetime Caps on coverage, and a long list of mandatory Preventative Services at no out-of-pocket cost when done in-network.

It's very clear that the name of the game for healthcare policy this year seems to be "What comes after the ACA?"

For over a year now, I've been strongly urging the passage of some sort of "ACA 2.0" upgrade package, primarily based on my own wish list entitled "If I Ran the Zoo", a collection of about 20 assorted ACA fixes. The reality is that a couple of the items on my list start to move away from an "upgraded ACA" and drift over into what I've mentally compartmentalized as the next phase in achieving Universal Healthcare Coverage.

Since I first posted my wish list just over a year ago, several new proposals have been released by various Democratic politicians and 3rd-party organizations such as the Center for American Progress, some of which are revised versions of other long-proposed systems. These include:

Last month I urged Democrats to go strongly on offense re. campaigning on healthcare policy in 2018 given the general landscape but especially the exit polling out of the special Congressional election in Pennsylvania:

  • Health care was a top issue to voters. Health care was ranked as a top issue for 52% of voters (15% saying it was the most important issue and another 37% saying it was very important). Only 19% said it was not that important or not important at all.
  • Conor Lamb won big especially among voters for whom health care was a top priority. Among voters who said health care was the most important issue for them, Lamb beat Rick Saccone 64-36 and among the broader group of voters who said it was either the most important or a very important issue Lamb beat Saccone 62-38.
  • On health care, voters said Lamb better reflected their views by 7 points (45% to 38%) over Saccone. With independents, that gap widened to 16 points with 50% saying Lamb’s health care views were more in line with theirs to only 34% for Saccone.

I was originally just planning on comparing the various provisions of the House and Senate Democratic versions of their "ACA 2.0" bills against my own, year-old "If I Ran the Zoo" wish list.

Then I wrote a post about a whole bunch of stand-alone bills in California which Louise Norris alerted me to and decided to throw those into the comparison table as well.

And now, with quick state-level action in both Maryland and New Jersey in recent days, I decided to expand this project across every state. I've started color-coding the status of each bill and am even adding some recent/past bills and/or waivers which have failed as I go (i.e., the failed/delayed mandate penalty restoration efforts in Connecticut and Maryland).

This is a work in progress, so the table is probably pretty incomplete for now and will likely be changing constantly as various bills are introduced, moved to committee, voted on, pass/fail, signed/vetoed by governors and actually implemented (or legally challenged).

UPDATE 4/20/18: Whew! OK, I've incorporated a bunch of Louise Norris' links for several states and have moved it to a full Google Docs spreadsheet. Be warned, it's pretty big now...

A note about the headline: I originally referred to "ACA 2.0 vs. Trumpcare", but the more I thought about it, the more I realized that as of this moment, Donald Trump and the GOP have only partially mutated the Affordable Care Act into their own warped vision. They've managed to scare off carriers, confuse enrollees, cause unsubsidized premiums to shoot up an extra 18%, and with the repeal of the individual mandate (and potentially the massive expansion of #ShortAssPlans via #RegulatorySabotage) starting next year are about to cause those same premiums to jump another 16% or so on average.

A year ago I wrote up my own "wish list" of 22 recommendations for fixing, improving, strengthening and expanding the Affordable Care Act (it's officially 20 items but two of them really should have been split into two entries apiece). I called it "If I Ran the Zoo", and it received quite a bit of praise, even though I didn't come up with most of them myself; it was mostly a compilation of ideas which had been floating around progressive healthcare wonk circles for awhile.

In any event, now that the Republican "ACA stabilization bill" (Alexander-Collins) appears to be dead and buried, I figured it might be helpful to line up both the House and Senate versions of the ACA 2.0 bills to see how they compare to each other as well as to my own list of recommendations.