Obamacare

 

(sigh) It's been over 14 years since the Patient Protection & Affordable Care Act was signed into law by President Obama.

It's been over 9 years since Donald Trump came down his gold elevator and promised to repeal the ACA.

For years he kept promising that he had a much better healthcare plan which was always just "Two Weeks" away.

And here we are again. From the debate last night:

LINSEY DAVIS: This is now your third time running for president. you [Trump] have long vowed to repeal and replace the Affordable Care Act, also known as Obamacare. You have failed to accomplish that. You now say you're going to keep Obamacare. Quote, unless we can do something much better. Last month you said, quote, we're working on it. So tonight, nine years after you first started running, do you have a plan and can you tell us what it is?

This is actually from a couple of weeks ago (I'm playing catchup from my trip to Houston): via the Massachusetts Health Connector:

The Massachusetts Health Connector is celebrating today’s 18th anniversary of health care reform in Massachusetts, highlighting all-time high enrollment in health and dental plans, and providing health insurance to more than 1.1 million Massachusetts residents since 2015.

Today, 350,000 Massachusetts residents get their health or dental coverage (or both) through the Health Connector, the most in the Marketplace’s history. This includes more than 250,000 in ConnectorCare coverage, the Health Connector’s landmark subsidized health insurance program.

Welp. With last weeks news that House Republicans have decided to once again go to war with the Affordable Care Act if they gain a federal trifecta this November, it's time once again to take a look at just how many of their constituents are at risk of losing their healthcare coverage entirely or, at best, facing massive premium increases (which in most cases would have the same effect by making their coverage cost far more than they could possibly afford).

Alongside this weekends release of the final, official 2024 ACA Open Enrollment Period (OEP) data, The Centers for Medicare & Medicaid Services (CMS) has also pulled together estimates of how many residents of each Congressional District selected ACA exchange plans during the 2024 OEP:

See Part 1 Here

Again, here's the Republican Study Committee (RSC, aka House Republicans) 2025 Budget Proposal. The ACA-related section begins on page 86:

Under the RSC Health Care Task Force plan, protections pertaining to guaranteed issue and the prohibition on coverage exclusions would be retailored to reward continuous coverage and promote portability in the individual marketplace.

"RETAILORED." DANGER WILL ROBINSON.

Scratch Guaranteed Issue.

Additionally, to provide Americans with options that fit their individualized needs, each state would again be allowed to determine the minimum attributes and cost-sharing parameters of plans to best meet the needs of their own citizens. In no case, however, would carriers be able to rescind, increase rates, or refuse to renew one’s health insurance simply because a person developed a condition after enrollment.

As I noted back in December...

Since Donald Trump was defeated in the 2020 Presidential election, most people seemed to be under the impression that the Republican Party's decade-long obsession with tearing down President Obama's signature legislative accomplishment, the Patient Protection & Affordable Care Act, was finally over.

Healthcare journalist extraordinaire Jonathan Cohn even pulled the trigger on publishing his definitive history of the ACA, The Ten Year War...although honestly, there was still one remaining major legal loose end to tie up which wouldn't happen until about eight months later.

Note: I decided that while the original headline accurately reflected my feelings about this WSJ Op-Ed, it was a bit over the top, so I've changed it to something less crude.

For years, the Patient Protection & Affordable Care Act, generally shorthanded as the ACA or, more colloquially known as "Obamacare," was the top policy target of Republicans and other conservatives.

It seemed as though not a day went by without some right-wing opinion piece being published attacking the ACA for one thing or another. Once in awhile these attacks had some validity, but the vast majority were either completely baseless or grossly exaggerated.

And yet, after the dust settled on the infamous 2017 ACA "repeal/replace" debacle, it seemed as though the GOP had pretty much tired of their relentless assault on the healthcare law. They had failed to repeal it even with control of the White House, Senate, House of Representatives and Supreme Court, and ended up settling for zeroing out of the federal Individual Mandate Penalty as a consolation prize.

ASPE

Back in late January, I crunched the numbers on the total number of Americans who currently have healthcare coverage directly via the Affordable Care Act. This includes three categories: Exchange-based Qualified Health Plans (QHPs); the Basic Health Plan (BHP) progams in Minnesota and New York; and Medicaid Expansion in the 38 states (+DC) which had implemented it as of that point.

I concluded that the total numbers for each were roughly 15.4 million QHPs, 1.2 million BHPs and 23.5 million Medicaid expansion enrollees, or around 40.1 million people total.

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) confirmed my estimates and even came in slightly higher, at around 40.2 million. They put effectuated QHPs at 15.6 million and Medicaid expansion enrollment at around 23.4 million.

via Quinn Yeargain of Bolts:

A decade ago, when conservatives were attacking President Barack Obama’s Affordable Care Act as government encroachment in health care, they worked to amend state constitutions around the country to affirm a broad right for people to control their own medical decisions.

“Each competent adult shall have the right to make his or her own health care decisions,” reads section 38(a) of the Wyoming constitution’s Declaration of Rights, under the header “Right of healthcare access.” The provision was placed on Wyoming’s ballot by state lawmakers and approved by voters in 2012; voters saw ballot language that described the measure as preserving this right “from undue governmental infringement.”

Now these anti-ACA provisions—and their broad affirmations of a right to decide—have turned into an unlikely weapon in progressives’ fight against restrictions on abortion. 

Note: I'm breaking this analysis into several sections:

Part 1Part 2 / Part 3 / Part 4 / Part 5 / Part 6 / Part 7

Finally, we come to HOUSEHOLD INCOME BRACKETS.

This is, of course, extremely important since household income is one of the most critical factors in calculating how much financial assistance enrollees receive, as well as whether or not they're eligible for Advance Premium Tax Credits (APTC).

Note: I'm breaking this analysis into several sections:

Part 1Part 2 / Part 3 / Part 4 / Part 5 / Part 6 / Part 7

Next up: METAL LEVELS.

If you've ever wondered why healthcare wonks (myself included) almost never even bring up the ACA's Catastrophic Level plans and why the only time I ever discuss Platinum Plans is in the context of high-CSR enrollees being eligible for "Secret Platinum" plans (labeled as Silver), this table should explain why.

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