By better focusing the Affordable Care Act’s subsidies on the subset of individuals who are uninsurable in an actuarially priced market, STLDI deregulation would increase overall insurance enrollment. Reductions in premiums for individuals able to enroll in STLDI plans are likely to greatly exceed the slight increase in costs for higher-income unsubsidized individuals remaining on the exchange. STLDI deregulation might even save taxpayers a little money too.
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Congress has been unable to agree on “market stabilization” for the Affordable Care Act (ACA), and it was left out of the recently passed omnibus. Yet, a key discussion has been missing from the conversation, the need to rethink the single risk pool in the ACA.
Throwing money at the status quo will simply slow a market decline, which could leave millions with no access to affordable coverage. Splitting subsidized lives from nonsubsidized into two different risk pools could provide structural relief that allows markets to stabilize longer term.
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Arkansas recently became the third state to receive approval from the U.S. Department of Health and Human Services (HHS) to implement a work requirement for Medicaid adults. The hand-delivered approval follows the department’s endorsement of work requirements submitted by Kentucky and Indiana and comes ahead of action on similar requests from a host of other states, including Arizona, Maine, New Hampshire, Utah, and Wisconsin. Arkansas’s request was among several proposed amendments to the state’s Section 1115 demonstration waiver for its Arkansas Works program, including a proposed income eligibility cap at 100 percent of the federal poverty level (FPL) for the expansion population, which HHS did not approve at this time.
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I come to bury IPAB, not to praise it.
Like Brutus and his co-conspirators wielding the knife against Julius Caesar, the budget deal Congress passed in the early morning hours of February 9 put to death an idea whose time apparently never came and, now never will. The Independent Payment Advisory Board (IPAB), created in the Affordable Care Act (ACA), is history.
It is a rare moment when Republicans and Democrats agree on something they don’t like about the ACA. Behind IPAB’s demise is a belief that Congress shouldn’t delegate its powers to determine Medicare’s rules and a massive political force that reinforced that belief.
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On February 21, 2018, the District of Columbia (D.C.) moved one step closer toward becoming the second in the nation, behind Massachusetts, to adopt an individual health insurance mandate. The Executive Board of the D.C. Health Benefit Exchange Authority (Authority) approved a resolution recommending the adoption of a District-level mandate as well as a number of other policy proposals. The resolution will have to be approved by the D.C. Council before going into effect.
D.C. would be the first to adopt its own mandate in the wake of repeal of the Affordable Care Act’s (ACA’s) individual mandate, but it joins at least eight states considering or studying their own individual mandate.
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Republicans in Congress and the Trump administration failed to fulfill their commitment to repeal and replace the Affordable Care Act (ACA) in 2017, but they did succeed in repealing the tax penalties enforcing the law’s individual mandate, starting in 2019.
The GOP still might try again to fully repeal and replace the ACA in 2018, perhaps with a modified version of the Graham-Cassidy legislation. However, with Republicans now down to a 51-seat majority in the Senate and some House and Senate members facing difficult mid-term elections this November, it will be even more challenging to get a sweeping rollback of the ACA through Congress in 2018 than it was in 2017.
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In “Is Obamacare Harming Quality? (Part 1),” Michael Cannon explains that new research shows that Obamacare is not working how it is supposed to work in theory: The law’s preexisting conditions provisions create perverse incentives for insurers to reduce the quality of coverage; those provisions are reducing the quality of coverage relative to employer plans; and the erosion in quality is likely to accelerate in the future. In this post, he explains why regulators cannot fix this problem, and why providing sick patients secure access to quality health care requires allowing consumers to purchase health plans not subject to Obamacare’s preexisting conditions provisions.
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Cannon offers new research showing that Obamacare’s preexisting condition provisions create perverse incentives for insurers to reduce the quality of coverage, reducing the quality of coverage relative to employer plans. The erosion in quality is likely to accelerate in the future. In a follow-up post, he explains why regulators cannot fix this problem and why providing sick patients secure access to quality health care requires allowing consumers to purchase health plans not subject to Obamacare’s preexisting conditions provisions.
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axpayers who do not have minimum essential coverage (through an employer, a government program, or individual insurance) or qualify for an exemption must pay an individual responsibility tax. The tax is calculated on a monthly basis and is the greater of either a fixed dollar amount or 2.5 percent of household income above the tax filing limit, up to the the national average premium for a bronze (60 percent actuarial value) health plan.
The IRS has announced that for the 2016 tax filing season the average bronze plan premium used for calculating the maximum penalty will be $232 for each member of a tax household up to $1,360 for five or more members.
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If a bipartisan compromise is to be reached on health reform, it must go beyond the immediate crisis and (relatively) simple fixes that get the most attention in Washington. Bipartisan discussion should focus on stabilizing the market in the short run, improving support for the middle class, striking a compromise on Medicaid expansion and reform, exploring alternatives the individual mandate, improving the ACA’s delivery system reform agenda, repealing the IPAB, and making Consumer-Directed Health Plans available to all individual insurance market enrollees.
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