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What’s Next for the ACA and Health Reform?

What’s Next for the ACA and Health Reform?. Nancy Turnbull Regis College March 2019. Massachusetts: Lowest Rate of Uninsurance in US since 2008. Percent of Population With No Health Insurance. ACA. U.S. MASSACHUSETTS. 2010. 2.

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What’s Next for the ACA and Health Reform?

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  1. What’s Next for the ACA and Health Reform? Nancy Turnbull Regis College March 2019

  2. Massachusetts: Lowest Rate of Uninsurance in US since 2008 Percent of Population With No Health Insurance ACA U.S. MASSACHUSETTS 2010 2 Source: Massachusetts Division of Health Care Finance and Policy, 2008-2014 Household Insurance survey; US Census Bureau CPS, Urban Institute 2007 study for BCBSMAF

  3. Comparison of Major Coverage Components of Massachusetts Law and the ACA

  4. In Massachusetts: More People Covered But Little Progress on Financial Security Overall Percent of Non-Elderly Adults Source: MHRS, 2018, BCBSMA Foundation

  5. In Massachusetts, Difficulties Obtaining Health Care Are Common, Worse for Lower Income Individuals Percent of Non-Elderly Adults Source: MHRS, 2018, BCBSMA Foundation

  6. November 2016

  7. After 2016 ElectionRepublicans Tried and Failed to Repeal ACA

  8. Where are we now? Congressional stalemate Trump Administration still trying to sabotage ACA Courts a real threat Action moves to the states

  9. Trump Administrative Actions to Weaken/Sabotage the Law Weaken individual mandate Reduce subsidies Discourage enrollment/reenrollment Disinformation Encourage states to weaken Medicaid Public charge proposed rule Allow insurers to sell products with fewer benefits and protections Weaken standards for coverage

  10. Action in the States: Medicaid 14 states have not yet expanded Medicaid

  11. Expand Medicaid

  12. What States Are Doing for Now • Expand Medicaid • State Level Individual Mandates • Mass, NJ, DC, Vermont

  13. Improve the ACA Subsidies • ACA subsidies too low to make good coverage affordable for many • So Massachusetts “tops off” the subsidies with state funds • Comes from tobacco tax and employer assessments • State Enrollment Assistance

  14. Massachusetts Subsidies are Larger and Coverage Is Better Than in ACA Note: Actuarial value of APTC silver plan ~70% ; with cost-sharing subsidy for <250% FPL is 73% to 94%; actuarial value of ConnectorCare plans ~94-99%.

  15. What States Are Doing for Now Expand Medicaid State Level Individual Mandates Improve ACA subsidies at state level Weaken Medicaid

  16. Weaken Medicaid Work Requirements in the states Source: https://www.commonwealthfund.org/publications (work requirements)

  17. What States Are Doing for Now Expand Medicaid State Level Individual Mandates Improve ACA subsidies at state level Protect insurance market reforms Weaken Medicaid Lower Drug Prices Social Determinants of Health

  18. What’s in the Future? Court decisions in lawsuits that challenge certain administrative actions? The Presidential Elections in 2020? Medicare for All? Can the U.S. ever control its health care costs? ?

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