Dem ACA improvement plan hikes subsidies, incentivizes Medicaid expansion

House Democrats on Monday unveiled legislation that would tweak the Affordable Care Act to expand premium subsidies and incentivize states to expand Medicaid, among other changes.

The bill was originally intended to be a messaging bill in commemoration of the tenth anniversary of the ACA in March, but the plans were derailed by the crush of COVID-19 relief legislation. A House vote is expected before July 4 but the Republican-led Senate won’t take it up.

The vote timing coincides with the June 25 deadline for the Department of Justice to file its opening brief with the Supreme Court in its lawsuit that could invalidate the ACA. House Democrats’ campaign arm is planning to make the Trump administration’s lawsuit a centerpiece of its healthcare messaging.

House Democrats’ bill would increase premium subsidies for ACA exchange plans. Georgetown University health law professor and ACA expert Katie Keith said the changes would enable individuals in the Medicaid coverage gap to access premium-free ACA coverage, and decreases the percentage of income others would have to pay toward premiums.

The proposal would also direct HHS and state exchanges to establish network adequacy standards for exchange plans. HHS and states would be required to coordinate to protect consumers from rate hikes.

House Democrats also target the Trump administration’s healthcare agenda, and their bill would rescind the Trump administration’s rule that expanded short-term, limited-duration insurance plans and revoke 2018 guidance on 1332 waivers.

The new bill includes several incentives to expand Medicaid, including giving states that haven’t expanded Medicaid yet a renewed 100% in federal Medicaid funds for the first three years and reducing administrative matching funds for non-expansion states. States would have to provide 12 months of continuous coverage for Medicaid and Children’s Health Insurance Program beneficiaries.

Medicaid programs across the country would be required to continue postpartum Medicaid eligibility for a year compared with the current mandate of 60 days.

House Democrats proposed paying for the ACA changes with the drug-price negotiation portion of their signature drug-pricing bill passed in December.

House Republicans are unlikely to support the proposal, and House Ways & Means ranking member Kevin Brady (R-Texas) said June 12 that Democrats had not reached out to him about it.


Tags: covid-19, pandemic

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