Senators Alexander and Corker (R-TN) have a proposal to tweak the ACA. I can’t figure out what the actual problem is that they are trying to fix.
Alexander/Corker intro ACA fix: waive mandate penalty for people w/ no options and let them use the subsidy on a plan outside the exchanges. pic.twitter.com/nxrFZFJjOi
— Sahil Kapur (@sahilkapur) March 29, 2017
Right now if there is no on-exchange plan in a county, a hardship exemption can be triggered by the Secretary of Health and Human Services to waive the mandate. That was the most likely scenario that would have occurred in Pimal County, Arizona last August when it looked like there were to be no carriers in that county. Blue Cross/Blue Shield stepped in at the last minute.
Taking the subsidy to go buy insurance off-exchange means the subsidy would either apply to an Off-Exchange QHP or to a mini-med or to a health sharing ministry. As a short term fix, I get this. But there is a major problem here.
“If you like it, you can keep it”
That is the problem. The politics of the situation will grandfather individuals who bought a non-QHP during a no-choice year will keep that policy and the attendant subsidy. Mini-meds and HSM both underwrite and limit benefit choices. They weaken the long run risk pool as healthy people will stay in them and sick people will migrate back to the QHP non-underwritten pool as quickly as possible.
I don’t see what problem Alexander-Corker are trying to solve other getting a good headline back in Tennessee as there are sixteen counties with no plans committed to for 2018 yet.
evodevo
It’ll weaken the pool? Hey! Win-win. Thousand cuts and all that.
WereBear
Like Republicans ever come up with sound legislation these days.
zach
States will be able to determine what’s a permissible plan; plans won’t have to meet same standards required to be sold on exchange. So depending on how loosely a state is regulated there’s a collective incentive for insurers to all exit the market and sell something worse for the same price.
Hunter Gathers
White Trash Senators representing a White Trash state giving Get Out of Jail Free cards to their moonshine soaked White Trash constituents. It’s just another thing that White Trash gets to whine their way out of, like responsibility and fancy book learnin’.
efgoldman
Hypocritical pandering politics is its own reward
WereBear
@Hunter Gathers: And complain about welfare while sucking up the majority of the dollars…
Hunter Gathers
@WereBear: It’s only welfare when blahs, browns, knocked up teenage sluts and those who pray to dirty brown gods collect it. For god fearing ‘Christians’, it’s money blessed by tax cut Jesus himself. So they can use it for crank, booze and cable subscriptions so they can watch rasslin’ and Tennesee football. Go Vols and hold my beer.
Ken Kelly
No hardship waiver is necessary. The penalty is is zero unless the cheapest plan is under the affordability threshold. If there is no such plan, the affordability exemption is automatic.
BBA
So what happens if the death spiral kills the off-exchange individual market too?
I’m visiting the US Virgin Islands in a couple of months. Because I’m curious about these things, and a nerd with no life, I looked into what the health insurance situation there is. Turns out the territory is so small and so poor that there are no companies selling individual health insurance there at all. In practice, this affects a minimal number of people, since Medicaid covers just about everyone under 65 without employer-sponsored insurance, but one wonders how a state would deal with that scenario.
cervantes
The problem it is addressing is that the ACA is reasonably successful. They are trying every angle they can find to destroy it. It is possible to grant hardship exemptions without going through the rulemaking process, so this is available to them as a way of undermining the law. That’s their objective.
rikyrah
You can’t trust them, Mayhew.
Don’t trust it.
Period.
mai naem mobile
Because God forbid they do something to get insurance companies to go on the wxchange.
RepubAnon
Counter proposal: allow Medicare buy-in for such areas…
schrodingers_cat
No. That’s my answer to any R proposal.
Lurking Canadian
@RepubAnon: That is so obviously the answer that there is no way it will happen.
TooTall
On last night’s Tennessee news, this was spouted by the local media as a “temporary workaround” while the ACA is still the law of the land. Maybe the TN senators don’t trust the Sec. of HHS to allow what should be an automatic exemption.
Paul W.
It is purely an optics bill that addresses one of their favorite talking points (that “many” markets are down to a single insurer and could soon have none) without every dealing with the problem. It is just meant to keep that talking point alive and even if the problem doesn’t exist it makes it look like they are solving it.
sherparick
Here is the sad thing. All Ryan cares about his getting the tax cuts for the .1%. An unfortunately, the key Republican donors: Koch Brothers, Mercers, the Hedge Fund Managers like Schwartzman, the Walton family, a few dozen others that go to the Koch Brothers seminars, all they care about is the tax cut and eliminating any Government oversight on how they make money. Trump and Bannon can do what they like to appease the blood lust of the Republican base.
Charles Pierce documents the atrocities (and Yemen and Somalia, between war and famine, we will be talking about millions of deaths, directly or indirectly, at the hands of the U.S.) esquire.com/news-politics/politics/news/a54216/trump-middle-east-policy/
We are dealing with some profoundly evil, wicked people.
Fair Economist
The problem is clear and legitimate – counties with no Exchange insurance. The solution’s problem of corroding the minimal coverage requirements is real, although for the (R)’s maybe helping insurance companies and hurting voters is a desirable side effect.
Offhand, I’d say the best solution would be for the state to allow Medicaid buy-ins. They could price it to be at least roughly cost-neutral. Of course, they might make mistakes – for which risk corridors would be a good assist, hint, hint.
a thousand flouncing lurkers (was fidelio)
The Tennessee state legislature is a wholly-owned subsidiary of the Koch Brothers’ political operation at this point, and even if Tax-cut Jesus appeared in person at the state capitol to give his blessing to a Medicaid Expansion, they would die before passing it.
Tennessee is also a state rich in small rural counties with low populations–counties small enough they have trouble maintaining a full-service hospital as there’s literally not enough business for it–even when people can pay. So it’s got a lot of places that aren’t very attractive to insurers and a state government that would rather be fed to giant catfish that approve the Medicaid expansion. Corker and Alexander are undoubtedly hearing a lot of screaming from Tennesseans who’d like some coverage but haven’t bothered to read the fine print on the ACA in order to figure out how to make it happen. So this allows them to appear to be heroes for the home folks, without provoking the cage full of crazy that stands in for our state senators and representatives.
How bad is the Tennessee Lege? Bad enough that our Republican governor, Bill Haslam, finds them hard to work with in many instances. He comes from the old, established, Moneybags wing of the party and finds the frantic bigotries and unrealistic plans of Screaming Shit-eating wing of the party a little distressing–they’re too busy trying to pass laws against public displays of affection between teenagers when they could be trying to help him select the best leopards to eat our faces instead.
Robisan
@RepubAnon: Yes, Medicare buy-in in this instance. Or better still, Medicare option added to all exchanges with fewer than three private insurance options.