David Anderson, Duke University
I need to see the details. There are so many different ways this could spin.
What does the plan design look like? Is it a silver plan [70 percent actuarial value], or is it 97 percent? On costs, that’s gonna be tough. The number of states that can take on a significant new [Medicaid] obligation long term is not high.
Big questions: How do states pay for this, and how does the benefit design integrate into the ACA?
I think the big divide within the Democratic Party is not if we need to have everyone covered, but how to do so. How much disruption is plausibly tolerable in each iteration of reform?
The details of the plan matter. Right now we are seeing that Senator Schatz wants to bump up Medicaid rates to Medicare rates with the Federal government taking on 100% of the increment like the Feds did with the 2013-2014 PCP bump. The option would be available on a state by state basis. I think the rating cells would be based on the above 133% total buy-in population and it would play by ACA rules on risk adjustment and benchmarks.
I am still thinking this one through and the details are really going to matter.