The Affordable Care Act Section 1331 is the Basic Health Plan (BHP) option for states. The BHP is intended to replace ACA marketplace coverage for people earning between 138% to 200% Federal Poverty Level with a state based program. States get a per-capita block grant that is determined by what enrolled individuals in the BHP would have gotten from ACA subsidies. The per-enrollee grant is 95% of what the individual would have received if they had enrolled in an ACA plan. This saves the federal government a little bit of money on a per capita basis and shapes the policy space for states. The coverage has to be at least as affordable and at least as good as a benchmark silver plan with Cost-sharing reduction benefits applied.
As of now, only two states have elected to enact a BHP. New York was attracted to a BHP as it allows for the state to cover immigrants at much lower cost to the state than the previous coverage option of putting these individuals on 100% state funded Medicaid. Minnesota has an active BHP program as well.
Oregon and Kentucky, despite their wildly different politics, are pursuing an Obama-era policy that uses federal dollars to establish a health insurance plan for people who make too much money to qualify for their state’s Medicaid programs. The goal is to provide residents who find Obamacare plans too expensive a less costly option, while smoothing insurance gaps for people teetering on the edge of Medicaid eligibility…
In Oregon, Democrats passed a bill in March to establish a basic health program, the details of which are being ironed out by a task force that began meeting this week. In Kentucky, Republicans approved $4.5 million in state funds this spring to set up a basic health program, which was signed into law by the state’s Democratic governor. An estimated 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to enroll in the plans as soon as next year.
This is an area of interest going forward as it is a significant devolution of policy autonomy to states within the framework of a per-enrollee block grant.