Come for the politics, stay for the snark.

And now I have baud making fun of me. this day can’t get worse.

“Until such time as the world ends, we will act as though it intends to spin on.”

The unpunished coup was a training exercise.

Let’s bury these fuckers at the polls 2 years from now.

Trumpflation is an intolerable hardship for every American, and it’s Trump’s fault.

Disappointing to see gov. newsom with his finger to the wind.

If you cannot answer whether trump lost the 2020 election, you are unfit for office.

When someone says they “love freedom”, rest assured they don’t mean yours.

Let me eat cake. The rest of you could stand to lose some weight, frankly.

75% of people clapping liked the show!

Some judge needs to shut this circus down soon.

Dear media: perhaps we ought to let Donald Trump speak for himself!

Baby steps, because the Republican Party is full of angry babies.

Optimism opens the door to great things.

If senate republicans had any shame, they’d die of it.

There are no moderate republicans – only extremists and cowards.

Peak wingnut was a lie.

Accountability, motherfuckers.

My right to basic bodily autonomy is not on the table. that’s the new deal.

Consistently wrong since 2002

Whoever he was, that guy was nuts.

Only Democrats have agency, apparently.

If you voted for Trump, you don’t get to speak about ethics, morals, or rule of law.

Historically it was a little unusual for the president to be an incoherent babbling moron.

You are here: Home / Anderson On Health Insurance / Reconciliation and the ACA

Reconciliation and the ACA

by | 19 Comments

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Last night, the Manchin approved reconciliation text was released.

It is mostly a tax and climate bill with a tiny bit of ACA. The following language is the entire ACA language in a 725 page bill:

SEC. 12001. IMPROVE AFFORDABILITY AND REDUCE PRE4 MIUM COSTS OF HEALTH INSURANCE FOR
CONSUMERS.
(a) IN GENERAL.—Clause (iii) of section
36B(b)(3)(A) of the Internal Revenue Code of 1986 is
amended—
(1) by striking ‘‘in 2021 or 2022’’ and inserting
‘‘after December 31, 2020, and before January 1,
2026’’, and
(2) by striking ‘‘2021 AND 2022’’ in the heading
and inserting ‘‘2021 THROUGH 2025’’.
(b) EXTENSION THROUGH 2025 OF RULE TO ALLOW
CREDIT TO TAXPAYERS WHOSE HOUSEHOLD INCOME
EXCEEDS 400 PERCENT OF THE POVERTY LINE.—Section 36B(c)(1)(E) of the Internal Revenue Code of 1986
is amended—
(1) by striking ‘‘in 2021 or 2022’’ and inserting
‘‘after December 31, 2020, and before January 1,
2026’’, and
(2) by striking ‘‘2021 AND 2022’’ in the heading
and inserting ‘‘2021 THROUGH 2025’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to taxable years beginning after
December 31, 2022.

So what do these 134 words do?

Section A — extends the temporary ARP subsidies for people earning between 100% Federal Poverty Level (FPL) to 400% until December 31, 2025.

Section B — extends subsidies for people earning over 400% FPL with no income cap

Section C — deconflicts this new law with previous law so everything is copacetic for timing purposes.

What does it not do?

It does nothing to provide Medicaid Expansion to the people who earn under 100% FPL who live in non-Expansion states.

Compared to current law this is a significant change in affordability but there is still work to be done.

There is significant language on Medicare Part D in Section 11201 that puts in an out of pocket limit for Medicare Part D that is initially $2,000 which then will be indexed to a growth rate.  Currently Medicare Part D has no top limit on what someone can be held liable for.  Given the proliferation of biologics and branded drugs that could routinely cost $100,000 or more for a year of treatment, some older adults currently have insurance that has them exposed to $5,000 — $10,000 — or even $20,000 in cost-sharing as well as premiums.  This is an unusual event but not a rare event.  This language changes that makes Medicare Part D true protection against catastrophic expenses.  I’ll defer to the pharmacy pricing experts to say more.

Reader Interactions

19Comments

  1. 1.

    l3000

    So people at 400% of poverty level get help continued, but the very poor in the Medicaid gap get left out as usual. Shocker. Glad for the families that needed relief, but not really a surprise that the very poor once again are left out.

  3. 3.

    Brit in Chicago

    Thanks for the summary of a very important part of the bill!

    The change to Medicare Part D looks like a really big deal.

    “I’ll defer to the pharmacy pricing experts to say more.” I think you’re too modest. Do any commentators here know more?

  5. 5.

    l3000

    And by a decision to choose to extend subsidies for 100-400% but ignore the Medicaid gap. Some of us can’t afford to move to a blue state.

  6. 6.

    Baud

    @l3000:

    I’m sorry you are badly affected by the Republican government of the state you live in.  But there’s a long history of portraying Democratic progress as failures because they didn’t go far enough that only serves to make things more difficult on everyone.

    Assuming this passes (a big if), I’m going to celebrate it and encourage voters to elect more Dems so we can continue to make things better for more people.

  7. 7.

    david anderson

    @Brit in Chicago:

    As part of my knowledge building and training over the past eight years, there are limits to what I can know at a deep expert level.  I made the very intentional decision to be comparatively rationally ignorant on Rx policy so I can focus on other things.   My knowledge goal on Rx policy is to know enough to know who I need to read.  I’ll be reading what Drs. Stacie Dusetzina & Erin Trisch and Professor Rachel Sachs have to say on Part D.  I know the three of them have devoted just as much thought to pharmacy pricing as I have devoted to ACA premium game playing so I’m very happy to defer to them.

  8. 8.

    azlib

    @Baud: Blame Manchin and perhaps Sinema for the limits and every Republican Senator. I am sure the issue came up in negotiations, but Manchin likely nixed it. Red States had ample opportunity to expand Medicaid, but decided not to for entirely political reasons. Also, John Roberts fingerprints are on this as well, since he decided Medicaid expansion was optional and not mandatory.

  10. 10.

    WaterGirl

    @l3000:  It’s awful to be caught in the gap, and I don’t think anyone here is trying to downplay how big a problem that is for the folks in the gap.  It sounds like you are, which sucks.

    Just trying to point out that politics is the part of the possible, and it’s kind of shocking that even this might be possible with Manchin.

    I am studiously trying to not get my hopes up because of, well, Manchin.

  11. 11.

    jonas

    @azlib: ​
     

    Red States had ample opportunity to expand Medicaid, but decided not to for entirely political reasons

    Well, once you let a poor person see a doctor just one time…boom! They’re like back in there for every little disease or injury. Vicious cycle.

  12. 12.

    jonas

    That Medicare Part D cap is a real game changer for millions of seniors. What a relief to know you won’t have to drain your entire retirement account to pay for some cutting-edge cancer treatment or something. The trick, as always, is seeing whether Democrats can claim credit for this. As I whined on the other thread, a few tweets from some progressive policy institute ain’t gonna cut it.

  14. 14.

    PaulB

    If that passes, it will save me about six thousand dollars next year. Keeping my fingers crossed.

  15. 15.

    Ohio Mom

    Wow! Something I support that might actually help me. I’m referring to the cap on Medicare Part D — it will be a small help to Ohio Family.

    Mostly though I’m happy (or hoping to be happy, this isn’t a done deal yet) because every small bit of progress is a small bit of progress for everyone.

    For some reason I am reminded of our old next door neighbors, staunch Republicans, who had an adult son with Intellectual Disability (the condition formerly known as mental retardation). I often brooded on the fact that to tne extent that their son received the funding and other supports he needed, it reflected my voting record; to the extent that my son did not, it reflected their voting record (and their adult son’s voting record, he reliably comes back to this neighborhood on Election Day to pass out Republican literature).

  17. 17.

    Noname

    @David Anderson: David, I am currently on my state exchange, income is much lower than I predicted for this year.  Was told that I had to apply for Medicaid due to low income, but if I applied for Medicaid I would have to pay full price for insurance coverage while waiting for approval and if denied would have to wait until open enrollment to reapply.  This seems insane.  Do I have any other options?

  18. 18.

    Ohio Mom

    @Noname: Since David doesn’t seem to be checking in this thread, you might want to send him an email. There are instructions how to do that on the top of the page — to the right of the man holding the balloon, click on the horizontal parallel lines.

    He was VERY helpful to Ohio Family several years ago. Saved us a bunch of money when we were in a pinch.

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