One: From February 15 through May 15, people have a special enrollment period, ordered by President Biden, to sign up for new Affordable Care Act plans. Millions of uninsured people, including those who’ve recently lost jobs, qualify for coverage under existing ACA rules.
Two: ACA rules are likely to be made much more attractive, They are contained in the health care provisions of the president’s $1.9 trillion rescue program, which is tied to the pandemic and the extensive economic damage it’s caused.
Three: Medicaid may become easier to get and states no longer can require people to seek work before being eligible.
Assuming Democrats in the U.S. Senate can approve the rescue program via a budget resolution that does not require Republican support, the ACA will be expanded for at least the next two years. Unless, of course, the U.S. Supreme Count strikes down the law, which it may do in a case now before the court.
If the law survives, as most pundits expect, consumers can look forward to expanded tax credits that will make ACA plans more attractive to both low- and middle-income individuals and households.
The ACA is complex, featuring different tiers of coverage (bronze, silver, gold, and platinum) and income-based rates and tax credits. A program to help people navigate these rules and sign up for coverage was gutted by former president Trump but would receive added funding in the Biden rescue program. The timing of that boost is not known but until then, there are solid help websites operated by the Kaiser Family Foundation and the Georgetown Center on Health Reforms.
The Center on Budget and Policy Priorities (CBPP), a liberal Washington think tank, assessed Democrats proposals developed in the House of Representatives. Here are examples of how the changes would affect people at different income levels:
|Affordable Care Act Monthly Premiums|
|$18,000 (141% FPL)||$54||$0||$54|
|$30,000 (235% FPL)||$195||$85||$110|
|$45,000 (352% FPL)||$369||$274||$95|
|$60,000 (470% FPL)||$511||$425||$86|
|$30,000 (174% FPL)||$132||$24||$108|
|$45,000 (261% FPL)||$325||$167||$158|
|$60,000 (348% FPL)||$492||$360||$132|
|$75,000 (435% FPL)||$1,920||$531||$1,389|
|Family of four*|
|$45,000 (171% FPL)||$193||$32||$161|
|$60,000 (229% FPL)||$379||$158||$221|
|$90,000 (343% FPL)||$737||$531||$206|
|$120,000 (458% FPL)||$1,445||$850||$595|
|*Two adults age 40, children age 10 and 5|
The CBPP’s projected impacts of the changes include:
- If the remaining states expanded Medicaid nearly 4 million uninsured low-income adults could gain coverage.
- More than two million other low-income people are now in the so-called coverage gap and could get coverage. They have incomes below the poverty line and thus are ineligible for premium tax credits for ACA coverage and also ineligible for Medicaid under their state’s rules.
- Premium tax credits for 2021 and 2022 would lower to 8.5 percent from 9.83 percent the ceiling on how much of a person or family’s income can be spent on ACA plans, “eliminating or reducing premiums for millions of current marketplace enrollees.” This applies to people with income of 300 to 400 percent of the federal poverty level. Premium caps for higher earners also are proposed.
Medicaid is also on the president’s to-do list. Late last week, the Centers for Medicare & Medicaid Services (CMS) reversed Trump’s requirement that states could require people to seek work before they were eligible for Medicaid. That effort has been at least temporarily halted by the courts, and presumably won’t be pursued by any states now.
In a potentially more important action, the rescue bill offers more funds to entice Medicaid participation in ACA plans by the 14 states that did not expand Medicaid following enactment of the ACA – Alabama, Florida, Georgia, Kansas, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, South Dakota. Tennessee, Texas, Wisconsin, and Wyoming.