In a long-delayed rule, the Biden Administration has reversed the Trump Administration's expansion of short-term health plans that were exempt from the ACA's requirements for coverage of pre-existing conditions and essential benefits.

cms.gov/newsroom/press… The Trump Administration had allowed short-term plans exempt from ACA rules to be purchased for up to 364 days and renewed for up to 3 years. The Biden Administration is limiting them to no more than 4 months.

The House Republican Study Committee budget plan would make sweeping changes to health care, reducing federal spending significantly and rolling back regulations. 🧵 The House Republican Study Committee budget would convert the ACA premium subsidies and Medicaid into block grants to states and reduce federal spending on those programs by $4.5 trillion over a decade.

This somewhat complicated chart from the body that advises Congress on Medicare (@medicarepayment) is quite stunning when you think about it.

It costs the government $83 billion more to provide coverage through private Medicare Advantage plans than in traditional Medicare. It costs the government more to provide coverage through private Medicare Advantage plans than it would in traditional Medicare due to a kind of double whammy. Plans enroll healthier than average people. Yet, they are good at coding diagnoses that make them look sicker.

A somewhat wonky thread on what a $2,000 cap on out-of-pocket drug costs in private insurance would mean. A similar cap will apply in Medicare next year under the Inflation Reduction Act. Before the new $2,000 cap on drug costs in Medicare, there was no cap on out-of-pocket drug costs or any cap on out-of-pocket costs at all. So, this will help people with high drug costs a lot. Plus, the government subsidizes the premium.

New: Based on KFF's compilation of the latest public data, at least 728,000 people have now been disenrolled from Medicaid through the unwinding of the pandemic continuous coverage provision.

kff.org/medicaid/issue… The share of Medicaid disenrollments due to failure to complete the renewal process ranges from a high of 89% to a low of 43%.

In many cases, this is people falling through the cracks due to red tape.

In other cases, people may already have other coverage.

A federal judge in Texas has struck down major portions of the ACA's requirement that health insurers cover preventive services with no patient cost-sharing, with the ruling applying nationwide.

storage.courtlistener.com/recap/gov.usco… About 100 million people use preventive services under the ACA in a typical year. It is the part of the ACA that affects people most broadly.

healthsystemtracker.org/brief/preventi…

It would be hard to find a clearer example than this of the difference between government negotiation of drug prices and the private market.

https://twitter.com/abettel/status/1583489164921942017

Government purchasing of COVID vaccines -- which will end if Congress does not appropriate more funding -- has served three purposes:

1. Getting a lower price.
2. Ensuring availability.
3. Guaranteeing a market for the vaccines.

Over 8 years after the main provisions of the ACA went into effect, the Biden Administration has issued a new rule fixing the "family glitch," which has locked millions of families with unaffordable employer insurance out of ACA coverage.

federalregister.gov/public-inspect… Under the ACA, people with access to affordable health insurance from an employer -- meaning the employee premium is less than about 9% of their income -- are ineligible for ACA premium assistance.

New: U.S. Census survey finds the number of people uninsured fell by over 1 million in 2021, driven largely by increases in Medicaid coverage.

census.gov/library/public… Increases in health insurance coverage were particularly notable for Black people, with the uninsured rate dropping from 10.4% in 2020 to 9.0% in 2021.

After trying for decades, Democrats are finally succeeding at giving the federal government authority to negotiate drug prices.

This is not the sweeping drug pricing measure originally envisioned, but it is the biggest political loss the pharmaceutical industry has suffered. Democratic candidates will have very effective talking points this campaign season, giving Medicare the authority to negotiate drug prices and capping medication costs for seniors.

The Senate parliamentarian has jettisoned the provision of the Inflation Reduction Act that would have limited drug price increases in private insurance to inflation.

Medicare will still be able to negotiate drug prices, and price hikes in Medicare will be restrained. Losing restraint on drug price hikes in the private sector means less federal revenue and less political support from employers.

Prescription drugs will now work like the rest of health care, with lower prices in Medicare and no constraints for those in private insurance.

It looks like Democrats are on their way to giving the government the authority to negotiate the prices of certain drugs in Medicare and enhancing ACA affordability.

This would be the biggest health reform since passage of the ACA itself over 12 years ago. The significance of passing drug price negotiation over the objection of the pharmaceutical industry cannot be overstated. Pharma does not lose often on Capitol Hill.

There are many downsides to our employer-based health insurance system.

But, it is hard to imagine a public single payer plan covering abortions and related travel expenses for people in states where abortion is now banned. Abortion has often been a contentious issue in debates over expanding health coverage and affordability, including the ACA. That will likely now be even more true going forward.

New: During the public health emergency, states have been prohibited from dropping people from Medicaid.

When the emergency ends, Medicaid enrollment could drop by 5 to 14 million, depending on what states do to help eligible people stay enrolled.

kff.org/medicaid/issue… We estimate the continuous enrollment requirement in Medicaid during the public health emergency will cost states $47 billion through the end of fiscal year 2022.

But, states will receive a total of $100 billion extra in federal Medicaid funding, providing net fiscal relief.

The Biden Administration is expected to propose a fix to the ACA’s family glitch. But, what actually is the family glitch? The ACA said that people with access to affordable employer coverage – a premium contribution below a certain percentage of income, now 9.6% -- could not get premium help in the marketplace.

Capping out-of-pocket costs for insulin at $35 per month would increase government spending by $6.6 billion over 10 years and decrease government revenue by $4.8 billion.

https://twitter.com/USCBOcostest/status/1509187627139964930

Why does capping out-of-pocket insulin costs decrease government revenues? Glad you asked.

It increases premiums.

In ACA plans, that increases premium subsidies, which are tax credits.

In employer plans, that decreases wages and/or profits, which means less tax revenue.

New federal data shows Medicaid and CHIP enrollment up by over 15 million during the pandemic, driven by a requirement for continuous coverage during the public health emergency.

The potential loss of coverage is massive if care isn't taken in unwinding the emergency. Here's a link to the latest Medicaid and CHIP enrollment data.

medicaid.gov/medicaid/natio…

The White House announces over 14.5 million people have signed up for ACA coverage, an all-time high.

President Biden campaigned on reinvigorating the ACA, and there's no question he's followed through on that.

whitehouse.gov/briefing-room/… Key factors in the record ACA enrollment:

A temporary increase in premium assistance provided through the American Rescue Plan.

A reversal of outreach funding cuts imposed by the Trump Administration.

A record 13.6 million people have signed up for ACA coverage.

This enrollment growth is being driven by increased premium assistance in the American Rescue Plan, a reversal of cuts in outreach, and an administration touting rather than trashing the ACA.

cms.gov/newsroom/press… These ACA enrollment gains are at risk if Build Back Better does not pass and extend the American Rescue Plan's enhanced premium assistance beyond next year.

Enrollees would get notice of big premium increases right before the midterm election if premium help isn't extended.

The Biden Administration will be distributing 500 million rapid at-home COVID tests for free.

We don't want to be hermits, so we'll want to be using more tests than that to continue gathering safely during the winter wave. This sends an important signal about how to do so. The Biden Administration previously announced that insurers will be required to reimburse for rapid at-home tests people buy. While cumbersome, that will help make tests more affordable for people, supplementing the distribution of 500 million free tests.

CBO estimates that capping cost-sharing for insulin at $35 per month in the Build Back Better Act would decrease federal revenue by $4.6 billion over a decade, which is an indication of how much people who use insulin would save.

cbo.gov/publication/57… There are two ways capping insulin cost-sharing leads to lower federal revenues:

1. It raises premiums in ACA marketplace plans, which increases the premium tax credits paid by the federal government.

2. It raises premiums in employer plans, which are not taxed as income.