1. What’s Next for the ACA and Health Reform?
Nancy Turnbull
Regis College
March 2019

2. Massachusetts: Lowest Rate of Uninsurance in US since 2008
Percent of Population With No Health Insurance
ACA
U.S.
MASSACHUSETTS
2010
Source: Massachusetts Division of Health Care Finance and Policy, Household Insurance survey; US Census Bureau CPS, Urban Institute 2007 study for BCBSMAF 2 2

3. Comparison of Major Coverage Components of Massachusetts Law and the ACA
Medicaid Expansions √
Subsidized Coverage
Insurance Market Rules
Health Insurance Exchange/Marketplace
Individual Mandate
Employer Responsibilities

4. Percent of Non-Elderly Adults
In Massachusetts: More People Covered But Little Progress on Financial Security Overall
Percent of Non-Elderly Adults
Source: MHRS, 2018, BCBSMA Foundation

5. Percent of Non-Elderly Adults
In Massachusetts, Difficulties Obtaining Health Care Are Common, Worse for Lower Income Individuals
Percent of Non-Elderly Adults
Source: MHRS, 2018, BCBSMA Foundation

6. November 2016

7. After 2016 Election Republicans Tried and Failed to Repeal ACA
March 2017
American Health Care Act
-24 million
No Vote
May
Revised American Health Care Act
-23 million
Passed House
June
Senate Better Care Reconciliation Act
Repeal, No Replace
-22 million
-32 million
July
BCRA
Rejected
Health Care Freedom Act
-16 million
Rejected 49-51
Sept
Graham-Cassidy
-21 million
No vote

8. Where are we now? Congressional stalemate
Trump Administration still trying to sabotage ACA
Courts a real threat
Action moves to the states

9. Trump Administrative Actions to Weaken/Sabotage the Law
Weaken individual mandate
Reduce subsidies
Discourage enrollment/reenrollment
Disinformation
Encourage states to weaken Medicaid
Public charge proposed rule
Allow insurers to sell products with fewer benefits and protections
Weaken standards for coverage

11. Action in the States: Medicaid
14 states have not yet expanded Medicaid

12. Expand Medicaid

14. What States Are Doing for Now
Expand Medicaid
State Level Individual Mandates
Mass, NJ, DC, Vermont

15. Improve the ACA Subsidies
ACA subsidies too low to make good coverage affordable for many
So Massachusetts “tops off” the subsidies with state funds
Comes from tobacco tax and employer assessments
State Enrollment Assistance

16. Massachusetts Subsidies are Larger and Coverage Is Better Than in ACA
Individual FPL
Income
(2017)
Federal
Maximum Enrollee
Annual Premium Contribution after APTC*
Mass
Enrollee Annual Premium for
ConnectorCare %
$11,770-$15,654 $ $0
133%-150%
$15,655-$17,655 $ %
$17,656-$23,540
$710-1,492
$512 %
$23,541-$29,425
$1,492-2,392
$989 %
$29,426-$35,310
$2,392-3,376
$1,471
Note: Actuarial value of APTC silver plan ~70% ; with cost-sharing subsidy for <250% FPL is 73% to 94%; actuarial value of ConnectorCare plans ~94-99%.

17. What States Are Doing for Now
Expand Medicaid
State Level Individual Mandates
Improve ACA subsidies at state level
Weaken Medicaid

18. Work Requirements in the states
Weaken Medicaid
Work Requirements in the states
Source: (work requirements)

19. What States Are Doing for Now
Expand Medicaid
State Level Individual Mandates
Improve ACA subsidies at state level
Protect insurance market reforms
Weaken Medicaid
Lower Drug Prices
Social Determinants of Health

20. What’s in the Future?
Court decisions in lawsuits that challenge certain administrative actions?
The Presidential Elections in 2020?
Medicare for All?
Can the U.S. ever control its health care costs? ?