1/ THREAD: Trump’s signing his EO tomorrow. Here’s how it can destroy the Individual Market: acasignups.net/17/10/10/how-t… #ACASabotage
2/ Here’s the breakout of how healthcare spending is concentrated nationally, according to @KaiserFamFound :
3/ As you can see, 1% of the population accounts for 23% of all healthcare spending. Think cancer patients undergoing chemo, etc.
4/ 5% accounts for 50% of all spending. 10% accounts for 66%. 20% accounts for 82%, and 50% of the pop. accounts for 97% of ALL spending.
5/ Let’s say you have 100 people who collectively rack up ~$47,000/month in healthcare costs (avg. #ACA policy premium is ~$467 this year).
6/ (Not worrying about deductibles, co-pays, etc etc; this is for illustrative purposes only).
7/ Let’s also assume all 100 are enrolled in the same benchmark Silver plan to keep it simple.
8/ And finally, also to keep it simple, assume they’re all the same age & live in the same area.
9/ OK, so all 100 are paying (before subsidies) around $467/month. Half of them earn <400% of the fed. poverty line, half earn more.
10/ The 50 who earn <400% FPL are subsidized on sliding scale, so let’s say 5 are paying nearly full price (not thrilled but tolerate it)…
11/ …while the other 45 are more generously subsidized & paying much less (say, $50 - $350/mo depending) after subsidies. They’re happy.
12/ Meanwhile, the *other* 50 who earn MORE than 400% FPL (around $48K+ for an individual) are all paying full price. They’re grumbly.
13/ OK, so Trump’s EO *keeps* #ACA exchange plans (which require full EHB coverage, guaranteed issue, community rating, etc etc) in place…
14/ …but also removes restrictions on “association plans” and allows “short term” plans to become year-round.
15/ Since #ACA regulations (EHBs, guaranteed issue, comm. rating) don’t apply to association/short term plans, they’re dirt cheap, right?
16/ OK, so anyone who a) earns >400% FPL and b) doesn’t have some expensive ailment flocks to the Short Ass Plans.
17/ (yes, I’m calling these #ShortAssPlans. I’m 12 years old at heart)
18/ Meanwhile, anyone who earns <400% FPL *or* who earns more but needs the protections of full EHBs/etc sticks with #ACA plan.
19/ So now, anyone who’s subsidized + anyone w/pre-existing cond. is on exchange. Anyone who’s higher income/healthy goes to #ShortAssPlans.
20/ What does that look like? Well, remember, 50% of pool = 97% of the cost. That looks like this:
21/ The #ShortAssPlans only cost $28/month, woo-hoo! Those folks are thrilled! Unfortunately, the #ACA plans now cost $906/mo unsubsidized.
22/ The good news is that most of these folks are heavily subsidized. The bad news is some of them aren’t. They can’t afford full price.
23/ …so the remaining unsubsidized (or only lightly subsidized) shift to #ShortAssPlans. Eventually we have something like this:
24/ Now the #ShortAssPlans cost $105/mo. That’s a lot more than $28 but still quite reasonable. Unfortunately, #ACA plans are now $1,900/mo.
25/ By now, the ONLY way to afford an #ACA plan is if you’re HEAVILY (and I mean heavily) subsidized. EVERYONE unsubsidized drops out.
26/ At this point the #ACA exchanges have been turned into a de facto High Risk Pool. As long as it’s properly funded, that MIGHT work…
27/ …for everyone UNDER 400% FPL (assuming every carrier hasn’t dropped out of the exchanges altogether by this point). Meanwhile…
28/ …the #ShortAssPlans are still pretty cheap, hooray! Everyone over 400% FPL is happy, right? Except for one little problem…
29/ What happens when someone earning >400% FPL on a #ShortAssPlan is diagnosed with something not covered by it? Ut oh.
30/ Let’s say you earn $60K/year (around 500% FPL), you’re on a #ShortAssPlan and are diagnosed w/cancer, diabetes, whatever.
31/ Your dirt-cheap #ShortAssPlan doesn’t cover your expenses (that’s what makes it dirt-cheap). So assuming you survive until Nov. 1st…
32/ …you can switch to an #ACA plan which HAS to cover it, right? Except you earn $60K, so you have to pay full price.
33/ Remember, at this point “full price” on the #ACA exchange would be $1,900/mo. That’s $23K/year on a $60K income…
34/ …which you probably aren’t earning anymore anyway because you have cancer now and can’t work.
35/ …which, is just as well, actually, because the only way to get subsidies is for your income to also drop BELOW 400% threshold anyway.
36/ In short, if it went through (AND survives legally AND the carriers actually stick around the exchanges)…
37/ …it would create not one, not two but THREE effectively separate risk pools: insanely⬆to treat, heavily subsidized exchange enrollees…
38/ …fairly ⬇to treat, high-income #ShortAssPlan enrollees…
39/ …and middle/high-income people w/expensive conditions who would be UTTERLY screwed w/no place to turn.
40/ This would include people like @lpackard…but it *could* include ANYONE who earns >400% FPL sooner or later.
41/ Of course, there’s a simple solution to most of this problem: REMOVE THE 400% CAP ON TAX CREDITS.
42/ That wouldn’t solve everything, of course, but it’d resolve a big chunk of it. A good 4-8M people >400% FPL…
43/ …would get a Silver #ACA plan (w/full protections) for no more than 10% of their income: acasignups.net/17/07/25/updat…
44/ But here’s the larger point of all this: Here’s those tables again (50/50, 80/20, as well as hypothetical 90/10, 95/5 and 99/1):
46/ Slicing people up into different risk pools in & of itself does NOTHING to actually reduce the actual total *cost* of healthcare.
47/ And in fact doing so goes completely against the very CONCEPT of health insurance: Pooling Risk. /end.
P.S. One more thing: Short-term plans *as they stand now* aren’t necessarily all bad; they do serve a need for some situations. HOWEVER…
…here’s an example of why they’re useless for anyone w/a serious problem: uhc.com/individual-and…
I should also clarify one other important point: High Risk Pools are NEVER properly funded, BECAUSE they’re so insanely expensive. /end2
RELATED: Here’s the type of policy which used to be offered on the individual market as a “major” medical plan:
Yet Another PS: Here’s an example of the type of “major” medical plan which used to be typically available: acasignups.net/17/05/29/some-…
$10K-$40K/year in maximum benefits? Awesome! That’s enough for…one day in the neonatal unit for a premature infant? A single chemo session?
OK, I won’t say /end this time, I’ll leave it open-ended, since there’s so much more to say about this insanity…but /end for the moment…
While I’m at it, for what it’s worth...

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More from @charles_gaba

Aug 27, 2018
⚠️ GRAPHICS-HEAVY THREAD: Next week, the #TexasFoldEm lawsuit brought by 20 Republican Attorneys General against the #ACA goes to court. The Trump Administration is refusing to defend against it even though it EVERY legal expert says it’s a pile of steaming garbage. 1/
2/ If the #TexasFoldEm plaintiffs succeed, federal protections for those w/#PreExistingConditions would be gone. Not just on the individual market…people w/EMPLOYER coverage would be at risk as well, especially since most people are out of a job at least once in their lives.
3/ Here’s a reminder of the idiotic “argument” the #TexasFoldEm plaintiffs are using:
1. SCOTUS ruled the #ACA mandate is only Constitutional because it’s a tax.
2. The GOP repealed the mandate tax.
3. Therefore, they get to repeal the rest of the #ACA as well.
Really. That’s it.
Read 67 tweets
Aug 21, 2018
THREAD: For those who still don’t understand how important the #ACA #TexasFoldEm case is (along #StopKavanaugh), here’s a simple timeline of the ACA’s 3-Legged Stool:
1/ Here’s how the #ACA’s 3-Legged Stool was *supposed* to work when the law was passed. The blue leg includes the patient protections. The red leg is the part everyone hated but which served an important purpose. The green leg is the financial help for people to pay for it.
2/ This is what it ACTUALLY ended up looking like: There were two main problems. The financial assistance was cut off at 400% FPL income (& wasn’t generous enough), and the mandate penalty wasn’t strong enough to be fully effective. Both were EASILY fixable.
Read 13 tweets
Aug 13, 2018

Do you remember “Harry & Louise”?

Here’s a reminder. Watch both commercials, but especially the second one. There’s a LOT going on here:

2/ First of all, notice how in 1993, “community rating” (i.e., not being allowed to charge people more based on their health status) was considered a HORRIBLE thing.
3/ Cut to 2018: 8 yrs after the Affordable Care Act was signed into law, 89% of the public thinks it’s important NOT to charge people more for their health insurance based on their health status. EIGHTY-NINE PERCENT. This is the real legacy of the #ACA.

Read 19 tweets
Aug 10, 2018
ATTENTION MICHIGAN RESIDENTS: I’m trying to track down the Twitter handles for the following 2018 Democratic nominees; please help if you can, thanks!

HD001: Tenisha Yancey
HD003: Wendell Byrd
HD004: Isaac Robinson
HD005: Cynthia A. Johnson
HD006: Tyrone Carter
HD012: Alex Garza
HD013: Frank Liberati
HD014: Cara Clemente
HD016: Kevin Coleman
HD022: John Chirkun
HD024: Laura Winn
HD025: Nate Shannon
HD028: Lori M. Stone
HD030: John P. Spica
HD031: William J. Sowerby
HD032: Paul Manley
HD036: Robert Murphy
HD045: Kyle Cooper
HD048: Sheryl Y. Kennedy
HD049: John D. Cherry
(yes, THAT John Cherry…he doesn’t seem to be on Twitter?)
HD050: Tim Sneller
HD051: David E. Lossing
HD054: Ronnie D. Peterson
HD056: Ernie Whiteside
HD057: Amber Pedersen
HD058: Tamara C. Barnes
HD059: Dennis B. Smith
HD063: Jennifer Aniano
Read 5 tweets
Aug 10, 2018
THREAD: Yeah, I have insomnia, so here’s some wonky info re. single payer, M4A and the Michigan Gubernatorial primary. 1/
2/ Now that the #MIGov primary is over, since the most contentious debate between El-Sayed and Whitmer (besides 'dark money') was about single-payer healthcare, let's get a few things straight:
3/ 1. "Single Payer" refers to any healthcare system where the gov’t is the payment source for healthcare providers (doctors/hospitals/drug cos/etc).
Read 44 tweets
Aug 8, 2018
How Much More Will #ACASabotage Cost Unsubsidized Enrollees in YOUR Congressional District???
1/ Last year, I posted state-by-state infographics which broke out the estimated number of Americans who would lose healthcare coverage if each of the various #ACA repeal bills form the GOP were to become law.
2/ At first I used my own estimates, but then @EmilyG_DC and her colleagues from the Center for American Progress (@amprog) stepped up and started compiling their own projections. Their methodology was different but our estimates were generally in the same range.
Read 67 tweets

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