The Effects of Expiring Pandemic Relief Measures on Coverage and Affordability: A Future Outlook
July 15, 2022
In light of the COVID-19 public health emergency (PHE), the federal government implemented temporary changes to routine Medicaid, CHIP, and Marketplace eligibility and enrollment operations to help stabilize insurance coverage. Medicaid and CHIP enrollment has grown to nearly 85 million individuals due largely to the continuous enrollment condition. Over 3 million new consumers have joined the Marketplace due partly to enhanced premium tax credits from the American Rescue Plan Act of 2021 (ARPA). However, ARPA’s enhanced and expanded subsidies are only authorized through the end of 2022. Additionally, Medicaid eligibility flexibilities and increased matching funds will terminate shortly after the PHE declaration ends, with Medicaid disenrollment potentially beginning as early as November 2022. As a result, the corresponding increases in coverage numbers could be temporary, leaving federal policymakers to decide whether and how to extend these policies.
This event outlined the various coverage-related elements at play over the next six to nine months, their tradeoffs, and how they may impact various stakeholders, including consumers, state leaders, and payers. Panelists will explore enrollment, risk pool, and premium forecasts, approaches that state and health plan leaders may take, as well as implications on overall costs to the system.
Speakers:
- Scott Brockman, ASA, MAAA, Vice President, Marketplace Strategy, CareSource
- Sara Collins, Ph.D., Vice President for Health Care Coverage and Access, Commonwealth Fund
- Katie Keith, J.D., MPH, Director, Health Policy and the Law Initiative, O’Neill Institute for National and Global Health Law, Georgetown University Law Center
- Kevin Patterson, MPA, MURP, Chief Executive Officer, Connect for Health Colorado
- Elizabeth Wroe, J.D., Principal, Leavitt Partners
- Sarah J. Dash, MPH, President and CEO, Alliance for Health Policy (moderator)
This event was made possible with support from the Commonwealth Fund.
Presentation: The Effects of Expiring Pandemic Relief Measures on Coverage and Affordability: A Future Outlook
Event Resources
Key Resources
(listed chronologically, beginning with the most recent)
“Emergency Declarations and Waiver Authority.” McDermott Plus Consulting. June 22, 2020. Available
Averting Premium Shock for Marketplace Consumers.” Keith, K. The Commonwealth Fund. May 26, 2022. Available here.
“Mitigating Coverage Loss When the Publish Health Emergency Ends.” Corlette, S., Kona, M. The Commonwealth Fund. April 26, 2022. Available here.
“What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access.” Cubanski, J., Kates, J., Guth, M., et al. Kaiser Family Foundation. April 8, 2022. Available here.
“Medicaid Provisions in the American Rescue Plan Act.” Musumeci, M. Kaiser Family Foundation. March 18, 2021. Available here.
Additional Resources
(listed chronologically, beginning with the most recent)
“Americans Are on the Brink of Experiencing Premium Pain and Health Insurance Loss.” Collins, S. The Commonwealth Fund. July 13 2022. Available here.
“Drivers of 2023 Health Insurance Premium Changes.” American Academy of Actuaries. June 2022. Available here.
“Drivers of 2023 Premium Changes: Effects on Premiums Infographic.” American Academy of Actuaries. June 2022. Available here.
“Family First Prevention Services Act.” NCSL. April 26, 2022. Available here.
“The Coronavirus Aid, Relief, and Economic Security Act: Summary of Key Health Provisions.” Moss, K., Wexler, A., Dawson, L., et al. Kaiser Family Foundation. April 9, 2022. Available here.
“Learning from COVID-19-Related Flexibilities: Moving Toward More Person-Centered Medicare and Medicaid Programs.” The SCAN Foundation, Manatt Health, and Health Management Associates. March 2022. Available here.
“Next Big Health Crisis: 15M People Could Lose Medicaid when Pandemic Ends.” Messerly, M. POLITICO. March 2, 2022. Available here.
“PHE Unwinding for States.” Princeton University, State Health and Value Strategies. March 11, 2022. Available here.
“Millions of Children May Lose Medicaid: What Can Be Done to Help Them From Becoming Uninsured.” Alker, J. Brooks, T. Georgetown University Health Policy Institute Center for Children and Families. February 17, 2022. Available here.
“Public Health Emergency Declarations.” U.S. Department of Health and Human Services. January 14, 2022. Available here.
“Counties and the ARPA Recovery Fund: Executive Summary.” NACO. January 13, 2022. Available here.
Experts
Speakers
Sara Collins, Ph.D.
Commonwealth Fund, Vice President for Health Care Coverage and Access
src@cmwf.org
Sarah Dash, MPH
Alliance for Health Policy, President and Chief Executive Officer
sarahdash@allhealthpolicy.org
Katie Keith, J.D., MPH
Health Policy and the Law Initiative with the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, Director
Katie.Keith@georgetown.edu
Kevin Patterson, MPA, MURP
Connect for Health Colorado, Chief Executive Officer
executivedirector@connectforhealthco.com
Elizabeth Wroe, J.D.
Leavitt Partners, Principal Partner
elizabeth.wroe@leavittpartners.com
Experts and Analysts
Stephanie Anthony, J.D., MPH
Manatt Health, Senior Advisor
santhony@manatt.com
James Capretta, MPP
American Enterprise Institute, Resident Fellow and Milton Friedman Chair
jcapretta@aei.org
Debbie Curtis
McDermott+Consulting, Vice President,
Dcurtis@mcdermottplus.com
Charlene Frizzera
CF Health Advisors, Co-founder and President
cfrizzera@cfhealthadvisors.com
Genevieve M. Kenney, Ph.D., M.A.
Urban Institute, Senior Fellow and Vice President of Health Policy Center
jkenney@urban.org
Jennifer Podulka, MPA
Health Management Associates, Principal
jpodulka@healthmanagement.com
Tim Westmoreland, J.D.
Georgetown Law, Professor
westmort@law.georgetown.edu
Rodney L. Whitlock, Ph.D.
McDermott+Consulting, Vice President
RWhitlock@mcdermottplus.com
Government
Marvin Figueroa, Ed.M.
U.S. Department of Health and Human Services, Director of the Office and Intergovernmental and External Affairs
Marvin.figueroa@hhs.gov
Carries Hughes, M.A.
House Education and Labor Committee, Health and Human Services Director
Carolyn.hughes@mail.house.gov
Hannah Katch, MPP
Centers for Medicare and Medicaid Services (CMS), Senior Policy Analyst
Hanna.katch@cms.hhs.gov
David Meyers, M.D.
U.S. Department of Health and Human Services, Deputy Director at Agency for Healthcare Research and Quality
David.meyers@ahrq.hhs.gov
Stakeholders
Frederick Isasi, J.D., MPH
Families USA, Executive Director
fisasi@familiesusa.org
Hannah Maniates, MPH
National Association of Medicaid Directors, Policy Analyst
Hannah.maniates@medicaiddirectors.org
Hemi Tewarson, J.D., MPH
National Academy for State Health Policy (NASHP), President and Executive Director
htewarson@nashp.org
Aaron Wesolowski
American Hospital Association (AHA), Vice President of Policy Research, Analytics, and Strategy
awesolowski@aha.org
Transcript
This is an unedited transcript.
0:06
Good afternoon and welcome. Thank you for joining today’s webinar, The Effects of expiring Pandemic Relief Measures on Coverage and Affordability: Future Outlook. I am Sarah Dash, president and CEO of the Alliance for Health Policy. For those of you who are not familiar with the Alliance, welcome. We are a non partisan resource for the policy community, dedicated to advancing knowledge and understanding of health policy issues.
0:31
You can join today’s conversation on Twitter using the hashtag all health Lives, and join our community at all health policy, as well as on Facebook and LinkedIn.
0:41
Today’s panel is going to have a Q&A section at the end of the hour. And actually, hour and a half. We would like you all to be active participants. So, please, get your questions ready. There’s a dashboard on the right side of your web browser with the speech bubble icon. Go ahead and send your questions in through that icon at any time during the webinar, and we will get to as many as possible, and as well as if you have any technical issues, you can go ahead and chat about those. Today’s briefing is brought to you in partnership with the Commonwealth Fund. And I want to thank the Commonwealth Fund for making this possible. Also, want to thank the Alliance team members who contributed to the development of this webinar, Chris Holt.
1:21
OK, and yeah, and Devin, Laura, in particular, for making this possible, as well as a contractor. And so now, I’d like to introduce the panelists, who will be joining us for this in-depth conversation. First, we’ll hear from doctor Sarah Collins, She’s vice president for Health Care Coverage and Access at the fun, at the Commonwealth Fund. She’s an economist, and joined them in 2002, and has led the Funds National Program on Health Insurance since 2005.
1:49
Katie Keith provides, following the ACA rapid response analysis for Health Affairs Forefront, and it is the Director of the Health Policy and Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, where she also teaches a course on the Affordable Care Act. Katie also serves as an associate research Professor at Georgetown University’s Center on Health Insurance Reforms, and as an appointed consumer representative to the National Association of Insurance Commissioners. Welcome, Katie. We will hear from Kevin Patterson, who has served as Chief Executive Officer of Connect for Health Colorado. Since April of 2015. He previously served as Chief Administrative Officer, an interim Chief of staff to Governor John Hickenlooper, has an extensive history of public service. From his time at Connect for Health, Colorado, Kevin has been focused on improving the customer experience so they can focus on health insurance.
2:47
Scott Brockman will be our next panelist. He’s the Vice President of Marketplace Strategy at Care Source.
2:54
And he has worked in the healthcare industry for over 20 years. While it care source, he held the role of Chief Actuary building out their actuarial and risk adjustment capabilities to support members in their Medicaid marketplace and Medicare lines of business. He’s currently the leader of Care Sources Marketplace product, helping the organization manage through environmental changes and the Affordable Care Act to support the members that they serve. And last, but certainly not least, we’re thrilled that Elizabeth Row will be joining us. Elizabeth is principal at Leavitt Partners, where she develops and manages complex multi sector alliances and advises and informs clients on the impact of federal and state health care issues, and how to effectively engage with policymakers. Liz specializes in private health insurance, FDA, Food and Drug administration related regulated products, fiscal policy, digital health, and biodefense.
3:46
She is also a subject matter expert in Senate Rules and Procedure, Federal Authorizing Budget Appropriations, and Rulemaking processes. And she will have a lot of insight to share with us today. So, with that, let me now turn to Sarah Collins, and Sarah, take it away, Thanks.
4:07
Thank you, Sarah, and thank you to the alliance and the panelists for today’s briefing.
4:12
Both Medicaid and the marketplace enrollment have climbed over the course of the pandemic and the number of people uninsured at in the US. Has trended down. I’m going to spend just a few minutes explaining what’s driving these coverage changes and how Congress can protect them. Next slide, please.
4:36
CMS reported this month as 17 million more adults and children were enrolled in Medicaid and the Children’s Health Insurance Program in March 2022, and in February 2020, bringing the total number of people enroll to nearly 88 million people.
4:51
Why has an enrollment surge like this?
4:54
The Families first, Coronavirus Response Act of 2020, commonly referred to as spectra, requires states to keep people continuously enrolled in Medicaid in exchange for enhanced federal matching funds through the end of October 19 public health emergency.
5:09
The Congressional Budget Office estimates that this provision has increased Medicaid enrollment by about 13 million people.
5:17
Why did this make such a big difference in Medicaid enrollment?
5:21
Simply put, prior to existing state and federal policy, made it hard for eligible people to stay enrolled in Medicaid under federal law. States must verify that Medicaid enrollees remain eligible for coverage at least once a year, but many states check eligibility more frequently. Some states allow as few as 10 days, for enrollees to submit documents to prove eligibility.
5:45
Even small income bumps like from seasonal work can lead to dis enrollment, even though income might drop again in a few months, consequently the average length of enrollment in Medicaid is less than 10 months.
5:58
Exhibit two.
6:01
Marketplace Enrollment has also climbed to more than 14 million people. as you can see in the orange line on this slide, on this chart. I have to go to the next slide, please.
6:15
The primary reason is that the American Rescue Plan Act or ARPA, lower premiums for Marketplace plans by enlarging the subsidies that people get for them, this led to an average per person monthly savings of about $67.
6:30
CBO estimates that the ARPA enhanced subsidies increased 22,002 marketplace enrollment by two point three million people.
6:39
If you look at the blue line on the exhibit, you can see the combination of these two policies, continuous enrollment, and the subsidies, has helped to drive the number of people uninsured lower.
6:50
Bad news is that these coverage and premium protections will expire within a few months. First, the ARPA subsidies will expire at the end of 2022. Second, the continuous enrollment requirement and Medicaid will end on the Public Health Emergency and sometime next year. This will trigger a massive eligibility redetermination effort by states for all Medicaid enrollees.
7:13
People will lose Medicaid coverage both because of actual eligibility changes and because of anticipated errors and documentation barriers.
7:22
The end of these two pandemic policies have led CVO forecast that over the next 10 years, marketplace enrollment will fall by one point four million people in 20 20 through 3 with further declines after that.
7:37
Medicaid enrollment will decline by 12 million by 2025.
7:42
Consequently, the number of uninsured people under age 65 will jump from a low of 25 million people in 20 22 to 29 people by 2025.
7:52
Next slide, please.
7:55
And that’s not all according to the Urban Institute. The loss of the ARPA subsidies will, and a less healthy risk pool. As people leave the marketplaces will contribute to annual premium increases for people who are still enroll amounting to about $457 for individuals earning less than 150% of poverty, which is about $19,000 for an individual.
8:17
One thousand dollars for people earning between 150% and 400% of poverty. in $2000 for people earning more than 400% of poverty, which is about $51,000.
8:28
It’s important to note that the increases for the lowest income individuals can make it less likely that people who lose Medicaid eligibility at the end of the public health emergency will enroll in marketplace plans, they will just be too expensive.
8:42
Next slide, please.
8:45
With higher incomes are also hard to Cynthia *** estimates that in West Virginia or Wyoming, a 64 year old with income just over the subsidy eligibility threshold in 20 20 to about $51,000 would see premiums shoot up from 8.5% of their income to a whopping 41%.
9:05
Next slide, please.
9:07
So what can Congress do to prevent all this pain and coverage us? First, they can extend the marketplace subsidy enhancements. Second, at the end of the P a Public Health emergency, Congress could require States to conduct Medicaid Eligibility redetermination, Gradually, and phase down the enhanced Medicaid matching funds. Rather than eliminate them as soon as a public health emergency ends.
9:31
Third, Congress could provide a Federal fallback option for people eligible for Medicaid and the 12 States that have yet to expand their programs.
9:40
This could reduce the number of uninsured Medicaid eligible people in those states by an estimated three point two million people, or if Congress could apply the lessons from the pandemic and make it easier for adults to maintain Medicaid by Giving states a continuous eligibility option without the need to apply for a waiver. similar to what’s available available for children in Medicaid and the Children’s Health Insurance Program, states that I’ve taken this option have lower uninsured rates among children.
10:09
And finally, Congress could require states to provide one year of post-partum coverage and Medicaid.
10:16
Thank you and I’ll turn this back over to Sarah.
10:21
Thank you, Sarah. You’ve given us a lot to think about here. So, let me now turn it over to Katie Keith, Katie, take it away.
10:30
Great, thanks, Sarah. Thanks for having this event, and for having me, it’s just a terrific panel and thrilled to be here.
10:37
So I’m going to build a lot on what their columns actually just talked about, and drill down a little bit more on some of the marketplace numbers. So if you could advance, maybe two slides would be great.
10:48
So Sarah mentioned, as we actually have record high marketplace enrollment, we’re at 14.5 million people enrolled in marketplace coverage nationwide for 2022. The data that you have in front of you on the slide doesn’t go all the way back. But this is actually more than two million people more.
11:06
Then the previous peak for open enrollment, which was in 20 16.
11:11
So you sort of had this episode where, you know, on the Obama Administration’s way out, you’ve seen Marketplace Enrollment, Grow and grow year over year.
11:19
The Trump Administration came into Office and due to some of the policy changes and I think there no unwillingness or inability to use the marketplace to sort of leverage it and view it as a tool. You can start to see during the Trump administration, enrollment declined Not by a ton, but year over year.
11:38
The state based marketplace, as we’ll hear from, from Kevin in just a second, did not see those declined. They continued to sort of push ahead. And so, the real difference with what happened to federal marketplace enrollment.
11:48
So, if you had told me, as someone who watches the marketplace’s very carefully, that we would see the enrollment shoot up. Significantly during really what was only the administration’s first year in office.
12:00
I would have been very surprised. But yet, here we are record high marketplace enrollment.
12:05
State based marketplace is continuing to perform, but really seeing, about more than ten point three million people enrolled through healthcare dot gov. As Sarah mentioned, this is really the result, I think of these rescue plan. Subsidies that are about to expire at the end of the year, as well as broader by the Administration Policies, things like a six month covert 19 special enrollment period.
12:26
That was held throughout 2021 Additional investments in marketing and outreach, but really, I think the affordability changes are what driving what is driving that pretty significant increase over time.
12:38
So, if you go to the next slide, please, know that it has been a 21% increase in enrollment from 20 21 to 20 22 alone. And similar to some of the graphics that Sarah was showing, you’ve seen significant savings for consumers. So, 28% of consumers selected a plan for $10 a month or less in huge premium savings.
13:00
Those in hand subsidies, by making it more affordable to buy other plans, have also help reduce deductibles, pulled down out of pocket costs by enabling people to enroll and even more generous coverage. And so, even from that chart, you can really see the types of savings we’re talking about. huge savings for folks.
13:17
Certainly the lower income levels and then all the way up by eliminating what the Affordable Care Act had previously baked in, that subsidy cliff for folks at 400% of federal poverty level, which is about $51,000, as Sarah mentioned.
13:31
So huge, huge savings that are all at risk at the end of the year.
13:35
Next slide, please.
13:39
Sarah gave some great data on this, I think we are, without an extension by Congress.
13:44
We’re very much on the precipice of what could be huge significant coverage, losses and premium shock for millions and millions of consumers. So, you know, estimates from the Urban Institute, more than three million people could become uninsured.
13:58
There could be some very quick impacts, but especially folks who are losing that subsidy support may just not enroll and some will go back to being uninsured as they were before. More than 10 million people are going to pay more in premiums if this is an extended.
14:12
That’s going to be especially hard hit or middle income families who did not have any premium support before the American Rescue plan.
14:20
And, as Dan mentioned, I would emphasize, I think the biggest impact is going to be on older, middle income Americans in rural areas.
14:28
And that’s because that is the part of the country where premiums tend to be the highest.
14:32
And so that is where I think some of this premium shock will be most belt if Congress does not extend the subsidies.
14:39
And, you know, the timing here really matters. I’m going to be very deferential to Kevin and Scott on this because they can talk about it from an operational standpoint. But we sort of can’t afford to wait until the end of the year to actually extend the subsidy. It is true. They are in place through December, through the very end of the year. Folks will will continue their subsidy.
14:58
Support, their premiums will stay the same, but there’s so much work that goes into setting those premiums, getting them through the marketplace, approving rates, doing consumer outreach, that everything really has to be lined up by the third quarter, which is, you know, right around now, are coming up very, very quickly. And, again, state based marketplaces and insurers.
15:19
Some of the outreach groups are all working on this and very focused on this, but the timing really does matter.
15:25
I’m deeply concerned.
15:26
But, yeah, Congress does come to the table and extend the subsidies that so much it will have already been done, in terms of consumer outreach and notifications that will still lose people, who otherwise would still qualify, even if Congress comes back later, and does actually extend the subsidies.
15:41
So, I think this is very much something to pay attention to, and I do worry about sort of higher premiums down the road, as Sarah mentioned. If you lose all, you can have some significant coverage losses.
15:52
I think insurance companies are gonna, you know, assume adverse selection and set rates higher than what they should be, so, that’s another reason, I think the timing really matters here.
16:01
I think that’s it for my initial remarks, but looking forward to hearing the comments from the other speakers, I will turn it back to Sarah.
16:08
Thanks, Katie. And before I let you off the hook, I just want to point out a couple of things, right, because it sounds like both you and Sarah are talking about a couple of things here. one is like the direct impact.
16:18
Just speaking of the ARPA subsidies, for a second, there’s the direct impact of like enhanced, no subsidies, and then you both also pointed to some potential market impact.
16:30
So you both mentioned, so, for those of so, for those of folks in our audience, that maybe, no, we’re wondering, both of you mentioned older adults, particularly, and also the potential impact of adverse selection just on market.
16:45
So, I just kinda wanted to point out that it sounds like there’s two possible effects that you’re talking about in terms of what might contribute to, um, no changes in coverage, and in in marketplace dynamics. So, I just wondered if you had anything to add to that, or if you could kinda point out that piece, and then we’ll turn it to to Kevin.
17:10
Yeah, I think that’s another way, I think, to two things I would add one to channel, Sarah. I think the other thing you won’t have is you have to think about the Medicaid dynamics that she was talking about.
17:19
So at the end of the public health emergency, if you don’t have these sort of enhanced subsidies that are quite generous for folks at the lowest income, from 100, from the poverty level to entrepreneurs or poverty, Folks coming off of Medicaid, or maybe not going to have such a soft spot to land in.
17:33
If you don’t have this too, so I think it’s, it’s probably three things, premium shock for current enrollees who might drop coverage.
17:40
It is broader impacts on the market where premiums would end up being higher than they should otherwise be, if it is these are going to be extended.
17:48
And then it’s sort of the Medicaid implications and seeing huge coverage losses, because folks willing off of Medicaid maybe, are not making their way or finding the coverage affordable in the marketplace.
17:56
So, I would add that dynamic, and I guess maybe one sort of more macro point, before I turn it back is, we’re in this world where the Affordable Care Act between Medicaid expansion And the marketplaces is at peak success, peak enrollment, it’s more affordable and ever, Congress has come back and sort of built on it for the first time.
18:15
And, I just feel like we’re standing at the edge of the cliff, and going, Oh, my gosh, look at this wave. That could crash over all of this. Even at a moment, where, you know, we’re 12 years out from the law.
18:25
In place, I find it very frustrating that maybe that’s the reality that is about to happen, But I want, this is the strongest superbug has ever been.
18:33
And we’re still sort of waiting and watching to see what’s going to happen next. So, a little bit. Thanks for indulging my editorial there.
18:40
Great, thank you Katie. And now we’ll turn to Kevin who is managing a lot of these dynamics in. a very important state, state of Colorado. So, Kevin, thank you for joining us today and I turn to you.
18:55
Thanks, Sarah. It’s a pleasure to be here. I appreciate you all having me here this morning. Still morning in the Mountain Townsville. My name again is Kevin Patterson.
19:03
I’m CEO of Connect for Health, the State Marketplace, for Colorado.
19:08
It’s, let’s go to the next, because they’re the panels that have already gotten me thinking about what points I want to make sure we emphasize today.
19:17
So, this graphic here just kind of lays out the work that we’ve been doing with our partners at the Colorado Department of Health Care Policy and financing on how we’re working through to make sure.
19:31
all of our consumer outreach is supported by a lot of the work that we do with our, our existing stakeholders or brokers, assisters, The regional accountability entities who are Medicaid providers under the Medicaid contract and trying to make sure that they are able to push out health burst information, Which is the way the name for Colorado’s Medicaid program. And trying to help us co-ordinate between a lot of the messaging that we provide, where we can work through, with issuers, what work we can do to make sure that our res, Regional Accountability Entities have that.
20:07
And we’re working with our department Division of Insurance, rather, on trying to make sure that we’re really, really co-ordinated amongst all those different actors on what message gets to the consumer, when they’re going to get it And who’s delivering that message.
20:22
And so, we’re really just trying to say that it’s important for us to look at our special enrollment periods, and how we can strategically use those in ways to make sure that the messaging gets to the consumer at a time they understand when they need to act. What they need to do. And how to make the transition away from, what they have been maybe used to under the Medicaid, without a verification, and moving over into private insurance, which is a very different shopping experience.
20:49
But usually, if someone knows that they have a doc, a prescription, a particular therapy that they’re using, they know which type of network they’re looking for, that we can, we can send them through our quick cause plan finder tool, to make sure that they’re able to have continuity of care. And they don’t have a break.
21:11
And so we’re really, really working hard to make sure that we do that work, you know, in a much more co-ordinated fashion with our, with our customers.
21:22
We’re also making sure that they can shop and enroll before the end of the 60 day period.
21:27
Making sure that anybody that’s at 150% of poverty is able to also come in for a special enrollment period. So we, we’ve really been able to get people to use special enrollment periods as a way to continue their coverage, making sure that they understand how to use their coverage. And really partnering with those, that the sisters and sort of, application centers that are close to a clinical setting.
21:52
So that folks actually, not just aren’t getting insurance, but they’re actually using it and understanding what the benefit of having insurance really means. And so, having that clinical side supporting what we’re doing on the health insurance coverage side has been, I think, really successful, especially in a lot of our rural communities, where there’s not a lot of competition, but we can get them in the right kind of care and make sure that they’re shopping in a way that extends their benefits and gives them in the right type of plan.
22:18
Depending on if there are high, medium, or low user of health insurance, you know then they can find the plan that actually prepares them and has the financial benefit for them as as well.
22:28
So let’s get to the fun slide next.
22:37
OK, I thought we didn’t want to have, like, all right, so without congressional action, we are looking at 76% of our marketplace coverage, seeing their coverage, their coverage reduced or eliminated with their financial help that they are receiving.
22:53
We think that you’re going to see about 40% annual increase in spending, and about 20, little over 25,000 coloradans losing coverage.
23:04
So, I think, you know, Katie said something. I thought that was really important That I want to spend a second with.
23:10
You know, we are actually doing things. When it’s not open enrollment, We’re pretty busy making changes to our platform. We have a number of state subsidies that we’re supporting in Colorado with, our 13 32 waiver that we received very recently.
23:25
There’s a good bit of work in what’s supposed to be the quiet period which of course has been under a pandemic for the last couple of years.
23:34
But right now, here we are, our rates in Colorado, that list of preliminary rates were announced this week.
23:40
We are working very hard, too, with our division of insurance to see what those rates look like when they come back and begin to start talking to people about what do they do.
23:52
How do they respond to what the changes may be?
23:55
And then the question is, Well, what are the changes going to be? And when are they going to happen?
23:59
Well, we can’t wait forever to put something in in the, in the system.
24:06
So, we’ve gotta build a system that shows what the plans cost, what the out of pocket max is going to be, so people can make informed decisions, and at some point, represent renewal notices out, and I understand that, you know, healthcare dot gov is not sending numbers in their renewal notices. And at first, I was quite shocked about that response.
24:27
But then I’m like, well, you either are going to send a very large increase, that people are going to get scared away from health insurance, or you’re going to send current law, you’ll send something low. And then they’ll get a bill that they’ll be like, wait, this is different than what I thought I was signing up for.
24:45
And then you have the problem of, well, if Congress acts later, how do you actually get them to get the right information?
24:52
So, the timing of this is extremely important, and my largest concern right now is just the huge amount of consumer confusion. We’re all going to have to deal with it in exchanges and Medicaid to try to figure out how to get people the right information, when they’re going to maybe get something wrong, and that it changes drastically at the last minute.
25:13
So, you know, we just get really concerned as exchanges about not just the fact that we’ve seen huge gains over the past couple of years. We’ve had record enrollment two years in a row in Colorado.
25:26
Now, we have to worry about losing our standing with our customers that has taken quite a lot of effort and time to build up.
25:32
So as we think about how important it is to dovetail this with, what happens with the end of the public health emergency planning.
25:41
You know, I think there’s an opportunity to begin to think about how do we make sure we have better communication and co-ordination amongst all of our health policy world on how we communicate with employees and employees with consumers. And how we use our employees to actually support other community based organizations that are also seeing these folks, dealing with other kinds of challenges that they’re having.
26:04
So, we’re trying to make sure that we have a co-ordinated, very strategic focus on how we’re communicating. And supporting other groups that are trying to have this kind of communication to make sure that we’re able to leverage our effort, and give that kind of that messaging to folks that they can use if they see them. And maybe the Exchange is not there at that particular moment.
26:26
So I think with that, I’m ready to cede the floor, and I’m happy to be around for questions.
26:36
Thank you, Kevin, and I see Scott has already ANSA Scott, take it away from a plan perspective.
26:44
Yes, thank you very much. Appreciate the Alliance for having me join the discussion today. I don’t have slides to share, but I’ll tell you everything that the panelists have already worked through and talked about, really, from an actuarial perspective. That’s where I’m gonna go. Questions that that we have in our industry.
27:04
How do we manage, How do we make this easier for the member to understand, how do we rate this appropriately so that, you know, we can continue to be profitable, to support the ACA going forward. So, right now, we’ve talked about timing is critical and key. Currently, all of the files, the filed rates, are there with the states being reviewed. Those will get shifted over to CMS, I think, in the next few weeks. So these challenges, I’m about to, to call out here, we’ve already had to make determinations around how, how do you rate? What does it mean? Is that what kind of impact do we think it’s going to have to the risk pool?
27:42
So I would encourage the American Academy of Actuaries did release there, and it will drivers of health insurance, premium change. So it’s an issue brief. Look that up, there’s a 2023 version.
27:55
A couple of things, I’ll pull out to note.
27:58
So, as we talked about risk, identifying the risk pool you’re supposed to, all issuers are supposed to rate the risk pool based on market average risk. But when you have things like the … ending, is it going to end, when is it going to end, maybe not right now.
28:17
That has an impact, obviously, we talked about on the Medicaid membership, but then what kind of Medicaid membership are going to come.
28:25
And then, have the ACA, as the, as their availability in order to get coverage states. When are they going? Not only when, but how are they going to re determine these members? Some have been very if communicated, this is what they’re looking at, the Medicaid agencies, others, maybe haven’t posted that as broadly. But, you know, there are different strategies about the length of time to do that. Who should be redetermination?
28:53
First, are they going to use some AI logic to try to figure out who most likely, you know, could be pre-determined and get that coverage from an actuarial perspective? Long covert impacts? How does that apply? the Flint Family Glitch?
29:07
Fix that many of you have been heard about, and we’ve been talking about the subsidies we just talked about today, going away, know, what, if it’s driving up the cost of insurance, what kind of member, you know, what’s the price sensitivity? That would cause that member to to continue to purchase coverage or may forgo coverage, because it’s unaffordable. And then there were some other things around, you, know, in ACA tightening up some of the rating mechanics around metal AV ranges and creating standard plans to try to reduce confusion, make it easier for the consumers.
29:45
We’re living in a world of high inflation, you know, 30 40 years. Highs now of inflations, What does what does that do from a impacting trend and what are issuers putting into the rates for that? Future covert strains, you know, we’re living through, yet it yet another variant. And then, you know, costs that are no longer going to be covered by the federal government. So, funding around, you know, vaccines are testing.
30:09
All question marks that we’ve had as we’ve tried to set up, you know, what we think appropriate rates would be as we design the products and file those for 23.
30:19
So, very complicated. I’ll move into, you know, so what can we do about it, and we’ve talked about, you know, several things already.
30:26
But, you know, from an actuarial perspective, I keep going back to how do we stabilize the risk pool or make the risks fall more known? So, obviously, making policy decisions earlier in the year to align with the rate cycle is what everyone would appreciate from a renewal letter process. Kevin had just mentioned, you know, that is, that is critical. What are we going to tell our members when we try to have them renew? Are we going to give them an estimate of, you know, what they had? What their current coverages or subsidy levels are that that doesn’t, you know, really make it satisfying, because that potentially will change. But we’re right in the middle of developing all of those, and getting them into production.
31:06
Something has to be, you know, out there, state, state waivers, considerations.
31:12
Again, Kevin mentioned that some of the tools that have been used, like a re-insurance program, it’s a one-time tool. It might reduce overall premiums for, you know, for the given year that it’s implemented, But, you know, long term, you know, trend trend will continue on and persist. Disclosing Medicaid agencies as much as they can disclose and communicate the redetermination methodologies within the States that’s extremely helpful to issuers. So that we can figure out how do we work more hand in hand with them in order to help members as they move and stay covered between a Medicaid coverage to, to our ACA coverage, you know, care sources of Managed Care plan. And so there are some plans that kinda live in both of these, these worlds, Medicaid, and ACA.
31:59
So, you know, can can we do to make some creative ways of sharing and communication reach outs with our call centers in order to help support members through this coverage journey, extending the subsidy? Obviously, before the end of the year, the … subsidies would be extremely helpful. Again, to help with our members understanding, you know, what, what is coverage going to be, like, or look like, in the future.
32:26
The other thing that we’ve been looking at, and it’s very difficult to do from a risk standpoint is, is, if you do issuers, if they do have both Medicaid and ACA coverage, what kind of members do we think are most likely to read a term, and what kind of coverage? Acuity low, Do they have, and, you know, can we estimate what, what their costs would be under our ACA coverage versus Medicaid? Extremely difficult.
32:54
No one expected this to last as long as it has, and so even knowing which members might re determine within an issuer side is it’s very difficult at this point.
33:04
Can’t just say, you know, those who who look like, they should have redetermination back end 2020, April of 2020 or May are on the list. It’s it’s not as simple anymore, based on the length of time.
33:16
So with that, I will turn it back to Sarah for our next panelist.
33:22
Thank you so much, Scott. And I will say you’ve just spent the last 10 minutes or so just outlining a dizzying array of questions and uncertainties. And so look forward to the discussion in terms of how we link sort of these policy decisions to the operational questions and challenges that you’re facing as a plan. And then to course, what ultimately, the consumer journey ends up being. So, with that, Liz, really looking forward to hearing from you, and, because we’re not talking about any of this stuff in a vacuum. There’s very live conversations happening in Washington, right now, as we speak, and across states.
34:07
With enormous implications. And there are certainly isn’t agreement from all quarters on sort of how to proceed. Now, you know, we were talking before, we started here, that this is a great timing for this conversation. Not only as folks have already talked about as far as, you know, where we are in, kind of rate filing, but also where we are kind of in the congressional calendar. And really, at this point, where, you know, policymakers have to start making some decisions, so maybe we’ll talk through a couple of the factors that they’re thinking about. We can move to the next slide.
34:44
So, first, obviously, since, you know, so many folks had talked about, we can even go to the next slide, also. Thank you.
34:51
Perfects, and I think if you click, again, the whole thing will pop up.
34:55
No.
34:56
Clearly, based on what we’ve heard from all of our previous panelists, the reauthorization or extension, the … subsidies from the …
35:07
legislation, is kind of a central question, two, what is the market going to look like? And, you know, for Congress, they kind of have two paths forward.
35:18
one is a process called Budget Reconciliation, the other is called regular Order, which would require some type of bipartisan deal on the budget reconciliation side. You know, as folks may remember last year, there was a lot of focus on President Biden’s Build Back better agenda, which included a number of policies on, you know, taxes, climate change, health care. And the expansion of the ACA subsidies was a central part of that package, in the fall, The House, I guess, had passed their package, and it just was not able to come up to some type of agreement in the Senate.
35:58
So since then, there’s been kind of conversations behind the scenes with Senate Democrats and the White House around, you know, what is the package that could actually pass the Senate and then get sent over to the house.
36:12
And kind of key in those conversations has been Senator Mansion who has raised concerns about some fiscal responsibility issues around debt and deficits, and then particularly inflation.
36:25
So, while it seems like there’s been nothing happening in this space for months behind closed doors, again, there’s been a lot of conversations around, you know, what can you do in kind of three areas, health care, taxes, and climate change.
36:40
And just over the last week or so, we’ve started to see some kind of public momentum around portions of the health care package. And, you know, the first piece of that is policy around prescription drug prices. We’re not going to get into the details of that, but the Senate Finance Committee, you know, release new language, that would save $287 billion over 10 years.
37:05
They have a CBO score for it, and they’re kind of starting to talk through the process. That’s really an important piece of putting together a kind of a reconciliation package.
37:16
Because, number one, it’s going to help them figure out, kind of what they have the votes for in the drug pricing space, but also how much money or savings they have to play with.
37:26
one of the things that I think Congressional Democrats have been clear on, is that they want to have whatever they do within this budget reconciliation package they want it to be paid for.
37:35
And so, you kind of need to know what you’re working with, in order to figure out, you know, within budget reconciliation, there’s so much numbers going on that you kind of have to make sure that the day, you know, what you’re able to do.
37:49
Some of the policies around … expansion that are on the table include a short-term, kind of, reauthorization of probably two years, three years, maybe, We’ve also seen policies for permanent.
38:03
There’s also been some conversation about changes to policy itself, you know, Do you get rid of silver loading and put, you know, back in, cost sharing reduction subsidies? You know, is that something that you could still get, you know, significant coverage for individuals, and, maybe, less than, the score, a little bit.
38:22
Are there things that you could do and further means testing, or, you know, the affordability threshold within an employer sponsored coverage? So, you know, particularly as the experts on this call, know, you know, better than most, there’s so many different dials That could be turned That folks are talking about.
38:39
Then, the third piece of the package that’s kind of emerged is Medicare solvency. And well, obviously we’re not going to focus on that in detail.
38:46
I think the reason I’m mentioning it is because of these concerns around inflation and deficits and debt, there’s been this question mark of, like, OK, well, what can you do about it in this type of legislation? Like, what is it that you can actually do?
39:01
And it seems like within the healthcare context, the IPs is being able to show that you’re making Medicare more solvent for 1, 2, 3 years.
39:11
So I guess from my perspective, you’re starting to see the contours of what a health reconciliation package could look like. You know, so you’ve got the drug pricing pieces, you know, yesterday, last night? I think Senator Mansion? You know, this was in a lot of the press had made a comment.
39:28
I guess that you know, where he’s at right now is that he would support two years of expansion of the … subsidies.
39:37
In the past, he hadn’t been super clear publicly on where he was going fall on that. But right now, at least that’s what kind of press reports are telling us is that you signaled that. That’s kind of his line in the sand.
39:49
And then, the third piece of, you know, really important, being kind of the Medicare piece, a couple of things just to think about within this budget reconciliation kind of context.
40:00
And for the members having this discussion, you know, obviously, inflation, we just talked about that.
40:06
one of the things that’s really interesting, as some of the other panelists talked about, is, you know, you have to take into consideration, you know, what’s the cost of expanding the subsidies, But there’s also a cost of not expanding them, right. And so, CBO put the Congressional Budget Office, put out updated estimates of just overall health care spending on subsidies about two weeks ago.
40:29
And one of the things that the Congressional Budget Office Notes is that they think that there were more kind of younger and healthier individuals that came in to the individual market, because of the enhanced subsidies than they had originally projected.
40:45
And there, they’re kind of viewing the world does. Yes, in 20 23, there aren’t the enhanced subsidies.
40:52
You’ll see some premium spike, and you’ll see some loss, but you might see some of those young kind of people still stay on.
40:59
But really, in 20 24, you could create, see, a really significant premium spike.
41:05
And one of the things that oftentimes we forget is that the spending federal spending on ACA subsidies is tied to premiums.
41:14
So as premiums go up, you’re actually spending more.
41:18
And so, again, these are their balances. You have to kind of look at it.
41:22
But know, as a policymaker, you know, that if you choose not to expand the subsidies, you at least need to know what the budgetary kind of con struts look like on that side.
41:34
The other thing, I would say, in addition to Budgetary Mathis, is political math.
41:38
And unfortunately, that’s a very real consideration. I think one of the things that I would be thinking about if I was advising a policymaker is, you know, if you’re only able to do a short term expansion, what does that look like? And kind of what are the years if you do two years, you’re bumping it right up against the presidential election.
41:59
And is that something that is, you know, wise for folks? I’m not so sure.
42:04
The other thing that I think this the contracts that folks need to understand is, as we just talked about, is deadlines.
42:10
There are very real deadlines and the implications of not reauthorizing the subsidies. Both for states trying to do right filings for consumers.
42:20
The other thing is, is that the budget reconciliation, this ability to pass a bill with only 51 votes in the Senate, that goes away October first.
42:29
So for many in Congress, the new administration, they’re looking at October first as kind of the deadline for when they need to get this done.
42:38
Whereas, I think there’s some pressure to say, no, actually, really, August first has to be the deadline.
42:44
And so you’re seeing increasing pressure to try to get something on the Senate or in the next couple of weeks.
42:50
I’ll talk about the process on that a little bit in a second.
42:54
You just want to kind of briefly touch on, kind of, the bipartisan path.
42:58
And this is something that a lot of folks, I get asked this all the time, of, you know what, what exactly, no Republicans, generally in Congress, haven’t been supportive of the ACA expansion.
43:09
Couldn’t they support like a year or two more if it’s combined with something that Republicans want.
43:15
And my general view is to our, you know, never say never but this is one where it feels like congressional Republicans have been so strong in their concerns about the PTC spending.
43:28
In the past obviously we saw kind of their concern around cost sharing reduction subsidies.
43:34
I have a hard time, seeing a bipartisan path of some type of deal, particularly given. what?
43:41
if you are a House Republican or even a Senate Republican and you think there’s a chance that you’re taking Congress back next year, just doesn’t seem like the, you know, it’s aligned to see something bipartisan.
43:54
The other thing is vehicle, there’s just not a lot of bipartisan bills moving.
43:58
And so really, the main legislative vehicle to get this done would be a continuing resolution In September. That’s going to be fraught with a lot of other issues. So again, it seems really unlikely to me that you’d be able to get, you know, a bipartisan deal and move it on a CR. It seems to me it would put the continuing resolution at risk.
44:19
If you tried to do that.
44:20
Last two things, a Hyde amendment. You know, I think the Hyde amendment is an amendment that goes on appropriations bills. It’s also in some laws that restricts the use of federal funds for abortion.
44:32
The ACA also has its own restrictions on the use of subsidies for abortion, but they’re slightly different.
44:39
And in the past, Congressional Republicans have raised concerns about the protections that are under the ACA and their preference for the Hyde amendment.
44:49
In the past, when you’ve seen focused on, you know, trying to reauthorize cost sharing reduction subsidies, that became the big hang up. And that’s kind of where I get to 20 17 lessons learned.
45:01
In 20 17, the individual market was, you know, facing some stabilization issues and there were attempts to try to come up with a bipartisan compromise to address and to stabilize the market. And the backdrop of that was this was before the rollout, and so it was the possibility of Bear County’s significant increases.
45:21
And, you know, repeal and replace had died.
45:25
So, really, the only thing you could do was bipartisan and it still blew up and part of that really was because of some of the Hyde Amendment issues, parts of it also was just around kind of spending.
45:38
But just wanted to say, I mean, I think, not to be too overly negative about it, but I mean, I think the way I view this is to get this done. It’s really budget reconciliation, you know, or nothing, at this point.
45:49
So, if we go to the next slide. We’ll do this really quickly. This is just a reminder, folks, kind of what I just set up, process wise.
45:56
If the Senate was to be able to cut a deal on reconciliation, how would this happen? And so we, if people have questions, we can do this in much more detail. But essentially, what we would see happening, if they have video, is that the Senate would take up the House Reconciliation Bill that already passed, and then they would put in their own kind of substitute amendment. Hopefully pass that, and send that back to the house.
46:20
Sounds kind of easy, but it’s really not, and there’s a number of different rules around reconciliation and ways that policies have to comply. So there’s a lot of kind of back and forth processes that have to go into that. But, happy to talk about that in further detail needed.
46:36
And then, finally, last but not least, kind of what can the administration be doing while Congress’s sorting itself out and we can go to this next slide. That would be great. And I think it was folks talked about, you know, extending the public health emergency, we’re expecting, if it hasn’t happened already. An announcement on that today.
46:55
Rate flight filing flexibility, this is something that we’ve seen, You know, States asked for, is the ability to kind of adjust and refile rates as needed.
47:05
We’ve talked about this a lot of folks who talked about the additional guidance on Medicaid redetermination. It’s also kind of increased consumer support and communications. So continuing to have those increased focus on talking to consumers and making sure that they understand, kind of how to navigate this.
47:23
Then also, you know, if we do see a situation where it’s later in the year and the subsidies are somehow being re-authorized, which, technically, could happen if they have, like another budget resolution, but it’s tough.
47:36
You could see some type of, you know, special enrollment period or something else next year to try to make up for the fact that you had a slightly confusing open enrollment period.
47:46
So, happy to leave it there and answer any questions and wish I had a better kind of crystal ball answer, that at least these are some of the things that we think that policy makers are thinking about now.
47:58
Thanks.
47:59
Thank you so much, Liz.
48:00
And while I invite the rest of our panelists to come on for Q and A, You know, you’ve really outlined, well, the other panelists, and, you know, Kevin and Scott in particular, outlined a lot of the, the real important operational questions that states and plans are facing. in order to try to get coverage to their members. You, you outlined a lot of political policy uncertainties and, like, in a very short timeframe. I mean, August first is like two weeks, right? If that’s a true deadline.
48:34
But, you know, I can’t help thinking about the time I was in sixth grade and, like, wait until the last minute to finish my science projects. And it feels like that’s a, how a lot of policymaking gets done, kind of for better or for worse and, and because of some of the challenges, you know.
48:52
Like, yeah, I’m going to want to talk about the longer term implications here on this panel for first sort of bipartisanship.
49:02
and, kind of longer term, more sustainable planning as, like, obviously people in American households have to do household planning, too and they’re doing their household budgets and, and wondering, like, What that’s gonna look like. And, they’re, they’re obviously juggling. A lot of other considerations right now as well.
49:21
In the current economic environment, So, but, but, but just to take it back to, like, the next two weeks, or two months, you know, I mean, what, from your perspective, do you think people ought to be?
49:38
like if you’re sitting there at your kitchen table and watching the news, like, what do you think are signals coming from Washington that people should be paying attention to?
49:48
Or is this just so inside the beltway that like it’s dizzying, and it’s impossible to keep track of?
49:54
So, yeah. So I would say the rooms would have two things on one. I would say it is kind of inside the beltway.
50:02
The negotiation at this point, really seems to be that Senator Manchin has a lot of power. And because without him, they’ve shown, they can’t pass anything.
50:13
And he’s kind of been focused on a number of different policies and now’s the time, or it’s kinda, they’re seeing if there’s a there there. And last night, I think he made some announcements around, You know, Didn’t feel like he could go there, and some of the climate change. They couldn’t go there on some of the taxes. So it’s really emerging that it could be that the only thing that might be able to move is kind of this small care package. So if I’m, you know, a normal human out in America, I would just try to enjoy your life.
50:41
If you don’t get sucked in, if you are a stake holder, if you are a healthcare stakeholder and you care about these issues, no matter what, I would really encourage you to try to share with your members of Congress and the committees of jurisdiction, the impact in your districts and in a very detailed level. And again, goes either way, right? This is no matter where you are on the issue.
51:12
You know, We saw some of the impacts of kind of overall what happens if the subsidies aren’t re-authorized to a member of congress That’s impactful, Like, when you’re on committee, you’re in your leadership, and you’re thinking of policy, big picture.
51:29
But honestly, what they care about is what’s happening in their county, and what’s happening in their state.
51:34
And so, the more you can personalize, the impact, the better. The other thing I would say is, you know, I worked for budget committee, and then helped committee.
51:43
And I can tell you with all honesty, like, there’s not enough of an understanding of, like, the rate filing process and what some of those deadlines are.
51:53
So, in DC, particularly, you hit it exactly, where it’s like, not only are they doing their homework at the last minute, it’s like their dog eat their homework, They, you know, then they lost their notebook and then they were sick for three days.
52:06
And then, then, maybe they, like pass in, like, a third of what they were asked to do, like, a week late, and then there’s, like, all right, I did it, Like, that’s kind of where we’re at badly.
52:18
And so I just think the more you can be educating people about when timelines are real, and that they’re going to have a real impact, and what that means, you know, that’s what I would be saying. So, you know, the average American, I would just say, go to the beach. But healthcare stakeholders, I will say, engage, engage, engage, and really try, again, focus on real-world impacts, and really focus on kind of local as much as possible.
52:43
And I think that’s big, particularly in the ACA context, as you said, Sarah, Like, it’s so political of all the issues I worked on.
52:51
I’ve never there’s no other issue like this, where it’s almost like you.
52:56
It’s so impossible to have a detailed conversation, because everyone’s at the it’s amazing.
53:02
It’s awful, still.
53:04
And so, again, the more you can break away from that and get into like brass tacks, I think you’re gonna have a much better chance with members.
53:13
And Sarah, I think 1, 1 thing that is, like top of mind for families right now, maybe not everybody, but it, like in the wake of Dobbs.
53:22
I guess, I would just connect some of this discussion to access to, I don’t know, contraceptives and maternity care and abortion where it’s cover.
53:30
And so, I think there is, I don’t know, that you can like, fully, always divorce some of the conversations we’re having about abortion from coverage. And I would maybe emphasize that to that, to the extent that folks are. There’s a lot of uncertainty out there. And folks are not feeling stable in their access to healthcare.
53:46
Having a world where, A, we’re not filling the Medicaid coverage gap in the State, you know, that that has sort of maybe, fallen off given the news last night that those 12 States will be left behind.
53:55
Those are some of the States with these restrictions, without, you know, a lot of converge, if any, for adult, with just a real challenges there and some of the worst maternal health outcome, I think contraceptive access through the marketplace. Obviously, quite right.
54:08
If you’re going to have a bunch more people uninsured, at a time, when you don’t have access to abortion, there’s a real maybe crisis there, too. And so I were going to tie this a little bit to something that is probably even more top of mind. And, you know, marketplace deadlines, which I tend to agree, is not there. I think there’s a strong link between what’s happening reproductive healthcare and the need to make sure folks have the coverage that they would just add that in.
54:31
Thanks for pointing that out. I mean, it’s, you know, it’s certainly for anyone who’s sitting there with, you know, any kind of condition, diabetes, heart condition, what have you. Right, and, and like. might be. Those are the people who are waking up every day, kind of wondering what is going to happen to their coverage more so than probably like somebody that’s healthy enough to go to the beach. Right, that’s, I mean, that’s kind of the point you and Sarah, made about risk selection, right, and I think Scott also kind of made this point about.
55:00
If you’re if you’re dealing with a health condition, you’re more perhaps likely be tuned in to some of this stuff, and like maybe you’re more willing to spend more money, even if your premium goes up, just stay in the marketplace and someone who’s otherwise healthy, is that is that a fair Thing to say like for Scott our actuary friend.
55:24
And maybe Kevin, as you’re looking at, like the rate filings, like how much how do you translate some of these numbers of like, these really big, broad numbers about what coverage loss might kinda look like into Like, who’s really going to be affected and it’s, you know, we all know coverage, it’s not like, we all wake up, and we want coverage Just for the sake of having coverage, it’s totally to have access to care, and then health outcomes.
55:52
So, like, how do you, how do you think about that in terms of your data and your patient member populations.
56:01
Yeah.
56:02
So, I mean, it’s, I know very much what Liz said, you know, from a strictly West Virginia, it’s, it’s probably the highest premium in the nation or second highest.
56:14
And so those subsidies that the amount of members that are subsidized, at least $1 is higher than any anywhere else. So it’s critical for them. I mean, they cannot afford the cost of rural health care. They’re, you know, I won’t blame it, necessarily, on even the networks.
56:30
It’s the it’s the cost to try, to, to provide coverage and, and where they live, And so, you know, back to you know exactly what Kevin had had shown you. Know, we are advocating, especially in, in West Virginia with the mansion.
56:45
I’m like there that this does have an impact on the people that you you serve.
56:51
And, and the the issue that we have, you need flexibility. Issuers have to have the ability and have some guidelines to live with them when you set a rate, but it’s very challenging. If everyone is making the same assumption then, you know, like Liz said, the subsidy levels kind of all move together and, and, you know, maybe maybe were covered from a sustainability side.
57:15
But, you know, what if somebody puts in a market acuity adjustment, happen, when the individual mandate went away of a 5%. And that’s, I could be very competitive at a very unaffordable. an affordable cost for the plan. So, it’s very difficult, you don’t know what what the competitor your competitors are doing, and trying to set something that’s appropriate for the member. But then, also, you know, allows us to sustain and be an option on these exchanges for the long term.
57:45
Hmm, hmm, hmm.
57:45
Yeah, thanks, Scott, and obviously I won’t put you on the spot, in terms of care, source in particular, but you know, um, and I’m wondering if Kevin can chime in here too, but like to some extent. I mean, during the CSR debate, like we heard over and over, the uncertainty creates higher premiums. Like, you have to bake uncertainty into your premiums.
58:06
So, I mean, Kevin, maybe I’ll turn to you, do you think, from your perspective of like, overseeing a number of plan and plan offerings?
58:16
Is that something that you think is going to happen?
58:20
And I think it was, Elizabeth, I think you were the one that made the point about, we might see more of a premium spike in 24, I’m just does that. Is that the connection there? To the timing that?
58:30
Like, rates are already almost baked for next year or soon to be baked. And so we might see more impacts in a couple of years. Like How does that work from your perspective?
58:41
So so from from where I see it when Scott and in his industry are nervous. We pay more because he’s talking about risk.
58:50
So nothing pejorative about what you guys do Scott.
58:53
I’m just saying I don’t like to make y’all nervous Because that’s what happens.
58:58
I mean, there, and and I think that it’s, if there were one thing. I mean, you know, in years past it has been, OK. Individual mandate was one year, CSR was a different year. Now.
59:10
We’ve got multiple big things happening at the same time, and is if they’re like in different planes of existence, but they’re all going to impact it, but it’s an assumption on an assumption, on an assumption and I think that’s where there’s a little nervousness and rightfully so and I. and so, it’s hard to know exactly how that’s going to play out.
59:30
But I will say, you know, when, when we think about how we’re messaging, whatever the rates look like, messaging is important, but affordability is the key.
59:41
And if you’re explaining something that’s affordable, it’s a lot easier than explaining something, that’s not.
59:47
And, and folks understand that, especially around kitchen table economics issues.
59:52
If, I could just say two quick things. one, I think, Sir, you or your Science project, one, was really a good analogy. But to me, it’s like a science project.
1:00:01
But everybody else gets to the great, and not you, because it’s really the impact that they’re having on other people, that I think is a challenge for folks to understand. Well, why is this taking so long, why can’t they just figure this out, And folks, I think if they do pay closer attention, they’re gonna get more and more frustrated, So I totally agree with Elizabeth around that piece. And I think, you know, and a lot of times, what we’ve tried to do it from the exchange perspective, is talk about what the average looks like. And I don’t think averages is the right conversation. I think it is about these real specific examples. Like the one we were using, in Colorado about, What happens between the 30 year old and a 55 year old in rural Mesa County.
1:00:40
And the western slope of Colorado, if the AARP has an extended because the the age piece is a piece of this and how much they’re going to have to pay differently. And I think those are really impactful conversations for us to have And we were happy to do that. We do that all the time. And it will be really important for us to kind of think about what rates look like in Colorado and say, all right, now this is what it’s gonna look like for you. Because last year, we’re like, oh, rates are coming down.
1:01:06
But then it was like, well, but if you’re on financial assistance, you might actually pay more just because the way the math work. And so I think it’s really important to wait until a little more of the dust settles before we try to explain things. Because then you’re going to try to explain what you explained before. That might not be exactly the same.
1:01:24
Hmm.
1:01:24
Hmm, hmm, hmm, hmm, Yeah, You had something to jump in. And then I have another question focused on Medicaid.
1:01:31
Yeah.
1:01:31
Well, and I might add just from a, maybe a national perspective, I think No. Because there, you referenced on the cost sharing reduction, right. This was a policy in October, 2017. President Trump shut up those payments.
1:01:43
I would. And in many ways, the marketplaces are sort of a victim of their own success, Right? There was an incredible amount of planning that had gone into that, folks were able to like flip a switch and by November first, consumers never knew the difference, it was not disruptive at all.
1:01:56
But having worked at the, you know, NPIC and the state level and watch, but states were doing, and regulators were incredibly prepare. They’d asked a lot of them that directed their insurers, the file to set the rates. Everything was baked. Everyone will really prep for that, and I want to draw a comparison to where we are this year. Because that is not what’s happening and validated to see some nodding heads. The law states are A haven’t been as directive to say to raise one with rescue plan subsidies. Extension one without: I think a lot of insurers are probably do, I would like to think, are doing that on their own, but we don’t have the same sort of, it has not been nearly a uniform response to the states are doing different things. I think it’s yours are already letting premiums creep up as a result, even if they’re doing with an extension because of all this uncertainty.
1:02:40
There’s sort of we haven’t seen, I don’t think we’re going to be able to flip the switch in the same way. And the other thing I want to add on that even if states are as prepared as possible where they’ve done, you know, have two sets of wavelength.
1:02:53
If Congress does anything to change from the rescue plan. Subsidies structure, right? There has been talk of maybe would cut it off at 400.
1:03:02
Or maybe you would, you know, do extra subsidies at this and get, like, if it looks like anything different, these marketplaces, it’s going to be a delay in implementing that, which then, delays people’s care and adds to the confusion and everything else. And so I, again, victims of our own success, marketplaces bend over backward and insurance, insures to bend over backwards to make this work.
1:03:21
This year, I think, feels different. And we’re very lucky if there is no disruption, but it’s only because we’re sort of putting folks through the wringer. So did wanted, I’ve been here, the CSR comparison and want to maybe empathetic help a little bit different this year.
1:03:35
Maybe just to jump off of that. So, during that, I worked for Senator Lamar Alexander, who was the lead Republican trying to negotiate that bipartisan deal. And had had here.
1:03:45
I mean, so the difference congressionally, right, was that like, I think Bill Burnup, it was like repeal and replace, died at some point in July in I told this story before, but literally five minutes after, John McCain, you know, stuck his thumb down.
1:04:00
Lamar Alexander starts walking behind on the Senate floor and goes over to the Democratic Side Bench In the middle of reconciliation at two o’clock in the morning, and starts talking to Patty Murray.
1:04:12
And we’re all going, oh gosh, we’re just exhausted.
1:04:15
And we ended up spending two hours in a Senate Hideaway with the Murray and Alexander staff, that night slash morr that morning.
1:04:26
Figuring out what we were going to do over August, because we knew that we knew what was going to happen in silver loading, was nothing.
1:04:34
So, in that context, you had August, that was full on, staff work, an entire month of hearings in September, drafting. You know, legislation trying to get it ready to move, Silver loading ended up happening.
1:04:49
And so, I think, it, it actually ended up, partly because of silver loading. The urgency on the legislation kind of went away.
1:04:56
But, again, I would, I agree with you completely because even then, you had a lot of congressional focus on figuring out what’s plan A, plan B, plan C And that’s not the conversation nursing.
1:05:09
Hmm hmm, I just I just want to point out whatever remarkable story that is. I mean, like, that’s remarkable on so many levels and it’s gonna take me a minute to absorb that.
1:05:18
But that like, moments after what, you know, had been a really parse and conversation that, that your boss then had reached across the aisle that those conversations went for until four o’clock.
1:05:32
Whatever our time in the morning. So thank you for your public service and to all of our congressional staffers who put an unbelievable hours behind the scenes. And then that you put in a ton of staff work. So anyway, I just had to pause and editorialized there that this stuff, you know, everything we’re talking about does not just like magically happen.
1:05:53
So, so thank you. I want to move to a question from the audience. And I again want to remind our audience that we have about 20 minutes left for questions. And there was a question here about Medicaid redetermination. So I want to make sure we get to that because a couple of you, Kevin, you sort of drew a flowchart of the consumer. The person’s journey, sort of through that.
1:06:16
The question is around, regarding Medicaid re determinations Do you have a sense of the profile of the individuals that are likely to lose coverage? You know, are you looking at maternity related kids? Are you looking at income related? You know, you mentioned, talked about the age reading a couple of times. Do you have a sense of the likelihood of where those individuals are likely to end up? Like, who’s most likely gonna get to take up coverage? On the marketplace side? I’m too curious, are you worried, might end up uninsured, like is there sort of a way to stratify your your audience? I’m excuse me, your membership from that perspective.
1:06:57
So I think this is going to be not your regular Medicaid redetermination population. I think this is going to be a very heterogeneous population, which means we have to think of the different profiles of why people are coming off. So I will be through the regular determinations.
1:07:16
Some will be that they either have, they are eligible or have moved on, the employer sponsored care, but usually Medicaid kind of goes through that and figures that out as they’re going.
1:07:26
It could be folks that are just like, well, I kinda know I can get Medicaid, so I’ll just sit here until they told me I don’t, then I’ll go over to the exchange. So, I think we’re just kind of kind of ready to catch whatever comes our way.
1:07:39
It’s kind of what we’re used to doing anyway, Whether somebody’s coming out as a small business owner, whether they’re a business of one, whether they’ve been laid off, all those kinds of things, or what we’re used to doing.
1:07:51
As exchanges, I think we’re just, what I’m telling my staff is be ready for different personas of that population and not, I don’t think it’s going to be a one size fit all in what we do.
1:08:02
Mmm hmm.
1:08:03
Yeah, And I, I had mentioned, you know, having both the Medicaid in some of our markets, having both the Medicaid and the marketplace side of things we’ve tried to profile. It’s, it’s just been so long that this has been on that, you know. For the most part, you know, we’re seeing it’s more adults, the non traditional Medicaid situation. But then also did they expand or not so that, you know, is there a lot of folks that are that are, you know, going to lose coverage under Under that one of our states. We don’t have that. And so, you know, the marketplace has already been sort of a place for, for a lot of those members to go.
1:08:40
So, it’s, it is very difficult to a challenge to look at.
1:08:45
Millimeter And, Sarah, I want to bring you and Sarah Collins to bring you to the conversation here for awhile. So, you’re, you know, you’re an expert on surveys, on consumer surveys, and sort of looking across populations.
1:08:58
How are you thinking about kind of what the the the tailored or disparate effects might look like for different people or different groups of people?
1:09:12
That’s, I think, that what’s, what we’re probably going to see is this end of the public health emergency plan out very differently across states.
1:09:21
Just just like we, just, just, like we see now, across the states, free, people, people handle states handled eligibility determinations, very different way, and some states are very aggressive in. Some states are less aggressive and so in some states are sometimes they’ve been very eager to get people to move off their Medicaid and Medicare and Medicaid programs.
1:09:44
And so, you’re likely going to see big spikes and uninsured rates or at least gaps in coverage. And some of those states, and in states like Colorado, which are taking a much more measured approach to this less, less coverage loss, I’d also like to put this in the context of inflation, and these are, these, are people with very limited incomes. And when you think about affordability, what’s important to think about, is how much people are gap, as a share of their income.
1:10:12
So, so people eligible for the marketplace plans are, are pretty moderate income group of people, and then people in Medicaid are pretty low.
1:10:21
So if you’re looking at shifting from Medicaid where you’re not paying much at all or nothing and premiums and all of a sudden you may face if ARPA subsidies aren’t extended, any, any size premium is going to be a disincentive for you to to enroll in marketplace coverage.
1:10:41
So, people in the lowest income brackets are always the most hurt during high inflation periods, and, and having a big seeing, a spike and premium is really going to be the last straw for a lot of a lot of these families.
1:11:00
Thank you.
1:11:02
We have about 15 minutes left. And, so, again, want to encourage folks to ask questions. Let me go again, to sort of our bank of audience questions here.
1:11:16
Know, there is a question of, I think one of you mentioned this kinda earlier, is there any talk of funding? The CSR is to helped pay for higher subsidies.
1:11:24
So, again, like, it sounded like, um, you know, that was unlikely, but, you know, from a federal perspective, I mean, like, is there any tinkering with the CSR is at this point? Are we just going to let silver loading?
1:11:40
Um, be what it is.
1:11:43
No, I’ll just say, we’ve heard, in passing that looking at silver loading was one of the levers of potentially, Congress was looking at it as if they were going to kind of adjust the subsidy. Obviously, that gets really challenging. I mean, there’s just challenging them in the perspective of, there’s so many ramifications from it, right?
1:12:04
So, if I was looking, I was in my old, you know, Hill job and was trying to figure out, OK, if you’re trying to expand the subsidies, but maybe you have to tailor it back. That, to me, is, it’s got a significant impact.
1:12:17
So I don’t know if I know, I think it’s highly likely, but I do think it’s one of the levers within how the tax credit is structured that. If you’re a policymaker, you could dial up or dial down.
1:12:39
Thanks.
1:12:41
All right, audience, kind. You gotta keep those questions coming, But Kevin, it’s like. you were about to say something. Yeah. Yeah. No.
1:12:47
I just wanted to jump on something, Elizabeth, saying, I think I’ve heard a few machinations about what it would be different.
1:12:55
Whether it’s a cliff at 700, whether we do two years worth all that other stuff.
1:13:00
The longer we go and the changes that we make, the more concerned I think state exchanges will be.
1:13:06
And I think healthcare dot gov will follow the same place about actually being able to do anything at anytime, because you’re you’re kind of burning up. You’re running out the clock, and we just don’t, we will do whatever we can to get everything there.
1:13:20
But there is just a limit to how much risks we take on?
1:13:26
giving people the right eligibility if we if this continues to delight. So I just want to make sure that was stated.
1:13:32
Hmm, hmm, hmm, hmm, there’s also a practical element, which we didn’t touch on. But I remember kind of drafting legislation.
1:13:38
We get technical support from the Department of Treasury, as they, anytime, we changed anything related to, like, the calculation of the subsidy. And we didn’t give them like a year to kind of, like, figure it out. The TA was, you know, explicit. And so that’s the other thing that I think, if any, if they’re going to actually try to change anything with the calculation.
1:14:01
But the technical assistance that they’re going to get from the Department of Treasury about whether or not that can be implemented, you know, within a couple of months, is highly unlikely. So to meet.
1:14:13
I think if you’re dialing, you’re going to dial with years.
1:14:17
Rather than completely re-open this thing, that just would be my assessment.
1:14:23
Like, technical assistance. From some. that are a little, I’m gonna use that myself. I guess I had a question. Maybe gotten. Yes, I mean, if they did know appropriate CSRS for next year, I think you’d have to completely redo rate.
1:14:39
I assume, or, I don’t know, like, I don’t know, I haven’t heard anyone modeling that, are like, doing a separate rate filing for that. Versus if you’re gonna be, we’re gonna do that, pushing that out for 2024, which is sort of what you suggested lives.
1:14:49
But, that, to me, seems extremely disruptive, And at this point, that’s kinda where I was.
1:14:55
I was thinking that, no. We’ve already built-in.
1:14:58
We’ve already loaded our rates based on expected silver blend, and so, if all of the benefit comes to the issuer or let’s go into the wrong, it’s going in the wrong place, needs to get to the member, which means the premiums would have to be adjusted.
1:15:13
So, OK, there’s, There’s going to be so many more process questions in a second, but that does lead me to a little bit of a related question. That came in from the audience. Which was, actually, It’s quite a significantly related question, Right, depending on how you dial the policy, which is just like, where is the money going to come from to pay to extend the subsidies. And I think, you know, Elizabeth, I’m one of your slides.
1:15:35
You kind of showed right, some potential savings are offsets from prescription drug spending. Which, again, like, I think, well, the topic of this conversation is, is the specific impacts are not of the …
1:15:49
and the Medicaid re determinations, You know, like it’s probably not lost on anybody that that’s a pretty significant Chunk of money that, you know certainly has been reported as coming out of the pharmaceutical industry, So I’m just curious like is that gonna cover the cost? If if if it were to go through like beyond that. I know there’s some tax sort of questions at play, but you know, can you kind of talk about where the money is coming from, but also?
1:16:21
Maybe just remind us, if, if possible, like is there a score of how much it costs to sort of extend extend the subsidies? No. Or again, is that all just stole so in Flux, because CBO can’t score anything until some key decisions get made.
1:16:42
Sorry, that was a lot of questions, but so let’s start with, like, how much we think it costs, and then where does the money come from?
1:16:49
Yeah, I was gonna say Katie and Sarah have what they are thinking, that’s kind of their most recent thinking on what the subsidy expansion would cost.
1:17:00
Just a recent estimate that about 22 billion a year to extend the subsidies and if you do the math on the prescription drug over 10 years here, you’re obviously say, you’re obviously offsetting the subsidy cost.
1:17:16
Also does add to this when we get really caught up and how much things cost and pay borders.
1:17:24
But, you know, these if you think about the ARPA extensions and then only doing them for two more, two more years. And these are changes that really did need to be made to the marketplaces. I mean, the subsidies really were not adequate from people on the cost. sharing reductions Have two that are actually not adequate for people. People face, really high deductibles. So this was an important change and we did during the pandemic, but just because the pandemic is winding down doesn’t mean we should. We should get rid of these policies, the continuous enrollment in Medicaid. That’s a very important change that allow people to stay on coverage. And just because the pandemic winds down doesn’t mean we shouldn’t. We should abandon that ideal of keeping people enrolled in Medicaid. So both these policies are very important changes in and of themselves regardless of pandemic and the expenditure is actually a relatively low to make going forward on subsidies.
1:18:24
Thanks, Sarah, for, for that. So, we heard the estimate of 22 billion per year, and, you know, with the possibility of you can switch the number of years and that kind of thing.
1:18:32
You know, you also made the point that, um, Sarah, that was, this, isn’t necessarily, while this happened during the midst of a public health emergency, you know, that, that, there were, know, and, I think, let’s face it, like, over the last 10 years, not much, sort of substantive has happened in terms of improving or fixing, right? Sort of the current health insurance coverage system, if you will. So, I guess, with that, let me, let me see if anyone has any further comments on this, right. I mean, like, the fiscal piece of this is still obviously concern to a lot of people.
1:19:08
Like, what are the odds of overcoming that?
1:19:14
I was just gonna say, for offsets, you know, I do think the current thinking is that the drug pricing piece, know, it’s 28.7 billion. I think there’s a small piece of that, that potentially, I’m saying potentially smoke you potentially, if I had to argue so. We didn’t talk about the Byrd rule, because that’s so far inside the beltway. You don’t want to go there, But it’s one of those reconciliation rules and kind of limit what you can do. So, I’m going to say safely.
1:19:40
They have 250 to 280 billion over time, and I think what we’ve heard about the Medicare solvency piece is that there’s an interest in having a dedicated new source of revenue that would go directly into the trust fund.
1:19:57
So, I think that there’s plenty of, you know, I think there’s room on the table.
1:20:02
Certainly, to look at a couple of years of the BTC expansion, kind of described this, as with reconciliation, they’re puzzle pieces, and they’re almost like puzzle pieces that kind of like move.
1:20:15
And, we’re starting to see them move towards each other, and them start.
1:20:22
So, just the fact that, like, they made policy changes within the drug pricing, language, that got them a higher score, that also probably helped make it easier to get done. OK, so that’s Watson.
1:20:35
Well, that got them enough to cover, You know, more subsidy.
1:20:38
So, then that’s going to help slot that in and then if there’s something left on the table, or, you know, a smaller tax provision that can give you something directly to the trust fund, that slots baton. And then you have a health care package.
1:20:52
What happens on tax and climate, I think, is outside my, you know, world. I just think the question is going to be your congressional Democrats.
1:21:03
I don’t know what else you get it. If it’s not this, I don’t know what the other option is, because I don’t see a bipartisan path forward. And I think that that’s going to be the real conversation for policymakers, is, if not, this, what? And I don’t think there is another option.
1:21:22
Yeah, please, could I ask, Sorry, I’m just asking questions. We want to sunshine as usual. I, so that means setting aside the, like, in terms of what else could be on the list that you’re slotting in, right? So I think coverage gap is out there and I’d love maybe your opinion on that.
1:21:40
And then there’s, I mean, at least in the house, password, to build back better for all these other Medicaid policies that are super important, You know, like, permanent or mandatory like post 12 months, post-partum, continuous coverage for kids. Some really important again in the moment that we find ourselves in, that would be historic changes and medic. I don’t know if you do have an opinion on those? Or any insight into where those are sitting? I do not, which is why I’m curious.
1:22:02
Yeah, so, think the late.
1:22:07
So I really think the inflation numbers have read, um, not that they need to refocus. I think that senator management is very clear that he is going to scrub every single provision of what they do for an impact on inflation. And for me, what that means, that in some ways it’s overall spend, right? Because some of those individual policies don’t have kind of a direct impact on inflation.
1:22:31
So, I think if you can make the case, I think it’s, I think it’s a tough, tough negotiation in the sense of how do you draw the line between kind of, what’s necessary in this time, and what it’s been, what’s not?
1:22:47
Hmm, again, I’m, I’m trying to think about, not so much in a more pessimistic perspective. But if I’m really thinking of it from like, a purely budgetary perspective and I almost have met Gnostic on the Policy, we just kinda what you have to do for Some of these, is, just to kinda think about it. It helps you make your arguments to, I think, That’s the other thing, too. Sometimes, if you’re, particularly when you’re dealing with budget reconciliation, I try to tell people.
1:23:13
I’m a lawyer, by training. I like words. I like statutes that the puzzle, I like to figure out, the fact that there’s numbers involved like that. It’s hard for me, even though I work. And so, when reconciliation happens, you have to flip your brain.
1:23:29
You have to think, for me, is where are the how are all the numbers moving.
1:23:33
And then, kind of the policy almost, becomes a secondary piece to it, which is just, to me, not how one should legislate but that’s just when you’re in budget reconciliation lives.
1:23:42
So I’d have to look at the numbers you know and see kind of what they look like and how you can argue know who that inflationary lens is going to be.
1:23:52
I think they’re really important.
1:23:54
Wait a little bit things. OK, I think, you know, when, when a number of us, state exchanges were in DC and May, you know, we were making this same argument. And it was pretty clear, They were talking about drug pricing.
1:24:06
And I think what we’re saying is the budget becomes the policy question, because you can’t say yes or no until you know what the numbers allow you to do.
1:24:14
And so, what we have, what we had to kinda just do, is like, OK, we have to wait our turn, because we know we’re not the biggest number for what we’re talking about are the subsidies. And they have to see if they can squeeze out enough somewhere else to make this even an option.
1:24:29
So mmm hmm.
1:24:32
You know, I come from a place where the budget is where we start, so maybe it’s just I just see it a little differently at all.
1:24:39
I guess I’m thinking, if we’re only talking about subsidies for two years, that’s 44 billion. What else is that drug that maybe, leaves a lot of room and plotting? So, yeah, like the state of play on Medicaid, I guess what this is super helpful. I totally agree about the analogy gradient.
1:24:55
Thanks, everyone. So this has been a really great discussion, and we have just a few minutes left, and I want to let everyone go onto their afternoon on time.
1:25:03
But I think just kind of, to this point, right? It’s like, inside the beltway, you know. And in a reconciliation process, like the budget for the policy, we’re talking about things that are, you know, dialable in sort of DC. Terminology, you know, do we extend it only for two years do, we means test. You know, I don’t know, You know, we don’t have maybe too much time to get into the technical details, but I think there was some report that maybe Senator Manchin had indicated that, like, he’d be fine with the ARPA subsidies only up to, like, the 400% of poverty rate, which also, then creates A cliff, potentially. Right. So, at some point, you know, again, sort of our last few minutes.
1:25:41
I just want to sort of take the focus from the, the policy, sort of, to the people and sort of, regardless of how this current short-term situation gets resolved.
1:25:53
Are we just, no, and I, I get that, this is a little bit more of, like, looking into the crystal ball. But, this whole entire conversation, I mean, the number of times, we’ve talked about timing of uncertainty.
1:26:08
Like, you know, real pocketbook, consequences for people, I mean, what, does it take to get to a conversation where it’s not these, like, short-term, sort of lurching from one thing to the other with all the complex factors and things that like everyone’s sort of dealing with at the various levels?
1:26:29
Is there a world where the American people can expect a little bit more of a strategic approach to some of these questions that sort of works for them, right?
1:26:41
So, they don’t wake up one day and get a letter that says, sorry, you’re premiums higher or sorry, are, you know, you’ve got to change your coverage again or what have you. So, I’m just gonna kind of like, in three minutes, let everyone just answer that question, or chime in.
1:26:59
I mean, what does it take to get from shorter term, to longer term thinking?
1:27:07
Kind of interpret that as like, when is Congress going to fix it, so that, you know, you see the world with your own lens, right?
1:27:15
So, um, I don’t know.
1:27:19
I mean, I, I feel like, I’m still, I don’t wanna say I’m still kind of impacted by the 2017 experience, right?
1:27:28
Of like, you had Republicans come in, and they had the House, and the Senate, and the White House.
1:27:32
And, like, you know, repeal and replace was the big thing. And like, couldn’t pull that off.
1:27:37
And then you had this moment where you actually had this, like, bipartisan, like all of these working groups and the members were working together and we had all these different breakfasts and actually I remember we had hearings and Governor Hickenlooper came and you had like you know, bipartisanship at the government at the state level. And like we’re like, oh my gosh!
1:27:55
We’re going to legislate and then it got too political.
1:28:00
Well, and so for me, like I don’t know what it’s going to take.
1:28:04
It’s kind of almost a combination of like crisis plus divided government, because I think when you have one party that’s like solely in charge, there’s so much pressure of like, Oh, you have this moment, and you have this agenda.
1:28:20
You and neither party will let their other like their members walk away from like the whole of what they’re You know, to be able to refer. somebody like …
1:28:31
Alexander to be able to do that by partisan work the Repeal and Replace had to die, which is why the sequencing, we just talked about happen.
1:28:41
But even then, it had to be there.
1:28:44
It was that plus a crisis, and so, I don’t, I don’t really know, I just no shocked that we’re still kind of where we are in this, in this conversation.
1:28:58
Because I think even as someone who worked for Senate Republicans, there are conversations that you could have around, OK, so maybe the subsidies stay in place. Let’s talk about flexibility or on plan design.
1:29:09
Let’s talk about, you know, 13, 32 acres. Like, there are things that you can talk about that could bring, you know, more competition and to the market.
1:29:17
And let’s have that dialog. But if you can’t even engage, I think that’s it becomes really, really challenging. And it’s been 10 plus years of not being able to engage. And so it’s going to take a lot to be able to kind of unwind from that.
1:29:31
Again, my sunshine right here. Always, Ray of sunshine. Well, I want to, this is clearly a TV, continued conversation, and I think there’s still a lot of conversation to be had. If there’s a lot of action to watch for over the next couple weeks.
1:29:45
I know Folks like, Kevin and Scott have their hands full, and in terms of just operationalizing this stuff, know, those of us at that sort of, policy level and political level of a lot to watch for, you know. But I hope we can kind of conclude, and we are out of time.
1:30:04
But just, I think, for all of us, kind of, whether people are waking up and identifying as Republican or Democrat or whatever it is, that, you know, at, at some point, all of these complexities really do impact people’s lives. And so, that there’s, there’s, there’s still a lot of work to be done to get to a better place there. But, in the meantime, I want to thank Elizabeth Row, Katie Keith, Kevin Patterson, Scott Brockman of Coursera Collins for joining us today. Thank you for all of the deep thinking and analysis and work that you do. We’re going to, next week, after 2.5 years of webinars, we’re going to be, I Will take the survey. Please take the survey we do. We do take everyone’s comments into account as we as we plan our future programming.
1:31:01
Next week, we have our first in person event and 2.5 years, the Alliance does, so, we’re going to be talking about mental health and America at our summit. We’re super excited. We have bipartisan congressional leaders and sending remarks by video. We have Secretary Sarah will be joining us for Fireside Chat and we have the real life perspectives of some really, really special people. So, I hope that you can join us for that, for those who want to watch a recording of the webinar or check out the additional materials checkout, All health policy dot org. And I am one minute late, so I’m sending you back into your hopefully, sunny and lovely afternoons. Thank you so much again for joining us today, and have a great weekend, everybody.