Oct 22, 2019

States working on ACA backup plans before federal court case decision

Pro-ACA protestors. Photo: Erik McGregor/Pacific Press/LightRocket via Getty Images

States are beginning to make contingency plans in case the courts strike down the Affordable Care Act, WSJ reports.

Yes, but: There's only so much they can do.

Where it stands: As we all wait for the 5th Circuit Court of Appeals to hand down its ruling, and then for the likely appeal to the Supreme Court...

  • Colorado is looking to its state-level public option, still under formation, as an ACA fallback.
  • Nevada has formed a commission to look for ideas.
  • Louisiana is working on a plan to establish a high-risk pool for sick people.

The catch: Even setting aside the fact that this is only a small handful of states, even the most motivated blue state probably couldn't make up for the total loss of the ACA.

  • They could not deliver themselves a federally funded Medicaid expansion, for starters, and would have to raise an awful lot of revenue to replace the premium subsidies on the ACA's exchanges.
  • States would face their own drawn-out political battles if they wanted to re-impose the ACA's protections for pre-existing conditions and the accompanying rules that give the coverage mandate teeth.

And that's just the ACA's coverage expansion: States definitely couldn't fill the ACA's shoes on Medicare policy, biosimilars approval or the host of other programs that would fall by the wayside if the law is ultimately struck down.

Go Deeper: 10 states to experiment with wellness programs in their ACA markets

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How Georgia plans to radically reshape its individual health insurance market

Georgia Gov. Brian Kemp Photo: Kevin C. Cox/Getty Images

Georgia Gov. Brian Kemp released a set of waiver proposals yesterday that would remake the individual market, the Atlanta Journal-Constitution reports.

Between the lines: Kemp's proposal — which must be approved by the federal government — would move more control over ACA dollars to the state while attempting to lower premiums in the individual market.

Go deeperArrowNov 1, 2019

Grieving widow's slide into depression leads to $22K hospital bill

A grieving widow's slide into depression landed her in a hospital for five nights, which then turned into a $29,894.50 medical bill that her insurance didn't cover, Kaiser Health News reports with NPR. The bill was then reduced to $21,634.55 because her insurance didn't cover mental health care.

Why it matters: The woman had an association health plan. Her story illustrates how these plans can backfire on patients.

Go deeperArrowNov 1, 2019

ACA premiums are going down as competition increases

Illustration: Lazaro Gamio/Axios

Premiums are going down and competition is going up as we head into the next Affordable Care Act enrollment period.

The big picture: Those are both good signs. But those metrics are improving, in part, because they got so much worse over the past several years.

Go deeperArrowOct 23, 2019