<div dir="ltr"><div dir="ltr"><div class="gmail_default" style="font-size:small">David Anderson, an expert on health insurance explains why partial Medicaid expansion, as proposed by the majority party in the legislature, will raise health care costs for middle-class Idahoans:</div><div class="gmail_default" style="font-size:small"><br></div><div class="gmail_default"><a href="https://www.balloon-juice.com/2019/03/22/idaho-partial-medicaid-expansion-and-the-400-fplers/">https://www.balloon-juice.com/2019/03/22/idaho-partial-medicaid-expansion-and-the-400-fplers/</a><br></div><div class="gmail_default"><br></div><div class="gmail_default"><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.5;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;color:rgb(68,68,68);background-color:rgb(244,244,244)">Medicaid is primarily health insurance for poor people or very sick people.</p><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.5;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;color:rgb(68,68,68);background-color:rgb(244,244,244)">Idaho’s legislature is monkeying around with the voter approved straight-up Medicaid expansion to 138% of the Federal Poverty Level (FPL)...</p><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.5;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;color:rgb(68,68,68);background-color:rgb(244,244,244)">...This will harm middle class Idaho families who need community rated, guaranteed issue insurance from the individual market.</p><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.5;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;color:rgb(68,68,68);background-color:rgb(244,244,244)">How does that work if Medicaid is health insurance for poor people?</p><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.5;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;color:rgb(68,68,68);background-color:rgb(244,244,244)">Cost Sharing Reduction (CSR) work-arounds of Silverloading and differential morbidity matter.</p><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.5;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;color:rgb(68,68,68);background-color:rgb(244,244,244)"><a href="https://www.healthaffairs.org/do/10.1377/hblog20190212.230279/full/" target="_blank" rel="noopener" style="box-sizing:border-box;margin:0px;padding:0px;border:0px;font:inherit;vertical-align:baseline;outline:0px;max-width:100%;text-overflow:ellipsis">Adrianna MacIntyre and I argued in a Health Affairs blog </a>that full expansion has two paths to decreasing premiums for people earning over 400% FPL that are not available if a state elects and receives a waiver for a partial expansion to only 100% FPL.</p><blockquote style="box-sizing:border-box;margin:20px 2em 20px 1em;padding:10px 20px;border:1px solid rgb(51,102,204);font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.2;font-family:Verdana,sans-serif;vertical-align:baseline;background:rgb(241,241,241);color:rgb(68,68,68)"><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-style:inherit;font-variant:inherit;font-weight:inherit;font-stretch:inherit;line-height:1.2;vertical-align:baseline;background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial"> evidence found that Medicaid expansion improved the risk pool of state individual markets, suggesting that the population between 100 and 138 percent FPL is sicker and more expensive, on average, than other exchange enrollees. Insuring this cohort through Medicaid is associated with a <a href="https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101704401-pdf" target="_blank" rel="noopener" style="box-sizing:border-box;margin:0px;padding:0px 3px;border:0px;font:inherit;vertical-align:baseline;outline:0px;max-width:100%;text-overflow:ellipsis;background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial;color:rgb(51,102,204)">seven</a> to <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hec.3809" target="_blank" rel="noopener" style="box-sizing:border-box;margin:0px;padding:0px 3px;border:0px;font:inherit;vertical-align:baseline;outline:0px;max-width:100%;text-overflow:ellipsis;background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial;color:rgb(51,102,204)">eleven percentage point</a> decrease in individual market premiums. …</p><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-style:inherit;font-variant:inherit;font-weight:inherit;font-stretch:inherit;line-height:1.2;vertical-align:baseline;background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial">household incomes between 100 percent and 150 percent FPL, those that would be eligible for 94 percent AV silver plans.  This income bracket overlaps the Medicaid expansion income group significantly.  States that fully expand Medicaid end up with far fewer people in the most generous CSR bucket, as they have moved the 100-138 percent population to Medicaid</p></blockquote><div class="gmail-wp-caption gmail-alignnone" style="box-sizing:border-box;margin:5px 15px 10px 0px;padding:0px;border:1px solid;font-style:italic;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:11px;line-height:inherit;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;max-width:100%;color:rgb(68,68,68);background-color:rgb(244,244,244);width:965px"><img class="gmail-size-full" src="https://www.healthaffairs.org/do/10.1377/hblog20190212.230279/full/Enrollment_in_CSR_94_plans_as_percentage_of_APTC_population.png" width="955" height="833" style="box-sizing: border-box; margin: 0px; padding: 5px; border: medium none; font: inherit; vertical-align: baseline; display: block; max-width: 100%; height: auto; width: 926.766px;"><p class="gmail-wp-caption-text" style="box-sizing:border-box;margin:0px auto;padding:3px 10px 5px;border:0px;font-variant:inherit;font-weight:inherit;font-stretch:inherit;line-height:1.5;font-family:Georgia,"Times New Roman";vertical-align:baseline;text-align:center;float:none">CSR 94 Enrollment by all APTC receiving enrollees 2018 Healthcare.gov</p></div><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.5;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;color:rgb(68,68,68);background-color:rgb(244,244,244)">Keeping a cohort that is more expensive than the rest of the ACA individual market risk pool in the risk pool raises premiums. Pulling the 100-138% population out of the ACA risk pool lowers market premiums as long as this group is more expensive than average. Furthermore while Idaho has engaged in the Silver Switcheroo, Silverloading increases premiums for folks who want a Silver plan and buy it on Exchange either because they don’t know if they will be just over or just under the subsidy cut-off point of 400% FPL or they can’t access an off-Exchange plan that meets their requirements.</p><p style="box-sizing:border-box;margin:0.85em 0px;padding:0px;border:0px;font-variant-numeric:inherit;font-variant-east-asian:inherit;font-stretch:inherit;font-size:14px;line-height:1.5;font-family:Verdana,Arial,Helvetica,sans-serif;vertical-align:baseline;color:rgb(68,68,68);background-color:rgb(244,244,244)">Full Medicaid expansion reduces the premium pain of the middle class. Partial expansion continues the pricing pain for the middle class.</p></div><div><div dir="ltr" class="gmail_signature"><div dir="ltr"><font size="2">Ron Force<br>Moscow Idaho USA</font></div></div></div></div></div>