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We wanted to share three pieces of related information that might be of interest to anyone who is concerned about possible repeal the Affordable Care Act.

1. A breakdown of who could lose coverage, by Congressional district

Ever since the Affordable Care Act first took effect, Charles Gaba has been tracking how many people have enrolled in health coverage as a result of the law. His website, ACASignups.net, has been cited by everyone from The Washington Post and The New York Times to Fox News and Breitbart as the most accurate source of estimates about the ACA’s coverage expansion

Lately Gaba has been working on a new project: estimating how many people would lose coverage in every Congressional district if Obamacare was repealed without a replacement. To give a sense of what that looks like, here are the figures for Pennsylvania:

2. Congress will be on recess next week

The recess means that most members of Congress will be back home in their districts, meeting with constituents and holding townhall events. There are a bunch of different ways to find out what your representative will be up to. You can call their office and ask (if you type in your address at the website Call to Action, it will give you the number of their district office). Or you can check out the Townhall Project Google doc, where volunteers have been compiling a list of every Congressional townhall they can find throughout the country.

There’s also the website Resistance Recess, where if you type in your zip code, it will show you not only if your representative is holding a townhall, but, if they’re not, whether constituents have organized their own townhall and invited your rep to attend.

3. Townhall events are a great opportunity to share how you feel about Obamacare

For example, at a townhall held by Rep. Diane Black (R-TN), a 35 year-old French teacher who lives in Cookeville, Tennessee gave one of the best defenses of the ACA we’ve ever seen, saying:

“My name is Jessi Bohon and I’m in your district. It’s from my understanding the ACA mandate requires everybody to have insurance because the healthy people pull up the sick people, right? And as a Christian, my whole philosophy on life is pull up the unfortunate. So the individual mandate, that’s what it does. The healthy people pull up the sick. If we take those people and put them in high-risk insurance pools, they’re costlier and there’s less coverage for them. That’s the way it’s been in the past, and that’s the way it will be again. So we are effectively punishing our sickest people. And I want to know why not, instead of fix what’s wrong with Obamacare, make companies like Aetna that pulled out and lied to their consumers about why they pulled out, and said they pulled out because Obamacare was too expensive, but they really pulled out because of a merger. Why don’t we expand Medicaid and have everybody have insurance?”

At a townhall held by Rep. Gus Bilirakis (R-FL), residents of Pascoe County got to demonstrate how they felt being lied to about death panels in the ACA:

But the best part of townhalls is that it’s a chance for those whose lives have been saved by the ACA to share their stories with the people who are trying to repeal it:

Hopefully this info helps when you’re making your own plans for the coming week.


No, Republicans haven’t repealed Obamacare… yet

Late last week, our Facebook feed started blowing up with posts about how Republicans in Congress just voted to repeal Obamacare. I think it started with an article by Charles Pierce at Esquire with the headline, “30 million people lost their healthcare in the dead of night”. There’s a link to what it calls “an easily readable rundown of the details of the crime” at ProPublica. That page is really just the vote tally for Senate Vote 26, which for some reason ProPublica gave the headline “Adopts Budget Resolution To Repeal Obamacare.

All of that sounds scary, but it’s super misleading. Here’s why.   [click to continue…]


It’s open enrollment time for the Affordable Care Act, which means that now through January 31 anyone who needs coverage can buy a plan. And in most states, TODAY (Dec. 15) is the last day to buy a plan that starts on January 1.

Also, there’s been a lot of confusion about what the recent election means for people who get coverage through the ACA, but keep in mind two things:

  1. If you a buy a plan now, you’ll be covered for all of 2017, regardless of what happens in Washington; and
  2. Not only do Republicans not have a plan for replacing Obamacare, they don’t have a set plan for how to repeal it either. The latest option they’ve floated is voting for a repeal that takes effect in three years, but they can’t do that without Democrats, who’ve said it’s a non-starter.

In other words, ACA coverage is safe for a while at least. On the other hand, the election means that the flaws with the ACA aren’t getting fixed any time soon either, and buying coverage can still be confusing– especially if it’s your first time. To help make the process a little easier, here’s our guide to getting covered under Obamacare, updated for 2017!   [click to continue…]


Trump’s 100 day “plan” for healthcare


So… this happened.

As you might have noticed, we haven’t posted in a while. Partly that’s because we’ve been busy with other projects, but it’s also partly because there hadn’t been much happening in the world of health policy. There were a couple snags with the ACA– premiums increased by more than they had in a couple years and a couple big insurers left the exchanges– but for the most part it was running like it always has, covering more than 20 million Americans who would have been uninsured otherwise. The stalemate between Congress and the White House plus an election year meant that no new health laws were being passed. Both Trump and Clinton posted healthcare proposals on their websites during the primaries (we looked at Trump’s here, and Clinton’s here and here), and Trump like every other Republican promised to repeal Obamacare, but otherwise, healthcare got little attention during the campaign.

And then the election happened.

One of the more troubling things about Trump being elected is that we have little idea of what he’ll actually do when he’s in office. He’s promised to replace Obamacare with “something terrific,” but the proposals on his website are, for lack of a better word, a mess. Even Obamacare critics have worried about Trump’s (lack of) plan. Michael Cannon, health policy director of the libertarian Cato Institute, a man who’s been described as “Obamacare’s single most relentless antagonist,” put it this way:

“This isn’t a health reform plan. It’s a campaign operative copying and pasting a bunch of stuff from the around the web, without knowing what it means or even realizing that he’s describing current law. It shows Trump is as unserious about reforming health care as ever. He doesn’t have a plan. He has paroxysms.”

So we thought that maybe Trump’s hundred days plan would give us some more insight into how he actually plans to tackle healthcare. It did not inspire confidence.   [click to continue…]


zika flier

We haven’t written much about Zika yet, mostly because there are already a ton of great resources explaining pretty much everything you need to know about the virus. In particular we’d recommend:

Also, Zika hasn’t sparked the same kind of public alarm that past outbreaks have, which in some ways is good, since there’s less misinformation floating around. It seems like there’s a general awareness that it’s spread primarily by mosquitos, but can also be transmitted sexually; and that the main risk is for pregnant women, because the virus can cause severe birth defects like microcephaly (although we should point out the World Health Organization estimates that only 1% of women with Zika will have a baby with birth defects). The vast majority (80%) of people who contract the Zika virus won’t show any symptoms; a minority (about 20%) will show minor symptoms like fevers, aches, headaches, and rashes; and in a very small number of cases (1 in 4,000) it can cause Guillain-Barré, a neurological condition that can sometimes lead to temporary paralysis.

However, perhaps because there hasn’t been a major public outcry, Congress has been slow to respond– even though that 1% risk to fetuses was enough for the WHO to declare a public health emergency back in January. Lawmakers on both sides of the aisle say that securing more Zika funding is critical, yet somehow Congress left for summer break without authorizing new funding. Meanwhile, the disease has arrived in the U.S.– it’s now being transmitted by mosquitos in Florida, and a baby born with a Zika-related birth defect died in Texas this week.

And so this week, we’ve seen editorials from Paul Ryan and other prominent Republicans blaming President Obama and other Democrats for blocking Zika funding. That seemed odd given that Republicans are usually the party opposed to new government spending. Turns out that in reality the GOP (1) demanded that the Obama administration use funding meant to prevent another Ebola epidemic, (2) sabotaged a Zika funding bill by adding provisions they knew Democrats wouldn’t agree to, and (3) refused to call Congress back to vote on a clean bill.  [click to continue…]


billy madison

This has probably happened to everyone at least once in school: the deadline for a big paper or presentation was coming up and you hadn’t actually read the book or done the research. At that point, you basically had two options: (1) ask for an extension; or (2) use as many words as you could to present what little information you did have, hoping that the length would obscure the fact that you weren’t really saying anything. There’s a great example of this at the end of Billy Madison:

For six years, Republicans in Congress went the first route, asking for extension after extension on their long-awaited plan to replace Obamacare, always claiming they were going to release one “soon.” That only works for so long though, and with a presidential election coming up, they were starting to face awkward questions from voters and the media about the fate of the 20 million people who would lose coverage if the ACA were repealed.

And so, House Republicans have moved on to the Billy Madison approach. Last week, speaker Paul Ryan released what he called “a first-time-in-six-years consensus by the Republicans in the House on what we replace Obamacare with.” At 37 pages, it’s long enough that on first glance it looks like it could be an actual alternative to the ACA; but just like Billy’s “rambling, incoherent response” was missing “anything that could be considered a rational thought,” the GOP’s rambling, incoherent health reform plan is missing, well, a plan. [click to continue…]


Obamacare’s forgotten OTHER subsidy

aca plan comparison laptop

Back in 2013, shortly before the first Affordable Care Act plans took effect, we wrote a post about what we called Obamacare’s “other” subsidy. In it, we explained how if your income is below 250% of the poverty line (currently $29,700 for a single adult), a provision called Cost Sharing Reduction (CSR) could dramatically lower your out-of-pocket costs if you buy a Silver level plan.

At the time, it seemed like hardly anyone knew this; while we’d seen plenty of articles mentioning the ACA’s help paying for premiums, CSR was largely ignored.

Unfortunately, over the past two and a half years, not much has changed. Even as high out-of-pocket costs have become a major campaign issue, Obamacare’s CSR has gotten little coverage, meaning many people who could benefit still have no idea it exists.   [click to continue…]



In our last post we talked about the wonky idea at the center of Martin O’Malley’s healthcare plan– an all payer system– and why both Hillary Clinton and Bernie Sanders should consider adopting it in their own plans.

But that’s not the only part of O’Malley’s plan that deserves a second look. In a piece for MedicareResources.org, Rob writes about his other good idea, which O’Malley calls Medicare Essential:

Originally proposed by researchers from John Hopkins University and the Commonwealth Fund, “Medicare Essential” could make Medicare simpler for enrollees, lower their premiums and out-of-pocket costs, and improve the quality of their care. It’s an idea that could strengthen Clinton’s “Medicare for More” plan or serve as a step toward Sanders’ “Medicare for All.” On top of that, it would cost the federal government nothing, making it hard for even a Republican Congress to vote no.

Go read the whole thing here!


martin o'malley doctors

Before you ask, yes we know Martin O’Malley dropped out of the 2016 presidential race months ago.

Here’s the thing: presidential campaigns in the U.S. are way too long. The UK’s most recent national election lasted 139 days, and the last Canadian election took just 11 weeks. Meanwhile, here in the U.S., the 2016 campaign began almost two years before election day, when Ted Cruz announced his candidacy. It’s a ridiculous amount of time to focus on an election, so aside from a quick post on the first Republican debate (which, like everyone else, we watched mostly just to see the Donald Trump circus) we decided not to cover the 2016 campaign until, well… 2016.

What that meant though is that by the time we started looking at candidates’ health plans, many of them had already dropped out. In the Republican race, this wasn’t a big deal since every GOP candidate promised basically the same thing on healthcare: to repeal the Affordable Care Act and replace it with some combination of catastrophic coverage, high risk pools, selling insurance over state lines, and block-granting Medicaid.

However, on the Democratic side Martin O’Malley had an interesting proposal that none of the other candidates touched on. Even though he’s out of the race, his ideas are still worth examining, because they could improve both Clinton’s plan, which builds on the ACA, and Sander’s single-payer approach– and possibly serve as a bridge between them.   [click to continue…]

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By far the most important change for pregnant women in the Affordable Care Act was the provision saying that all health plans have to include maternity coverage as an essential health benefit. (Before Obamacare, just 12% of plans on the individual market covered pregnancies.)  But the ACA didn’t stop there– it also provided pregnant women with more choices on how to give birth, by expanding access to midwives and birth centers.

In a piece for healthinsurance.org, Rob looks at why more women are choosing to give birth outside of hospitals, and how Obamacare has helped make that choice possible. Here’s a sample:

Elizabeth Criss knows all about the stigmas attached to giving birth outside of a hospital. “When I told my husband I was being interviewed about why we chose a birth center, he said I should just quote Jim Gaffigan: ‘We’re both lazy and the hospital was soooo far … the midwife was there because we believe in witchcraft.’”

In truth though, Criss did a lot of research into different birth options, and found that for low-risk pregnancies like hers, outcomes for babies are similar at birth centers and hospitals. Also, she had reservations about how quickly hospitals turn to medical and surgical interventions, which come with their own health risks; and she knew that if something happened, the midwives at her birth center, The Midwife Center in Pittsburgh, have admitting privileges at a nearby medical center. Plus, she’d been going there for well-woman visits for years before planning to become pregnant – the atmosphere was more homey and she felt more listened to than with past doctors.

“When you’re pregnant, there’s a lot going on physically and otherwise,” says Criss. “I liked that the care was more comprehensive and whole-person centered, and they don’t treat it like you’re just a uterus.”

Criss says she was happy with her experience at The Midwife Center, and she’s glad she had that option. Now, thanks to Obamacare, it’s a choice available to more women.

Go read the whole thing over at healthinsurance.org!