• Exchange subsidies: Slightly more ready for prime time?

    About my post on exchange subsidies, Judy Solomon of the Center on Budget and Policy Priorities writes me,

    There are definitely lots of issues such as those you identify in your second two points. However, I don’t think that the first issue you raise is a problem.  Here’s why.  I think that the discussion at the Alliance briefing confused Medicaid plans that would be offered to those determined eligible for Medicaid and qualified health plans offered in the exchange to those eligible for premium credits.  A state could decide to include the array of Medicaid plans as options in the exchange so that those using the new unified eligibility process could choose their plan once determined eligible for Medicaid. This is what Deb Bachrach’s paper suggests [slides here]. However, this is not actually required in the ACA.  A state could run the Medicaid plan enrollment process separate from the exchange.

    That makes perfect sense. I don’t know if by running Medicaid enrollment outside the exchange it creates some coordination issues around times of transition between Medicaid and non-Medicaid plans. It was my understanding from others that including both plan types within the exchange helps smooth such transitions. But, maybe I’m wrong.

    I can say that some folks working with state authorities are very worried about this issue and ones like it. These little details really matter, and take time to work out. So, the exchange subsidies, among other things, are still not ready for prime time. But they need not be. We still have a few years yet.

    • Timing is a concern in Utah and I suspect in other small, red states with unsophisticated, recalcitrant health and Medicaid departments. They don’t have the resources or the will to pursue a constructive dialog on these subtleties. In Utah ACA subsidies and Medicaid eligibility finding are already being viewed by Exchange staff as unworkable and beyond them, as well as politically not worth the effort. Clarity about how these things were supposed to work might make a difference in those attitudes, and it would at least enable advocates to argue back, “Yes you can.”