As the Republican plan to “repeal and replace” Obamacare falls apart in the Senate, it is becoming increasingly likely that Republicans and Democrats will be forced to work together to essentially fix Obamacare. Now, I believe, and the evidence shows, that Obamacare was a good law. A whole lot of people’s lives got a whole lot easier because of Obamacare. However, it was not a perfect law., and it made some peoples lives- mostly people with bare bones insurance plans that were outlawed by Obamacare- harder. There are improvements that can be made, and today I’ll detail a simple one that Republicans actually got right in the BCRA: Extending premium tax credits and subsidies below 100% of the poverty line.
Under current law, premium tax credits and payment subsidies only cover people whose income is between 100% and 400% of the federal poverty level, or FPL. People whose income is below 100% of FPL were supposed to be covered by the Obamacare Medicaid expansion, which expanded Medicaid from a program that only covered vulnerable low-income populations-pregnant women, children, mothers, the disabled- into a program that covers all low income individuals, including childless adults. However, 19 states still have not expanded their Medicaid program to cover childless adults who live below the poverty line. This situation leaves those individuals- childless adults with incomes below the poverty line in non-expansion states- in an odd situation: they are not covered by Medicaid, so they have to buy their own insurance, but they do not qualify for federal premium subsidies because they do not make over 100% FPL. These individuals are far too poor to afford private insurance without subsidies, so they stay uninsured.
In a perfect world, the 19 non-expansion states would stop intentionally harming their own citizens and accept the Medicaid expansion, allowing this population to be covered by Medicaid. However, we do not live in a perfect world, so the next-best solution is to remove the lower income limit on premium subsidies, extending them to individuals below 100% of FPL. This is the right thing to do, not only because it will allow millions of people to receive health insurance, but because it will bring in a much-needed population to insurance pools: young people.
This population- poor, childless adults- skews very young, mostly because older people in poverty typically have children and therefore qualify for Medicaid. Many of them were on Medicaid as a child, but lost coverage when they turned 18. They are often college or community college students who are young and healthy and cannot afford a $200+ monthly insurance premium on their near-minimum-wage incomes. By extending premium subsidies to this population they could be brought into the private insurance market. This would help to stabilize the marketplace by increasing the amount of young, healthy people in insurance pools.
This extension of subsidies appeals to both parties; Democrats like it because it expands insurance coverage, and we already know that Republicans like it because it was their idea. Most importantly, an extension of premium subsidies to individuals with incomes below the poverty line will make a lot of peoples lives easier by allowing them to afford insurance coverage and, as an added bonus, by stabilizing insurance markets through an influx of younger, childless people. An extension of premium subsidies to people in poverty should be a part of any Obamacare fix.