WELP. Iowa Governor Kim Reynolds has basically just signed the death warrant for at least a few hund
Long but informative thread. Red states are inflicting a lot of pain on their people and it will continue as long as repugs are in charge. damn
Charles Gaba
Verified account @charles_gaba
1/ THREAD: WELP. Iowa Governor Kim Reynolds has basically just signed the death warrant for at least a few hundred Iowans with expensive pre-existing conditions. Some of them may have no choice but to leave the state or stay and die. Here’s why:
3:14 PM - 2 Apr 2018 from Bloomfield Township, MI
Verified account @charles_gaba
23h23 hours ago
2/ In recent weeks, the Iowa state House and Senate passed a bill, which was just signed into law today by the Governor, which would allow the state Farm Bureau to open up non-ACA-compliant “health plans” (NOT legally defined as “insurance”) to ANYONE.
1 reply 73 retweets 91 likes
Charles Gaba
Verified account @charles_gaba
23h23 hours ago
3/ The only reason these plans are legal to sell is because they aren’t legally defined as “health insurance” in the first place. That means they aren’t subject to ACA regulations. That means they can once again deny coverage (or charge thru the nose) people w/pre-existing conds. 
1 reply 67 retweets 94 likes
Charles Gaba
Verified account @charles_gaba
23h23 hours ago
4/ It also means they don’t have to cover the 10 Essential Health Benefits required by the ACA like maternity care, mental health care, hospitalization, surgery, prescription drugs…you know, stuff you’d expect to be covered by “health insurance”. Because again…not insurance.
1 reply 56 retweets 101 likes
Charles Gaba
Verified account @charles_gaba
23h23 hours ago
5/ Basically, these plans are no more actual “health insurance” than a golf cart is an “automobile”. They may have some similar features—4 wheels, an engine, a steering wheel, seats—but that’s where the similarities end.
1 reply 50 retweets 105 likes
Charles Gaba
Verified account @charles_gaba
23h23 hours ago
6/ A golf cart may be fine for driving around the range…on a sunny day. In warm weather. At slow speeds. On mostly flat grass. But it’s pretty much useless in any other condition.
1 reply 29 retweets 69 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
7/ Now, golf carts are much less expensive than street-legal automobiles. A typical golf cart costs perhaps $5,000 or so, far less than even a small economy car like a Chevy Spark which runs around $13,000. Some people may think they only need a golf cart for now. Fine.
1 reply 27 retweets 61 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
8/ I’ll come back to the golf cart thing soon. Meanwhile, what does this mean for the Individual Health Insurance market in Iowa? Well, if you earn less than 400% of the poverty line—around $48K/year for an individual or $98K for a family of 4, you qualify for ACA subsides.
1 reply 34 retweets 62 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
9/ And if you earn less than *200%* of the poverty line ($24K individual or $49K for a fam of 4), you qualify for *heavy* ACA subsidies. But those subsidies are only available for ACTUAL HEALTH INSURANCE POLICIES sold on the exchange.
1 reply 33 retweets 68 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
10/ OK, so here’s what should happen starting in 2019: Iowa’s an expansion state, so if you earn <138% FPL you qualify for Medicaid, yay. If you earn 138-200% FPL, you get heavy ACA subsidies, yay. No problems for these folks. They’ll mostly stick with the ACA exchange plans.
1 reply 26 retweets 54 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
11/ However, from 200-400% FPL, the subsidies start to drop off. These folks might stay around if they have expensive problems…but if they’re healthy they’ll likely be enticed to drop out and go for the golf cart plan instead, trusting that they’ll stay healthy.
1 reply 28 retweets 56 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
12/ The real problem is for those OVER 400% FPL—these folks get NO financial help at all, and ACA policies are *already* too expensive for them (in large part due to a whole mess of deliberate sabotage efforts by Trump last year). The obvious solution is to remove that 400% cap.
1 reply 33 retweets 72 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
13/ Instead, Iowa has chosen to go the opposite route: They’re choosing to take a problem which was already kind of bad in 2016, which Trump deliberately made far worse in 2017, and make it even WORSE in 2018-2019.
1 reply 33 retweets 61 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
14/ Here’s why: Many healthy people earning, say, 300-400% FPL, along with pretty much EVERY healthy person earning >400% FPL, will flee the exchanges for the dirt-cheap golf cart plans. This will cause the following:
1 reply 22 retweets 54 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
15/ When those healthy people drop out, the only ones left on ACA plans will be really expensive to treat, turning exchange plans into a de facto High Risk Pool. Premiums will skyrocket, but ACA subsidies will climb to match, so SUBSIDIZED enrollees will pay about the same.
1 reply 22 retweets 54 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
16/ So, if you have pre-existing conditions (or even if you don’t) and earn under 400% FPL, you’ll have a safe haven. And if you earn over 400% FPL and are *currently healthy*, you can get one of these dirt-cheap golf cart plans. Problem solved, right? Well…
1 reply 22 retweets 46 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
17/ The problem is…what if you earn over 400% FPL but have a pre-existing condition? Or, alternately, what if you earn over 400% and are currently healthy but *develop* a condition which isn’t covered by the golf cart plan? Well…now you have a big problem.
3 replies 25 retweets 51 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
18/ You can’t get an exchange plan which covers your needs because you can’t afford to pay full price without subsidies, which you don’t qualify for. However, you can’t get (or use) one of the golf cart plans because you’ll be denied coverage or it won’t cover what you need.
1 reply 20 retweets 49 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
19/ So your choices are now limited to a) Try to get a job with a company which includes actual full health insurance benefits; b) Move out of Iowa; or c) Suffer and die.
2 replies 24 retweets 52 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
But let’s go back to the golf cart metaphor. Ted Cruz and other Republicans have often claimed that Obamacare “forces people to buy Lambourghinis”, but that’s not true. There’s plenty of far cheaper cars. HOWEVER, every car DOES include certain mandatory features required by law.
1 reply 22 retweets 58 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
21/ Every street-legal automobile…from the lowliest Ford Festiva to the priciest Cadillac Escalade, has to include doors, seatbelts, airbags, a crumple zone, etc etc. They have to meet certain minimum safety standards. They have to meet minimum emissions/efficiency standards.
1 reply 17 retweets 49 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
22/ But here’s the thing—not only are Iowa’s new plans “golf carts”…they’re not even subject to the same types of *legal protections* that golf carts are. Why? Because they aren’t considered insurance, and therefore aren’t regulated by the insurance department.
1 reply 21 retweets 43 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
23/ Per the Des Moines Register: http://acasignups.net/18/03/28/medical-gerrymandering-iowa-figures-out-how-get-rid-their-middle-class-undesirables …
1 reply 23 retweets 38 likes
Link to tweet
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
24/ With actual health insurance, you may have to fight with your insurance company to get them to pay your claim, which sucks, but at least you HAVE the law on your side. With golf cart plans…nope. Sorry. Your state insurance dept’s hands are tied.
1 reply 19 retweets 45 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
25/ Oh, and there’s another twist: Last year Wellmark, a huge Iowa carrier, announced they were dropping out of the ACA exchange, leaving Medica as the only carrier offering ACA policies. Wellmark recently announced they’re jumping back in next year:
1 reply 19 retweets 39 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
26/ I noted at the time that it seemed kind of suspicious:
1 reply 17 retweets 38 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
27/ Sure enough…the new “golf cart plans” will be offered by…Wellmark. Which means that Wellmark will get to have the best of both worlds—they’ll get heavy gov’t subsidies for sick/expensive ACA enrollees *and* corner the market on healthy/cheap Golf Cart enrollees.
2 replies 19 retweets 46 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
28/ But what about Medica? Well, they can still offer ACA policies if they want to, and could no doubt jack up their rates for 2019 to keep from losing their shirts…but guess when the golf cart plans are scheduled to start being offered? JULY 1st. https://www.legis.iowa.gov/docs/publications/FN/961243.pdf …
1 reply 17 retweets 36 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
29 Assuming the exodus starts in July, Medica could very well see several thousand of their current healthy ACA enrollees flee halfway through the year. However, Medica won’t be allowed to jack up their premiums to cover the loss until January 2019.
1 reply 16 retweets 32 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
30/ Since Medica is legally required to stick with their 2018 premiums thru 12/31/18, that means there also won’t be any additional tax credits/subsidies until 2019 either. Oh yeah—and most people wait until the 4th quarter of the year to have expensive medical treatments…
1 reply 16 retweets 33 likes
Charles Gaba
Verified account @charles_gaba
22h22 hours ago
31/ …because they want to get it in before New Year’s before their deductible is reset the following year. In short, Medica did Iowa a favor this year by agreeing to step in when Wellmark dropped out…and now Medica is likely to be screwed for their trouble.
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