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Affordable Care Act enrollment off to strong start as advocates eye its future warily

By: Erik Gunn
25 November 2024 at 11:45

WisCovered.com is operated by the Wisconsin Office of Insurance (OCI) to inform consumers seeking health insurance about their options, including BadgerCare and the Affordable Care Act's health insurance marketplace (Screenshot | WIsCovered.com)

People are getting health coverage under the Affordable Care Act (ACA) at a pace that approaches recent record-breaking years for the landmark federal health care law enacted 14 years ago.

In the first two weeks of November, when the annual open enrollment period to buy health insurance through the ACA’s platform Healthcare.gov began,  nearly half a million previously uninsured people in the U.S. signed up for coverage, according to the federal government. More than 2.5 million have renewed coverage that they purchased a year ago.

“We’re incredibly busy,” said Adam VanSpankeren, navigator program manager for Covering Wisconsin, a nonprofit that helps people looking for insurance. “There’s a lot of anxiety and people have concerns about the future of the ACA, but it’s not stopping them from getting coverage.”

Covering Wisconsin is federally funded and subcontracts with 44 navigator agencies across the state  — part of a program established under the ACA to guide people in assessing their options and choosing an appropriate health plan.

“Health insurance is really complicated,” VanSpankeren said in an interview. Navigators were included in the law to provide “people on the ground to explain to people how this works and how you sign up.”

Wisconsin health care coverage resources

  • Covering Wisconsin, at https://coveringwi.org/, is a federally funded navigator that provides guidance for people to assess their health insurance options, including through the federal health insurance marketplace.  
  • The Wisconsin Office of the Commissioner of Insurance (OCI) and the Department of Health Services (DHS) outline options through https://wiscovered.com a joint website.
  • OCI also has a website that consumers can visit to find which ACA-approved insurers are operating in their region of the state: https://oci.wi.gov/Pages/Consumers/FindHealthInsurer.aspx.
  • In Wisconsin, the official marketplace for ACA-approved health insurance plans is at https://healthcare.gov.

To help spread awareness of coverage under the ACA, the Wisconsin Office of the Commissioner of Insurance (OCI) has been distributing information to community agencies, including local libraries and county health departments.

“Ensuring that everyone has access to high quality and affordable insurance on Healthcare.gov has been a priority of our office,” said OCI communications director Susan Smith. “Last year’s open enrollment period was the highest ever in Wisconsin, with over 254,000 people getting coverage.”

The open enrollment period to purchase health insurance for 2025 through the marketplace began Nov. 1. Through Nov. 16, according to the Centers for Medicare & Medicaid Services (CMS), 48,564 Wisconsin residents signed up.

While that’s lower than the same period a year ago, when nearly 59,000 people had enrolled, VanSpankeren doesn’t find that difference significant this early in the enrollment period.

People who enrolled last year are automatically renewed if they don’t change plans, and their enrollment numbers aren’t listed yet, he said. The full open enrollment period ends Jan. 15, 2025. For coverage starting Jan. 1, 2025, the deadline to enroll is Dec. 15.

Expanding health coverage

Enacted in 2010 and fully implemented four years later, the ACA instituted new standards for health insurance plans, including barring insurers from denying health insurance coverage or increasing premiums for people due to pre-existing health conditions.

The law required insurers to cover young people up to age 26 under their parents’ health plans, and required coverage for preventive care such as vaccines.

It also expanded the federal Medicaid program to cover families with incomes up to 138% of the federal poverty guideline. Under a U.S. Supreme Court ruling in 2012, Medicaid expansion was made optional, with states deciding whether or not to take part. Wisconsin is one of 10 states that has not done so. 

Healthcare.gov, the health insurance marketplace, was a central element of the ACA, because uninsured Americans are mainly people who don’t get coverage from an employer or through programs such as Medicaid.

“Most people get insurance from their jobs, but there are still millions and millions of people who don’t,” VanSpankeren said. Those include self-employed people and people with multiple part-time jobs and no health coverage. They also include people whose employers don’t offer insurance or offer plans that require employees to pay more than they can afford for coverage.

Under the ACA, plans sold directly to individuals and families must cover a list of essential health benefits. The federal health care marketplace requires insurers who participate to offer plans meeting the federal standards.

Having a government marketplace that sets minimum standards protects consumers, VanSpankeren said.

“There’s a lot of bad actors with bad products” — insurance plans that don’t meet the ACA’s standards, he said. Without Healthcare.gov to vet participating plans, “you have kind of a Wild West scenario.”

Outside the marketplace, unscrupulous operators, often from out of state, misrepresent the plans they sell, sometimes even switching people’s coverage without their knowledge, said Smith of OCI. OCI and insurance regulators from other states are working with CMS to address what “is still a national challenge,” she said.

Safe in 2025; after that, uncertainty

VanSpankeren said people enrolling this year are asking Covering Wisconsin navigators about what they’ll have to pay in the new year. The recent election is also on the mind of many.

“They want to know if a change in administration means anything for their plan,” VanSpankeren said. Current provisions in the law remain in effect through 2025, so “we can reassure people everything they’re doing today for the next year is good.”

Those provisions include enhanced tax-credit subsidies based on a person’s income that lower the cost of their health insurance premiums purchased on the marketplace. Those increased subsidies were first introduced in 2021 and extended in 2022 through the end of 2025.

Beyond next year, however,  ACA advocates are worried about their future.

Republicans, who will hold majorities in both houses of Congress starting in January, and President-elect Donald Trump have been openly hostile to the health law and tried repeatedly in Trump’s first term to end it without success.

On Friday, Protect Our Care, a national campaign to support and strengthen the ACA, highlighted a series of analyses looking at the impact of ending the subsidies after 2025. Protect Our Care also cited the ambition of Congressional Republicans to block their renewal.

KFF, a nonprofit health policy research, polling, and news organization, reported in a study in July that 92% of people covered under the ACA were subsidy recipients.

In a study published Nov. 14, the Center on Budget and Policy Priorities called for Congress to act by the spring of 2025 to give insurers time to set their rates for open enrollment a year from now.

“If Congress allows the improved tax credits to expire, nearly all marketplace enrollees, in every state, will face significantly higher premium costs,” the center stated.

GET THE MORNING HEADLINES.

Trump labels Detroit a ‘mess,’ pledges to make car loan interest fully deductible

11 October 2024 at 09:43
Trump

The Republican presidential nominee, former U.S. President Donald Trump, speaks at the Detroit Economic Club on October 10, 2024 in Detroit, Michigan. Trump is campaigning in Michigan, a key battleground state, ahead of the upcoming presidential election. (Photo by Bill Pugliano/Getty Images)

WASHINGTON — Former President Donald Trump promised to “save the American auto industry” Thursday during a meandering speech to the Detroit Economic Club, during which he insulted his host city as a “mess” and announced a new plan to make car loan interest payments fully deductible.

Trump unveiled the new plank of his tax plan near the close of his remarks that included berating the United States as “dumb” on trade and pledging, if elected, to “have a lot of fun” renegotiating a trade agreement with Canada and Mexico.

The former president spoke for nearly two hours to the economic club in Michigan, a key swing state.

Trump is already running on a platform to impose across-the-board tariffs, up to 20%, on all imported goods, and at 60% on goods from China. On Thursday he said cars imported from Mexico could see tariffs as high as 200% if he wins in November.

He told the crowd that his newest plan to make interest on car loans fully deductible is “going to revolutionize your industry.”

“This will stimulate massive domestic auto production and make car ownership dramatically more affordable for millions and millions of working American families. This is a phenomenal thing, if I do say so myself,” Trump said.

However, it’s unclear whether the deduction would only be available to taxpayers who itemize, or also to those who take the standard deduction. For example, some deductions, like student loan interest, can be a special exception.

Another question would be the price tag of Trump’s proposal: Americans owe about $1.6 trillion in car loans, according to the quarterly consumer report issued in February by the Federal Reserve of New York.

R&D tax credits

The former president also promised — to applause from the crowd — that U.S.-based carmakers “will be rewarded with expanded research and development tax credits, very substantial, where they will be able to write off 100% of their cost of heavy machinery and other equipment necessary to build a plant in the first year, and full expensing for manufacturing investments.”

The Trump campaign did not respond to emails asking whether the proposals were new, or would be an extension of expiring policies enacted under Trump’s signature 2017 tax law, titled the Tax Cuts and Jobs Act.

Erica York, senior economist and research director for the Tax Foundation, wrote on X that “R&D tax credits are an entirely separate policy from deductions for R&D expenses or capital expenditures.”

“(B)ut if I had to guess, Trump is probably talking about bringing back immediate R&D expenses and restoring 100 percent bonus depreciation,” wrote York, who’s been closely following the tax debate during the 2024 presidential election.

Except for wanting to change the corporate tax rate — lowering it to 15% — Trump is campaigning on fully renewing the TCJA, which cleared Congress strictly along party lines. The law sunsets at the end of 2025.

‘Take a look at Detroit’

Trump also used his speech to attack trading partners and competitors, at one point describing the European Union as “brutal” and recalling an alleged conversation with former German Chancellor Angela Merkel.

“‘Angela, how many Chevrolets do we have in the middle of Berlin?’ ‘Oh, I do not know. Perhaps, perhaps none.’ ‘You’re right. Angela,’” Trump said he recalled.

“And yet, they send their cars to us. Like a bunch of dummies we are — BMW, Mercedes, Volkswagen, by the millions and millions and millions. We’re not doing that crap anymore,” Trump said. “Now they’re gonna have to play by our rules.”

It is a fact that American cars are on the streets of Europe.

But China was the “biggest abuser” of trade while he was president, he said.

“They were a professional abuser. They did things to us, and they go down as a ‘developing nation,’” he said, as if talking in another’s voice. “‘We are a developing nation.’ But we’re (the U.S. is) a developing nation too — just take a look at Detroit.”

His campaign did not answer an email asking for clarification about the remark.

Harris campaign responds to Detroit visit

Ahead of Trump’s Detroit appearance, Vice President Kamala Harris’ campaign organized a press call featuring Shawn Fain, president of the United Auto Workers.

Fain told reporters Trump “has done nothing” to help autoworkers.

“The job-killer-in-chief is once again back in Michigan to do what he does best. He’s going to lie about bringing our jobs back,” Fain said.

The union leader endorsed President Joe Biden in January, and promptly endorsed Harris in July when Biden exited the race.

Biden became the first sitting U.S. president to walk a picket line when he joined striking UAW members in September 2023.

Harris was in Las Vegas, Nevada, Thursday to record a live town hall for Spanish-language network Univision. The question-and-answer session for undecided Hispanic voters was organized by the network’s news division and moderated by TelevisaUnivision’s Enrique Acevedo.

Harris was scheduled to speak at a campaign event Thursday night in Phoenix, Arizona.

‘There will be no rematch!’ 

Once again, the question of another presidential debate has come, and apparently gone.

Fox News on Wednesday issued a final offer to host a live 90-minute presidential debate in Pennsylvania on either Oct. 24 or 27, with moderators Bret Baier and Martha MacCallum.

“THERE WILL BE NO REMATCH!” Trump posted Wednesday evening on his online platform Truth Social.

On Thursday, CNN offered to host live town halls with each candidate.

Ahead on the campaign trail, Minnesota Gov. Tim Walz will campaign in Wisconsin on Monday, hitting both Eau Claire and Green Bay.

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