What I’m thinking of is to slightly and generally increase the state Medicaid expansion share to 5% plus the highest rate of state income tax.
That would make Medicaid expansion cheaper for no income tax red states like Florida and Texas.
To help fund likely Medicaid expansion to states like Texas and Florida, the state Medicaid shares (traditional & expansion) would increase annually starting in 2028 by a percentage equal to the deficit in the fiscal year ending prior to the calendar year divided by $1 trillion. That would be a 1.5% increase for a $1.5 trillion deficit, or a .6% increase for a $600 billion deficit.
To also help fund likely Medicaid expansion to red states like Texas and Florida, I would impose these premium minimums, whichever is the higher:
1. 2% of the Medicare premium amount per insured year of age as of the start of coverage
2. a percentage of the premium amount equal to the household income percentage of FPL - 60% divided by 4
For a 5-year-old, 7-year-old, 32-year-old and 34-year-old, the ages would sum to 88 and for 1 the monthly absolute minimum premium amount would be a (88/65)*$185 or $250.46.
For a 5-year-old kid and a 27-year-old mom the ages would sum to 32 and for 1 the monthly absolute minimum premium amount would be (32/65)*$185 or $91.07.
To make all that palatable to the Democrats, I would lower the original PPACA subsidy threshold from 100% of FPL to 80% of FPL.
The maximum federal subsidy amount would go from 100% of the second cheapest copper plan at 80% of FPL to 0% at 400% of FPL.
Copper plans would be limited to a maximum deductible of three times the Medicare Part A amount (2025: $1676).
To help fund likely Medicaid expansion to states like Texas and Florida, the state Medicaid shares (traditional & expansion) would increase annually starting in 2028 by a percentage equal to the deficit in the fiscal year ending prior to the calendar year divided by $1 trillion. That would be a 1.5% increase for a $1.5 trillion deficit, or a .6% increase for a $600 billion deficit.
To that add:
To soften this increase for the states, I would have the federal government increase its share of Medicaid drug expenditures. This would have states assume more responsibility for medical service costs which they regulate, and the federal government assume more responsibility for drug costs which it has the power to regulate.
goof fix:
The maximum federal subsidy amount would go from 100% of the second cheapest silver plan at 80% of FPL to 0% at 400% of FPL.
Silver plans would be limited to a maximum deductible of three times the Medicare Part A amount (2025: $1676).