Updated Trumpcare Bill Will See 41 Million Americans Be Health Care Losers

Sick people would probably have to pay more under the health bill passed by the House, the Congressional Budget Office reports. Credit Ozier Muhammad/The New York Times

The Senate now has a clearer sense of the 41 million Americans who would lose under the health bill the House sent them by Donald Trump and the Republicans. It also got a startlingly direct message from government analysts about how destabilizing one of the House ideas could be.

The Congressional Budget Office published its assessment of the House health bill on Wednesday, and warned that a last-minute amendment made to win conservative votes would result in deeply dysfunctional markets for about a sixth of the population. In those places, insurance would fail to cover important medical services, and people with pre-existing illnesses could be shut out of coverage, the budget office said.

It found that about half the country would face thinner coverage for people who buy their own insurance, as it would be unlikely to include mental health and addiction treatment services, maternity care or rehabilitation services. Medical deductibles would also increase.

As in the original version of the bill, winners would include people who are young, healthy and earn higher incomes. They would be better off, assuming they didn’t develop serious health problems. The bill makes big cuts to taxes on payroll and investment income for those earning more than $200,000, and provides more subsidies to buy insurance for people earning between about $50,000 and $150,000. On average, premiums for health plans people buy for themselves would decline over the 10-year period, as coverage becomes less generous.

The report was sharply critical of the idea that sicker patients could be protected in a system that allowed insurers to charge them higher premiums. In the minority of states it predicted would pursue broad waivers of Obamacare’s insurance regulations, the office said that sick customers would face far higher prices and many would be priced out of the market altogether.

The bill would save the federal government $119 billion in a decade.

The largest savings would come from cutting Medicaid and reducing tax credits for middle-income insurance buyers.

Projected cumulative change in deficit, in billions

Because Republicans are using a special legislative process to avoid a filibuster in the Senate, the bill had to comply with special rules. They include saving the federal budget at least $2 billion over 10 years.

An initial version of the bill would have saved the federal government $337 billion over a decade, and a subsequent version would have saved half that amount. House Republicans pulled an earlier bill from the floor because they did not have enough votes to pass it.

In the final bill, however, lawmakers added more spending in various areas to get enough votes to pass, including $8 billion over five years to help cover insurance costs for people with pre-existing conditions.

One of the bill’s most expensive items is a provision that would eliminate about $600 billion in taxes imposed under the Affordable Care Act, including taxes on investment income, prescription drugs and indoor tanning.

23 million more Americans will be uninsured in 10 years.

The budget office projected that in 2018, the number of uninsured would increase to 41 million and would continue to grow. In 10 years, it would become closer to what it was before the Affordable Care Act, President Barack Obama’s signature health law, took effect.

Number of uninsured

People with Medicaid coverage would take the largest loss. In a decade, 14 million fewer people would be enrolled in the program.

The C.B.O. estimates that the increase in the number of uninsured would be disproportionately larger among older people with low incomes.

Cost of insurance could rise more than nine-fold for some older people with low incomes.

The House bill included last-minute amendments that let states seek changes to certain insurance regulations.

The C.B.O. estimates that premiums could go down about 10 to 30 percent for people in states that make moderate changes to these regulations. This is largely achieved by offering skimpier plans and pricing out the old and sick from the insurance market.

Senate leaders, aware of the criticism already leveled at the House bill, say they are writing their own bill. This analysis is likely to offer guidance in where they will and won’t want to go.

Read the complete articles in the New York Times here and here.

Republicans Fake Healthcare

‘This more egalitarian vision of healthcare freedom may sound utopian, but it is entirely achievable.’ Photograph: Mark Makela/Getty Images

aul Ryan is promoting Trumpcare as if it were some sort of medical Magna Carta – a brave declaration of healthcare freedom. “We’re not going to make an American do what they don’t want to do. You get it [healthcare] if you want it. That’s freedom” he recently said on Face the Nation. Freedom to die uninsured, that is.

It’s not that House Republicans are proposing some libertarian healthcare promised land wherein open heart surgeries and rounds of chemo are bartered and traded like tubes of toothpaste – far from it. Instead, the bill largely relies on Obamacare’s blueprint, although it mangles its details for the benefit of the rich while stripping coverage from a staggering 24 million people by 2026 (according to Monday’s estimates from the Congressional Budget Office).

Ryan’s healthcare bill would, like the Obamacare, provide subsidies (or tax credits) for the purchase of private insurance policies. Yet these tax credits would be comparatively more regressive and less generous than those in the Affordable Care Act (ACA); many Americans would thus be freed from having affordable premiums.

The Republican bill also discards Obamacare’s cost sharing subsidies for low-income individuals, who would henceforth have the freedom to pay higher copayments and deductibles. Additionally, it prevents tax credits from being used for the purchase of plans that cover abortion, freeing more women from control over their own reproductive systems.

The bill would also punish those with low incomes by squeezing federal funding of Medicaid beginning in 2020, effectively emancipating millions of poor people from the ranks of the insured.

Trumpcare would at the same time cut the ACA’s taxes on the wealthy, which, as the New York Times recently reported, would redistribute upward some $144bn over a decade to millionaires. Now in fairness, this provision would increase freedom for some: freedom, for instance, to buy a second vacation home, or a first yacht.

And finally, what Ryan seems to see as Trumpcare’s greatest emancipatory element – the elimination of the ACA’s unpopular individual mandate – would simply be replaced by a 30% premium penalty, assessed by insurers, for those who spent time uninsured. As Patrick Henry might have put it: give me a continuous coverage premium surcharge as opposed to a tax penalty, or give me death.

Unbelievably, Ryan sees “freedom” in all of this devastation.

For Ryan and those in his ideological camp, freedom in healthcare is basically the freedom of the consumer, who should be free to buy – or not buy – the particular insurance plan that suits his or her needs and tastes. Hence the bewilderment of Representative John Shimkus who recently asked why, exactly, men should be compelled to buy plans that cover maternity care (Trump’s pick to lead the Center for Medicare and Medicaid Services, Seema Verma, has said something similar).

Ryan thus offers a peculiar vision of healthcare freedom. For the medical literature tells us – to no one’s surprise – that the uninsured are more likely to die. And as noted, the CBO has now estimated that Trumpcare will increase the ranks of the uninsured by 24 million in a decade from now.

The bill would thus increase our freedom to die of health conditions that are amenable to modern medical care, and thereby liberate tens of thousands of people a year off of the face of the planet.

Read the complete article on The Guardian newspaper web site.

Trump’s Cabinet Looks For Healthcare Solutions.

 

If you are middle class, or poor, or sick don’t read this. You may get sick or sicker.

affordablecareact

House Republican leaders on Thursday presented their rank-and-file members with the outlines of their plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.

What does ‘expanded Medicaid’ mean?

ACA Medicaid Expansion – What is it?

The Affordable Care Act (ACA) called for a nationwide expansion of Medicaid eligibility, set to begin in 2014. Under health care reform law, nearly all U.S. citizens under 65 with family incomes up to 138 percent of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012) will now qualify for Medicaid.

Some states opted in to expanded Medicaid, some states did not. An interactive map by state of Medicaid and expanded Medicaid recipients is available here.

As of January 2016, 72.9 million people were enrolled in Medicaid and CHIP. Over two-thirds of enrollees resided in states that have implemented the ACA Medicaid expansion.

Between Summer 2013 and January 2016, there was a net increase of nearly 15.5 million or 27% enrolled in Medicaid and CHIP among the 49 states reporting data for both periods. Most of this growth occurred in year one. Most of this growth was in large states in the West that implemented the Medicaid expansion.

Expansion states experienced significantly greater enrollment growth over the two year period, although there was variation across states. States that implemented the Medicaid expansion experienced over three times greater enrollment growth compared to states where the Medicaid expansion is not in effect (36% vs. 12%). Over the period, growth ranged from a high of 95% in Kentucky to slight decline in Wyoming and Nebraska.

Children account for a greater share of total Medicaid and CHIP enrollment in nearly all states that have not expanded Medicaid compared to states that have expanded. Reflecting higher eligibility levels for children, children accounted for a greater share of total Medicaid and CHIP enrollees in non-expansion states compared to states that have implemented the expansion to adults (68% vs. 44%). Read complete report from Kaiser Family Foundation here.

The federal government now pays more than 90 percent of the costs for newly eligible beneficiaries in states that expanded Medicaid. Under the House Republican plan, the federal share would decline to 50 percent in states like New York, New Jersey, Connecticut and California, resulting in a significant loss of federal revenue.

In a number of states that have expanded Medicaid, Republican governors and Republican members of Congress have made clear that they do not like the idea of a block grant or a per-beneficiary allotment.

The Congressional Budget Office says that 12 million people have insurance because they became eligible for Medicaid under the Affordable Care Act, and it estimates that federal spending for this group will be $70 billion this year. This 12 million figure differs from the 15 million reported by Kaiser Family Foundation. The KFF figure is net amount, the CBO doesn’t state how they arrive at their smaller figure.

The House Republican plan would immediately eliminate tax penalties for people who do not have insurance and employers that do not offer it.

It would also eliminate taxes and fees that help pay for the expansion of coverage under the 2010 health care law. These include fees collected from health insurance companies and manufacturers of brand-name prescription drugs and an excise tax on makers of medical devices.

The Republicans are removing any fees or taxes charged medical related companies which went towards providing funding for at least 12 million Americans.  They are also shifting the cost of providing health care away from the federal government and pushing costs onto the states. This means you the lucky taxpayer will have to pony up more cash in the way of taxes or fees or other costs to cover the lost revenue from the federal government.

So if you are middle class, poor, sick or may become ill during the time the Republicans are in office my word of advice to you or your family or your childen is ‘you can’t afford to get sick‘.

Read more about the Republicans health care plans on the New York Times web site. State Mandated Benefits map and legislation information by state.