Health Care

[wesfau2]

Thoughts on the Republican plan?

[CCTAU]

Maybe they will pass it so we can read it!

[Kaos]

Thoughts on the Republican plan?

Haven't read it. 
Won't read it, probably.
Already know it's better because it doesn't have the word "Obama" attached to it.  That piece of trash needs to just be a historical footnote next to the word "failed."

[GH2001]

It is DOA.

NEITHER side will pass it. For opposite reasons.

[wesfau2]

Haven't read it. 
Won't read it, probably.
Already know it's better because it doesn't have the word "Obama" attached to it.  That piece of trash needs to just be a historical footnote next to the word "failed."

Blind allegiance.  Atta boy!

[AUChizad]

Already know it's better because it doesn't have the word "Obama" attached to it.

I could have scripted this response from you...

[Kaos]

I could have scripted this response from you...

He's the worst president in the history of the United States.  Likely the most corrupt. 

Anything he did is worthless to me.

[AUJarhead]

It is DOA.

NEITHER side will pass it. For opposite reasons.

And then each side will blame the other side for hating Americans.

[AUChizad]

He's the worst president in the history of the United States.  Likely the most corrupt. 

Anything he did is worthless to me.

Here's a tip for how to have people who are not as hyperpartisan and tribalistic as you take anything you say even remotely seriously.

Take that exact quote and pretend it's Prowler saying it about Trump. How does it sound? Idiotic? Chances are that's exactly what people think of your post.

[Snaggletiger]

I'd like to see a side-by-side comparison of the changes because honestly, I haven't seen enough about the Repub plan to comment much.  I've seen that pre-existing conditions won't be affected and coverage won't be precluded on the new plans. (No brainer)  It also appears that individual requirements to carry coverage and the penalties associated for non-compliance will be done away with.  Maybe that was just part of the early rhetoric I'm basing that on. 

Have done little research on the new proposals.   

[AUChizad]

I'd like to see a side-by-side comparison of the changes because honestly, I haven't seen enough about the Repub plan to comment much.  I've seen that pre-existing conditions won't be affected and coverage won't be precluded on the new plans. (No brainer)  It also appears that individual requirements to carry coverage and the penalties associated for non-compliance will be done away with.  Maybe that was just part of the early rhetoric I'm basing that on. 

Have done little research on the new proposals.   

This is a good write-up from conservative Avik Roy for center-right Forbes. Roy has been critical of Obamacare from the start.

https://www.forbes.com/sites/theapothecary/2017/03/07/house-gops-obamacare-replacement-will-make-coverage-unaffordable-for-millions-otherwise-its-great/#7714c34037fd

House GOP's Obamacare Replacement Will Make Coverage Unaffordable For Millions -- Otherwise, It's Great

Avik RoyAvik Roy, Forbes Staff

That’s not an ironic headline. Leading House Republicans have included a number of transformative and consequential reforms in their American Health Care Act, the full text of which was published Monday evening. But those reforms are overshadowed by the bill’s stubborn desire to make health insurance unaffordable for millions of Americans, and trap millions more in poverty. Can such a bill garner the near-universal Republican support it will need to pass Congress?


The good: Medicaid reform

The strongest part of the American Health Care Act, by far, is its overhaul of Medicaid, the developed world’s worst insurance program. In 2013, a landmark study published in the New England Journal of Medicine found that people on Medicaid had no better outcomes than those with no insurance at all.

That’s because the program’s dysfunctional 1965 design makes it impossible for states to manage their Medicaid budgets without ratcheting down what they pay doctors to care for Medicaid enrollees. That, in turn, has led many doctors to stop accepting Medicaid patients, such that Medicaid enrollees don’t get the care they need.

The AHCA takes important steps to strengthen the Medicaid program, by converting its funding into a per-capita allotment that would give states the flexibility they need to modernize the program. It’s an idea that was first proposed by Bill Clinton in 1995 as an alternative to block grants, and one that could give Medicare enrollees the access to physicians and specialists that they struggle to have today.

Relative to the leaked AHCA draft from February 10, the new bill makes an important tweak to its Medicaid reforms. It improves the transition away from Obamacare’s Medicaid expansion, by preserving the 90 percent federal match rate past 2020 for people who had signed up for the expansion prior to that year. That helps expansion states cover those individuals without significant disruptions in funding.

The bad: Obamacare exchange replacement

Unfortunately, the AHCA’s efforts at replacing Obamacare's health insurance exchanges are problematic. A key limitation is that Republicans have decided to repeal and replace Obamacare on a party-line vote using the Senate’s reconciliation process. But reconciliation can only repeal Obamacare’s taxes and spending; it can’t replace most of the law’s premium-hiking insurance regulations.

The AHCA does make an effort to repeal Obamacare’s two costliest regulations: its requirement that plans charge similar premiums to the young and the old (age-based community rating); and its requirement that plans contain generous financial payouts (high actuarial value). So far, so good.

But the plan, due to the reconciliation process, appears to leave the vast majority of Obamacare’s regulations in place. The February 10 leaked draft contained language that would have returned control of essential health benefits to the states. That language appears to have been deleted.

Worse still, the bill contains an arbitrary “continuous coverage” provision, in which those who sign up for coverage outside of the normal open enrollment period would pay a 30 percent surcharge to the normal insurance premium. This surcharge is an arbitrary price control. While 30 percent represents an approximate average of the additional health risk of late enrollees, the 30 percent provision incentivizes those who face much higher costs to sign up, forcing insurers to cover them at a loss. This seems like a recipe for adverse selection death spirals.

The critical mistake of the AHCA is its insistence on flat, non-means-tested tax credits. The flat credit will price many poor and vulnerable people out of the health insurance market.

As I wrote last month, the AHCA creates a steep benefit cliff between those on Medicaid (subsidizing approximately $6,000 per patient per year), and those just above the poverty line who will get tax credits of about $3,000. People just below poverty will be strongly disincentivized to make more money, effectively trapping them in poverty.

Unlike in the February 10 leaked draft, in which the tax credits were available to everyone regardless of income, the AHCA begins to phase them out for those earning $75,000 a year, or $150,000 for joint filers. For every $1,000 in earnings above those thresholds, the value of the credit phases down by $100. Hence, for a single 40-something, the credit would phase out at $105,000 in income.

Amazingly, these thresholds are far more generous than Obamacare’s. Obamacare’s tax credits phase out at 400 percent of the Federal Poverty Level, or $48,240 in 2017. The AHCA’s tax credits would phase out somewhere above 850 percent of FPL.

As I note in Transcending Obamacare, the means-tested tax credit should actually go in the other direction, phasing out somewhere around 300 percent of FPL. According to the Congressional Budget Office, the vast majority of people making more than 300 percent of FPL have access to employer-sponsored coverage, and don’t need an individual-market tax credit.

The AHCA's transitional schedule of means-tested tax credits. House Ways & Means Committee
The AHCA's transitional schedule of means-tested tax credits.

The terrible: Sabotaging Medicaid and employer health reform

What’s so wasteful about all this is that the AHCA buries a much better idea within its own text. The bill contains a transitional schedule of means-tested, age-adjusted tax credits that would actually improve the individual health insurance market in combination with the bill’s regulatory reforms. The AHCA would be dramatically improved by junking the flat tax credit I described in the previous section of this article, and instead preserving the means-tested schedule in the above table.

The irony is that the AHCA’s stubborn insistence on a flat tax credit has put its promising Medicaid reforms in jeopardy. As I noted above, the Medicaid expansion offers enrollees subsidies of about $6,000 per year. The ACA exchanges, wisely, carry that subsidy along and phase it out gradually at 400 percent of FPL. By creating a benefit cliff, the AHCA gives Medicaid expansion states a strong incentive to oppose repeal of the Medicaid expansion. If the AHCA simply used the above table to means-test its tax credit, states could walk away from the Medicaid expansion, knowing their residents would have robust options for private health insurance.

The exclusion from all taxation for employer-based health insurance is the original sin of the U.S. health care system, the reason why its costs are far higher than those of every other advanced nation. GOP health reform has long sought to reform the employer tax exclusion, in order to lower health care costs and make coverage more affordable for all.

The February 10 leaked draft contained a well-designed and significant reform of the employer tax exclusion, in which employer-based insurance plans exceeding the 90th percentile in value would have their excess costs included as taxable income. That provision was deleted in the current AHCA draft and replaced by a postponement—but not repeal—of Obamacare’s Cadillac tax.

Here, again, the problem is the interaction between the AHCA’s generous tax credit and the employer-based health insurance system. The availability of the credit to upper-income workers means that employers would have a strong incentive to drop their sponsorship of coverage. A more focused tax credit would have avoided this problem.

Plowing ahead without the CBO

The American Health Care Act repeals nearly all of Obamacare’s taxes, save the postponement of the Cadillac tax. But Obamacare’s tax hikes comprised about 60 percent of its funding for the law’s coverage expansion. So the $2 trillion question is: does the AHCA explode the deficit, or is it relying on steep Medicaid cuts to keep the deficit in line? We won’t know until the CBO scores the bill.

But, remarkably, House GOP leadership plans to move forward with marking up the bill on Wednesday without even having the CBO score available. It’s not clear why they’re proceeding without a score, but it means that members of the House Energy & Commerce and Ways & Means Committees will not have the information they need to make informed decisions about how best to revise the bill.

The CBO is likely to score the AHCA as covering around 20 million fewer Americans than Obamacare. There are flaws in the way the CBO models health reform legislation, but the AHCA itself contains enough flaws that there can be little doubt that the plan will price millions out of the health insurance market.

Expanding subsidies for high earners, and cutting health coverage off from the working poor: it sounds like a left-wing caricature of mustache-twirling, top-hatted Republican fat cats. But not today.

[wesfau2]

So employers, like our esteemed captains of industry here on the X, are disincentivized from providing employee coverage.

Wasn't that a major complaint about ACA?

Premiums go up, millions are unable to get insurance and the wealthy get some sweet tax breaks.

Awesome deal!

[GH2001]

This is a good write-up from conservative Avik Roy for center-right Forbes. Roy has been critical of Obamacare from the start.

https://www.forbes.com/sites/theapothecary/2017/03/07/house-gops-obamacare-replacement-will-make-coverage-unaffordable-for-millions-otherwise-its-great/#7714c34037fd

My honest take on ACA and the future of it...

It was a massive redistribution of wealth disguised as a social program. It was played on people's emotion and well being. To make healthcare affordable (translate to subsidized or free) for 20% of the population, prices increased on the other 80%. Sorry but that's wealth redistribution at its finest. It was a giant ponzi scheme from the start in the fact that it needed x number of healthy young people paying premiums or a "mandate tax" for it to break even at best. That hasnt happened. Insurance companies have also hedged, are charging most of us much more for our existing plans and they are making money hand over foot.


The problem now is we have millions on the dole. What do we do with them? That's the magic question. Now we're in a quandary. Do you throw people to the wolves? But do you also let other continue to pick up the tab for them? Neither is right.


I feel like we could have taken some smaller more incremental steps to fix our issues than to implement this pile of garbage. State line removal and competition, focus on decreasing hc COSTS (nobody seems to address this), pre existing condition reform, age limit reform, etc. These things would have put a big dent in the issue.

[CCTAU]

Here's a tip for how to have people who are not as hyperpartisan and tribalistic as you take anything you say even remotely seriously.

Take that exact quote and pretend it's Prowler saying it about Trump. How does it sound? Idiotic? Chances are that's exactly what people think of your post.

How can it be the same? We don't have 8 years of Trump to compare to. Bad comparison. Did not get your point across.

[chinook]

So employers, like our esteemed captains of industry here on the X, are disincentivized from providing employee coverage.

Wasn't that a major complaint about ACA?

Premiums go up, millions are unable to get insurance and the wealthy get some sweet tax breaks.

Awesome deal!

i haven't read it yet but will do so in time. 

i guess you could think in those regards...and it isn't wrong to do so.  however, i look at an opportunity for businesses to choose rather than be forced upon the federal government on an inferior product that did in fact make it costly to the employee and employer...directly, indirectly or both. 

i don't think businesses [perhaps a few] will do away from offering health insurance.  jobs are being created and are currently available.  i think business will market themselves strongly with pay and benefits...that's what middle class american wants and needs.

i don't think you'll see premiums go up.  it will be a competitive market.

rich get richer regardless...including the lawyers on the X. 

as far as the millions that will go uninsured...well that is a bone you have thrown out and i am not running after it. 

[wesfau2]

i haven't read it yet

i guess

i don't think

i don't think

Edit note:  That's unfair to you, nook.  None of us have read it, but the pie in the sky hopes and dreams in your post seem about as likely as a Kaos/Prowler 69.

[chinook]

you're such a direct asshole. 

[wesfau2]

you're such a direct asshole.

No doubt.

But, I did edit it while you were posting.

Hug it out?

[War Eagle!!!]

i look at an opportunity for businesses to choose rather than be forced upon the federal government

jobs are being created and are currently available.

it will be a competitive market.

[chinook]

No doubt.

But, I did edit it while you were posting.

Hug it out?

i'll smoke it out.  next time you visit in oregon.