Health Care Legislation Is A Mess
July 1, 2017 at 3:12 a.m.
By Gary [email protected]
It shows how the changes would impact different segments of the population.
The Senate draft was the one that Sen. Majority Leader Mitch McConnell scuttled on Tuesday. He’s delaying the vote until after the July 4 recess. He wants changes in the Senate draft before it goes to a vote. After you read this, you’ll see why.
People under 26
Obamacare: Can get insurance through a parent’s plan or buy independently.
House bill: Stays the same.
Senate draft: Stays the same.
Adults under 65
Obamacare: Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid.
House bill: Will see tax credits to pay premiums based on age, not income, that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020.
Senate draft: The CBO report says 22 million people would lose health insurance over the next 10 years, with people between 50-64 disproportionally impacted. The oldest people under 65 would pay five times more than younger people on the exchanges. Subsidies to help pay for insurance would be less and end at incomes of 350 percent of poverty level. Federal contributions to Medicaid start to decline in fiscal year 2020.
Low-income nursing home residents
Obamacare: Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income.
House bill: Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline.
Senate draft: Skilled nursing care covered by Medicare up to 100 days per illness. Medicaid coverage for nursing home services could be cut as federal payments to states decline.
People with pre-existing medical conditions
Obamacare: Coverage cannot be denied or cost more.
House bill: States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions.
Senate draft: Insurance companies would be required to accept all applicants regardless of health status. But the draft bill lets states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans. That could result in “substantial increases” in costs for people who want those services, according to the CBO. Caps on annual and lifetime spending by patients would no longer apply if the benefit is no longer classified as essential.
People who go to Planned Parenthood
Obamacare: Federal programs reimburse for most Planned Parenthood services.
House bill: A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood.
Senate draft: A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood. The CBO estimates 15 percent of women would lose access to family planning care, increasing birth rates and Medicaid spending for childbirth and children’s insurance. But those increases would be offset by Planned Parenthood cuts.
People with disabilities
(The majority of Medicaid dollars go to people with disabilities.)
Obamacare: May qualify for Medicare and also Medicaid.
House bill: Services covered by Medicaid could be cut as federal funding to states declines over time.
Senate draft: Services covered by Medicaid could be cut as federal funding to states declines over time. The CBO report suggests that by 2026, Medicaid enrollment would fall by more than the 15 million people.
People who use mental health services
Obamacare: Covered by all plans under essential health benefits.
House bill: Could lose coverage in states that get waivers from covering essential health benefits.
Senate draft: States could request waivers to opt out of requiring essential health benefits. If a state opted out of coverage for mental health care, the CBO says insurance that includes mental health care coverage could become “extremely expensive.”
Working poor on Medicaid
Obamacare: Thirty-one states and the District of Columbia offer expanded Medicaid coverage.
House bill: Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion.
Senate draft: Federal funding for Medicaid expansion phases out between 2021 and 2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately in Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico and Washington. Further reductions would start in 2025. In a separate provision, states could impose a work requirement on recipients. Most able-bodied adult Medicaid recipients already work.
The wealthy
Obamacare: Pay extra taxes to support ACA.
House bill: The bill would repeal ACA taxes on corporations and cut taxes for the wealthy by about $592 billion.
Senate draft: Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies. That would add up to about $563 billion in tax cuts over 10 years, according to the CBO.
Pretty much everybody agrees that Obamacare is in trouble as providers keep pulling out of exchanges and rates keep rising.
But the Republicans are in a serious pickle here.
After the Congressional Budget Office scored the bill it seems some 22 million people would lose coverage. Even though the majority of those would lose coverage by choice as mandates are eliminated, that’s a wonderful talking point – if you’re a Democrat.
The CBO says the plan would decrease the deficit by $321 billion – reducing federal outlays by $1,022 billion and federal revenue by $701 billion.
Average premiums in 2019 would be slightly higher and out-of-pocket costs could increase in some states. By 2020, average premiums would be about 30 percent lower than under current law, and about 20 percent lower by 2026.
One of the main ways the bill saves money is by cutting Medicaid by $772 billion by 2026.
That’s a hard sell to the American people when 40 percent of kids and 60 percent of nursing home patients use Medicaid.
Couple those woes with these two facts: There are conservatives who won’t vote for anything that doesn’t lower premiums and reduce deficits and there are moderates who won’t vote for anything that reduces coverage.
Sadly, for the system to remain solvent, I think the converse of both of those things has to happen: Coverage needs to be reduced and premiums need to rise.
Of course, no one will ever vote for a plan like that, now will they?
If members of both parties could ignore politics and work together, they might be able to solve a complex problem like this, but I don’t see that happening.
I wish the Republicans all of the luck in the world with this health care reform fiasco.
They’re going to need it.
It shows how the changes would impact different segments of the population.
The Senate draft was the one that Sen. Majority Leader Mitch McConnell scuttled on Tuesday. He’s delaying the vote until after the July 4 recess. He wants changes in the Senate draft before it goes to a vote. After you read this, you’ll see why.
People under 26
Obamacare: Can get insurance through a parent’s plan or buy independently.
House bill: Stays the same.
Senate draft: Stays the same.
Adults under 65
Obamacare: Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid.
House bill: Will see tax credits to pay premiums based on age, not income, that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020.
Senate draft: The CBO report says 22 million people would lose health insurance over the next 10 years, with people between 50-64 disproportionally impacted. The oldest people under 65 would pay five times more than younger people on the exchanges. Subsidies to help pay for insurance would be less and end at incomes of 350 percent of poverty level. Federal contributions to Medicaid start to decline in fiscal year 2020.
Low-income nursing home residents
Obamacare: Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income.
House bill: Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline.
Senate draft: Skilled nursing care covered by Medicare up to 100 days per illness. Medicaid coverage for nursing home services could be cut as federal payments to states decline.
People with pre-existing medical conditions
Obamacare: Coverage cannot be denied or cost more.
House bill: States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions.
Senate draft: Insurance companies would be required to accept all applicants regardless of health status. But the draft bill lets states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans. That could result in “substantial increases” in costs for people who want those services, according to the CBO. Caps on annual and lifetime spending by patients would no longer apply if the benefit is no longer classified as essential.
People who go to Planned Parenthood
Obamacare: Federal programs reimburse for most Planned Parenthood services.
House bill: A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood.
Senate draft: A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood. The CBO estimates 15 percent of women would lose access to family planning care, increasing birth rates and Medicaid spending for childbirth and children’s insurance. But those increases would be offset by Planned Parenthood cuts.
People with disabilities
(The majority of Medicaid dollars go to people with disabilities.)
Obamacare: May qualify for Medicare and also Medicaid.
House bill: Services covered by Medicaid could be cut as federal funding to states declines over time.
Senate draft: Services covered by Medicaid could be cut as federal funding to states declines over time. The CBO report suggests that by 2026, Medicaid enrollment would fall by more than the 15 million people.
People who use mental health services
Obamacare: Covered by all plans under essential health benefits.
House bill: Could lose coverage in states that get waivers from covering essential health benefits.
Senate draft: States could request waivers to opt out of requiring essential health benefits. If a state opted out of coverage for mental health care, the CBO says insurance that includes mental health care coverage could become “extremely expensive.”
Working poor on Medicaid
Obamacare: Thirty-one states and the District of Columbia offer expanded Medicaid coverage.
House bill: Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion.
Senate draft: Federal funding for Medicaid expansion phases out between 2021 and 2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately in Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico and Washington. Further reductions would start in 2025. In a separate provision, states could impose a work requirement on recipients. Most able-bodied adult Medicaid recipients already work.
The wealthy
Obamacare: Pay extra taxes to support ACA.
House bill: The bill would repeal ACA taxes on corporations and cut taxes for the wealthy by about $592 billion.
Senate draft: Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies. That would add up to about $563 billion in tax cuts over 10 years, according to the CBO.
Pretty much everybody agrees that Obamacare is in trouble as providers keep pulling out of exchanges and rates keep rising.
But the Republicans are in a serious pickle here.
After the Congressional Budget Office scored the bill it seems some 22 million people would lose coverage. Even though the majority of those would lose coverage by choice as mandates are eliminated, that’s a wonderful talking point – if you’re a Democrat.
The CBO says the plan would decrease the deficit by $321 billion – reducing federal outlays by $1,022 billion and federal revenue by $701 billion.
Average premiums in 2019 would be slightly higher and out-of-pocket costs could increase in some states. By 2020, average premiums would be about 30 percent lower than under current law, and about 20 percent lower by 2026.
One of the main ways the bill saves money is by cutting Medicaid by $772 billion by 2026.
That’s a hard sell to the American people when 40 percent of kids and 60 percent of nursing home patients use Medicaid.
Couple those woes with these two facts: There are conservatives who won’t vote for anything that doesn’t lower premiums and reduce deficits and there are moderates who won’t vote for anything that reduces coverage.
Sadly, for the system to remain solvent, I think the converse of both of those things has to happen: Coverage needs to be reduced and premiums need to rise.
Of course, no one will ever vote for a plan like that, now will they?
If members of both parties could ignore politics and work together, they might be able to solve a complex problem like this, but I don’t see that happening.
I wish the Republicans all of the luck in the world with this health care reform fiasco.
They’re going to need it.
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