Friday, 24 January, 2020

What Is the “Obamacare Nightmare Scenario?”

News Update for March 13, 2017

What Is the “Obamacare Nightmare Scenario?”

Axios and researchers at the Robert Wood Johnson Foundation have developed some findings that show what would happen to coverage availability if various insurance companies decided to exit the individual insurance exchanges for 2018.  The findings estimate how many people would be left either without coverage or with only one insurance company as an option for coverage if certain insurance companies were to opt out. The departure of Anthem, for instance, would result in around 250,000 people having no option for coverage through the Obamacare exchanges. Over 550,000 consumers would have only one option for insurance. Compounding this “nightmare scenario” is the fact that each time an insurance company leaves the exchanges “it raises the stakes for the next carrier to leave,” says Katherine Hempstead of the Robert Wood Johnson Foundation.

Speaker Paul Ryan Interviewed on Obamacare Repeal

Speaker of the House Paul Ryan was interviewed on CBS’s “Face the Nation” on Sunday. Here are some highlights:

New Bill Proposed by House Republicans Would Help Employers Find Out How Healthy Their Employees Are

The Preserving Employee Wellness Programs Act has been introduced by Representative Virginia Foxx (R-NC). This bill seeks to strengthen company wellness programs by making it easier for an employer to obtain personal medical and genetic data from employees and their dependents. The bill “would also significantly increase the financial costs faced by someone who does not join a company wellness program.”

The bill is currently under review by House committees, but many consumer and privacy advocacy groups are already voicing passionate opposition to the bill. The bill’s opponents object to the bill on privacy grounds and also believe it could lead to the imposition of “draconian penalties on employees who choose to keep [their] information private. The bill’s supporters believe it would help companies make better decisions to help lower healthcare costs.

How Will the AHCA Cover People with Pre-Existing Conditions?

A new article by the Kaiser Health Foundation examines how the American Health Care Act might attempt to keep coverage available for people with pre-existing conditions. The provision to protect that coverage is one of Obamacare’s more popular provisions. Many insurance companies were worried that if they were required to allow sick people to buy their products, medical costs would get out of hand, and healthy people would leave the insurance pool because of rising premium costs. Obamacare’s individual mandate to require people to pay insurance or be subject to a fine was a way of offsetting this worry. The new bill takes out this mandate and, instead, would put in place a fine for “[p]eople who experience a gap in coverage.” The fine of a 30 percent higher premium for a year would be paid to the insurance company. According to Kaiser, this would make it so that people with pre-existing conditions would be guaranteed that their insurance plans would cover their illnesses, but there wouldn’t be a way to guarantee that they could buy the plan.

News Update for March 10, 2017

Voting on Second Healthcare Bill Early Next Week?

Speaker Paul Ryan, speaking with Sean Hannity on Thursday, said that House Republicans will be voting on a second, currently unrevealed, healthcare bill the same “week they vote to repeal Obamacare.” Republican leaders are tackling Obamacare repeal and replacement in 3 phases: passing the American Health Care Act, cutting down healthcare industry regulations through the Department of Health and Human Services, and passing more healthcare reform bills.

In a private meeting with grassroots conservative leaders recently, President Donald Trump said that the companion healthcare bill to the American Health Care Act would be revealed to the public soon, possibly as early as next week. Republicans are intending for the AHCA to handle budgetary measures related to the Affordable Care Act. By doing so, the bill will only require 50 Senate votes to pass. The second bill will need 60 votes. This second bill will be part of the third phase discussed earlier.

White House Takes on Congressional Budget Office in Fight over AHCA

White House Press Secretary Sean Spicer is asking people not to pay too much attention to the Congressional Budget Office’s upcoming budgetary evaluations next week for the American Health Care Act. The CBO is a bipartisan Congressional agency that helps Congress with economic and budgetary findings.

Many lawmakers, including prominent Republicans, are interested in what effect the AHCA will have on the federal deficit. Some experts predict that “the CBO score of [the AHCA] is almost certain to be less favorable than that of Obamacare.” This could greatly influence whether or not the AHCA will pass. CBO Director Keith Hall, a Republican appointee who favors “free-market economic views” and rejects “the political limelight,” is widely considered by his peers as a staunch non-partisan in terms of assessing the budget. His office is coming under fire for some miscalculations with Obamacare’s budget. Others believe that the White House is preemptively discrediting the CBO in anticipation of a bad review in order to drum up support for the AHCA.

House Majority Whip Is Confident the House Will Pass the AHCA

In the past few weeks, there has been a lot of focus on whether or not conservative and moderate Republicans would fall in line to vote to pass the AHCA through the House. On Thursday, Representative Steve Scalise, the House Majority Whip, told the media that the House was going to get the AHCA passed. The Majority Whip is responsible for rallying and keeping track of votes. “Despite being awake for 33 straight hours, fueled by adrenaline and several cups of chicory coffee from New Orleans,” Scalise appeared to be in a very good mood and, smiling, elatedly told reporters, “We’re gonna get this done.” Scalise also said that the GOP divisions were blown out of proportion by the media.

White House Weighs Supporting Rollback of Medicaid Expansion

According to “two senior [Trump] administration officials and a senior House conservative aide,” the White House is privately considering rolling back Medicaid expansion sooner than the American Health Care Act currently calls for. This is a possible concession to House conservatives who want to rein in spending as soon as possible.

While talking to reporters on Thursday, Representative Mark Walker (R-NC) said if this provision was added he would “lean yes.” Walker said that if the bill instituted work requirements for healthy, childless adults on Medicaid, he would definitely vote yes.

This move has a great capacity to alienate moderates in the Senate, however. Many Republicans are strong supporters of the Medicaid expansion.

News Update for March 9, 2017

AHCA Clears Two House Panels, Even as Democrats Attempt to Stall

Despite some obstructionist tactics from the Democrats, the GOP was able to advance the American Health Care Act through two key committees. The House Ways and Means Committee advanced the bill early in the morning (around 4:30 a.m., Eastern Standard Time) on Thursday. The House Energy and Commerce Committee advanced it Thursday afternoon. “Despite what you hear in the press, healthcare is coming along great,” tweeted President Donald Trump. However, many Democrats and Republicans think that the House bill is advancing too quickly. Senator Tom Cotton (R-AK) tweeted, “Get it right, don’t get it fast.”

Doctors, Hospitals, and Many Insurance Companies Line Up Against AHCA

On Wednesday, the American Medical Association released a letter to Congress saying that it “cannot support the [American Health Care Act] as it is currently written.” The AMA “calls itself the largest physician advocacy group in the country.” It backed the nomination of Tom Price, one of the principal authors of the bill, for the office of Secretary of Health and Human Services. Other major physician groups have also come out to either voice their opposition or major concerns with the bill.

Most hospital associations have come out against the bill as well. The nation’s largest hospital association, the American Hospital Association, joined with 6 other associations to send a letter to Congress voicing their disapproval. The letter stated that the associations feared the proposal would “lead to tremendous instability for those seeking affordable coverage.” According to USA Today, “virtually every type of hospital” is represented among the opposition. The hospital associations are also “deeply concerned” that the law will result in massive cuts in federal funding for their healthcare services.

The health insurance industry’s largest trade association, America’s Health Insurance Plans, also sent a letter on Wednesday. This letter was much more appreciative of some of the proposed changes, but it was concerned that the bill would not give enough money to Medicaid and that the new system of tax credits wouldn’t be enough to keep younger, healthier consumers in the insurance marketplace.

White House Avoiding “Trumpcare” Nickname for New Bill

The Trump Administration will not be using “Trumpcare” as a nickname for the American Health Care Act, the Republicans’ new proposed bill to replace Obamacare. Ryan Williams, a former longtime spokesman for Mitt Romney, told Politico, “Anything with the word ‘care’ in it pretty much sounds bad to people these days.” Many other Republican figures were asked about the name “Trumpcare,” and many of them avoided the question or shot down the suggestion.

On the other hand, Democrats are eager to utilize the nickname, possibly as a way of assigning any perceived faults in the law to the president himself. “What we have after the repeal is Trumpcare. Whatever is left after the dust settles is Trumpcare,” said Senator Claire McCaskill (D-MO).

Only 3% of Americans Affected by Premium Increases

More than 90 percent of Americans have health insurance and get it through an employer or government programs that don’t include the Obamacare exchanges. Eighty-five percent of people who buy insurance through these exchanges receive federal subsidies that protect them from premium increases. According to a new, interactive infographic released by The New York Timesonly 3 percent Americans are affected by Obamacare’s premium increases. According to the U.S. Census Bureau though, the population of the U.S. is around 320 million, so this number would still affect about 10 million Americans.

News Update for March 8, 2017

Conservatives Continue to Oppose “Obamacare Lite” while Trump Pushes for Speedy Replacement

Conservatives continue to oppose Paul Ryan’s new healthcare reform draft, giving it several disparaging nicknames: Obamacare Lite, RyanCare, and RINOcare (Republican in Name Only). Michael Cannon from the Cato Institute said, “It is remarkable that they’ve produced a bill that is so out of touch with ACA opponents.”

However, President Trump doesn’t seem to want any more delays in repealing and replacing Obamacare. Trump has been very direct when addressing lawmakers about the proposed bill: He wants it to be approved promptly and delivered “largely intact.” Trump has also committed himself to becoming “personally involved in persuading skeptical lawmakers and warned that failing to pass the legislation would result in trouble at the ballot box for Republicans who pledged to repeal and replace Obamacare.”

GOP Factions Pose a Threat to New Healthcare Bill

Three GOP factions pose a threat to Paul Ryan’s American Health Care Act’s ability to become law over certain healthcare reforms.

  1. Western and Midwestern senators: This faction is opposed to any plan that doesn’t provide stability for Medicaid.
  2. Conservative and Libertarian senators: This faction is opposed to subsidizing individuals’ healthcare expenses.
  3. Moderate Supporters of Planned Parenthood: This faction may oppose the bill because of severely decreased funding for Planned Parenthood, a nonprofit healthcare clinic catering to women.

To see the Senators in each faction and a full explanation of their arguments, read the Washington Post’s article.

Elijah Cummings Continues Attempts to Lower Prescription Drug Costs

After being delayed for a month, House Democrat and Senior Black Caucus Member Elijah Cummings is meeting with President Trump today to discuss potential ways to lower prescription drug prices. Cummings stated that Trump “promised—both during the campaign and after—that he would support efforts to stem the skyrocketing prices of prescription drugs, so I am looking forward to discussing ideas he said he supports.”

News Update for March 7, 2017

House Republicans Unveil Long-Awaited Obamacare Reform Bill: The American Health Care Act

On Monday, House Republicans released a long-awaited proposal to replace Obamacare. Billed as a “more conservative vision” for American healthcare, the bill would be a “remarkable moment” in healthcare legislation because Congress has never before reversed a major program of social benefits that has affected this many people. The House has proposed the legislation, which is designed to ensure the long-term financial stability of the healthcare industry, under two bills.

Here are some of the changes:

  • The individual mandate, which penalizes Americans for not having health insurance, would be removed. Insurance companies would be permitted to “impose a surcharge of 30 percent” to people who discontinue coverage and then resume it later on.
  • The employer mandate, which penalizes large employers when they don’t provide health insurance to their employees, would also be eliminated.
  • Age-based tax credits ranging from $2,000 to $4,000 [would replace] the Affordable Care Act’s income-based subsidies.
  • A major overhaul of Medicaid that phases out the open-ended federal funding system it is currently using with a program with spending caps.
  • Insurance companies would be permitted to charge older enrollees 5 times as much in premiums as compared to the cap of 3 times as much under Obamacare.

American Health Care Act Has Long, Uphill Climb Before Passage

In the House, many conservative Republicans are still voicing their displeasure with the bill. Representative Dave Brat (R-VA), a member of the conservative Freedom Caucus, told Politico that he has “seen no evidence that this bill will bring the cost curve down.” Representative Justin Amash (R-MI) insulted the bill by calling it “Obamacare 2.0.” It’s not known if House conservatives will attempt to vote against the bill though. GOP leaders in the House expect that some conservatives and moderates in their party will vote against it. The bill can only lose 21 Republican votes, assuming that the Democrats stand against it unanimously.

If Democrats vote against it along party lines, the bill would lose if just 3 of the Senate’s 52 Republican senators defected. Four Republican senators have already told Senate Majority Leader Mitch McConnell (R-KY) that they plan to oppose any plan that would cut Medicaid for people in their states. Two conservative Republican senators, Rand Paul (R-KY) and Mike Lee (R-UT), have already come out publicly against the plan as well.

On the other side of the aisle, Senate Minority Leader Charles Schumer (D-NY) sharply criticized the American Health Care Act, calling it a “sham of a replacement.”

American Health Care Act Reforms Obamacare, But Also Leaves Parts of It Unchanged

The American Health Care Act seeks to get rid of almost all of Obamacare’s taxes, except the “Cadillac” tax, which taxes high-cost health plans. There is a lot of bipartisan opposition to this tax, which was originally going to take effect in 2020 under Obamacare. The new bill proposes keeping this provision in order to not add to the deficit.

The law also keeps some of the more popular parts of Obamacare unchanged:

  • Insurance companies “have to offer health plans to people, regardless of” pre-existing conditions.
  • “Plans cannot cap the amount they pay in claims in a year or” in their customers’ lifetime.
  • Adult children can stay on their parents’ plans until age 26.
  • Some of the required benefits of Obamacare’s Essential Health Benefits will stay in place, including “preventive medicine and maternity care.”

Tax Credits Between Affordable Care Act vs. American Health Care Act

The Kaiser Family Foundation has released a new tool that compares estimates of premium tax credits Obamacare Marketplace enrollees would receive under Obamacare in 2020 with what they would receive under the newly proposed American Health Care Act. The map shows county-by-county results for how much more or less enrollees would receive in tax credits depending on age, income, and home county. Both policies include tax credits, but Obamacare “takes family income, local cost of insurance, and age into account,” whereas the new policy focuses “only on age, with a phase out for individuals with incomes above $75,000.”

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