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How Many People Across America Are at Risk of Losing Their Health Insurance?

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Between 2010 and 2015, more than 19 million people in the United States gained health insurance, mostly through key provisions under the Affordable Care Act, according to an analysis by the Urban Institute.

Many of the newly insured were not poor enough to qualify for Medicaid but too poor to buy their own coverage. Others were shut out because of pre-existing conditions.

These groups and others make up the millions that the Congressional Budget Office says could lose their coverage under the Republican plans to repeal and possibly replace the Affordable Care Act.

“All of the elements that enabled more people to get insurance under Obamacare — protections for pre-existing conditions, the expansion of Medicaid and subsidies to make insurance more affordable — are potentially at risk under the various options the Senate is debating,” said Larry Levitt, a policy expert at the Kaiser Family Foundation.

Under six Republican proposals that the Congressional Budget Office had analyzed, the number of uninsured in America would increase by 22 million to 32 million people in 10 years — essentially erasing much of the gains made under the Affordable Care Act. A C.B.O. analysis released Wednesday night showed that a “skinny” repeal measurebeing floated by lawmakers would increase the number by 16 million in 10 years.

“It’s a dramatic understatement to say there’s uncertainty about where this debate will end up,” Mr. Levitt said.

Healthcare groups blast skinny repeal, warn premiums will spike

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Healthcare groups blast skinny repeal, warn premiums will spike

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Healthcare groups are coming out against the Senate GOP’s plan to pass a scaled-down ObamaCare repeal bill, saying it would spike insurance premiums.

The American Medical Association, the Blue Cross Blue Shield Association and the American Cancer Society Cancer Action Network are among the range of healthcare groups blasting the bill.

The scaled-down, “skinny” repeal bill would repeal ObamaCare’s mandate for people to have insurance, which insurers and other groups warn would lead to a sicker group of enrollees and spiking premiums.

The Blue Cross Blue Shield Association warned of “steep premium increases and diminished choices that would make coverage unaffordable and inaccessible.”

“Eliminating the mandate to obtain coverage only exacerbates the affordability problem that critics say they want to address,” said Dr. David Barbe, president of the American Medical Association.

“We again urge the Senate to engage in a bipartisan process — through regular order — to address the shortcomings of the Affordable Care Act and achieve the goal of providing access to quality, affordable health care coverage to more Americans,” Barbe said.

The Congressional Budget Office previously found that repealing the individual mandate would lead to 15 million more uninsured people and cause premiums to increase by about 20 percent.

Republican senators argue the scaled-down repeal bill will never actually become law, and is just a way to set up negotiations with the House on a larger plan. But the House is making no guarantees that it won’t simply vote on the bill and send it to the president.

“The continuing effort by Senate leaders to figure out by trial and error some bill that might gain the needed 50 votes to pass is a threat to millions of Americans including cancer patients and survivors who must have comprehensive coverage in order to access prevention and medical treatment,” the American Cancer Society Cancer Action Network said in a statement.

“The legislation could cause the individual insurance market to collapse putting millions of American families at financial risk,” the cancer group said.

In addition to repealing the individual mandate, the skinny bill would also defund Planned Parenthood, cut the ObamaCare prevention and public health fund, and repeal the employer mandate.

Many healthcare groups have been strongly opposed to the GOP effort to repeal ObamaCare throughout the process, instead urging a bipartisan approach.

Medicaid cuts had been a major focus, though those are not be included in the current bill.

Regardless, America’s Essential Hospitals, which is strongly opposed to Medicaid cuts, said it is still opposed to the “skinny bill.”

“While it doesn’t directly affect Medicaid, it still would badly undermine coverage and access by destabilizing the private marketplace,” Bruce Siegel, the group’s president, said in a statement.

The AARP, a powerful senior group, also warned against it.

“The bill will leave millions uninsured, destabilize the health insurance market and lead to spikes in the cost of premiums,” it wrote in a letter to congressional leaders.

“AARP will inform our members and the public how their Senators voted,” the letter added.

Four GOP senators threaten to block ‘skinny’ repeal

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Four GOP senators threaten to block ‘skinny’ repeal

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Four GOP senators — enough to kill the legislation — say they need hard assurances from House Speaker Paul Ryan that a “skinny” ObamaCare repeal bill won’t be Congress’s final product before they’ll vote for it.

Sens. John McCain (Ariz.), Lindsey Graham (S.C.), Ron Johnson (Wis.) and Bill Cassidy (La.) said Thursday evening they are prepared to vote against a skinny repeal unless they get a guarantee it will go to a conference committee with the House.

“There’s increasing concern on my part and others that what the House will do is take whatever we pass” and pass it without making changes, Graham said.

“The skinny bill as policy is a disaster. The skinny bill as a replacement for ObamaCare is a fraud,” he said. Graham added that if the skinny bill passes the House, the GOP will own the collapse of ObamaCare.

“I’d rather get out of the way and let it collapse than have a half-assed approach where it is now our problem,” he continued.

If the skinny bill were to become law, insurers and other healthcare groups have warned it could cause premiums in Obamacare’s insurance markets to skyrocket.

Graham said a conference committee would buy time for the Congressional Budget Office (CBO) to score proposals from himself and Cassidy, as well as by Sen. Rob Portman (Ohio) and Ted Cruz (Texas).

When asked how he’d know any assurance from House leadership is ironclad, Graham said, “It’s like pornography, you know it when you see it.”

If the Senate does pass a bill, both chambers would have to approve whatever emerges from the House-Senate conference. Alternatively, the House could simply approve the Senate’s skinny bill — a prospect that prompted the press conference from the four GOP senators.

Nothing has been determined yet in the House; GOP leaders appear to be keeping their options open and could call up the bill any time between now and Tuesday.

Senate Majority Whip John Cornyn (R-Texas) said he has had no formal assurances from the House, but has every expectation a conference committee will be called.

“There has been some communication in which it has been reported to me that Paul Ryan said the House is preparing to go to conference,” Cornyn said, noting, “I have not talked to Paul Ryan. The Senate doesn’t determine whether the House goes to conference.”

A spokeswoman for Ryan said the House hadn’t yet decided its course of action.

“Conference Committee is one option under consideration and something we’re taking steps to prepare for should we choose that route after first discussing with the members of our conference,” AshLee Strong said.

GOP leaders have not yet revealed their scaled-down measure, but it is expected that it would repeal the employer and individual mandates from ObamaCare.

In another key provision to win conservative support, it would also block federal funding for Planned Parenthood, which provides abortion services. The skinny bill could also cut ObamaCare’s prevention and public health fund, while adding money for community health centers, sources said.

It would not cut Medicaid, which has been a concern for centrist Republicans. However, conservatives could add the Medicaid cuts back into the bill during a conference committee.

It’s not clear when the Senate will take a final vote on the skinny measure, but Republicans can only afford two defections and still rely on Vice President Pence to break the tie.

The bill is expected to be the final amendment at the end of a marathon voting session beginning Thursday evening.

House Majority Leader Kevin McCarthy’s (R-Calif.) office has warned House lawmakers that they should not immediately depart Washington on Friday, in case the Senate does approve a repeal bill.

CBO: 16 million more uninsured under GOP ‘skinny’ repeal

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http://thehill.com/policy/healthcare/344264-cbo-16-million-would-lose-coverage-under-gop-skinny-repeal

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The GOP’s newly released “skinny” repeal of ObamaCare would result in 16 million additional people without insurance by 2026, according to a report by the Congressional Budget Office (CBO) released Thursday night.

The bill, released just hours before its vote Thursday night, would repeal ObamaCare’s individual insurance mandate permanently and its employer mandate for eight years.

The CBO also estimated that premiums in the individual market would increase by 20 percent compared to current law in all years between 2018 and 2026.

The bill would lower the deficit by $135.6 billion in ten years, the CBO estimates. 
The Senate’s scaled-down ObamaCare repeal bill, the Health Care Freedom Act, would also defund Planned Parenthood for a year, repeal the medical device tax for three years and increase contribution limits to Health Savings Accounts for three years.

A vote on the bill is expected after midnight. Lawmakers could then offer amendments to the legislation.

‘Skinny’ Obamacare repeal still lacks votes to pass

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http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982

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A bare-bones plan picks up some key GOP support, but centrists and conservatives are skeptical.

Even a bare-bones repeal of Obamacare is no sure thing in the Senate.

A handful of key Republican senators who had spurned earlier overtures from GOP leadership endorsed the latest plan to gut Obamacare’s individual and employer coverage mandates and its medical device tax. But several centrists said they’re undecided on the so-called skinny repeal, leaving the GOP in limbo through at least the end of the week.

Jockeying on the scaled-back approach came as the Senate rejected a straight repeal of Obamacare in a 45-55 vote Wednesday. The night before, senators turned aside a comprehensive replacement plan that had been crafted by Senate Majority Leader Mitch McConnell. The roll calls were the latest reminders that GOP leaders’ best hope at this point is just to get something — anything — through the chamber with a bare majority and into a conference with the House.

“Sure. There’s plenty we agree on,” said Senate Majority Whip John Cornyn (R-Texas) late Wednesday when asked whether he can get 50 votes. One challenge for GOP leaders is “trying to explain the concept that we need to do it this way, as opposed to solving all the problems in a Senate bill now.”

Cornyn said broader negotiations on Medicaid reforms and other divisive issues would likely re-emerge in bicameral negotiations with the House. But some Republicans are worried that those talks would revive efforts to wind down a Medicaid expansion that’s benefited their states.

Centrist GOP Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia were undecided on the so-called skinny repeal Wednesday. Another Republican from an expansion state, Sen. Dean Heller of Nevada indicated he would back it.

“We’ll see at the end of the day what’s in it, but overall I think I’d support it,” Heller said. He said slashing Obamacare’s Medicaid expansion or its growth rate should be a nonstarter.

Conservatives could be another matter.

“I don’t like it,” Sen. David Perdue of Georgia said of the process. “Because I don’t know where we end up. This whole [health care system] holds together or falls apart in totality. We’ve got a system that is collapsing.”

South Carolina Sen. Lindsey Graham on Tuesday called the possibility of a skeletal plan a “political punt,” but it may be able to clear the narrowly divided chamber. Graham said he would vote for the slimmed-down plan only if House and Senate lawmakers use it to go to conference and come up with a fuller replacement.

Sen. Jeff Flake of Arizona also indicated that he could get on board with the skinny option.

“In Arizona, you have 200,000 people who were paying the [Obamacare insurance mandate] fine and can’t afford insurance,” Flake told reporters. “We gotta have relief to those who, one: can’t find affordable insurance so they have to pay the fine; and, two: even those that can afford to pay the premium, generally can’t afford to utilize the coverage because the deductibles are so high.”

Whether Sen. Mike Lee of Utah can back a trimmed-down proposal “depends how skinny it is,” a spokesman said. But Sen. Rand Paul of Kentucky signaled he could live with the minimalist approach.

“I’ve always said I will vote for any permutation of repeal. Obviously, I want as much as I can get, but I’ll vote for whatever the consensus can be. It’s what I’ve been saying for months: Start on what you can agree on,” Paul said in an interview Wednesday. “Starting small and getting bigger is a good strategy.”

That would leave out the divisive issues of cuts to Medicaid spending and efforts to create a new tax credit system for the individual markets. Republicans can afford to lose just two votes to pass whatever they come up with in the end.

Many Republicans are in the dark about the emerging proposal. And aides said senators were still focused on amendment votes, floor tactics and the chaotic atmosphere, making it difficult to tell what can clinch 50 votes.

“I don’t know what would be in the skinny repeal,” said Sen. Susan Collins of Maine. “Until I see what’s in it, I’m not ruling it out because I don’t know what it would be.”

The Senate also rejected on Wednesday an attempt to send their repeal effort to congressional committees for several days.

Republicans need a score on any proposal from the Congressional Budget Office to vote at a 50-vote threshold. They are aiming for a vote on Friday on their final plan after the unlimited amendment process known as vote-a-rama, which is expected to begin sometime Thursday.

In the final bill, Republicans could try to add more elements than repealing the mandates and device tax, but that could complicate efforts to get a quick CBO score.

“Look for victories where we should find them. In my opinion, the victory will always include: individual mandate repeal, employer mandate repeal and [eliminating] the medical device tax,” said South Carolina Sen. Tim Scott. “If we can add to it, we should … as much as you can repeal, let’s get it done.”

The CBO has scored those three pieces of the proposal in the past and could deliver an analysis of the “skinny repeal” more speedily than of a more wide-ranging effort, GOP senators said. Still, Republicans will have to add additional Obamacare provisions to the bill to meet minimum savings requirements required under reconciliation, the budget mechanism that allows for a bare majority instead of 60-vote threshold.

Republicans are likely to cut the Prevention and Public Health Fund, for instance. The goal would be to increase the bill’s scope enough to meet Senate savings targets without losing political support, according to Republican sources. They may be able to do so because slashing the mandates means millions would drop insurance coverage — and the subsidies that come with it.

In the end, Senate leaders would want the House to either take up their bill or go to conference and hammer out a compromise that can pass both chambers.

“I can’t imagine at the end of the process that we haven’t agreed on something,” said Sen. Roy Blunt (R-Mo.). “And all we have to do is agree on something that keeps this going.”

But conservatives are wary of a House-Senate negotiation.

“I would [be in] favor if we have a skinny repeal, just sending it over to the House and seeing if they can pass it rather than going to conference,” Paul said. “Conference committee to me means Big Government Republicans are going to start sticking in those spending proposals.”