Tag Archives: ACA Repeal

American Medical Association opposes GOP ObamaCare bill

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http://thehill.com/policy/healthcare/322889-largest-doctors-group-opposes-gop-obamacare-bill

American Medical Association opposes GOP ObamaCare bill

The nation’s biggest doctors group on Wednesday came out in opposition to the GOP’s ObamaCare replacement bill, warning that it would cause millions of people to lose coverage.

“As drafted, the AHCA would result in millions of Americans losing coverage and benefits,” said Dr. Andrew Gurman, president of the American Medical Association (AMA), referring to the American Health Care Act.

“By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive — if not out of reach — for poor and sick Americans. For these reasons, the AMA cannot support the AHCA as it is currently written.”

The opposition from the powerful doctors group adds to a range of objections from the healthcare industry to the GOP bill. The American Hospital Association on Tuesday also came out against the legislation.

The AMA also objected that the GOP bill bases its tax credits on someone’s age, not their income, giving less help to low-income people. The group warned of rolling back ObamaCare’s Medicaid expansion, an area where some GOP lawmakers also have concerns.

The AMA also opposes a provision in the bill defunding Planned Parenthood.

“We encourage you to ensure that low and moderate income Americans will be able to secure affordable and adequate coverage and that Medicaid, [Children’s Health Insurance Program], and other safety net programs are maintained and adequately funded,” the AMA said in its letter to Congress. “And critically, we urge you to do all that is possible to ensure that those who are currently covered do not become uninsured.”

 

Why House Republicans Are Rewriting Their Obamacare ‘Replacement’

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http://thefederalist.com/2017/03/06/house-republicans-rewriting-obamacare-replacement/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202017-03-07%20Healthcare%20Dive%20%5Bissue:9345%5D&utm_term=Healthcare%20Dive

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House staff are re-writing their legislation to correct a major flaw in its structure: giving people a new entitlement for health insurance will cause millions to drop employer insurance.

On Friday, Politico reported that Republicans were considering ways to amend their Obamacare “replacement” legislation, by placing income limits on the bill’s new refundable tax credit for health insurance. The Politico story implied the income cap sought to prevent wealthy individuals like Warren Buffett from obtaining federal subsidies for health insurance, but in reality House staff are re-writing their legislation to correct a major flaw in its structure.

Based on my conversations with multiple sources close to the effort, the Congressional Budget Office (CBO) had indicated to congressional staff that the prior House framework could see at least 10 million, and potentially up to 20 million, individuals losing employer-sponsored health insurance. Further, CBO stated that that House framework, even after including a refundable tax credit for health insurance, would not cover many more people than repealing Obamacare outright.

By comparison, Obamacare led to about 7 million plan cancellation notices in the fall of 2013. While those cancellations caused a major political firestorm, the framework the House released prior to the recess could cause a loss of employer coverage of several times that number. What’s more, that framework as described looks for all intents and purposes like a legislative orphan appealing to no one—neither moderates nor conservatives—within the Republican party:

  • A significant erosion of up to 10-20 million individuals with employer-provided health coverage;
  • A new entitlement—the refundable tax credits—that by and large wouldn’t expand coverage, but instead cause individuals currently in employer plans to switch to the credits;
  • More federal spending via the refundable tax credits;
  • A tax increase—a cap on the current exclusion for employer-provided health coverage—to pay for the new spending on the credits; and
  • An increase in the uninsured (compared to Obamacare) of at least 15 million—nearly as much as repealing the law outright.

Details of the bill are changing constantly, and no doubt House leadership will claim these figures pertain to prior drafts of the legislation. But even if those numbers reflect outdated drafts, the combination of major re-writes to the bill and the lack of a CBO score at any point in the process thus far should cause significant pause on Capitol Hill. Members are being asked to vote on legislation before knowing its full effects, or even how it will look in its final version.

Coverage Quicksand

According to CBO, the combination of a cap on the exclusion for employer-provided health insurance, coupled with an age-rated tax credit for insurance, created a dynamic where expanding health insurance coverage was all but impossible.

An age-rated credit provides much greater incentive for firms to drop coverage, because all workers, not just low-income ones, can qualify for the credit. Moreover, because an age-rated credit provides the same subsidy to all individuals, regardless of income, low-income enrollees—the only individuals who have enrolled on exchanges in significant numbers—would have much less financial incentive to purchase insurance than they do under Obamacare, hence the lower coverage numbers overall.

On their bill, House Republicans put themselves in coverage quicksand. The more they thrashed to get out of the quicksand—by increasing the subsidies or adjusting the cap on the employer exclusion, or both—the deeper they sank, by increasing the erosion of employer-sponsored insurance.

House GOP’s Obamacare Replacement Will Make Coverage Unaffordable For Millions — Otherwise, It’s Great

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https://www.forbes.com/sites/theapothecary/2017/03/07/house-gops-obamacare-replacement-will-make-coverage-unaffordable-for-millions-otherwise-its-great/#3540ba3d37fd

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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?

 

3 Republican concepts for replacing the ACA — and what they mean

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http://www.healthcaredive.com/news/3-republican-concepts-for-replacing-the-aca-and-what-they-mean/437475/

The bottom line

These policy ideas popular among conservatives could certainly push health insurance costs down for some — like those with few healthcare needs and reliable income — but they also would undoubtedly offer fewer benefits to those with low incomes and high healthcare costs.

“The value of the policies that insurers are offering is going to go down under all these options,” Blumberg said. “They’re going to end up attracting the higher needs population and they can’t sustain that.”

Hospitals would see significant revenue losses if millions lose coverage under repeal of the ACA and are unable to afford new coverage under the replacement plans the GOP has put forward. Some executives have warned they would have to cut vital services, such as behavioral health.

A report prepared for the American Hospital Association found that hospital revenues would decrease nearly $400 billion between 2018 and 2026 with ACA repeal. The plans put forward by Republicans would barely dent that projection, experts say.

Hospital revenues are projected to decrease by $400 billion between 2018 and 2026 under ACA repeal, according to the AHA.

The leaders of the American Hospital Association and Federation of American Hospitals have written to President Donald Trump asking him not to repeal the ACA without an adequate replacement.

“Losses of this magnitude cannot be sustained and will adversely impact patients’ access to care, decimate hospitals’ and health systems’ ability to provide services, weaken local economies that hospitals help sustain and grow, and result in massive job losses,” they wrote. “As you know, hospitals are often the largest employer in many communities, and more than half of a hospital’s budget is devoted to supporting the salaries and benefits of caregivers who provide 24/7 coverage, which cannot be replaced.”

Republicans continue to debate whether, how and when to replace the ACA. Just as the reform law had major impacts on the industry, the process of finding alternatives will have significant consequences as well.

 

GOP releases bills to repeal and replace ObamaCare

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http://thehill.com/policy/healthcare/322609-gop-releases-bill-to-repeal-and-replace-obamacare

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Click to access AmericanHealthCareAct.pdf

Click to access AmericanHealthCareAct_WM.pdf

House Republicans on Monday unveiled their long-awaited legislation to repeal and replace ­ObamaCare, with plans to quickly push the measure through committee votes this week.

The two measures dismantle the core aspects of ­ObamaCare, including its subsidies to help people buy coverage, expansion of Medicaid, taxes and mandates for people to have insurance. The bills also dramatically restructure the Medicaid program overall by capping federal payments.

In its place, Republicans would put a new system centered on a tax credit to help people buy insurance.

House Republicans plan to take up the legislation at a breakneck pace, with two committees — Energy and Commerce and Ways and Means — scheduled to hold votes on Wednesday. A vote in the full House is expected to soon follow, within weeks.

House Ways and Means Committee Chairman Kevin Brady (R-Texas) said Monday on Fox News that he’s confident the legislation will pass with solid Republican support despite recent party infighting over the details.

“We’ve been listening very carefully to our Republican members for months now to make sure we get it right,” he said. “I am confident we are going to pass this.”

Brady noted that many of the elements of the bills have passed the House “a number of times” over the years.

Speaker Paul Ryan (R-Wis.) in a statement claimed that ­ObamaCare “is rapidly collapsing” and vowed the GOP’s plan — dubbed the American Health Care Act — will “give every American access to quality, affordable health insurance.”

Republicans acknowledge that their plan will cover fewer people, saying that unlike ­ObamaCare, they are not forcing people to buy coverage through a mandate. They say their system is less intrusive and provides people a tax credit without mandates or a range of tax increases.

But the measures face a rocky path, particularly in the Senate. Four Republican senators earlier Monday objected to an earlier version of the House plan, saying that it fails to protect ­ObamaCare’s Medicaid expansion.

Even in the House, there are objections. Conservatives in the House Freedom Caucus object that the new tax credit is a “new entitlement.” They have enough votes to kill the legislation, but it remains to be seen whether they will actually vote against a bill that dismantles the core of ­ObamaCare.

The GOP measure significantly restructures the Medicaid program, which provides coverage for around 70 million poor, disabled and elderly people, to cap federal payments.

The repeal of the Medicaid expansion and ­ObamaCare’s subsidies would not take effect until 2020, meaning current enrollees could keep their coverage this year.

Republicans would also grandfather in current Medicaid enrollees so that they can stay on the program. But once 2020 arrives, the federal government would no longer provide the extra federal funds that allow for expansion.

That plan has drawn objections from more centrist Republican senators, who want to protect the expansion and are worried about constituents losing coverage and their states losing federal funds.

The legislation would maintain ­ObamaCare’s protections for people with pre-existing conditions, who could still not be denied coverage by insurers. Instead of ­ObamaCare’s mandate, the GOP plan would seek to encourage healthy people to sign up by allowing insurers to charge people 30 percent higher premiums if a new enrollee has had a gap in coverage.

The legislation also repeals nearly all of the taxes created by ­ObamaCare, including the medical device tax and health insurance tax, starting in 2018. The bills scrap a controversial Republican proposal in earlier drafts that would have started taxing some employer-sponsored health insurance.

To ensure that the legislation passes muster under special budgetary rules, it keeps ­ObamaCare’s “Cadillac tax” on generous plans after 2025. That provision, which could prove controversial, will help ensure that the measure does not add to the federal deficit in that decade.

Obstacles ahead as GOP begins ObamaCare repeal

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Obstacles ahead as GOP begins ObamaCare repeal

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Republicans who have vowed for years to repeal and replace ObamaCare are now seeking to turn their campaign pledge into reality, with markups of legislation potentially beginning this week.

With narrow majorities in the House and Senate, Republicans won’t be able to pass healthcare legislation unless they remain united.

That could prove difficult, as there are several knotty issues raised by the repeal effort that threaten to push lawmakers into opposing camps.

Here are the four biggest issues that Republicans will have to resolve before an ObamaCare repeal bill can reach President Trump’s desk.

Tax credits

One of the biggest sticking points for Republicans is how to provide tax credits to help people pay for health insurance.

While there is broad support in the GOP for providing assistance through the tax code, they are at odds over the details.

House Republican leaders are pushing for a refundable, advanceable tax credit — something conservatives have denounced as a new government entitlement.

“I think there is still a significant divide within the conference on how you deal with refundable tax credits,” said Rep. Mark Sanford (R-S.C.), a member of the conservative House Freedom Caucus.

“I think the refundable tax credit in its present form represents a new entitlement,” he said, adding that he would have “very, very strong reservations” about supporting a bill that included them.

Sen. Rand Paul (R-Ky.) has compared the refundable tax credits to the subsidies some people get under ObamaCare.

“The problem that I have with a new refundable tax credit is it’s essentially a subsidy by another name,” he said last month.

“ObamaCare had subsidies. If we call them refundable tax credits, have we really done anything other than change the name? So I think that’s a problem.”

 

Repeal of Health Law Faces a New Hurdle: Older Americans

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Republican plans to repeal the Affordable Care Act have encountered a new obstacle: adamant opposition from many older Americans whose health insurance premiums would increase.

AARP and its allies are bombarding congressional offices with objections as two House committees plan to vote on the Republicans’ bill this week.

If the law is repealed, the groups say, people in their 50s and 60s could see premiums rise by $2,000 to $3,000 a year or more: increases of 20 percent to 25 percent or higher.

Under current rules, insurers cannot charge older adults more than three times what they charge young adults for the same coverage. House Republican leaders would allow a ratio of five to one — or more, if states choose.

Insurers support the change, saying it would help them attract larger numbers of young customers.

The current rating restrictions, they say, have increased premiums for young adults, discouraging them from enrolling.

But the Republican proposal would “increase the financial burden of older Americans, making coverage significantly less affordable,” says a letter to Congress from the Leadership Council of Aging Organizations, a coalition of nonprofit groups that represent the interests of older Americans.

The letter was addressed to Representative Greg Walden, Republican of Oregon and the chairman of the Energy and Commerce Committee, one of two House panels planning to vote this week on a bill that would roll back major provisions of President Barack Obama’s signature domestic accomplishment.

David M. Certner, the legislative policy director of AARP, said the proposal would have “a severe impact on Americans age 50 to 64 who have not yet become eligible for Medicare.”

At the same time, Mr. Certner said, the Republican proposal could reduce the financial assistance available to help people pay insurance premiums.

Republicans say their proposal would reduce insurance prices by stimulating competition and by allowing insurers to sell a leaner, less expensive package of benefits.

 

 

Risk Adjustment at Heart of “Incredibly Complex” Health Care Reform

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http://www.realclearhealth.com/articles/2017/03/06/risk_adjustment_at_heart_of_incredibly_complex_health_care_reform_110479.html?utm_source=RealClearHealth+Morning+Scan&utm_campaign=9e734f1560-EMAIL_CAMPAIGN_2017_03_06&utm_medium=email&utm_term=0_b4baf6b587-9e734f1560-84752421

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President Donald Trump’s core principles for health care include ensuring that Americans with pre-existing conditions have access to coverage, and that Americans should be able to purchase the health insurance plan they want, not one forced on them by the government. Each of these goals is laudable and achievable, taken separately. But President Trump and others are about to confront what others have learned the hard way: Achieving both goals simultaneously is extremely challenging.

Those attempting to implement the Affordable Care Act (ACA) have faced the dilemma under easier conditions and, even after years of trying, have not solved it. Unless President Trump’s technocrats can fix something known as “risk adjustment” that has bedeviled the Obama administration, his dual principles cannot coexist.

The problem arises from the peculiarities of insurance markets. If insurance policies can vary greatly in their coverages and networks, people will tend to sort themselves into the coverages and networks that fit them best.

On the surface, this sounds great: Americans get the plans they want, not uniform plans put together by some government bureaucrat who knows best or is attempting to use insurance to achieve political goals. But in the unique case of insurance markets, there are adverse consequences.

With a great diversity of plans available, people who believe themselves to be high-risk usually purchase policies that have great coverages and broad networks. People who believe themselves to be low-risk usually purchase policies with lesser coverages and narrower networks. This separation means that the policies with great coverages are going to start to get really expensive, because they are full of higher-risk policyholders.

Neither Democrats nor Donald Trump want to let insurers charge people buying the same policy different rates based on their health conditions. And they don’t want to let insurers impose pre-existing condition limits that would make the more generous policies less expensive for insurers to service. The result, under these constraints, is that only one group of people will buy the premium policies: People with really, really expensive medical conditions.  The price of these policies go up until they essentially no one can afford them.

In the end, almost everyone else would migrate to lesser policies, and we would end up with an unstable environment in which only policies with poor coverages and narrow networks are really able to survive. So, yes, insureds and insurers on paper have freedom to design policies that they actually want, but the market this freedom produces is fatally unstable.

 

With ‘Trumpcare’ On Horizon, Voters Go Wobbly On Repeal

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http://khn.org/news/with-trumpcare-on-horizon-voters-go-wobbly-on-repeal/

UNITED STATES - FEBRUARY 22: Protesters gather outside before Rep. Leonard Lance, R-N.J., holds a town hall meeting at the Raritan Valley Community College in Branchburg, N.J., on Wednesday, Feb. 22, 2017. (Photo By Bill Clark/CQ Roll Call)

As candidate Donald Trump hammered the Affordable Care Act last year as “a fraud,” “a total disaster” and “very bad health insurance,” more Americans than not seemed to agree with him.

Now that President Trump and fellow Republicans show signs of keeping their promise to dump the law, many appear to be having second thoughts.

Multiple polls show rising support for the ACA, including two recent ones indicating Americans feel more positively about it than ever. True, many still dislike what’s known as Obamacare. One survey showed 42 percent see it unfavorably while 48 percent viewed it favorably.

But as the national conversation swells on the fate of a law that affects millions of people in multifaceted ways — and the issue takes center stage at raucous town hall meetings — it’s increasingly clear that many Americans don’t see the ACA as an either-or proposition.

“At first it was a good deal — that was three or four years ago,” said Mark Bunkosky, 56, an independent contractor in Michigan who buys coverage through one of the law’s online portals. “Every year it’s gone up. From where it started, the premium has doubled, and now my deductible has also doubled. And my income has not doubled.

Bunkosky, a Republican, views the ACA unfavorably but believes Washington should fix it, not toss it. He supports keeping some of the law’s Medicaid coverage for low-income people and its prohibition on discriminating against those with preexisting illness.

his week Trump acknowledged that health care is “so complicated.” So are voter opinions on what to do next with the ACA, which expanded coverage to some 20 million.

“I didn’t like that it mandated people to carry health insurance. And I thought it was just a lie” when it promised affordability, said Amber Alexander, 27, a Pennsylvania independent whose seasonal income puts her on Medicaid in winter and a commercial plan the rest of the year.

However, she said, “I don’t think it should be thrown out altogether. There are people that do benefit from it, but there are also a lot of people that get screwed.”

Carol Friendly, 67, is an Oregon Republican who voted for Hillary Clinton for president and favors the health law’s Medicaid expansion, which many Republican policymakers excoriated but has gained support among some GOP governors. She objects to the ACA’s reproductive health coverage, saying consumers opposed to birth control and abortion shouldn’t have to pay for them.

On the other hand, “I know it put 22 million in the health care system that weren’t there before,” she said. “So that’s a plus.”

Adding to the political fog are mixed signals from Republicans.