The House GOP Leadership’s Health Care Bill Is ObamaCare-Lite — Or Worse

https://www.cato.org/blog/house-gop-leaderships-health-care-bill-obamacare-lite-or-worse

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During the presidential campaign, Donald Trump promised legislation that “fully repeals ObamaCare.” Monday night, the Republican leadership of the House of Representatives released legislation it claims would repeal and replace ObamaCare. Tuesday afternoon, Vice President Mike Pence will travel to Capitol Hill to pressure members of Congress to support the bill. On Wednesday, two House Committees will begin to mark-up the legislation. House and Senate leaders are hoping for quick consideration and a signing ceremony, maybe by May, so they can move on to other things, like tax reform and confirming Supreme Court nominee Judge Neil Gorsuch.

Everyone needs to take a step back. This bill is a train wreck waiting to happen.

The House leadership bill isn’t even a repeal bill. Not by a long shot. It would repeal far less of ObamaCare than the bill Republicans sent to President Obama one year ago. The ObamaCare regulations it retains are already causing insurance markets to collapse. It would allow that collapse to continue, and even accelerate the collapse. Republicans would then own whatever damage ObamaCare causes, such as when the law leaves seriously ill patients with no coverage at all. Congress would have to revisit ObamaCare again and again to address problems they failed to fix the first time around. ObamaCare would consume the rest of Congress’ and President Trump’s agenda. Delaying or dooming other priorities like tax reform, infrastructure spending, and Gorsuch. The fallout could dog Republicans all the way into 2018 and 2020, when it could lead to a Democratic wave election like the one we saw in 2008. Only then, Democrats won’t have ObamaCare on their mind but single-payer.

First, let’s look at how the main features of this bill fall short of repeal.

 

Negative reactions roll in for Republican ACA replacement bill

http://www.healthcaredive.com/news/aca-repeal-bill-reactions/437591/

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Dive Brief:

Dive Insight:

The AHCA is getting criticism from all sides and is centered in a big pile of uncertainty regarding varying ACA repeal bills. But when push comes to vote, it will come down to the Republicans to decide whether to go forward with the new repeal-and-replace bill.

So far, the bill hasn’t been taken positively from either side of the aisle. Democrats obviously oppose the legislation but several conservatives have taken shots at the measure as well. Heritage Action CEO Michael Needham released a statement on Tuesday saying, “Many Americans seeking health insurance on the individual market will notice no significant difference between the Affordable Care Act (i.e., Obamacare) and the American Health Care Act.  That is bad politics and, more importantly, bad policy.”

The American Medical Association called the bill “critically flawed.”

“The AMA supported health system reform legislation in 2010 because it was a significant improvement on the status quo at the time; and although it was imperfect, we continue to embrace its primary goal – making high-quality, affordable health coverage accessible to all Americans,” AMA President Dr. Andrew Gurman said. “As drafted, the AHCA would result in millions of Americans losing coverage and benefits. 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.”

Washington Post stating the most lasting impacts of the measure would be steps toward “forcing permanent changes to Medicaid and Medicare.” He added, “If this bill became law, [House Speaker Paul Ryan] would finally be positioned to change Medicare to a voucher program.” AARP EVP Nancy Leamond had similiar concerns with Medicare, writing in a statement the organization opposes the AHCA stating it would “would weaken Medicare, leaving the door open to a voucher program that shifts costs and risks to seniors.”

The American Hospital Association released a letter on Tuesday stating any ability to evaluate the bill is “severely hampered by the lack of coverage estimates by the Congressional Budget Office…[I]t appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care.”

Getting the Brush-off on Health

http://otherwords.org/getting-the-brush-off-on-health/

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Someone recently asked me whether I consider myself a liberal or a conservative on healthcare. But what does that even mean?

We all want the same thing: affordable coverage we can actually use, lower costs, and a healthier population. I don’t think the ACA achieved all of these goals, but getting coverage for over 20 million people was a huge step in the right direction.

Why tear down years of progress and start from scratch when we can simply fix what we have?

Behold the G.O.P. Civil War on Health Care

 

As people began to digest the Republican health care plan on Tuesday, a few things became clear:

1. “This isn’t an Obamacare repeal, it’s a Medicaid repeal,” as the political writer Jonathan Allen put it.

Many Republicans have long viewed Medicaid — a health insurance program for the poor, the disabled and some elderly — with skepticism. This plan would make very large cuts to the program. The details are somewhat technical, and Edwin Park of the Center on Budget and Policy Priorities explains them. But the real-world effects will be concrete: Many people will lose coverage, and some kinds of care, if the bill becomes law.

2. Conservative policy experts hate the bill, and the criticisms come from both the far right and the center right.

Peter Suderman of Reason had an excellent frame for understanding the right’s civil war over health care: Conservatives don’t even agree on what their goals are. Making health care less expensive? Reducing the government’s role? Ensuring that the poor receive fewer subsidies?

Lacking this agreement, many Republicans have pretended that a magical health plan exists, one that would cover everyone, provide good insurance and cost less money. Wouldn’t that be nice!

 

American Medical Association opposes GOP ObamaCare bill

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’

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

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

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

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.