Five takeaways from the leaked Republican bill to repeal Obamacare

http://www.pbs.org/newshour/rundown/5-takeaways-leaked-republican-bill-repeal-obamacare/

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A formal draft of the House Republican plan to repeal and replace the Affordable Care Act leaked out on Friday.

The final version is likely to be different — how much different, it’s hard to say. The draft obtained by Politico is dated two weeks ago, and rumors have been swirling here that Republicans received an unfavorable analysis from the Congressional Budget Office, the official scorekeepers on the cost and coverage implications of legislation.

But this is nonetheless an important milestone — real legislative text, prepared with an eye toward the complex parliamentary procedures needed to pass ACA repeal with only Republican votes, and presumably with the endorsement of House leadership.

Much attention will be paid to the proposed tax credits offered for people to buy health insurance and the changes to the tax treatment of employer-based insurance. Here are five provisions with big implications for health and medicine.

 

Medicaid’s Role: What’s at Stake Under a Block Grant or Per Capita Cap?

Medicaid’s Role: What’s at Stake Under a Block Grant or Per Capita Cap?

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A new video slideshow from the Kaiser Family Foundation explains how Medicaid works now and what is at stake as policymakers in Washington consider converting program financing to a block grant or per capita cap.

The 3-minute video describes how Medicaid is financed under current law, whom it covers and how spending is distributed across various groups of enrollees, including children, adults, seniors, and people with disabilities. It shows, for instance, that although seniors and people with disabilities comprise about a quarter of Medicaid enrollees, they account for nearly two-thirds of Medicaid spending because they have more complex health needs and therefore higher per person costs.

Proposals to convert Medicaid to a block grant or per capita cap financing could reduce federal Medicaid spending over time and be tied to increased flexibility for states in how they run their Medicaid programs. However, the video slideshow also explains how such proposals may shift costs to states, beneficiaries and providers, as well as limit states’ ability to respond to changes in medical costs and/or demand for Medicaid.

PD Editorial: 20 million reasons to retain and repair Obamacare

http://www.pressdemocrat.com/opinion/6701027-181/pd-editorial-20-million-reasons

For six years, and over the course of five dozen high-profile, low-probability votes, Republicans in Congress vowed to do away with Obamacare.

Republicans denounced the Affordable Care Act as “a crime against democracy” and labeled it “the most dangerous piece of legislation ever passed.” Oklahoma Sen. Tom Coburn went so far as to warn seniors, “You’re gonna die sooner.”

The election of Donald Trump removed the specter of a presidential veto, yet the Affordable Care Act hasn’t been repealed.

Large and boisterous crowds supporting Obamacare at town hall meetings probably are making some lawmakers nervous about the fallout from killing a program that provides insurance for 20 million Americans. Here’s another possible explanation: Despite its shortcomings, Obamacare has delivered on its basic promise — expanding access to health care by reducing the cost of insurance, especially in states such as California that fully embraced the program.

California has reduced its uninsured rate to a record low of 7.1 percent, according to a report issued this month by the Centers for Disease Control and Prevention.

That’s a decline of 9.9 percentage points since the Affordable Care Act took full effect in 2013.

The CDC figures, based on data for the first three quarters of 2016, also showed a marked improvement on a national scale, with 8.8 percent of Americans lacking health insurance. In 2013, the uninsured rate was 14.4 percent.

Let those be benchmarks.

Trump and congressional Republicans still say they’re going to repeal and replace the Affordable Care Act. But any plan that results in fewer people having coverage isn’t a replacement. It’s retrenchment. And that isn’t acceptable.

Despite their harsh criticism of Obamacare, Republicans are far from agreeing on any replacement. They have promised to keep the most popular provisions of Obamacare, including protection for people with pre-existing conditions and coverage of dependents up to age 26. There also is GOP support for retaining requirements that insurers cover treatment of mental illness and substance abuse. Targeted for elimination are the financing mechanisms needed for the program to remain viable — individual and employer mandates and subsidies to help low- and middle-income families pay insurance premiums. A proposal to convert Medicaid to a block grant program almost certainly will result in some states raising the threshold for eligibility.

The numbers simply don’t add up.

Hospitals justifiably fear a return to the days of writing off millions of dollars from providing emergency care to uninsured patients, and insurers will have little choice but to drop out of the exchanges — 11 participate in California — if people can wait until they’re sick before buying coverage.

That’s the death spiral Republicans have been predicting since the Affordable Care Act passed in 2010. It could become a self-fulfilling prophesy if insurers conclude that the risk pool that undergirds the insurance market has been, or will soon be, undermined.

No big program is perfect. Republicans have pointed out Obamacare’s shortcomings for years while refusing to work with Democrats on improvements. If it collapses now, some Republicans will point fingers at Obama and claim the program was fatally flawed. But if millions of people who gained access to health insurance suddenly find themselves without coverage once again, many of them are going to blame the people who wrote the cancellation notice.

 

Conservatives Want Obamacare Repeal, and They Want It Now

http://www.rollcall.com/news/politics/demint-to-congress-repeal-obamacare-now

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Conservatives rallying here are calling for their congressional brethren to keep the faith and quickly gut the 2010 health care law, dismissing concerns about lost health coverage and motivated voters at town halls.

Reported remarks by former Speaker John A. Boehner, R-Ohio, far away from the conservatives gathered at the convention hotel provided the latest cause for alarm. Boehner had said that repeal and replace was “not going to happen,” according to Politico.

“The last I checked, Boehner doesn’t have a vote anymore,” Sen. Ted Cruz of Texas told Roll Call just as a cacophony of barking came from nearby police canines.

“This is a test. It’s a test for Republicans in the executive and both Houses of Congress. Do we honor the promises we made? This election was a referendum on repealing Obamacare,” Cruz said in a brief interview. “I think failure is not an option.”

“We’ve got to keep that promise, and I believe we will,” Cruz said.

 Cruz, who has been among the loudest voices for rolling back as much of the 2010 law as possible, was one of few lawmakers appearing at CPAC during the February congressional recess, flying back from Texas for the occasion. He got a heroes welcome from the conservative activists and media assembled at the hotel just outside D.C.

Heritage Foundation President Jim DeMint, the former South Carolina Republican senator, called on activists attending the Conservative Political Action Conference to push their members of Congress to send to President Donald Trump the same legislation that dismantled the law and was vetoed by President Barack Obama with all due haste.

“We must and we can repeal Obamacare now,” DeMint said. “They should send that same bill to President Trump right now.”

DeMint called the idea that there needs to be a replacement on the front end, “absolutely ludicrous.”

 

The left rallies to save Obamacare with passion but little cash

http://www.politico.com/story/2017/02/obamacare-progressives-town-halls-235333

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Obamacare is blowing up congressional town hall meetings from California to Virginia. But high rollers aren’t stepping up to write checks to defend the law and possibly turn voter outrage over losing coverage into a sustainable movement.

Though many Republicans charge the town hall sessions are stoked by moneyed interests and professional protesters, health care groups and foundations that have been crucial to the Affordable Care Act cause have remained on the sidelines. Without cash, the smaller progressive organizations left could be hard-pressed to fight a long battle as conservatives spend heavily to pressure lawmakers to finish off the law and, possibly, revamp Medicaid.

“If you’re looking for where funding used to go to fight for the health care bill … I think you gotta keep looking,” said Ezra Levin, a former Democratic congressional staffer now helping direct the Indivisible Project, which is organizing pro-Obamacare demonstrations and other protests against President Donald Trump’s agenda. “It’s not coming to us, at least not right now.”

The flow of funds began slowing not long after the law was passed. After securing former President Barack Obama’s signature domestic policy achievement, key players involved with messaging and advocacy declared victory and moved on without fully completing the sales job. The Health Care for America Now coalition, one of the most audible voices in getting the law enacted, folded in late 2013 after mounting a $60 million campaign to pass Obamacare and protect it during implementation.

It’s left to groups such as the Indivisible Project to confront GOP lawmakers and tap outrage or voter anxiety over the party’s repeal-replace effort. The progressive forces also include the Protect Our Care campaign backed by health consumer groups, and some of the original backers of Health Care for America Now. Another group, the Alliance for Healthcare Security, has aired several rounds of ads that are largely being funded by the Service Employees International Union, though the SEIU declined to specify how much it had contributed.

Huge amounts of cash for advertising and outreach may not be as essential in a social media-fueled crucible, where town hall confrontations can almost instantly go viral and organizers can rely on Facebook and other tools to mobilize. The pro-ACA groups scoff at the notion advanced by the Trump administration and some GOP lawmakers that Democrats are paying protesters to make a ruckus over Obamacare at town halls. “To say that we’re a ‘grasstops’ thing is a complete lie,” said Indivisible Project co-founder Angel Padilla.

But the pro-ACA groups are up against formidable foes. Republicans intent on not only dismantling the ACA but capping the open-ended nature of Medicaid are getting backing from money powerhouses such as the American Action Network, which is aligned with House Republicans, and One Nation, a group with ties to Senate GOP leadership that’s spending millions of dollars targeting vulnerable Democratic senators up for reelection in 2018.

Data Note: Variation in Per Enrollee Medicaid Spending Across States

Data Note: Variation in Per Enrollee Medicaid Spending Across States

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President Trump and other GOP leaders have called for fundamental changes in the structure and financing of Medicaid along with repeal of the Affordable Care Act (ACA). The GOP has proposed transitioning Medicaid from its current structure that provides an entitlement to coverage and provides states guaranteed federal matching dollars with no pre-set limit to a block grant or per capita cap. A block grant would limit all federal Medicaid spending and per capita cap could limit federal funding per enrollee. To understand per capita cap proposals, it is helpful to understand variation in per enrollee spending and per enrollee spending growth across states and enrollment groups.  A per capita cap policy could lock in historic variation.  A more detailed analysis of per enrollee spending can be found in this brief. This data note uses interactive maps and tables to show variation in per enrollee spending and spending growth by state and eligibility group.

KHN On Call: When Is ACA Repeal For Real?

http://khn.org/news/khn-on-call-whats-next-for-the-aca/?utm_campaign=KFF-2017-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=43341984&_hsenc=p2ANqtz-9_1GvdgggkqzXvKT5fq_mHP4_2YnM-JB9ak6X07OsxNOeRkPvXsuNMM6Ar2K0ZNnRUpliWC_lblb9JzfI-iC7Q5W2WEw&_hsmi=43341984

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Health care under the Affordable Care Act is poised to change — again. The Republican-led Congress has vowed to “repeal and replace” the health law known as Obamacare.

That has left many people anxious and confused about what will happen and when. So NPR’s Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead.

Many of the questions or comments that have come in so far have to do with timing. For example, Steva Stowell-Hardcastle of Lewisburg, Pa., said, “I’m confused about what parts of the ACA have been repealed and when those changes take place.”

First, while some parts of the huge health law have been altered since it passed in 2010, nothing substantive has been repealed in 2017.

Amid Repeal Debate, Public Views Obamacare More Favorably Than Unfavorably

Amid Repeal Debate, Public Views Obamacare More Favorably Than Unfavorably

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Public Remains Split on Repeal but a Small Share, Including 31% of Republicans, Favor Repeal Without Replace

Large Majorities Want to Continue Federal Funding for Medicaid Expansion; Two Thirds Favor Current Federal Role over Block Grants or Per-Capita Caps

As President Trump and Congress weigh repealing the Affordable Care Act, the latest Kaiser Health Tracking Poll finds more Americans viewing the law favorably than unfavorably (48% compared to 42%). This is the highest level of favorability measured in more than 60 Kaiser Health Tracking Polls conducted since 2010.

The shift largely reflects more favorable views among independents, who now are more likely to view the law favorably (50%) than unfavorably (39%). Most Democrats (73%) continue to view the law favorably while most Republicans (74%) view it unfavorably.

In spite of these more favorable views, the public remains divided along partisan lines on whether Congress should (47%) or should not (48%) repeal the law. At the same time, more of those who favor repeal want lawmakers to wait until the details of a replacement plan are known (28% overall) than want Congress to repeal immediately and work out the replacement’s details later (18% overall).

Even among Republicans, while the majority want to see Congress vote to repeal the law – fewer want them to vote to repeal the law immediately (31%) than want them to wait until they have the details of a replacement plan announced (48%), and 16 percent of Republicans do not want the law repealed at all.

Kaiser Health Tracking Poll: The Public’s Views on the ACA

http://kff.org/interactive/kaiser-health-tracking-poll-the-publics-views-on-the-aca/#?utm_campaign=KFF-2017-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=43341984&_hsenc=p2ANqtz-86QHWrVmP48BmyhPmTDVzazJzgFw37Y9zF2saKAABCYN_VGfiT50yr02b8kiJf-WmBSkdlh44Cmpb6p44N6sOQUKft_Q&_hsmi=43341984&response=Favorable–Unfavorable&aRange=twoYear

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The public has remained deeply divided on the health reform law since it was passed in March 2010. Click below to examine how specific groups feel about the law and how those opinions have changed or not changed over time.

We asked: “As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?”