March 11, 2017

Obamacare repeal issues

Political Wire - “Americans who swept President Trump to victory — lower-income, older voters in conservative, rural parts of the country — stand to lose the most in federal healthcare aid under a Republican plan to repeal and replace the Affordable Care Act,” according to a Los Angeles Times analysis of county voting and tax credit data. “Among those hit the hardest under the current House bill are 60-year-olds with annual incomes of $30,000. In nearly 1,500 counties nationwide, such a person stands to lose more than $6,000 a year in federal insurance subsidies. Ninety percent of those counties backed Trump, the analysis shows.”

Huffington Post - Repealing the Affordable Care Act is going to be a windfall for America’s wealthiest families, even as it wipes away programs that have allowed millions of poor and middle-class Americans to get health insurance. A new government report shows just how big that windfall is. According to that analysis, which the Joint Committee on Taxation prepared shows households with incomes of more than $1 million will get tax cuts that, over the next decade, would add up to roughly $157 billion.

The American Hospital Association, which represents 5,000 hospitals and health care organizations, over 270,000 physicians, and 2 million nurses, came out against the Republicans’ new health care plan.“We ask Congress to protect our patients, and find ways to maintain coverage for as many Americans as possible,” wrote Richard Pollack, the president and CEO of the American Hospital Association.

Overall, it would be “a big transfer. This is a massive tax cut for unpopular industries and wealthy individuals,” said Andy Slavitt, who was acting administrator of the Centers for Medicare and Medicaid Services during the final years of the Obama administration. “It is about cutting care for lower-income people, seniors, people with disabilities and kids to pay for the tax cut.”... 
There were many ways that Obamacare also redistributed the burden of medical costs — from the sick to the healthy, with provisions such as the one denying insurers the ability to refuse coverage to people with preexisting conditions; from the old to the young, with a mandate that everyone have coverage or pay a penalty; from the rich to the poor, with an array of new taxes.
By contrast, “the Republican plan, as outlined right now, really is centrally about income redistribution, of the reverse Robin Hood variety,” said Austan Goolsbee, a University of Chicago economics professor who was chairman of Obama’s Council of Economic Advisers

Millions of people who get private health coverage through the Affordable Care Act would be at risk of losing it under the replacement legislation proposed by House Republicans, analysts said Tuesday, with Americans in their 50s and 60s especially likely to find coverage unaffordable.
Starting in 2020, the plan would do away with the current system of providing premium subsidies based on people’s income and the cost of insurance where they live. Instead, it would provide tax credits of $2,000 to $4,000 per year based on their age.

But the credits would not cover nearly as much of the cost of premiums as the current subsidies do, at least for the type of comprehensive coverage that the Affordable Care Act requires, analysts said. For many people, that could mean the difference between keeping coverage under the new system and having to give it up.

The American Health Care Act, as Republicans are calling it, would allow insurers to make premiums for older Americans five times what they charge younger workers - provided that a state’s regulations allow for it. Obamacare had capped this ratio, known as an “age rating,” at 3 to 1.

The new House Republican health plan would shift an estimated $370 billion in Medicaid costs to states over the next ten years, effectively ending the Affordable Care Act’s Medicaid expansion for 11 million people while also harming tens of millions of additional seniors, people with disabilities, and children and parents who rely on Medicaid today.

Here's a sweet deal for insurers buried in the GOP's new Obamacare bill. Health insurance companies could realize a $1 billion or more windfall over the next decade — and end up paying their CEOs even more money — because of a simple tweak in the GOP's proposal to replace Obamacare. That tweak, buried in cryptic language on page 67 of the bill, would end the $500,000 cap that health insurers currently have under the Affordable Care Act on deducting the cost of executives' compensation as business expenses on their taxes.

While official numbers are not available on the number of people who would lose coverage, "a report from Standard & Poor’s estimated that two million to four million people would drop out of the individual insurance market, largely because people in their 50s and early 60s—those too young to qualify for Medicare—would face higher costs," reports the Times. "Other analysts, including those at the left-leaning Brookings Institution, have estimated larger coverage losses."

"Legislation could also fundamentally weaken the insurance market by doing away with the so-called individual mandate, which requires people to have coverage or pay a tax penalty," reports the Times. "While it would be replaced by a 30 percent surcharge when someone buys a policy after dropping coverage, the surcharge could be weaker than the current mandate, and younger people might continue to gamble on not having coverage until they get sick. The result, said Donald H. Taylor Jr., a health policy professor at Duke University, is that people who buy coverage are sicker, causing the cost of premiums to soar."

The American Medical Association, the largest association of doctors in the country, warned House lawmakers on Wednesday that the GOP's Obamacare replacement plan introduced earlier this week is "critically flawed" and puts millions of Americans at risk of losing their coverage. The association's president, Andrew Gurman, says his group's highest priority is to ensure the largest number of people are guaranteed health coverage and complained it is impossible with the Republican plan — the American Health Care Act — to determine how many people would get or lose coverage compared to former President Barack Obama's Affordable Care Act. "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," Gurman said.
The measure was chief among the reasons AARP, the nation’s largest organization for older Americans, cited in explaining its opposition to the House bill.

Look beyond the bill’s quasi-mandate and tax credits, and the Obamacare replacement bill is a $600 billion tax cut, with the benefits going almost entirely to the wealthy. To pay for its spending, Obamacare included several taxes on couples making more than $250,000, like a 3.8 percent surtax on investment income and a 0.9 percent surtax on wages. Last year, those levies brought in about $27 billion, according to Wall Street Journal analysis of IRS data. Repealing them would cost about $275 billion over the next decade; which is to say, it would transfer $275 billion from public-health spending to the richest 1 or 2 percent. Other provisions, like repealing the limit of flexible spending accounts and expanding health savings accounts, will also disproportionately benefit the rich.
A US Representative from Kansas has apologized for his remarks that poor people do not want healthcare, a statement that has echoes in the White House. In an interview about healthcare with Stat News, Obstetrician Roger Marshall argued that the Affordable Care Act could not be structured to only benefit those with low incomes. "Just like Jesus said, ‘The poor will always be with us.’ … There is a group of people that just don’t want health care and aren’t going to take care of themselves," he told the publication. "Just, like, homeless people. … I think just morally, spiritually, socially, (some people) just don’t want health care," Mr Marshall continued. "The Medicaid population, which is (on) a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising."

Kirsten Gillibrand:
1. It allows health insurance companies to charge older Americans up to five times more.

2. It repeals the employer mandate, causing many families covered by their employers to lose coverage.

3. It will take insurance away from millions of individuals and cripple state budgets by phasing out the Medicaid expansion.

4. It gives health insurance companies a tax break for CEO pay over $500,000.

5. It defunds Planned Parenthood, leaving millions without access to breast exams, birth control, and pap smears

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