The Bishop and the Butterfly: Murder, Politics, and the End of the Jazz Age
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    GOPs Same Old Health Care Plan to Be Unveild

    By oldenGoldenDecoy on Mon, 03/06/2017 - 6:31pm |

     

    February 06, 2017 at 6:10 PM | WaPo

    House Republicans release long-awaited plan to repeal and replace Obamacare

    (Pertinent snippets)

    Legislation to repeal the health-care law, drafts of which are expected to emerge as early as Monday evening, will propose refundable tax credits that would hinge on earnings as well as age.

    The goal of lessening the government’s role also is behind another major change from the ACA that the Republican plans envision: getting rid of the federal requirement on insurers to include a minimum set of “essential benefits” in health plans sold to individuals and small businesses.

    The member of Congress who was briefed on changes to the proposal over the weekend said that drafters were not only moving toward capping the tax credit, but were also exploring how to avoid taxing employer-provided plans for the first time — something that could provoke a fierce response from conservatives. Instead, the member said, the cost of the scaled-back tax credits could be offset by savings gained by rolling back the ACA’s Medicaid expansion over the coming years.

    ====

    Four key Republican senators said they would oppose any new plan that would leave millions of Americans uninsured.

    Sens. Rob Portman (R-Ohio), Shelley Moore Capito (R. W.Va.), Cory Gardner (R-Colo.) and Lisa Murkowski (R-Alaska) said they would vote against any reform bill that fails to protect Americans who became eligible for coverage under the ACA’s expansion of Medicaid, the government-run health program for the poor and disabled.

    All four senators represent states that opted to expand their Medicaid program under the ACA.

    ====

    With 52 Republicans, McConnell would not have enough votes to pass repeal without the support of at least two of those senators.

    ====

     

    ~OGD~

     

     

    Comments

    Here are the key parts:

     

    The bill, called the American HealthCare Act (AHCA), does away with Obamacare's individual mandate that compels all American to buy insurance or face a fine. Instead, it has penalties such as increased premiums for failing to maintain continuous access to coverage.

    The new AHCA also shifts funding for people accessing healthcare outside of an employer or Medicare/Medicaid and adjusts funding for the expansion of Medicaid.

    • Effectively defund Planned Parenthood: The bill prohibits "direct spending" of federal dollars on any "prohibited entity" including those that provide abortions for anything other than the life of the mother, incest, or rape. This would seem to include Planned Parenthood.
    • Allow people with pre-existing conditions to access coverage, but penalize lapses in coverage: Under the new law, insurers still could not deny coverage based on a pre-existing conditions, but anyone who does not have coverage for a period of 63 days or more in the previous year is subject to a 30% increase in premiums as a penalty. The idea here is to keep people from waiting until they are sick to access coverage without a penalty.
    • Move to block tax credits for individual to access health insurance: Instead of the ACA's tax credits which adjusted the amount given based on income and the beneficiaries residence, the AHCA would give lump tax credits to Americans.
    • Providing grants to establish high risk pools and encourage enrollment: Much like the leaked draft, the AHCA would have a fund for states to institute a number of programs to stabilize the insurance market, most notably "the provision of financial assistance, high-risk individuals who do not have access to health insurance coverage offered through an employer." This would allow states to establish high risk pools for people with pre-existing conditions, a plan often floated by Republicans. The plan would give states a total of $15 billion in each 2018 and 2019 and $10 billion every year after that through 2026.

    House Speaker Paul Ryan said in a statement that the plan will help reform the American healthcare system for the better.

    Business Insider - March 06, 2017

    ~OGD~


    by oldenGoldenDecoy on Mon, 03/06/2017 - 7:23pm

    I foresee a rash of "lapses in coverage" for people who have pre-existing conditions or need expensive care.

    And the Republican administrations, state or federal, are not going to assist you when for profit Wall Street health insurance corporations claim you had a 'lapse of coverage'.  Meaning: we don't want you anymore.

    There were ardent Germans who never stopped 'believing' their demagogue would 'win' for them, until Russian artillery shells came through their neatly tiled roofs.


    by NCD on Mon, 03/06/2017 - 8:32pm

    NYT:

    The bill would also repeal subsidies that the government provides under the Affordable Care Act to help low-income people pay deductibles and other out-of-pocket costs for insurance purchased through the public marketplaces. Eliminating these subsidies would cause turmoil in insurance markets, insurers and consumer advocates say.  However, the House Republicans would provide states with $100 billion over nine years, which states could use to help people pay for health care and insurance.

    $100 billion over 9 years for subsidies for people with high and expensive needs for health care they cannot afford, called "Risk Pools".  It equals $11 billion a year, for the nation.

    $11 billion a year amounts to a whopping 0.3% of our $3.35 trillion a yearly health care expense.

    These are not "risk pools" they are "death pools".

    At a minimum health experts said $150 billion a year would be needed to serve high needs people without the means to pay for care, and the expert said 'risk pools' are the absolute worst way to cover a population.


    by NCD on Tue, 03/07/2017 - 12:31am

    Lots to chew on there OGD, thanks.  By the way, read this somewhere else but it's a good point. . .is the penalty for not having coverage a tax, the basis upon which ACA survived S. Ct the first time?  Doesn't seem to be, it's a premium increase that would not go to the government as I understand it.


    by Bruce Levine on Mon, 03/06/2017 - 8:40pm

    Bruce... the answer to your question...

    From ObamaCareFacts,com

    The ObamaCare Mandate and How You Can Qualify for an Exemption from the Tax “Penalty.”

    If you decide not to get coverage and don’t qualify for an exemption, then you’ll have to make an Individual Shared Responsibility payment on your income tax return for each month you went without minimum essential coverage.

    --snip--

    Those who can afford it and choose not to purchase health insurance, the tax will be unavoidable. The money collected from these taxes goes towards funding ObamaCare and subsidizing hospitals, which will have to cover unpaid emergency room visits. The money is also a down payment on your almost inevitable use of the health care system.

    NOTE: ObamaCareFacts.com is a free informational website, nothing on our site should be taken as legal advice.  Check out the official IRS website on exemptions and the Individual mandate for additional details.

    ~OGD~


    by oldenGoldenDecoy on Tue, 03/07/2017 - 2:49am

    Thanks man. 


    by Bruce Levine on Tue, 03/07/2017 - 5:33am

    And Congressman Chaffetz defines the debate--it's a choice between i-phones or health insurance.  Oh man.

     


    by Bruce Levine on Tue, 03/07/2017 - 9:05am

    Especially since the cost of an I-phone wouldn't even get you one month's premium of virtually any unsusidized plan. surprise Even on the exchange, one month's premium costs at least that much for someone with a decent income.

    It's like Geo. Bush Sr. and the cost of a gallon of milk.


    by artappraiser on Tue, 03/07/2017 - 12:43pm

    p.s. It constantly slays me how everyone involved in planning this for us has no idea of the actual money involved! Not just the lawmakers with dandy coverage they don't have to think about, a lot of providers, too. I used to pay out of pocket a couple years back and when I would challenge docs wanting certain tests I thought I didn't need, asking "but how much would it cost?" they would always say proudly "I don't know anything about costs." Which would be a fine and dandy professional attitude IF we were involved in a non-profit system like we should be. But sucks when we are all trying to navigate the profit motive being involved in an area where it doesn't belong.

    Edit to add: most employers who provide health insurance to employees would be thrilled if employees understood that the coverage they are given costs like 25 or more I-phones a year!


    by artappraiser on Tue, 03/07/2017 - 12:59pm

    We pay $1000.00 per month for our coverage through my husband's job with the feds.  It isn't free. I believe the total cost of our health insurance premiums is 25460.00 per year. I believe most people do indeed understand the costs of their insurance as most of us pay for a portion of our health insurance. But for sure federal employees understand, we pay almost 50% of our own premiums. Do we get great coverage, you bet, it's great health insurance and we do have many choices as you say, but we most certainly pay for it, and it isn't cheap. 


    by tmccarthy0 on Tue, 03/07/2017 - 1:14pm

    Thanks for putting actual prices out there, tm. And I for one didn't know fed employees were paying 50%.


    by artappraiser on Tue, 03/07/2017 - 1:58pm

    My views on this (and some of you know I'm now an in-house general counsel for a group of union-employer benefit trust funds), and it may sound too simplistic, is that one thing I believe everyone outside of safe GOP districts in the House can agree on, is that repeal and replace is just plain dumb.  I have no problem, and I'm sure most of us don't with realistic proposals to reduce costs and to tinker with Obamacare in a serious way that doesn't hurt people. But first we have to know what folks want to change, if anything.  And then as we know, if you mess with, for example, the mandate, how do you get healthy young folks to buy insurance and expand the pool?  I'd like some bold republican or one afraid of losing his or her seat to call for putting the breaks on repeal and replace.  I also want. . .I know. 


    by Bruce Levine on Tue, 03/07/2017 - 1:35pm

    Your quandary should actually be a main point to them all. Health care negotiations are major major major money, make the whole economic world go round. Uncertainty: no good.


    by artappraiser on Tue, 03/07/2017 - 1:45pm

    Bruce... check this...

    From Sarah Kliff at Vox:

    http://www.vox.com/2017/3/6/14829526/american-health-care-act-gop-replac...

    AHCA, unlike Obamacare, does not mandate that all Americans be covered by health insurance or pay a fee.

    Instead, it has a different way of penalizing people who decide to remain uninsured: requiring those who don’t maintain “continuous coverage” to pay a hefty fine when they want to reenter the insurance market.

    This continuous coverage policy has shown up a lot in Republican replacement plans. It was part of Speaker Ryan’s A Better Way proposal and Rep. Tom Price’s Empowering Patients First Act.

    Here’s how it works: If a worker goes straight from insurance at work to her own policy, her insurer has to charge her a standard rate — it can’t take the cost of her condition into account.

    But if she had a lapse in coverage longer than 63 days — perhaps she couldn’t afford a new plan between jobs — and went to the individual market later, insurers could charge her a 30 percent premium surcharge. She would need to pay that higher premium for a full year before returning to the standard rate.

    A Congressional aide clarified that this surcharge would be the same for both healthy and sick people; insurers could not use it to turn away people they expect to have significantly higher medical costs.

    This might end up having unintended consequences, because only the people who really need insurance — and who have high medical costs — may want to pay the surcharge. Healthy people might be more comfortable staying out of the individual market for longer, perhaps until they get a job that offers coverage. That could drive up premiums for everybody.

     

    ~OGD~

     


    by oldenGoldenDecoy on Tue, 03/07/2017 - 6:41pm

    Bruce... check this...

    From Sarah Kliff at Vox:

    http://www.vox.com/2017/3/6/14829526/american-health-care-act-gop-replac...

    AHCA, unlike Obamacare, does not mandate that all Americans be covered by health insurance or pay a fee.

    Instead, it has a different way of penalizing people who decide to remain uninsured: requiring those who don’t maintain “continuous coverage” to pay a hefty fine when they want to reenter the insurance market.

    This continuous coverage policy has shown up a lot in Republican replacement plans. It was part of Speaker Ryan’s A Better Way proposal and Rep. Tom Price’s Empowering Patients First Act.

    Here’s how it works: If a worker goes straight from insurance at work to her own policy, her insurer has to charge her a standard rate — it can’t take the cost of her condition into account.

    But if she had a lapse in coverage longer than 63 days — perhaps she couldn’t afford a new plan between jobs — and went to the individual market later, insurers could charge her a 30 percent premium surcharge. She would need to pay that higher premium for a full year before returning to the standard rate.

    A Congressional aide clarified that this surcharge would be the same for both healthy and sick people; insurers could not use it to turn away people they expect to have significantly higher medical costs.

    This might end up having unintended consequences, because only the people who really need insurance — and who have high medical costs — may want to pay the surcharge. Healthy people might be more comfortable staying out of the individual market for longer, perhaps until they get a job that offers coverage. That could drive up premiums for everybody.

     

    ~OGD~


    by oldenGoldenDecoy on Tue, 03/07/2017 - 6:41pm

    Interesting OGD, thanks.  Highlights what often is the folly of predicting what rational human behavior looks like.  In short, absent any kind of penalty or tax or whatever Obamacare has, a young healthy person might not buy insurance just because it's cheaper than what the guy down the street is paying.  In the meantime, sick folks don't care about the premium-they need the insurance, period.  Thanks OGD, starting to realize how much I need to catch up on.  Kind of complicated.


    by Bruce Levine on Tue, 03/07/2017 - 7:27pm

    The i-phone is the 2017 version of the "welfare/cadillac queen" whistle or, at best it's a concession that anything that the House intends to push will require lower income folks to tighten their belts.  Or it was just a completely stupid and insensitive thing for him to say.  Or a combination of all or none of the above.  [Things are happening too quickly these days.]


    by Bruce Levine on Tue, 03/07/2017 - 1:25pm

    It seems like it was only a couple years back when "big screen TV" was the replacement whistle, until pol staffers finally got them to realize that the price of those had fallen a great deal.

    Edit to add: Got to hand it to Apple that their P.R. continues to scream: we sell desirable luxury goods! cheeky


    by artappraiser on Tue, 03/07/2017 - 1:47pm

    They do know how to market, indeed.


    by Bruce Levine on Tue, 03/07/2017 - 1:49pm

    Your iPhone can be a tremendous health aid. It can monitor your steps and calories expended in walking or jogging. It can remind you when to take medications. It can alert you to adverse interactions between prescribed drugs. It can keep a record of your blood pressure and serum glucose. The cost of an iPhone could save you health care dollars.


    by rmrd0000 on Tue, 03/07/2017 - 1:35pm

    good job sounding here like some of the mailers from my health insurance wink


    by artappraiser on Tue, 03/07/2017 - 1:40pm

    They will have to pry my iPhone and iPad from my cold, dead hands. (Until the next electronic shiny ball comes along.)


    by rmrd0000 on Tue, 03/07/2017 - 2:07pm

    Belongs on this thread as well as the other I just posted it on:

    Powerful conservative groups line up against House GOP health plan

    Heritage calls it 'bad policy.' FreedomWorks pans it as 'Obamacare-lite.' And the Club for Growth called it a 'warmed-over substitute for government-run health care.'

    Politico.com, Updated 03/07/17 02:11 PM EST


    by artappraiser on Tue, 03/07/2017 - 2:19pm

    same @ the NYTimes: Conservatives in Revolt Over G.O.P. Health Care Bill

    By JENNIFER STEINHAUER 1:47 PM ET

    Before the bill has even reached House committees, conservative senators and groups have come out against the plan to replace the Affordable Care Act.


    by artappraiser on Tue, 03/07/2017 - 3:20pm

    Trump's already walking back on any ownership of the House Bill:

     


    by artappraiser on Tue, 03/07/2017 - 8:55pm

    huh, meeting with Trumka a few hours before & he avoids the topic of whether they talked health insurance:

    Trump meets with union president amid conflict over health care

    By Dan Merica, CNN, Updated 8:55 PM ET, Tue March 7, 2017

    President Donald Trump and AFL-CIO president Richard Trumka met at the White House hours before the union president blasted the health care plan backed by House Republicans and the Trump administration on Tuesday.

    While Trumka said the duo spoke about wages, trade and infrastructure during the meeting, it doesn't appear that they spoke about health care -- an issue the union leaders slammed the President on hours after meeting with him [....]
    uncle, I give, time to let this lay a couple days, I think just spinning wheels to follow it, going to let the good journos like Sarah Kliff do the leg work.

    by artappraiser on Tue, 03/07/2017 - 9:33pm

    Sean Spicer says, when it comes to health care legislation, size does matter:

     


    by Bruce Levine on Tue, 03/07/2017 - 3:37pm

    hilarious, thanks for sharing

    you've got me looking at that whole feed and clearly CNN is all excited to have Spicer back again live on teevee, they want some of that pure gold before SNL writers and Melissa McCarthy grab onto it.


    by artappraiser on Tue, 03/07/2017 - 3:48pm

    Circum sized or circus size? They keep doing 3-ring-binder/3-ring circus thing of a "folders on a desk" prop expecting us to be convinced of something. At least Romney had folders full of women - that had some (fatal) attraction. But folders full of blank copying paper? I may have been born at night, but not last night...


    by PeraclesPlease on Tue, 03/07/2017 - 5:22pm

    Binders full of women. Sounds like some S&M kink to me.


    by ocean-kat on Tue, 03/07/2017 - 6:03pm

    You know Mormons...


    by PeraclesPlease on Tue, 03/07/2017 - 6:58pm

    You would think that Donald Trump would insist on having the health plan that makes the highest stack of papers, more than anyone's. . .the best stack.


    by Bruce Levine on Tue, 03/07/2017 - 7:28pm

    AARP doesn't seem to like the House bill very much.


    by Bruce Levine on Wed, 03/08/2017 - 9:46pm

    nor the AMA nor the American Hospital Federation; that makes one pretty yuge grand trine; I add my thoughts at the link which goes to OGD's new thread.


    by artappraiser on Wed, 03/08/2017 - 9:59pm