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Friday, June 23, 2017

A Tale Of Two Tweets — And Discussion Of The Senate's 2017 Bill For Healthcare Reform





And what of the most recent healthcare bill, which some have called ObamaCare Lite? According to the Conservative Tribune:
...Both the House and Senate versions of health care reform would get rid of the individual mandate, phase out Medicaid expansion, eliminate Obamacare’s onerous taxes on the wealthy and defund Planned Parenthood for at least one year.

The bills differ in regard to subsidies for purchasing insurance, as well as the rate at which Medicaid expansion would be stopped. The Senate has proposed a more gradual path than the House put forward....
Business Insider offers this detailed rundown of the Senate version, known as the Better Care Reconciliation Act of 2017 (as well as the full version of the bill):
Tax credits:

What's in the bill: To help people pay for insurance, the Senate bill proposes tax credits based on income level, a feature of Obamacare, rather than on age, as the House bill calls for. The bill would make anyone earning up to 350% of the poverty level eligible for credits; Obamacare caps that at 400%. It would, however, adjust the credits so they were less generous as a person aged. for instance, a person age 33 making 175% of the federal poverty limit would receive enough in credits so they were spending 5.3% of their income on premiums. For people over age 59, that would increase to 8.3% of their income. Additionally, the credits would be capped at a lower percentage of overall medical costs than those under Obamacare, making them less generous overall.

What it means:
While the tax credits would be more generous for older Americans than the House bill, fewer middle-income people would get financial support to pay for coverage — and those who do would get less.


Medicaid expansion:


What's in the bill: Obamacare's Medicaid expansion, which extended the program to those making 100% to 138% of the federal poverty limit, would be phased out over four years. 90% of the current federal funding would be provided in 2020 and it would decrease by 5% each year until 2023, after which it would be eliminated. People would not be allowed to join the expansion from 2020 onwards. The tax credits will be available to people that fall off the expansion.

What it means: While this would save the federal government money, it also means the millions of people that have gained access to Medicaid would be rolled off. These people would be able to fall back on the less generous tax credit and access coverage through the individual insurance market.


Medicaid spending growth:

What's in the bill: The Senate bill retains the House's per capita cap for federal Medicaid spending. After 2025, however, growth in spending would shift from the consumer price index for medical care to the CPI for all goods, a lower level of growth.

What it means: States would receive less funding each year from the federal government to help cover low-income Americans, and after 2025 the rate of growth would decline, leading to even deeper potential cuts for the program.


States can institute Medicaid work requirements:


What's in the bill:
This would allow states to create a provision under which people must maintain employment, as the state defines, for a period of time, also determined by the state, in order for a person to receive Medicaid.

What it means:
This is another long-time wish for Republicans, but it also gives a significant amount of leeway to states to define what counts as work and for how long someone has to hold a job. It does not apply to students, pregnant women, or the disabled.


Cost-sharing subsidies:


What's in the bill:
The bill would allocate money for cost-sharing subsidies through 2019. These payments offset the costs for insurers to offer low-income Americans plans with smaller out-of-pocket costs. The uncertainty around these payments has led to instability in the individual insurance market.

What it means: This should reassure insurers desperate for guidance ahead of the 2018 plan year and could bring down premium increases for next year's individual insurance market.



State waivers for Obamacare regulations:

What's in the bill:
The Senate bill would allow states to request a waiver to opt out of Obamacare's so-called essential health benefits, which mandate that all plans must cover 10 basic types of care. The ability to opt out of providing those benefits was a key sticking point in the House legislation, and its inclusion ultimately allowed it to pass. The Senate bill, however, would not allow states to repeal community rating, the provision mandating that all people of the same age in the same area be charged the same amount. That's a change from the House bill, which drew criticism from health-policy experts who said a repeal of community rating would allow insurers to charge people with preexisting conditions more.
What it means: If a state receives a waiver for the EHBs, this would allow skimpier coverage offerings on the state's insurance market, which would have cheaper premiums but higher out-of-pocket costs.



Repeal Obamacare's taxes:

What's in the bill:
Much like the House version, the Senate would do away with things like Obamacare 3.8% tax on investment income on people earning an annual income above $200,000.

What it means: The taxes in Obamacare fall predominantly on a small percentage of wealthy Americans, who would see their tax bills fall. For instance, Republican megadonor and casino magnate Sheldon Adelson could have his 2017 tax bill cut by roughly $44 million.



A fund to provide grants to fight the opioid crisis:


What's in the bill:
The bill would establish a $2 billion fund for states for programs to "support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders."

What it means: This is a one-time fund for 2018, but will likely be favored by senators from states hit hard by the opioid crisis. This was a key ask from Ohio Sen. Rob Portman.



No funds can be used for abortions:

What's in the bill: No plans purchased using funding from the bill can cover abortions. Additionally, none of the funds allocated by the bill can be given to healthcare providers that are involved with abortion.
What it means: In addition to restricting anyone who uses the credits or other funds from getting plan that covers abortions, this would effectively defund Planned Parenthood. It is unclear if this will pass Senate rules.

Here is the full bill...
Read the rest HERE.

Have at it, commenters!

21 comments:

  1. 1) I appreciate your analysis.
    2) I mean I appreciate your effort.
    3) Fell asleep 1/3 way through.
    4) I will have no influence on it's passage or content just as I had no influence on Obamacare's passage or content.
    5) I'll reserve getting upset until then.

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  2. Ed,
    3) Fell asleep 1/3 way through.

    Truth be told, the only reason that I stayed awake is that I was am on this topic.

    Overall, whatever the new healthcare law might be, I no longer have a vested interest. I am now on Medicare.

    But if I were not on Medicare, I'd be following all this -- even though I will have no influence on it's passage or content just as I had no influence on Obamacare's passage or content.

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    1. But this will effect Medicare. The two are intertwined almost as much as Medicaid. Popular Medigap plans such as F and G were planned to be phased out at the end of either 2017 or 18.. can't recall, plus pages of regs as to reimbursement including death panels.
      Let me assure you, the bill whatever it ends up in the end will be meaningless. It will be those nasty Regs that promulgate it written by some worthless government drone that will kill us. We best learn to read the Federal Register as we get notice of what rule they are about to implement.

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    2. I have been looking for a good study of the impact but google is no help. This is the nub.... will this little item be undone?
      ....
      Over the years, Medicare spending has increased to the point that the program no longer helps as many people as it could with the amount of money it supposedly generates. In other words, Medicare has become inflated due to administrative costs and other expenses that render it virtually ineffective to its enrollees. Obamacare addresses this cost discrepancy by establishing a plan to cut Medicare spending by $716 billion dollars over the next decade. By cutting costs to Medicare in the short-term, lawmakers hope to balance out the effectiveness of Medicare in the long-term. A balanced Medicare spending plan ensures that senior citizens and others who are eligible for the program receive maximum benefits.

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  3. AOW, Thank you for the thankless task of breaking this down for us. I imagine it took hours of reading and editing. I have not had the patience.

    Nothing in this bill about the free market, efforts to reduce the costs of health care, or restoring price transparency.

    Unfortunately, this issue has been framed in concrete as something government provides to people or that government rules over like a sovereign, so true reform is impossible.

    Obamacare's big expansion came by putting more people on medicaid, and the GOP bill takes that away.

    This is removing the disastrous Obamacare, and replacing it with the equally disastrous (but in different ways) GOOPcare. It will cost over $100 billion over 10 years, or something like that.

    President Trump is swaying in the breeze, taking potshots from all directions, and the GOP continually demonstrates they know nothing of conservatism, fiscal responsibility or free market capitalism. Worst of all--unlike Democrats--they suck at propaganda and communication.

    The Swamp is rising, thanks in large part to GOP sewage.

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    Replies
    1. SF,
      Thank you for the thankless task of breaking this down for us. I imagine it took hours of reading and editing.

      About two hours -- and while I was trying to choke down breakfast before striking out to give a piano lesson.

      I realize that this bill will change before it is passed -- if it even is passed at all.

      That said, I think that it's important to understand why some of the GOP Senators oppose the bill.

      This is removing the disastrous Obamacare, and replacing it with the equally disastrous (but in different ways) GOOPcare.

      Spot on!

      In a way, it is excellent because the personal mandate is canceled. BUT, at the same time, that means that health insurance will be priced out for many.

      Obamacare's big expansion came by putting more people on medicaid, and the GOP bill takes that away.

      IMO, that could mean that some in the Sandwich Generation will have to stay home to care for their elderly parent(s) because those in certain nursing homes will no longer be able to stay there.

      Or, those in the Sandwich Generation will have to foot the bill for their parents' care. Not so long ago that was the case: back in the 1950s, my father and my uncle paid for the nursing-home care of their mother, when she had to be confined because of homicidal dementia. I well remember that my uncle had to liquidate some assets and "downsize" his children's college choices.

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    2. SF,
      President Trump is swaying in the breeze, taking potshots from all directions, and the GOP continually demonstrates they know nothing of conservatism, fiscal responsibility or free market capitalism. Worst of all--unlike Democrats--they suck at propaganda and communication.

      It's hideous to watch!

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    3. $10 billion (tip money) a year over ten years?

      Do you mean the table scraps made available for vouchers as they strip down Medicaid?
      What's the net reduction? That should please you or are you just upset that Medicaid isn't cut to nothing and the poor are left to rot?

      Bottom line: This bill is a tax cut for the upper decile paid for by the poor. A freaking libertarian dream. I don't see why anyone's whining.

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    4. SF nailed if below, but you've lost your marbles if you think corporate profits = Libertarianism.....especially when the primary question regards government meddling in what should be [and used to be] a function of the market.

      Delete
    5. Ducky, Probably the bestthing for you to just shut the hell up You are an embarrassment and you are ignorant this and most other the subjects.

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    6. FJ,
      I must say that I agree with that "musician."

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    7. I repeat...

      Career politicians are a plague upon the land.

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  4. Ducky, Probably best for you to just shut up about libertarianism. You are embarrassingly ignorant of the subject. There is absolutely nothing libertarian about GoopCare.

    The GOP is just shuffling around the deck chairs, following up the Obamacare disaster with a wrecked-up disaster of their own.

    The GOP are chickenshit scared of free markets.

    Market reforms would solve 80% of health care issues for the vast majority of citizens.

    Some kind of catastrophic policy and assistance for the poor, and we would be there, but no, the Demican-Republicrat statist progs have to build another socialist program superintended by one more federal, unelected politburo.

    The very fact that we are talking about "Government taking (fill in the blank) away, indicates we are already swirling down the statist prog toilet bowl.

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  5. Defund PP for only a year? That's BS.

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  6. Government has no business in health care for non-medicaid/medicare persons. Get Out. Fixing would be simple. Tort Reform. Sue some companies for profiteering drug companies, hospitals and others. Create/allow an environment of real competition.

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  7. It seems big companies envision the end of America sooner than later and they're raking in as much cash on the way out as they can.

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  8. Republicans in the Senate could only afford to lose two votes for renaming Obamacare "Trumpcare." There are now 5 Republicans and all the Democrats opposed.

    Repeal damned Obamacare. Flush it, don't polish it.

    ReplyDelete

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