This is not a Healthcare Bill. It is a tax cut and Medicaid reduction bill - 300 billion tax cut for the super rich over 10 years, an $880 million cut to Medicaid over 8 years. It even allows states to impose work requirements for Medicaid.
Universal coverage, the dream behind the Affordable Care Act, to make sure that all Americans had access to affordable quality health care, is gone. This was never even a GOP consideration.
The analysis which follows makes that clear.
The bill will cause millions to lose health insurance coverage. We don't know how many because this final version has not yet been scored by the nonpartisan Congressional Budget Office to estimate how many people it would cover and how much it would cost. The most recent score for the bill, before new amendments offered in recent weeks, found that 24 million more people would be uninsured by 2026.
Still, even without the CBO score, we have a very good sense of how the bill would work, whom it benefits, and whom it disadvantages.
First, the individual mandate is gone. We are ten steps further away from a country with universal health care.
This bill, if it passes the Senate, would get rid of the penalty imposed for not having insurance. Instead, One of its provisions- a one-year 30 percent surcharge that insurers could tack onto their rates-may well become an open invitation for people to game the system...have no insurance and then be penalized 30 percent for one year.
Two other provisions of the Affordable Care Act also no longer apply.
One, insurers no longer have to charge the same price to everyone regardless of their health history, as they did under the Affordable Care Act. That would, in practical terms, end a key protection for people with preexisting conditions. In specific, an amendment written last week by Rep. Tom MacArthur (R-N.J.) allows states to obtain a waiver from the Health and Human Services Department to charge customers with preexisting conditions more than other people. If HHS did not respond to a state's waiver request within 60 days, the requested change would automatically go into effect.
How does one define pre-existing conditions? The bill does not spell out either what sort of preexisting conditions insurers may take into account if states seek a waiver from the existing federal law. In the past, some insurers had identified domestic violence, sexual assault, Caesarean section and postpartum depression as grounds for either denying coverage or charging higher premiums. The list has also sometimes included asthma, congenital conditions and more. And yes, HIV/AIDS is sure to make the list which we can expect will grow.
Two, insurers no longer have to cover "essential health benefits," including such as maternity care and emergency services. The House bill would change that, leaving it up to each state whether to preserve this rule or create its own set of coverage requirements — or no requirements at all. The bizarre conversations by members of the the GOP during the lead up the vote make this lack of definition dangerous. Remember Rep. John Shimkus (R-Ill.) who argued that one reason Republicans are unhappy with the Affordable Care Act is because men must pay for health care plans that cover maternity services.
Public Health programs would also be severely affected.
The GOP bill eliminates funds for fundamental public health programs, including for the prevention of bioterrorism and disease outbreaks, as well as money to provide immunizations and heart-disease screenings. It guts something called the Prevention and Public Health Fund, which provides almost $1 billion annually to the Centers for Disease Control and Prevention. That fund accounts for about 12 percent of CDC's total budget. If the GOP bill eventually becomes law, those public health monies would be eliminated starting in October 2018.
A significant portion of those funds, about $625 million a year, goes directly to state and local health departments. If prevention funding is lost, public health advocates warn that Americans will be at greater risk for vaccine-preventable disease, food-borne infections and deadly infections contracted in hospitals. One of the biggest recipients of the prevention fund is the CDC's immunization program, which last year received $324 million. The money is sent directly to states and local communities to improve immunization infrastructure, such as registries that allow providers to know which patients have received what vaccines.
The effect on Older Americans would be devasting.
First, the bill would end Medicaid as an open-ended entitlement to health care and would put the program on a budget. States would receive an allotment of federal money for each beneficiary, or, as an alternative, they could take the money in a lump sum as a block grant, with fewer federal requirements. Medicaid cuts would total $880 billion over 10 years.
Insurance companies would be allowed to charge a 64-year-old customer five times the price charged to an 18-year-old one, to cite the most extreme example.
The changes in the subsidy formula would also require older middle-class Americans to pay a much larger share of their health insurance bill. The Congressional Budget Office estimates that far fewer older Americans would have insurance coverage under this bill than under the Affordable Care Act. it also allows states to impose Medicaid work requirements.
What else? Like the Elderly, poor people can be expected to suffer terribly under this bill, since it substantially eliminates the subsidies available for Americans just over the poverty line, the group that benefited most from the Affordable Care Act subsidies.
Poor Americans would be much more likely to become uninsured under the bill, according to the Congressional Budget Office, and those who retained coverage would pay much more of their limited incomes on premiums and deductibles.
Ah, but here is the punchline: there are clear Winners of TrumpCare.
The bill would cut the taxes of high-income people by nearly $300 billion over 10 years by repealing a payroll tax increase and a tax on their investment income imposed by the Affordable Care Act.
The bill eliminates two taxes on individuals earning more than $200,000 or couples earning more than $250,000: a 0.9 percent increase on the Medicare payroll tax, and a 3.8 percent tax on investment income. It also allows people to save more money in tax-excluded health savings accounts, a change most useful to people with enough money to have savings.
This is not a healthcare bill at all. When it touches on healthcare, it's only concern is taxes.
Even its minimal way to help people buy insurance, if they do not have coverage at work or under a government program like Medicare or Medicaid, or through the Department of Veterans Affairs, is about taxes. The bill offers $2,000 to $4,000 a year tax credits, depending mainly on age.
A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making over $75,000 a year and families making over $150,000. There would no longer be any subsidies.
The bill would also provide states with $138 billion over 10 years that could be used for various purposes like subsidizing premiums, providing coverage to people with pre-existing conditions and paying for mental health care and the treatment of drug addiction. This is the Upton Amendment from Rep. Fred Upton (R-MI) which claims to protect people with pre-existing conditions. If I were you, I wouldn't bet on it.
FInally, and this is the most important takeaway - it is really a tax cut for the very rich plus a way to cut Medicaid and public health programs.
This bill is not yet law. It needs to pass the Senate. Will it?
That is not clear. Before the Senate could even consider it, the bill would need to pass muster with the Senate parliamentarian, who would scrutinize it to ensure it fits within the chamber's rules on considering only matters with budgetary implications under the reconciliation process. Recent changes to the House bill — such as giving states power to decide whether to keep or jettison a set of essential health benefits that the ACA requires many health plans to include — could be an obstacle.
If and when the bill gets past the parliamentarian, many senators are wary especially of the changes the legislation would make to Medicaid.
The fate of this bill rests with you. Call those who voted for it and tell them you will remember. Call your Senators and tell them to reject this bill. Tell them what kind of America and what kind of Senator you want. As Nancy Pelosi said, this bill is a "moral monstrosity," posing as a healthcare bill
May 5,2017. A sad day in the history of the House of Representatives.
Addendum. Barron's predicts Hospital stock shares will fall. What else? Look for personal bankruptcies to increase. The Affordable Care Act had cut them by 50% since it began.
Here's another analysis of how this dreadful bill would hurt Americans, including people with insurance from their employers and people with disabilities and children in special education programs.
And I didn't even mention that the GOP House tried to exempt itself from the abhirrenbill they passed. That was finally changed. Read the sad hypocrisy here.