Speaker of the House Paul Ryan gave Thursday, you’ll see that he understands the problems. His argument is, basically: Democrats screwed up the health-care system. They won’t let us fix it cleanly, so if we’re going to do something, these half-measures are the best we can do. Let’s get this passed, address what we can through regulatory changes, then force Democrats to come to the table to negotiate the rest.
- .. One, the exchanges where individuals buy policies could fail, leaving people unable to buy insurance.
- Or two, the exchanges don’t fail, and we’re left with an unsatisfactory but still operational system.
.. In either case, the Republicans’ best option is to wait. Why? Because what they can do now — hastily, without touching the underlying regulations that have destabilized the individual market — is worse than either of those outcomes.
.. Stop the funding games the Democrats were using to prop up the exchanges. And if the exchanges collapse, say to the public: “Hey, look, we didn’t touch the individual market.
.. The only possible way to shore up Obamacare’s flawed design is through a big increase in subsidies for individual plans and bigger tax penalties for those who don’t participate. Democrats didn’t have the guts to do this, and they liked Obamacare.
.. Whatever it is, they’d better be prepared to do it fast, because if the individual market does collapse, there’s going to be a political crisis. They need to think about this now and have a bill ready to go as soon as it happens.
.. have the government pick up 100 percent of the tab for medical expenses that exceed 15 or 20 percent of a family’s adjusted gross income: basically, a single-payer catastrophic-care system for expenses that no one can realistically save for. Let people buy insurance for expenses below that, or, if it’s not too expensive taxwise, let people set aside more money tax-free in Health Savings Accounts. And make some more generous provisions for people closer to the poverty line, such as prefunding Health Savings Accounts for them.
.. voters don’t want genuine insurance, by which I mean a pool that provides financial assistance for genuinely unforeseeable and unmanageable expenses. Voters want comprehensive coverage that kicks in at close to the first dollar of spending, no restrictions on treatments or their ability to see a doctor
.. nor do they want their taxes to go up, or to pay 10 percent of their annual income in premiums.
- Old people hate paying more, of course. But the effect of the current system is to drive young people out of the market — which means that premiums are set to cover an old population, which means high. It’s not clear that this actually benefits old people in the long run.
.. There are too many Republican governors and senators among the 32 states that expanded Medicaid for total repeal to be politically feasible
.. The current financing structure, in which the federal government matches whatever states spend, encourages states to use the program as a piggy bank to reward favored interest groups in the health-care sector, without necessarily providing very good care to the poor. As Brian Blase of the Mercatus Center recently put it, “Because Medicaid spreads the burden of state spending decisions in this way, many states grow inefficiently large programs and create numerous accounting gimmicks to access as much federal money as possible.
.. A plan based on these ideas may, to be sure, end up covering fewer people than Obamacare currently does. But then Obamacare may end up covering fewer people than Obamacare currently does, because it seems to be slowly strangling the individual market
.. What they can’t afford to do is try to get it done in stages, or do half of it because that’s what can pass. That kind of thinking is what got us into this mess in the first place.
The Dark Strategy at the Core of the GOP Health Care Plan
How the House Republican plan to overhaul Obamacare went from repeal-and-replace to cap-and-strangle
The driving principle of Tryancare is to dangerously erode federal support for health insurance over time – both for individual policies bought in the marketplace and for Medicaid recipients.
.. It trades in Obamacare’s guaranteed payouts for a new program of federal spending that looks vaguely adequate in year one. But Tryancare then caps future payouts – at a growth rate far below health care inflation.
.. Tryancare would mail out a monthly refundable tax credit – essentially, a check from Uncle Sam – for Americans to buy their own health plans.
.. Because these are flat tax credits, Tryancare shifts money out of the pockets of the poor and gives it to the upper middle class. A 60-year-old with an income of $20,000 would lose more than half the premium support now paid for by Obamacare (average: $9,874), while a 60-year-old making $75,000, who today does not qualify for subsidies under Obamacare, would get $4,000 under Tryancare.
.. Obamacare provided funds to expand Medicaid from a program generally limited to women and children in poverty to create, instead, universal coverage for the poor and working poor.
.. states would have to pony up an additional $253 billion over the next decade to preserve the benefits of Obamacare’s Medicaid expansion.
.. the Tryancare contribution is capped. It grows only at the rate of the increase in the Consumer Price Index (a measure of inflation) plus one percent.
.. Subsidies climbed from an average of $291 a month in 2016 to $367 in 2017, a boost of $76 a month.
.. Four GOP senators, led by Rob Portman of Ohio, have warned that Tryancare’s changes to Medicaid risk making it a non-starter.
Affordable Care Act revision would reduce insured numbers by 24 million, CBO projects
But the GOP legislation, which has been speeding through House committees since it was introduced a week ago, would lower the deficit by $337 billion during that time, primarily by lessening spending on Medicaid and government aid for people buying health plans on their own.
The report predicted that premiums would be 15 percent to 20 percent higher in the first year compared with those under the Affordable Care Act but 10 percent lower on average after 2026. By and large, older Americans would pay “substantially” more and younger Americans less.
.. The 37-page report provides the most tangible evidence to date of the human and fiscal impact of the House GOP’s American Health Care Act. It also undermines President Trump’s pledge that no Americans would lose coverage under a Republican remake of the Affordable Care Act, which was enacted by a Democratic Congress in 2010.
.. Declaring that the plans would usher in “the most fundamental entitlement reform in a generation,” Ryan said the legislation “is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down. That’s what this report shows.”.. Despite that sales pitch, early signs emerged Monday night that the CBO report was not helping to solidify GOP support. Rep. Rob Wittman (R-Va.) announced he would oppose the bill.“I do believe that we can enact meaningful health care reforms that put the patient and health care provider back at the center of our health care system, but this bill is not the right answer,” he said in a Facebook post.Wittman’s stance could represent a new front of dissent among House Republicans. A six-term member who leads a House Armed Services subcommittee and represents a district that favored Trump by 12 percentage points, Wittman is neither a hard-right firebrand nor a wary moderate from a Medicaid expansion state. Rather, he is the sort of mainstream conservative that Ryan is counting on to toe the party line and pass the bill.
.. The analysis predicts that the number of people without health coverage would rise to 52 million by 2026, compared with 28 million if the Affordable Care Act remains intact. That erosion would mean that about 1 in 5 U.S. residents would be uninsured by 2026 — compared to 1 in 10 uninsured now and 1 in 6 who were uninsured before the Affordable Care Act was enacted.
.. “These kinds of estimates are going to cause revisions in the bill, almost certainly,” said Sen. Susan Collins (R-Maine).
.. the House GOP proposal would administer Medicaid by giving each state a fixed amount of funding per person in the program rather than covering a fixed percentage of its Medicaid costs, no matter how high.
.. While the deficit would be lower, the legislation also would reduce federal revenue by $592 billion by 2026 by repealing several taxes that the Affordable Care Act created to help pay for more people to get insurance — notably taxes on high-income Americans, hospitals and health insurers.
..“They are implementing the biggest transfer of wealth in our history,” House Minority Leader Nancy Pelosi (D-Calif.) told reporters Monday. “In terms of insurance coverage, it’s immoral. In terms of giving money to the rich at the expense of working families, it is indecent and wrong.”.. Next year, the forecast says, about 5 million fewer people would be on Medicaid. By 2026, the program’s rolls would shrink by nearly 15 million — almost 1 in 4 of the 68 million currently in the program... If the GOP plan is enacted, a 21-year-old making $68,200 would pay an average of $1,450 for a year’s worth of insurance premiums after the new tax credits, compared with $5,100 under the current law... On the other hand, the cost of a year’s worth of premiums would stay about the same for a 64-year-old at the same income level. For a 64-year-old making $26,500, the cost would rise sharply, from $1,700 to $14,600.
House GOP Releases Plan to Repeal, Replace Obamacare
Proposed legislation would dismantle much of Affordable Care Act, create refundable tax credit tied to age and income
Earlier versions included provisions opposed by both conservative and centrist Republicans, whose support for the now-altered bill will be crucial.House Republican leaders hope the package will be passed by Congress by mid-April... Under the House GOP proposal released Monday, the refundable tax credits would be tied to age, with people under 30 eligible for a credit of $2,000 per year, increasing steadily to $4,000 for those over 60. The size of a tax credit would grow with the size of a family, but would be capped at $14,000.
.. The GOP plan aims to appease their concerns by leaving the expansion untouched through the end of 2019. After that, funding would begin to be reduced in an attempt to make up for the revenue lost by repealing the taxes contained in the existing health law.
.. Republican Sens. Rob Portman of Ohio, Lisa Murkowski of Alaska, Cory Gardner of Colorado and Shelley Moore Capito of West Virginia sent a letter Monday to Senate Majority Leader Mitch McConnell (R., Ky.) expressing concerns over the House’s approach to overhauling the Medicaid program in an earlier draft of the bill.
.. The proposal would also end a special executive compensation limit that the 2010 law applied to health insurers. That law prevented companies from deducting more than $500,000 in pay to executives. Other companies face a $1 million limit, but that cap doesn’t apply to performance-based compensation.