Get a big cup of coffee, make yourself comfortable and read this through…
(This is from www.govtrack.us. unless noted otherwise. IV = Indivisible Ventura, WTF = WTFJHT)
The American Health Care Act of 2017 (AHCA), H.R. 1628, is the House Republicans’ leading proposal to “repeal and replace” the Affordable Care Act (aka Obamacare, but we’ll abbreviate it ACA) and “defund” Planned Parenthood.
A new deal among the Republican factions was reached. The changes to the AHCA, as reported by the Rules committee, are:
- States may opt-out of providing the ACA’s essential health benefits. (This requirement was already dropped in the bill for Medicaid but not for the individual market.)
- States may opt-out of requiring premiums to be the same for all people of the same age, so while individuals with pre-existing conditions must be offered health insurance there is no limit on the cost of that insurance. A new $8 billion fund would help lower premiums for these individuals.
- States may opt-out of limiting premium differences based on age.
- There would be a new $15 billion fund for risk sharing to help states lower premiums. (Many sources agree this is not nearly enough – IV)
After a fast-paced few weeks, the vote scheduled for March 24, 2017 was cancelled after the House Freedom Caucus, a band of some of the most conservative members of the House, pledged in block to oppose the AHCA because it did not go far enough to repeal the ACA.
What would stay the same:
- The AHCA would keep the ACA’s requirement that dependents can stay “on their parents’ plan until they are 26.”
- The exchanges (aka marketplaces) run by the federal government and states, which listed individual and small business health insurance plans, would continue as under the ACA.
- The AHCA would also continue to provide subsidies for premiums that are based on income, although the formula would be completely different and the subsidy would likely be much less for young, low-income Americans.
And according to this summary from USA Today:
- The AHCA would keep some Medicaid benefits for those that enroll prior to 2020 (more on that below).
- The AHCA would keep the restriction that subsidies can’t pay for health insurance that covers abortion.
The individual mandate stays too, but by any other name:
The AHCA even includes a penalty for individuals who don’t get coverage, referred to as the “individual mandate” in the ACA. While the ACA imposes a roughly $700 per year penalty for not holding health insurance, the AHCA would instead impose a surcharge of up to 30% the next time you get insurance after a lapse in coverage.
Depending on your premiums and how long you go without insurance, the ACHA’s penalty could be more or less than the ACA’s current penalty. In many cases, it might be about the same.
What would be expanded – something useless for people for a lot of people
- Contribution limits to Health Savings Accounts (HSAs) would be increased to encourage their use. With HSAs, you can put aside some of your income for medical expenses and not pay taxes on it. (More on that here.)
- Under the AHCA, federal subsidies for paying premiums could be used to pay for insurance both from and not from the exchanges.
(IV – More on HSA’s. They are great tax shelters for the well-to-do. Not so much for the rest of us.)
What would go away – things people need – some parts of the ACA would end:
If you’re on Medicaid…
- The ACA expanded Medicaid eligibility in 32 states that opted in to it. The AHCA would reverse the eligibility expansion beginning in 2020 (anyone enrolled by then would remain enrolled), and it would reduce federal support for Medicaid with caps on coverage.
- The ACA expanded required benefits under Medicaid, such as mental health and addiction services, which would no longer be required.
If you’re covered through your employer…
- Fines would be eliminated for large employers that don’t provide health plans.
- Small-business tax credits would end in 2020.
- You may be taxed for your benefits! …A long list of taxes created by the ACA to pay for its subsidies would be eliminated, but some new taxes will be added, such as a new tax on the value of health insurance provided by an employer. (IV – This is a big issue, so we’re going to spell it out. While reducing the taxes on the wealthy, they are going to tax the middle class on the value of their healthcare insurance “It would increase the taxes paid by middle-class workers on their wages by making the value of employer insurance taxable income. At the same time, it would cut taxes on employer benefit packages valued over $500,000, the tax on incomes over $200,000-$250,000, the tax on insurers’ profits, and the tax on brand-name pharmaceutical companies.”)
If you’re on an individual plan…
- The ACA limited what health insurance providers could charge in premiums. Under the AHCA, those limits would be adjusted so that younger people might see lower premiums and older people much higher premiums.
- The ACA’s complex cost-sharing provisions that lowered costs for some low-income Americans would be eliminated.
- The ACA’s awkward bronze/silver/platinum levels would go away.
Defunds a piece of important bipartisan legislation
- Parts of last year’s last-minute bipartisan 21st Century Cures Actwould be defunded. (https://obamacarefacts.com/2016/12/08/21st-century-cures-act/_)
Our legislators are exempting themselves from this so you know it’s bad. (WTF)
- Health care bill will exempt members of Congress and their staffs from losing popular Obamacare provisions. The amendment would ensure that staffers continue to have access to Obamacare programs, like a ban on discriminating based on preexisting conditions, while other enrollees could lose those policies if their state applied for a waiver. A Republican legislator has vowed to close the loophole in separate legislation.
Something else you should probably start thinking about…what exactly is a “pre-existing condition”? (WTF)
Sexual assault could be considered a pre-existing condition under health care amendment, which allows states to discriminate based on medical history. In addition to rape, postpartum depression, and cesarean sections are all considered preexisting conditions. Companies can also deny coverage for gynecological services and mammograms.
Defunding Planned Parenthood
The AHCA would also prohibit federal funding from going to Planned Parenthood, mostly through Medicaid, for one year.
This would pause federal reimbursements for Planned Parenthood’s reproductive health, maternal health, and child health services — but not its abortion services because federal funds are already prohibited from being used for abortion.
What’s the bottom line?
How the AHCA would affect you depends on your income, how you get your health insurance, and what kinds of health care you need.
- For older, low-income Americans with health insurance from the individual market: Premiums could increase by $3,600 for a 55-year-old earning $25,000 a year and $8,400 for a 64-year-old earning $15,000 a year.
- For low-income Americans covered by Medicaid, the federal cap on support would likely lead to fewer benefits and higher out-of-pocket costs. 5–18 million individuals are predicted to lose Medicaid coverage entirely.
- If you are covered through your employer, your employer would be allowed to stop providing coverage — and that’s made more likely because tax credits and the tax advantage for employer-provided coverage would be eliminated. But experts are split on whether the AHCA will affect employer coverage — and even whether the ACA ever had any effect on employer coverage to begin with.
- Americans with income around $40,000-$75,000 who purchase an individual plan may be better off because the ACA’s subsidies for low-income Americans would be spread out to income up to $75,000. (Unless premiums go up too.)
- If you have an income of $200,000 or more, or investment income, you can expect your tax bill to go down — those making $1 million or more can expect around $50,000 less in taxes each year.
- Major changes to the health insurance market like the ACA and AHCA have far-reaching effects on federal spending and the economy. But experts polled by The New York Times are split on whether the AHCA will save the government or cost more because the AHCA lowers both government spending and tax revenue.
Odds of passage
Despite now controlling both the legislative and executive branches, and having previously voted successfully 45 times in the House to repeal the ACA, the Republicans’ AHCA is not a done deal.
On the one hand, both the House Energy & Commerce and Ways and Means Committees passed their respective sections of legislation on March 9 with party line votes. On the other hand, the House Freedom Caucus, some high profile senators like Mike Lee (R-UT) and Rand Paul (R-KY), and industry groups like the American Medical Association and American Hospital Association have all spoken publicly against the legislation — some for the reason that it does not repeal enough of Obamacare. No Democrats will likely support it. The ACA also has all-time high support from the American public, with support reaching 54 percent last month.
Usage of the budget reconciliation process
The Republicans don’t have the votes to pass the AHCA the normal way. Knowing that it would be filibustered by Senate Democrats, Republicans are using the “budget reconciliation” process to move their bill forward. Budget reconciliation makes one bill each year immune to a filibuster (in the Senate), and the AHCA is this year’s bill. The Democrats used budget reconciliation to enact parts of the ACA originally, so the use of reconciliation to modify the ACA (but not repeal it) is fitting.
Reconciliation can only be used on some types of bills that affect the federal budget, limiting the sorts of provisions that can be included in the AHCA — a full repeal of the ACA wouldn’t be permitted under reconciliation rules. The reconciliation process also requires the House Budget committee to formally introduce the bill after it goes through committee — that’s why the AHCA was revealed to the public on March 6 as a draft at readthebill.gop and only formally introduced as a bill in Congress on March 20.
Although there are procedural similarities between how the ACA was enacted and what is happening now with the AHCA, there are also significant differences. The ACA was enacted after vigorous debate on competing and substantive policy proposals for nearly a year, with most of the final text available for several months before it was signed by President Obama. The AHCA is on track to going from draft to law within a matter of weeks and with hearings occurring when America is asleep.
Now it’s in the Senate’s Hands (WTF)
Several Senate Republicans said they will set aside the House health-care bill and write their own version instead. Without changes, the House bill arrives in the Senate well short of the 50 votes it needs to pass (including a tie-breaking vote by Mike Pence). Republicans have hold a 52-48 majority in the Senate, which means they can only afford to lose two votes. The bill is expected to undergo major changes that might leave it unrecognizable, including stripping away the provisions that earned the support of hard-right House members to secure its passage. Senate Republicans have opted to use a maneuver known as reconciliation to try to pass the bill with a simple majority, instead of having to clear the 60-vote threshold that is required for most legislation.