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The Republican Obamacare Replacement Bill is out. It is titled "The American Health Care Act" or AHCA. http://www.speaker.gov/press-release/statement-introduction-american-health-care-act The tl;dr summary of the bill: - No more employer or individual mandate That means small businesses with more than 50 employees can requires all of their employees to get individual coverage now and no longer have to provide health benefits. There is a 30% increase in premiums for a year if you go 2 months without insurance to replace the individual mandate. - The range of incomes for subsidies is much larger than Obamacare. You can get credits up to $109,000 in income. Obamacare subsidies ended just below 50k. Though the income range is much larger, the maximum subsidy amounts are much smaller than Obamacare. Anyone who makes less than 75k a year is eligible for a full subsidy. Higher than that and your subsidy is reduced by a % based on your age and income: - Subsidies are now partially age-based. The subsidy maximums are: $2,000 for those under 30 $2,500 for those between 30 and 40 $3,000 for those between 40 and 50 $3,500 for those between 50 and 60 $4,000 for those over 60 Older, richer, and healthier = Probably better off than under Obamacare Younger, poorer, and sicker = Probably worse off than under Obamacare A 28-year old making 25k could get up to 9k in subsidies under Obamacare. He would be capped at 2k under this plan. A 60-year old making 70k would get nothing under Obamacare. He could get a max of 4k under this plan. - Block Grant Medicaid - Medicaid expansion continues for 2 years. Afterwards it ends and if you ever get above the income limits, get employed, or move states you can't get back on. This is a way to kill the Medicaid expansion without throwing millions of people off of it all at once. - Keeping the provision to stay on parent's plan until 26 - Eliminate Medicare excise tax of 0.9% on incomes above 250k - Keeping the Obamacare rules banning denial based on pre-existing conditions. But insurers can charge you more based on your conditions and age. The cap was 2x higher premiums for someone 55+ under Obamacare and you could only charge extra for smoking. The new plan allows up to 5x higher premiums for age and 2x higher cap for pre-existing conditions. - Keep the Obamacare rule banning plans from having a "lifetime benefits" limit. They could impose some form of annual benefit caps though. - Repeal Obamacare medical device tax and tanning tax. - Plans that cover abortion are not eligible for tax credits. - Funding mechanism after the first two years is left to be decided and not spelled out. This is a big gap and something that there will be fights about when the full House and Senate take it up. - Mandatory coverage requirements are repealed. That means it is up to the insurers and individual plans to decide what birth control to cover. The first annual physical of the year and other preventative medicine are no longer free and it is up to the discretion of the insurer how they are handled. Who will benefit? The two groups that come out way ahead in the Republican health plan compared to Obamacare are: - Healthy males who make between 55-75k a year and have less than $200 in average annual out of pocket health expenses - A married couple with no kids who makes 145-150k a year and has no chronic illnesses. The groups that come out the worst compared to Obamacare are: - Anyone covered under the Medicaid expansion - Anyone Medicaid eligible who is single and not disabled - Anyone making less than 49k. - People (especially single women) who are under 35 and sicker than average (more than $1,000 a year in out of pocket health costs) This is just financially and not factoring in the benefits of near universal birth control and preventative care access. quote:This new tax credit structure could also hurt to many low-income Americans, whose subsidies would fall substantially. The Kaiser Family Foundation estimates that that these new tax credits would be anywhere between 31 and 82 percent lower for a 60-year-old who earns $20,000, depending on where that 60-year-old lives. How will it impact premiums? Starting in 2020, under the GOP replacement plan, insurers would no longer be required to offer the “essential health benefits package” — which right now requires that insurers cover maternity services and pediatric care. This addresses a constant Obamacare gripe from Republicans: the health care law mandates a benefit package that’s too big. This drives up premiums, they argue, and scares off some healthy and young enrollees who want to buy a skimpier plan. There is some truth to this argument. Obamacare’s marketplaces have struggled to attract young adults at the level the White House had initially hoped. (The Obama administration originally said it wanted one-third of the marketplace to be people between the ages of 18 and 34, but right now it’s only about a quarter.) The GOP replacement plan makes the individual market more advantageous for healthier people. Some states might choose skimpier benefit packages that would allow insurers to cut certain benefits they no longer want to cover — they could stop covering maternity benefits, for example, to make their plans less attractive to women who plan to become pregnant. This would likely benefit healthy people, who generally want less robust coverage at a cheaper price. But it’ll send the cost of more comprehensive plans — the plans sicker people need — skyrocketing. And it could leave someone who wants, say, health insurance to cover her maternity costs completely out of luck. quote:There are other ways the draft makes insurance better for young people too: by letting insurance plans charge them lower rates. Leon Trotsky 2012 fucked around with this message at 03:38 on Mar 7, 2017 |
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Mar 7, 2017 03:22
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SKULL.GIF posted:I read somewhere that this new bill will kick 15 million people off health insurance. Is that substantiated? Estimates based off of Medicaid changes and a Kaiser Health study. There is no CBO score out yet for an "official" estimate.
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Mar 7, 2017 03:30
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Also, the AHCA includes a ban on all federal dollars going to Planned Parenthood and prevents states from using Federal Dollars on payments to Planned Parenthood.
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Mar 7, 2017 03:41
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eviltastic posted:
There will be. The re-wrote the bill from the original draft form because the initial CBO score was incredibly bad (up to 20 million losing coverage, increased cost to consumers, and uncertain funding mechanisms.) The big challenges are going to be: - The CBO score - Getting 50 Republicans on board in the Senate - Figuring out how to fund it after the first two years. The CBO literally can't score it right now because they score on 10-year windows and the bill has no funding mechanism after the first two years. That's going to be the huge fight.
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Mar 7, 2017 03:47
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Bueno Papi posted:If there's no CBO score, how can it pass reconciliation? They are going to have to define a funding mechanism in the final bill and get a CBO score. They probably have no idea how to do that without either kicking tons of people off or having half the party revolt. That's likely why it wasn't in the committee draft.
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Mar 7, 2017 03:54
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Hieronymous Alloy posted:I think we should focus on all the kids this will kill. The CHIP program covers kids. Block granting Medicaid won't hurt kids the most. It will hurt them, but they will be spared the first and second rounds of eligibility tightening. The people who will get hurt the most are people who are single, not disabled, and poor (but not completely destitute) Basically, single people making more than 8k and less than 20k without a disability are the ones who are going to get bounced first.
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Mar 7, 2017 04:14
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Hieronymous Alloy posted:Current Medicaid must cover transplant services for children, under the EPSDT mandate. Most of the money isn't in children's services in Medicaid. It is in chronic diseases and disabilities among older and impovrished adults. Diabetes complications, heart disease, renal failure, cornea and other ocular surgeries, cancer, and alcohol-related illnesses. Chip is about 1.5 billion a year. Total Medicaid spending is around 545 billion a year. About half of all Medicaid enrollees are 18 or under, but they actually only account for about 17% of the budget. The top 10% of Health Care users require 80% of the budget. This group is overwhelmingly middle-aged and older with chronic problems. Kids are the most cost-effective Medicaid enrollees.
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Mar 7, 2017 04:24
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EugeneJ posted:So wait - right now if I'm on an employer health plan, my employer contributes part of the premium and I pay the rest - but I don't get any premium assistance otherwise. Will employer plans qualify for the new tax credits? No. Employer plans are not touched by subsidies at all. There already exists a tax rule for companies to write off health insurance for employees as a deduction. Employer provided plans will not see a ton of major changes. The big changes to employer plans are: - No abortions - More barebones plans and catastrophoic plans available in group health options - No mandatory birth control, free physical, or other preventative medicine provided for free under all plans. - Cadillac tax in 2020 if you have an extremely generous plan from your employer. - If you work for an employer with 50 employees or more, then you employer can make you go get individual plans and is not penalized for not providing health benefits. Leon Trotsky 2012 fucked around with this message at 05:02 on Mar 7, 2017 |
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Mar 7, 2017 04:54
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EugeneJ posted:NY Times says this is still free and the EHB won't be changed Hmmm... the WaPo and Vox seem to disagree quote:Starting in 2020, under the GOP replacement plan, insurers would no longer be required to offer the “essential health benefits package” — which right now requires that insurers cover maternity services and pediatric care.
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Mar 7, 2017 05:06
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Sloober posted:Doesnt the abortion thing run up against row v wade somehow? For real thats almost as good as banning it to many. No. Not paying for something using public money is not the same as making it illegal.
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Mar 7, 2017 14:55
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One of the more esoteric parts of the AHCA is that it bans you from Medicaid if you win the lottery.
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Mar 7, 2017 15:00
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rudatron posted:I think I remember calling that Planned Parenthood was going to get the ACORN treatment as soon as Trump won, and got a reply of 'yeah because trump really cares about abortion' from a trump supporter. But money is fungible. If you give them Federal Dollars to pay for pap smears and cancer screenings that just frees up money for them pursue their real passion: the zygote holocaust.
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Mar 7, 2017 15:09
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Those funding details and additional regulations are apparently coming. There's 2 more bills to come to complete the reform package. https://twitter.com/realDonaldTrump/status/839108868584124417?ref_src=twsrc%5Etfw
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Mar 7, 2017 15:14
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Electric Phantasm posted:Is this saying states can automatically disenroll off your plan once you report your lottery winning? Also should we assume the worst and take high dollar to mean winnings you have to report? Yes, you will be kicked off Medicaid once you claim your prize. It's up to the individual states to determine the amount that qualifies as "high dollar" winnings.
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Mar 7, 2017 15:15
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Electric Phantasm posted:Thank you for the answer and just thought of one more question what about past lottery winners, can they be affected? The language seems vague enough to let states do it. Not sure. It's not clear in the law. The new law gives states wide latitude to determine eligibility and income. It seems like states could theoretically do that, but they'd have to apply it to your current income. Maybe if you won in the last 9 years and had a particularly aggressive state, then they could do it.
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Mar 7, 2017 15:25
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The AHCA also nearly doubles the cap on Health Savings Account contributions. A couple can now contribute a little over 13k per year. If you are generally healthy and have used up all of your tax-advantaged retirement space, then this is like another 13k a year you can invest or stash tax-free and withdraw with no penalty when you're 65. That's a significant boost for high-income and generally healthy people.
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Mar 7, 2017 15:33
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EugeneJ posted:So if a poor wins the lottery they die To be fair, if they win the lottery they can probably afford their own premiums. Also, you are only banned from Medicaid for a maximum of 10-years! So, don't be an idiot with the money for 10-years and don't get cancer at the same time and you're golden!
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Mar 7, 2017 15:35
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No Butt Stuff posted:Do HSAs have an earnings cap for contributions like 401ks? No, you just can't be on Medicare, can't be claimed as a dependent, and have to have a HSA compatible high-deductible plan.
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Mar 7, 2017 15:59
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Monkey Fracas posted:How is the "well now insurance companies can charge up to 5X as much based on age" thing going to play with the old farts that vote GOP? Will the increased subsidies for said old farts really cover that gap? No. The point of that provision is to allow the insurance companies to get more money from people who will be using a lot of services. It will incentivize healthier old people to go for skimpier plans. Right now, the cost burden of the top 20% of health care users is spread out gradually through the entire population. That means that everyone is paying a little bit extra to discount older and sicker people. This way, the cost is focused much more on older and sicker people to get everyone else a small discount. The broad themes and goals of the bill are: - Increase out of pocket costs for most plans. This will incentivize healthier people to get skimpier plans and seek treatment less often. - Increase costs on those who are likely to use lots of services and use that to give a discount to healthier people. - The first two points are combined to try to lower monthly expenses for people on individual plans, but greatly increase the upfront cost of using services. - Provide fixed costs to the government. Leon Trotsky 2012 fucked around with this message at 17:14 on Mar 7, 2017 |
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Mar 7, 2017 17:07
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FuturePastNow posted:The general population of the US would be primed to accept single-payer, since we're all socialized (pun intended) to seeing the MEDICARE TAX WITHHELD line item on every pay stub. Even if that number went up significantly, a lot of people would grumble but they'd accept it if they're getting something concrete out of it. Unfortunately, dedicated revenue streams and concrete costs are the quickest ways to make things unpopular. This is especially true if it is a "new" cost. Lots of programs continue to exist because they are paid for out of general revenue funds and can't have their funding source zeroed out. They had a poll that showed than 60% of Bernie Sanders supporters would not be in favor of single payer if it meant paying $1,000 more a year in taxes, but if you phrased it as "raised taxes to pay for it" then the opposed dropped down to around 20%.
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Mar 7, 2017 19:52
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Ape Agitator posted:This doesn't actually have a test to it though, right? So if you ever win the lottery you can never get support, even if you're bankrupt? It spreads your winnings out over 10 years and counts it as income. So, if you won a million dollars, then your income would be 100k + whatever you made for 10 years and you could be kicked off Medicaid for making too much money.
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Mar 8, 2017 01:30
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SimonCat posted:They buy into the horror-stories about other country's health care. My dad's favorite talking point is that apparently the British system doesn't cover knee replacements for the elderly. They do "ration" out care for non-essential procedures if you want the procedure to be free and you aren't in an age group or medical state where it would be critical. So, if you are 48 and have a bad knee, it could hurt all day every day, but it won't kill you and you are not likely to die from slipping. The NHS would schedule you 6 months out if they have hundreds of more critical patients who need knee surgeries first. Then you can wait or you can pay someone else to get it done immediately. (Note: I'm not sure how Knee Surgeries are specifically defined under the NHS, but this is the case for many surgeries that deemed not medically essential) Leon Trotsky 2012 fucked around with this message at 15:51 on Mar 8, 2017 |
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Mar 8, 2017 15:48
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Duke Igthorn posted:So does the new Healthcare poo poo include a "Congress gets to go back to Socialized Medicine" section or is that going to be separate and suuuuuuuuuuuuper quiet? Congress never had socialized medicine. They had access to the Federal Employee insurance plans, which are generally very good, and they got a subsidy to cover part of their premium costs. As part of a "gotcha" move the Republicans introduced an amendment to require members of congress to buy from the D.C. exchange and Democrats voted for it. Now members of congress buy the exchange plans and don't get a subsidy (which also applies to congressional staff and further compounds a problem where only the kids of rich or connected people can become congressional interns to work for free and live in DC for a couple years for the chance to eventually get hired as full time staff who barely make anything in DC.)
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Mar 8, 2017 18:57
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Monkey Fracas posted:Am I misremembering or is medical debt/bankruptcy somehow classified differently when compared to normal debt now? All debt is treated the same in personal bankruptcy except for student loans, civil judgements, and penalties issued by a court or government agency.
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Mar 8, 2017 19:50
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https://twitter.com/ddiamond/status/839657631232974848?ref_src=twsrc%5Etfw
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Mar 9, 2017 03:25
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And repeals the extra 0.9% Medicare tax on incomes over 250k.
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Mar 9, 2017 14:36
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Pollyanna posted:gently caress the GOP, the money-grubbing assholes. Actually, healthcare isn't about money at all. You're being very crass by even bringing money into the equation. quote:Asked about estimates showing large increases in premiums for many older and low-income Americans under the Republican Health Bill on "Good Morning America," Health and Human Services Secretary Tom Price said, "Our goal is to make certain costs come down."
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Mar 9, 2017 15:44
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Hollismason posted:So apparently there's going to be some negotiations on this because the Freedom Caucus is super pissed. Has anyone heard or read of the additional changes so this could pass the house? The Freedom Caucus wants: - A bill to completely repeal Obamacare to pass first. They say they aren't opposed to certain provisions, like the ban on rescission, but that they need to repeal Obamacare entirely to fulfill their campaign promise and the replacement bill should start from a point where Obamacare doesn't exist and not be build around preserving parts of Obamacare by reducing the damage to certain people. (All taxes, fees, and mandates that they kept in to help fund the replacement plan, but make it not look so bad in the budget are the big sticking points) - Get rid of the Medicaid expansion immediately or within one year instead of three and do not guarantee to keep subsidizing the states that expanded it. Those extra years cost more money. - Eliminate the Essential Health Benefits rules (the mandatory floors on what insurance has to cover and mandates on birth control, preventative medicine, etc) right away instead of in 2020 to allow extremely bare-bones catastrophic plans to be sold, so people with low health care requirements can buy extremely cheap plans that just cover them if they get hit by a bus or get cancer. - Tax credits to be awarded at the end of a tax year to give the IRS time to weed out any illegal immigrants who may be using a purchased social security number (this will also make it so less people sign up for subsidized insurance because people that can't afford to not get their rebate until the end of the year just won't get it) None of their demands are super likely to make it into the final bill. They are doing exactly what they have done before: Take a moderate win for the Republicans and tank it.
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Mar 10, 2017 15:48
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quote:Ryan On Millions Losing Care: 'Never Going To Win A Coverage Beauty Contest'
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Mar 10, 2017 16:40
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If you like your plan, you can keep it*quote:Price: Americans Will Be Able To Keep Their Plans, But Some May Be 'Moved' To Insurance That's 'Much More Desirable'
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Mar 10, 2017 17:52
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SousaphoneColossus posted:Given that the medicaid expansion is reasonably popular even in some red states, has anyone thought about making the "public option" just expanding medicaid to anyone who isn't already insured or eligible for medicare/tricare/whatever else? The only real complication I can think of is the SCOTUS decision that made it optional for each state. 1) The Supreme Court decision is a huge stumbling block 2) That would require enormous increases in state funds that many states can't or won't do
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Mar 10, 2017 19:21
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Hieronymous Alloy posted:I have a real fear that the CBO has dramatically cooked the books on this, and the entire past week has been an exercise in getting Democrats to talk up how important and reliable the CBP score is. Yes, he did. But the CBO has rules governing how they are allowed to assess legislation that they can't ignore. Some of these rules don't always make a ton of sense (they have to do a 10-year window for all legislation unless the bill specifically targets periods outside of that window, they have to assume conditions that the bill assumes, etc), but they can't get rid of them outside of statutory changes. Even if the CBO used dynamic scoring that is very favorable to the plan, then that wouldn't impact its analysis of coverage rates. It would just make the economic impact look better.
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Mar 13, 2017 21:11
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Hollismason posted:Jesus loving Christ I can't imagine what would happen if 52 million people were uninsured. This would be devastating economically, socially, etc. That is actually lower than the uninsured % was before Obamacare.
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Mar 13, 2017 22:49
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Confounding Factor posted:So who all here is worried their employer will stop offering insurance plans and/or lack the money to buy the insurance that has the coverage one needs? It just amazes me the illusion of choice offered to Americans, when it really comes down to those who are able to pay and those that can't. And who loving knows what coverage one needs in the future. What a sick twisted ideology Republicans adhere to. None of the plans or subsidies involved impact employer-provided plans unless your employer has less than 50 employees and didn't offer anything before they were required to.
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Mar 13, 2017 22:51
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Bueno Papi posted:Pre-ACA it hovered around 16%. Post-AHCA will be around 16%. Unless you've seen something I haven't seen. Post-AHCA in 2025 it will be about 15.5%. It hovered around 16% pre-obamacare.
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Mar 14, 2017 00:39
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Bueno Papi posted:Not to DnD you but what's your source? Was it in the CBO assessment? CBO estimate of 54 million uninsured in 2025. CBO cites the U.S. census estimate of a national population of 345.05 million in 2025. Uninsured rate of 15.6%
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Mar 14, 2017 00:52
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Somewhere in the neighborhood of 85% of Obamacare plans were profitable for insurers (and some of those 15% were loss-leaders for the companies that they provided to be able to access the exchanges, so not a total loss.) The issues that some insurers have with Obamacare are that: - There is a high degree of uncertainty about revenues and participants (people drop in and out, their subsidy amount might change, they can't screen participants, etc) - They are profitable, but not as profitable as other plans (catastrophic plans and comprehensive plans to screened individuals using an actuarial analysis to determine price) - They are limited in how much they can raise prices overall and on certain groups. Those 3 things combined means that even though they were making money, it was more work and more uncertainty about how steady the profits would be compared to other plans. Some of them were nervous about rising costs and the limitations on their ability to raise prices could lead to them getting locked in to a losing business plan for a year or more. Leon Trotsky 2012 fucked around with this message at 16:44 on Mar 17, 2017 |
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Mar 17, 2017 16:41
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Twerk from Home posted:What's pricing likely to look like if all that the Republicans accomplish is removing the individual mandate, and nothing else changes? Dramatically higher premiums or deductibles. If you can go without insurance until you need it, then that is what people will do. Employer plans will be largely unchanged, but the individual market will go into a spiral.
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Mar 17, 2017 16:46
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Tom Price was just in a hearing on Capitol Hill. He came outright and said: - HHS will not spend any money advertising Obamacare Open Enrollments going forward. ("We aren’t going to continue spending millions of taxpayers’ dollars promoting a failed government program.") - HHS is cutting the funds to states to help them advertise and enroll new people. - The IRS is unlikely to enforce the individual mandate penalty (they already barely do, but having the director say that they won't will encourage more people to go without it) - When asked about enforcing Essential Health Benefit Requirements, he said that they are the law, but they aren't going to go out of their way to check every single plan. They will look into them if someone files a complaint for a non-compliant plan. They will follow the law, though. He thinks people probably won't complain because premiums would be lower and "Individuals ought to be able to select the kind of coverage they want, not that the government forces them to buy." Basically, giving a green light to companies and individuals to not follow the law.
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Mar 29, 2017 19:26
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Vox asked the Governors of the 18 states that did not expand Medicaid if they will still turn down the free money now that Obamacare is "the law of the land" and there is no replacement plan. All 18 states are still going to reject expansion. The only slight change is that the Governor of South Dakota has gone from opposed to "not considering it at this time." http://www.vox.com/policy-and-politics/2017/3/29/15072636/medicaid-expansion-florida-texas-ahca-obamacare-repeal
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Mar 30, 2017 00:15
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