GOP Unveils Its Alternative To Obamacare

NY Times: GOP Alternative To Obamacare “Would Be Far More Oriented To The Free Market And Would Make Far-Reaching Changes.” House Republicans rolled out their plan to replace the Affordable Care Act (ACA) on March 6, The New York Times reported. The plan, according to the Times, would “roll back the expansion of Medicaid” and “undo other major parts” of the ACA. The bill would also create a penalty for people who let their coverage lapse and defund Planned Parenthood. From the March 6 report:

House Republicans unveiled on Monday their long-awaited plan to repeal and replace the Affordable Care Act, scrapping the mandate for most Americans to have health insurance in favor of a new system of tax credits to induce people to buy insurance on the open market.

The bill sets the stage for a bitter debate over the possible dismantling of the most significant health care law in a half-century. In its place would be a health law that would be far more oriented to the free market and would make far-reaching changes to a vast part of the American economy.

The House Republican bill would roll back the expansion of Medicaid that has provided coverage to more than 10 million people in 31 states, reducing federal payments for many new beneficiaries. It also would effectively scrap the unpopular requirement that people have insurance and eliminate tax penalties for those who go without. The requirement for larger employers to offer coverage to their full-time employees would also be eliminated.

People who let their insurance coverage lapse, however, would face a significant penalty. Insurers could increase their premiums by 30 percent, and in that sense, Republicans would replace a penalty for not having insurance with a new penalty for allowing insurance to lapse.

House Republican leaders said they would keep three popular provisions in the Affordable Care Act: the prohibition on denying coverage to people with pre-existing conditions, the ban on lifetime coverage caps and the rule allowing young people to remain on their parents’ health plans until age 26.

Republicans hope to undo other major parts of President Barack Obama’s signature domestic achievement, including income-based tax credits that help millions of Americans buy insurance, taxes on people with high incomes and the penalty for people who do not have health coverage.

Medicaid recipients’ open-ended entitlement to health care would be replaced by a per-person allotment to the states. And people with pre-existing medical conditions would face new uncertainties in a more deregulated insurance market.

The bill would also cut off federal funds to Planned Parenthood clinics through Medicaid and other government programs for one year. [The New York Times, 3/6/17]

OMB Head Mulvaney Makes Multiple False Claims About Health Care On Morning Shows

Claim: Republicans’ Per Capita Cap Proposal On Medicaid Will Provide Affordable Coverage

Mulvaney: Per Capita Caps On Medicaid Spending By States Would “Give People Health Care That They Can Afford” And Drive “Tremendous Long-Term Savings.” In an interview with Fox News, the director of the Office of Management and Budget, Mick Mulvaney, asserted that the GOP proposal to restructure Medicaid into a per capita spending scheme by states would “give people health care that they can afford” and drive “tremendous long-term savings.” From the March 7 edition of Fox News’ Fox & Friends:

MICK MULVANEY: We give the states something that Republicans have wanted for a long time, which is we give the states more control over their own Medicaid dollars. That drives tremendous long-term savings. So not only do we think this is a way to give people health care that they can afford, it also helps our long-term debt situation. [Fox News, Fox & Friends, 3/7/17]

Fact: Federal Caps On Medicaid Would Mean Loss Of Services, Coverage For Most Vulnerable

CBPP: Medicaid Per Capita Cap Would Result In “Loss Of Health Coverage And Less Access To Needed Health Care For Tens Of Millions Of Low-Income Americans.” The Center for Budget and Policy Priorities’ (CBPP) Edwin Park pointed out that “combined with the likely repeal of the Medicaid expansion,” a Medicaid per capita cap would “almost certainly” result in “the loss of health coverage and less access to needed health care for tens of millions of low-income Americans who rely on Medicaid.” He also noted that such a cap would “shift large and growing costs, as well as substantial risks, to states” and that it could put “severe pressure on state budgets and likely lead to significant Medicaid cuts.” From the February 27 report:

A Medicaid per capita cap would shift large and growing costs, as well as substantial risks, to states.  That would put increasingly severe pressure on state budgets and likely lead to significant Medicaid cuts affecting low-income beneficiaries and the health care providers and health plans that serve them. While federal funding under a per capita cap would rise if Medicaid enrollment grew (unlike with the funding formula under a block grant), the federal funding cuts a per capita cap imposes would result in states making considerably fewer people eligible or otherwise limiting enrollment.  Moreover, like a block grant, a per capita cap would not respond to greater-than-expected medical cost growth and the impact of the aging of the population. Combined with the likely repeal of the Medicaid expansion, the end result of a per capita cap would almost certainly be the loss of health coverage and less access to needed health care for tens of millions of low-income Americans who rely on Medicaid. [Center for Budget and Policy Priorities, 2/27/17]

Kaiser Family Foundation: Caps On Medicaid Payments Would “Restrict Benefits” And Shift Costs “To Beneficiaries.” The Kaiser Family Foundation explained that federal caps on Medicaid payments could “restrict benefits” and “result in eligibility restrictions and cost shifts to beneficiaries.” Additionally, the policy would have “a negative effect on enrollment and access to care for low-income beneficiaries.” From the June 22 issue brief (bolding original):

If federal Medicaid payments are limited, costs could be shifted to states, providers or beneficiaries.  While some states may increase state spending or achieve some program efficiencies to offset reduced federal payments, states also may consider options to reduce spending.

• States may have incentives to reduce Medicaid payment rates and restrict benefits. Given state requirements to balance their budgets (and resulting difficulty in increasing state spending in a given year), states may seek to restrict Medicaid spending to operate their programs within federal caps. Lower payment levels in Medicaid have contributed to its relatively low costs.  During economic downturns, states are likely to further restrict provider rates. Low reimbursement rates can contribute to issues around access to care and provider participation. In addition, states have a great deal of flexibility to design benefit packages.  Similar to provider rates, states often restrict benefits during tight budget times.  While a per capita cap may create additional incentives to increase efficiency, because states pay for a share of the program under current law there already are incentives to control costs.  States have also focused on efforts to control pharmacy costs, implement delivery and payment reforms and rebalance the delivery of long-term services from institutional to more community-based care to control costs and better deliver care.  Many payment and delivery system reforms often involve upfront investments to potential gain out year benefits.  Limited federal financing could hinder these reforms.

• New flexibility could result in eligibility restrictions and cost shifts to beneficiaries. As noted above, a per capita cap proposal could also come with changes to federal core requirements or additional flexibility for states.  If federal eligibility rules were changed, states could have incentives to restrict eligibility or make it more difficult for high-cost individuals with more complex needs to enroll.  Without the ACA requirements to streamline enrollment, states could also impose barriers that would limit enrollment.  Other changes in federal law could allow states to impose premiums or monthly fees on beneficiaries.  Research shows that this has a negative effect on enrollment and access to care for low-income beneficiaries. The House Republican plan specifies that states would have options to impose premiums and work requirements and to provide limited benefits, waiting lists and premiums for non-mandatory populations. [Kaiser Family Foundation, 6/22/16]

CBPP: “Medicaid Is Already Efficient And Innovative.” CBPP’s Park noted that “Medicaid costs per beneficiary already are far below those of private insurance.” He also noted that Medicaid costs “have also grown much more slowly, on average, than private insurance per-beneficiary costs.” From the November 30 article (emphasis original):

Medicaid is already efficient and innovative. Block grant supporters, including House Republican leaders, often argue that states could compensate for the substantial losses in federal funding they would experience under a block grant by using added flexibility to cut costs without harming beneficiaries. That claim doesn’t withstand scrutiny. Medicaid costs per beneficiary already are far below those of private insurance, after adjusting for differences in health status, due to lower payment rates to health care providers and lower administrative costs, even though Medicaid provides more comprehensive benefits than private insurance at significantly lower out-of-pocket cost to beneficiaries. And over the past three decades, they have also grown much more slowly, on average, than private insurance per-beneficiary costs. They are expected to continue growing more slowly than costs under private insurance in coming years, according to the Medicaid and CHIP Payment and Access Commission. [Center on Budget and Policy Priorities, 11/30/16]

Claim: Women Will Still Have Access To Health Care If Planned Parenthood Is Defunded

Mulvaney: We Will “Move” The Money Designated For Planned Parenthood “Over To The Federally Qualified Health Care Clinics.” Mulvaney told Fox & Friends that the plan defunds Planned Parenthood, but that it will “move” that money “over to the federally qualified health care clinics,” adding, “This is not about denying women access to care. … They will have it.” From the March 7 edition of Fox News’ Fox & Friends:

AINSLEY EARHARDT (CO-HOST): What does it mean for Planned Parenthood?

MICK MULVANEY: We defund Planned Parenthood and move extra money over to the federally qualified health care clinics, and sort of take that issue off the table. This is not about denying women access to care. We want them to have it. They will have it. They simply won't get it through places that also provide abortions. [Fox News, Fox & Friends, 3/7/17]

Fact: Health Care Clinics Cannot Make Up For The Loss Of Planned Parenthood

Public Health Professor: Argument That Community Health Care Centers “Can Absorb The Loss Of Planned Parenthood Clinics Amounts To A Gross Misrepresentation.” Experts have confirmed that even when community clinics do provide reproductive health services, they are not well-positioned to fill the gap that would be left if Planned Parenthood were defunded. Sara Rosenbaum, a professor at the George Washington University Milken Institute School of Public Health, wrote in an article for Health Affairs that the “claim that community health centers readily can absorb the loss of Planned Parenthood clinics amounts to a gross misrepresentation of what even the best community health centers in the country would be able to do”:

I have worked with community health centers for nearly 40 years, and no one believes more strongly than I do in their ability to transform the primary health care landscape in medically underserved low-income communities. But a claim that community health centers readily can absorb the loss of Planned Parenthood clinics amounts to a gross misrepresentation of what even the best community health centers in the country would be able to do were Planned Parenthood to lose over 40 percent of its operating revenues overnight as the result of a ban on federal funding.

[...]

It is important to set the record straight about what it would mean to women were health centers suddenly to have to respond to a hole in care of this magnitude, especially given absurd claims about their financial ability to do so, such as assertions that community health centers could do so for $1.67 per patient. Community health centers are extremely efficient, but the cost of caring for their patients averages about $600 per person annually.

While community health centers constitute a vital component of the nation's primary care safety net, three reasons underscore why it's misguided to suggest community health centers could--overnight--compensate for the loss of affordable women's health services at Planned Parenthood clinics. [Health Affairs, 9/2/15]

Guttmacher Institute: In 103 U.S. Counties, Planned Parenthood Is The Only “Safety-Net Health Center” With Accessible Contraception Services. In 2015, the Guttmacher Institute responded to a request from the Congressional Budget Office about the “geographic service availability from Planned Parenthood health centers.” The study found that in 103 U.S. counties, Planned Parenthood is the only “safety-net health center” able to provide publicly subsidized contraceptive services. The study also found that Planned Parenthood typically saw patients three to five days sooner than “other types of safety-net providers.” From the Guttmacher Institute (citations removed):

In 18 states, Planned Parenthood health centers serve more than 40% of women obtaining contraceptive care from a safety-net family planning health center.

In 11 of those 18 states, Planned Parenthood serves more than half the women obtaining contraceptive care from a safety-net health center.

[...]

In 103 counties with a Planned Parenthood health center (21% of counties with a Planned Parenthood site), Planned Parenthood serves all of the women obtaining publicly supported contraceptive services from a safety-net health center. [Guttmacher Institute, 8/14/15]

NY Times Editorial Board: Planned Parenthood Serves More Patients And Has “Higher Quality Care Than Centers Without An Emphasis On Reproductive Health.” In a September 9 editorial, The New York Times refuted the argument that “community health centers can easily provide the same family planning services that Planned Parenthood offers.” As evidence, the Times noted that Planned Parenthood “serves an enormous number of patients,” and that despite running “only 10 percent of all health centers that receive Title X funds” -- funding reserved for the provision of family planning services -- the organization regularly provides services to “about a third of all patients” receiving Title X services. The Times also pointed to a recent study which found that Planned Parenthood was able to offer “a wider range of family planning services and higher quality care than centers without an emphasis on reproductive health.” From the September 9 editorial:

Some state lawmakers have argued that community health centers can easily provide the same family planning services that Planned Parenthood offers. But a study published this year found that providers focused on reproductive health care, like Planned Parenthood, offered a wider range of family planning services and higher quality care than centers without an emphasis on reproductive health.

Planned Parenthood also serves an enormous number of patients; though it operates only 10 percent of all health centers that receive Title X funds, it treats about a third of all patients receiving federally funded family planning services nationwide.

[...]

If the [proposed Title X] rule takes effect, it will benefit people all over the country who need reliable reproductive health care. [The New York Times, 9/9/16]

Fact: State-Level Defunding Of Planned Parenthood Has Already Had Negative Impacts On Community Health

After State Funding Cuts Forced Rural Indiana Planned Parenthood Clinics To Close, Scott County Became Center Of “Exploding HIV Outbreak.” In 2011, Indiana’s anti-choice legislature cut state funding for Planned Parenthood -- forcing five Planned Parenthood clinics to close. These cuts left rural Scott County without an HIV testing center as it experienced a sharp increase in HIV infections. According to a 2015 article in The Huffington Post, the cuts made Scott County “the center of an exploding HIV outbreak” while the state was left “scrambling to erect pop-up clinics to combat an unprecedented HIV epidemic.” From the March 31, 2015, article:

Scott County, Indiana, the center of an exploding HIV outbreak, has been without an HIV testing center since early 2013, when the sole provider -- a Planned Parenthood clinic -- was forced to close its doors. The clinic did not offer abortion services.

The Scott County clinic and four other Planned Parenthood facilities in the state, all of which provided HIV testing and information, have shuttered since 2011, in large part due to funding cuts to the state's public health infrastructure. Those cuts came amid a national and local political campaign to demonize the health care provider. Now, the state is scrambling to erect pop-up clinics to combat an unprecedented HIV epidemic caused by intravenous drug use.

[...]

[Planned Parenthood of Indiana and Kentucky vice president for public policy Patti] Stauffer said if the Planned Parenthood facilities in Scottsburg and Madison, both in southwest rural Indiana, had received the funding they needed to stay open, they could have been a vital resource in preventing the current HIV outbreak. [The Huffington Post, 3/31/15]

Texas Defunded And Canceled Contracts With Planned Parenthood To The Detriment Of Community Health. Joseph Potter, a professor of sociology and the principal investigator of the University of Texas at Austin's Texas Policy Evaluation Project (TxPEP), investigated the impact of the Texas legislature's decision to exclude Planned Parenthood from the state’s reproductive health safety-net program. According to a 2015 guest column in the San Antonio Express-News, Potter found “not all federally qualified health centers” or community clinics were interested in “becoming a family-planning provider.” Similarly, he found that “there have also been problems for the women faced with finding a new provider” once Planned Parenthood was no longer an option. A June 2016 report by the Texas Observer found that in Harris County, TX -- which had the highest number of new HIV diagnoses in the state in 2014 -- the county’s health department hadn’t conducted a single HIV test since the elimination of its contract with Planned Parenthood in December 2015. [San Antonio Express-News, 8/15/15; Texas Observer, 6/8/16]

Claim: Ending The Individual Mandate Would Encourage More People To Get Health Insurance

Mulvaney: “Continuous Coverage” Requirement “Would Encourage People” To Sign Up. CBS This Morning co-host Anthony Mason asked Mulvaney if the new penalty for those who let their insurance lapse -- a provision the GOP is calling “continuous coverage,” which replaces the individual mandate – would “discourage people from getting back into the insurance market.” Mulvaney claimed it would do “the exact opposite.” From the March 7 edition of CBS This Morning:

ANTHONY MASON (CO-HOST): Director, one of the key changes here is that you’re eliminating the government’s mandate that you must have health insurance and replacing it with a penalty for a lapse in coverage and increase in premiums. How exactly is that going to work?

MICK MULVANEY: It’s called continuous coverage, and it’s sort of how we’ve proposed to deal with this concept called adverse selection. One of the problems with Obamacare now is that you can wait to buy insurance until after you get sick. And what we try and do is give people an incentive to go off and say, look, if you’re really worried about that, go up and sign up now and make sure that you can prove that you’ve had continuous coverage. And then if you do get sick, you can’t lose your coverage.

MASON: But if you have a penalty kicking in if your insurance lapse, won’t that ultimately discourage people from getting back into the insurance market?

MULVANEY: No, I think the exact opposite. It would encourage people, especially young, healthy people, one of the groups that Obamacare was never able to get into the system. [CBS, CBS This Morning, 3/7/17]

Fact: Ending The Individual Mandate Would Cause Skyrocketing Premiums And Would Increase The Number Of Uninsured

Families USA: “Premiums Will Skyrocket” If The Individual Mandate Is Repealed. Families USA explained, “If you end the individual mandate, premiums will skyrocket. You can’t require insurers to cover people with pre-existing conditions without also bringing healthy people into the insurance pool.” From the February 2017 fact sheet (emphasis original):

End the individual mandate — If you end the individual mandate, premiums will skyrocket. You can’t require insurers to cover people with pre-existing conditions without also bringing healthy people into the insurance pool. The balance of both healthy and sick people in insurance plans is needed to even out costs for everyone. [Families USA, February 2017]

CBO: Repealing The Individual Mandate Would Increase Premiums By 20 Percent. According to 2015 projections by the Congressional Budget Office (CBO), repealing the individual mandate would mean “premiums for policies in the individual market would increase by roughly 20 percent relative to current law in all years between 2017 and 2025.” [Congressional Budget Office, 9/15/15]

Claim: Health Savings Accounts Will Make Preventative Care Affordable

Mulvaney: Expanded Health Savings Accounts Will Allow People To Get Preventative Care “In A Very Affordable Fashion.” Mulvaney claimed that beneficiaries will still have access to preventative health care through health savings accounts (HSAs) during an interview on CBS This Morning. Mulvaney said the Republican plan’s “dramatic expansion of healthy savings accounts” would allow people to “get that care in a very affordable fashion.” From the March 7 edition of CBS This Morning:

NORAH O’DONNELL (CO-HOST): Let me ask you about preventative care. One of the things that Obamacare did was expand coverage, and mandate coverage, for preventative care, such as mammograms, contraceptive care, also mental health screenings. Will that continue under this Republican plan?

MICK MULVANEY: Yeah, the way we get at those things is a dramatic expansion of health savings accounts, so that you can use your pre-tax dollars. We've doubled the size of them, or nearly doubled the size of them, and then dramatically increase where you can use them. So we do feel people will still have the ability to get that care in a very affordable fashion. [CBS, CBS This Morning, 3/7/17]

Fact: HSAs Help The Wealthy, The Healthy, And The Educated -- Not The Uninsured

CBPP’s Park: “GOP Health Savings Account Proposals Would Mostly Help Wealthy, Not Uninsured.” CBPP's Park wrote that expanding HSAs “would mainly benefit high-income taxpayers and likely do little for those losing their health coverage if the ACA were repealed.” Park explained that “because a tax deduction rises in value with an individual’s tax bracket, HSAs provide the largest tax benefits to high-income individuals.” He noted that “research shows that at least 90 percent of the uninsured before the ACA were in the 0, 10, or 15 percent tax bracket, so they would receive an income tax benefit of no more than 15 cents for every $1 they can deduct — not enough to make coverage affordable.” From the November 17 article (emphasis original):

For his alternative to the Affordable Care Act (ACA), which he would repeal, President-elect Trump proposes to rely on Health Savings Accounts (HSAs). That’s consistent with the health plans of House Speaker Paul Ryan and other congressional Republicans, which would expand HSAs in ways that would mainly benefit high-income taxpayers and likely do little for those losing their health coverage if the ACA were repealed.

[...]

Because a tax deduction rises in value with an individual’s tax bracket, HSAs provide the largest tax benefits to high-income individuals. In addition, research shows that high-income people are likelier to make the maximum annual contributions to HSAs. Since there are no income limits on HSA participation, affluent people whose incomes are too high to qualify for individual retirement accounts (IRAs) or who have “maxed out” their 401(k) contributions can use HSAs to shelter more funds. Households with incomes of at least $100,000 account for most tax returns claiming an HSA deduction and the large majority of the total amount of HSA contributions (see chart).

[...]

Many other congressional Republican HSA expansion proposals (including the RSC plan) would also allow HSA funds to pay health insurance premiums. Because HSA contributions are tax-deductible, this would effectively create a tax deduction for the premium costs of a high-deductible plan in the individual health insurance market. But it would do little or nothing to help the uninsured. Research shows that at least 90 percent of the uninsured before the ACA were in the 0, 10, or 15 percent tax bracket, so they would receive an income tax benefit of no more than 15 cents for every $1 they can deduct — not enough to make coverage affordable. Those with no federal income tax liability would receive zero benefit. [Center on Budget and Policy Priorities, 11/17/16]

Economist Kathryn Phillips: Health Savings Accounts “Primarily Benefit The Wealthy, The Healthy, And The Educated.” Health care economist Kathryn Phillips of the University of California, San Francisco, wrote an article in Health Affairs outlining that while “HSAs are conceptually appealing,” in reality, “they primarily benefit the wealthy, the healthy, and the educated.” She noted that “most low-income individuals do not have a high enough tax liability to benefit from the tax deductions associated with HSAs.” She explained that “HSAs benefit not only the wealthier more but also healthier individuals who are more likely to be able to benefit from accrued savings over time.” She also emphasized that “an important but often neglected aspect of HSAs is that they require an educated and savvy consumer who can devote a great deal of time and effort to understanding their plan and shopping for care.” From the December 8 article:

One of the reforms proposed as part of the Trump health platform is to “allow individuals to use Health Savings Accounts (HSAs).” This increased emphasis on HSAs is a clarion call for more understanding about how to make HSAs work so that they are equitable, effective, and efficient.

Although HSAs are conceptually appealing and can play an important role in health reforms, current evidence suggests that they primarily benefit the wealthy, the healthy, and the educated. Thus, new approaches will be needed if HSAs are to be used more widely and improve health outcomes for the broader population.

[...]

In general, studies have found that HSAs combined with high-deductible plans can decrease overall use of services and costs, but there is little evidence yet that this results in improved health status. Most low-income individuals do not have a high enough tax liability to benefit from the tax deductions associated with HSAs — and that assumes that they even have enough disposable income to put aside into a savings account. Studies have found that the impact of HSAs differs by income level, e.g., lower-income workers (and their dependents) were more likely than higher-income individuals to reduce their use of physician office visits and certain high-value services not subject to the deductible, such as influenza vaccinations and breast cancer screenings. HSAs benefit not only the wealthier more but also healthier individuals who are more likely to be able to benefit from accrued savings over time. [Health Affairs, 12/8/16]

Kaiser Family Foundation: HSAs Can Increase Out-Of-Pocket Costs For “People With Chronic Conditions, Disabilities, And Others With High-Cost Medical Needs,” And They “Are Unlikely To Substantially Increase ... Coverage Among The Uninsured.” A Kaiser Family Foundation issue paper on the use of HSAs in low-income families found that “people with chronic conditions, disabilities, and others with high-cost medical needs may face even greater out-of-pocket costs under HSA-qualified health plans.” The brief also noted that HSAs “are unlikely to substantially increase health insurance coverage among the uninsured” because the majority of uninsured Americans are low-income and thus receive few benefits from HSAs. From the October 2006 report:

People with chronic conditions and disabilities often experience higher medical costs than those without these conditions. For example, the total health care costs for individuals with asthma, heart disease, and diabetes are more than double that of nonelderly adults in general. As a result, these individuals are much more likely to reach their deductible level each year, which by design, is set at a much higher level in HDHPs.

Health Savings Accounts and HDHPs are likely to be more attractive to healthy individuals and families who have had few major medical expenses. If the healthiest increasingly enroll in HSA qualified HDHPs while persons with chronic conditions and those with higher medical expenses remain in existing health plans, the premiums for traditional coverage will rise accordingly for the least healthy.

[...]

Over two-thirds of the nonelderly uninsured are low-income. Because they earn so little, over half of the uninsured have no tax liability. As such, health insurance proposals that rely on tax deductions as an incentive will have limited impact on the number of uninsured. In addition, high deductible health plans that require higher out-of-pocket spending will not offer the low-income uninsured enough financial protection to offset the premium cost. [Kaiser Family Foundation, October 2006]

Families USA: Health Savings Accounts “Are No Substitute For Health Insurance With Real Coverage Guarantees.” A Families USA fact sheet emphasized that HSAs “are no substitute for health insurance with real coverage guarantees we have today.” It also noted that they “don’t work for most families” that “do not have the additional financial resources to set aside thousands of dollars to pay for health care bills” and often just provide “another tax shelter for the wealthy.” From the February 2017 fact sheet (emphasis original):

Health Savings Accounts (HSAs) — Health Savings Accounts are not health insurance; they merely provide a place where people can stash their own money to later spend on health care. They are no substitute for health insurance with real coverage guarantees we have today. And these accounts don’t work for most families, especially those living paycheck to paycheck, who can’t afford to set aside thousands of dollars to pay the full cost of their health care bills. They are just another tax shelter for the wealthy.

• The majority of families who actually put money in health savings account are households making more than $100,000each year.

• When you look at all of the money put into health savings accounts in a year, 70 percent of that money comes from higher-income homes (households making more than $100,000).

  • More than 15 million family households in the United States are headed by women. About 29 percent of those families, or 4.4 million family households, have incomes that fall below the poverty level. Women and families living in poverty simply do not have the additional financial resources to set aside thousands of dollars to pay for health care bills.

• Plans that come with HSAs must have a deductible of at least $1,300 ($2,600 for a family). Kaiser Family Foundation found that 68 percent of lower-income households (between 100-250% of poverty) don’t have the financial assets to pay an even smaller $1,200 deductible. [Families USA, February 2017]

Claim: Obamacare Is In A “Death Spiral”

Mulvaney: “Obamacare Is An Unmitigated Disaster” And In A “Death Spiral.” In an interview on NBC’s Today, Mulvaney claimed that “Obama is an unmitigated disaster” and is in the midst of a “death spiral.” From the March 7 edition of NBC’s Today:

MICK MULVANEY: Well, you can’t even compare Obamacare to right now because what everyone seems to want to ignore is the fact that Obamacare is an unmitigated disaster. I live in one of the states, for example, South Carolina, where we're down to just one provider under Obamacare. If that provider leaves, my entire state loses Obamacare coverage. Obamacare is in one of these -- everyone seems to want to call it death spiral. Democrats even admit that the program is not working. [NBC, Today, 3/7/17]

Fact: Obamacare Is Not In A “Death Spiral”

CBS News: “Fact Check: Obamacare Is Not In A ‘Death Spiral.’” CBS News fact checked Speaker of the House Paul Ryan’s assertion that Obamacare is in “a death spiral,” noting that these claims “are exaggerated, if not downright false.”  The article emphasized that “experts agree that the law is not currently in a ‘death spiral.’:

President-elect Donald Trump says that President Barack Obama’s health care law “will fall of its own weight.”

House Speaker Paul Ryan says the law is “in what the actuaries call a death spiral.”

And Senate Majority Leader Mitch McConnell says that “by nearly any measure, Obamacare has failed.”

The problem with all these claims: They are exaggerated, if not downright false.

[...]

TRUMP, RYAN AND MCCONNELL: The law will “fall of its own weight,” is in a “death spiral” and “has failed.”

THE FACTS: Experts agree that the law is not currently in a “death spiral,” an actuarial term that refers to a vicious cycle when rising insurance costs force healthy customers out of the marketplace, resulting in still higher prices, which cause even more customers to bail, etc., until the system collapses.

But some say that if the current situation continues, that is a likely or possible scenario. Health care premiums are jumping by double digits this year, and the health care marketplaces created by the law are short on the healthy consumers who make insurance companies profitable.

“It’s not a failure in that 20 million people or more have insurance that didn’t used to have insurance. Everything else, it’s too early to judge,” said economist Gail Wilensky, who ran Medicare under former President George H.W. Bush.

“To say that the exchange markets remain unstable and in turmoil is an appropriate statement,” she said. “To say that they’re in a death spiral really depends on what happens.”

The American Academy of Actuaries itself disputed the “death spiral” claim Monday. The group provided a statement from its senior health fellow asserting that high premium increases in many states this year “do not necessarily indicate that a premium spiral is occurring” and could be a one-time adjustment. [CBS News, 1/10/17]

Right-Wing Media's Previous Claims Of A “Death Spiral” Have All Failed To Come To Fruition. In the early days of the implementation of the health insurance exchanges, right-wing media made numerous predictions that a lack of young, healthy enrollees would cause the Affordable Care Act to “go into [a] death spiral and implode.” Fox News repeatedly claimed that the inability to lure healthy individuals to participate in the marketplaces would doom the success of the ACA, despite contradictory evidence that enrollment numbers were on target and increasing. Another way in which the conservative media have reappropriated fears of a “death spiral” in the markets revolves around predictions of skyrocketing health insurance premiums. In 2014, several conservative media outlets predicted that health care costs would “skyrocket” as a result of the ACA's restructuring of the private insurance market. Conservatives continually predicted impending cost spikes that would result in customers refusing to purchase insurance plans, linking these false predictions of price increases to the alleged inevitable “death spiral” of the insurance market. After their predictions of an enrollment and premium increase “death spiral” fell flat, right-wing media shifted to focusing on the isolated failures of several underfunded health insurance cooperatives as proof that the president’s signature health care reform law was in a “death spiral.” They argued that problems in the co-ops were, as Fox’s Marc Siegel put it, a “symptom for the larger disease, which is that Obamacare was never as promised” and would result in the inevitable death spiral (which never came). [Media Matters, 1/2/14, 1/14/14, 3/30/14, 1/11/15, 3/20/14, 12/27/14, 7/16/15, 11/4/15]

The Republican Plan Is Even Facing Staunch Opposition From Republicans

Slate: The Republican Health Care Plan “Has Already Drawn Loud Criticisms From A Slew Of … Congressional Republicans.” Slate noted, “The Obamacare replacement bill released by House Republicans on Monday has already drawn loud criticisms from a slew of other congressional Republicans.” While some of the “fiscal hard-liners of the House Freedom Caucus” claim the bill is “‘Obamacare 2.0’,” “four Republican senators from states that passed Obamacare’s Medicaid expansion … also oppose the House GOP’s plan,” as does Sen. Rand Paul (R-KY). From the March 7 report:

The Obamacare replacement bill released by House Republicans on Monday has already drawn loud criticisms from a slew of other congressional Republicans. Leading the opposition, predictably, are some of the fiscal hard-liners of the House Freedom Caucus who put together their own repeal and replacement plan last month. Freedom Caucus member Rep. Dave Brat told the Washington Examiner that the House leadership’s plan was dead on arrival. “It doesn't matter who comes to us and asks us to go along with this devastating program," he said. “The answer will be no.” The Freedom Caucus’ Justin Amash dubbed the bill “Obamacare 2.0.”

[...]

Meanwhile, in the Senate, Sen. Rand Paul has given the new bill a Trumpian dismissal.

[...]

Four Republican senators from states that passed Obamacare’s Medicaid expansion—Alaska’s Lisa Murkowski, Colorado’s Cory Gardner, West Virginia’s Shelley Moore Capito, and Ohio’s Rob Portman—also oppose the House GOP’s plan and wrote a letter to Senate Majority Leader Mitch McConnell saying so. “We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” they wrote, “and we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.” [Slate, 3/7/17]

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