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The GOP Released Its Health Care Bill, The American Health Care Act

Vox: The AHCA Will Provide “Much Lower Subsidies,” Roll Back “Much Of The [ACA’s] Insurance Expansion,” And “Cut Medicaid.” Vox’s Sarah Kliff wrote a brief “explainer” on the American Health Care Act (AHCA), highlighting the major changes the proposed law would have on the health care system. She notes that it “will roll back much of the [Affordable Care Act’s] insurance expansion” by making coverage “less accessible to low- and middle-income Americans.” Kliff outlined potential cuts to Medicaid and explained that “AHCA provides much lower subsidies” than the Affordable Care Act (ACA) does. From the March 7 article:

The American Health Care Act is Republicans’ plan to repeal and replace Obamacare.

[...]

The AHCA gets rid of some popular parts of Obamacare, too. It will roll back much of the health law’s insurance expansion, which currently covers about 20 million people. It does this by making the two big sources of coverage under the law — Medicaid and private individual insurance — less accessible to low- and middle-income Americans.

In private insurance, AHCA provides much lower subsidies for those who buy coverage on the individual market — especially people who are low-income. The Kaiser Family Foundation estimates that, on average, the subsidies in this plan are 36 percent lower than those in current law. This means that it would become harder for people who earn about $20,000 or $30,000 a year to afford coverage if they don’t get it at work.

[...]

AHCA would keep the Medicaid expansion but only until 2020. At that point, states would have to stop enrolling people and anyone who fell off the program — perhaps because their income went up, or they simply forgot to enroll — would not be allowed back on.

AHCA changes the rest of Medicaid, too. Right now, the federal government pays a certain percent of every Medicaid enrollees’ bills no matter how high they go. AHCA would change that: It would have the federal government give states a lump sum for each person in Medicaid, meaning states could run out of money for especially high-cost patients.

We’re still waiting for more analysis on how much this particular provision could cut Medicaid. A lot depends on key details, like how big that lump sum is and how quickly it would grow. [Vox, 3/7/17]

State Editorial Boards Across The Country Criticized The GOP Proposal, Outlining A Variety Of Negative Impacts

Herald Tribune: The AHCA “Will Be Better … For The Well-To-Do, But Far Worse For The Millions Of Americans Who Lack Private Insurance Options.” The editorial board of Florida’s Herald-Tribune denounced the GOP health care plan, noting “it appears that the plan will be better for the deficit and for the well-to-do, but far worse for the millions of Americans who lack private insurance options.” The editorial emphasized that “the number of uninsured would rise by 24 million by 2026” and the AHCA would “also sharply increase insurance costs for baby boomers.” The editorial board summarized the GOP’s plan as one where “the government saves money, the well-to-do get a tax break, and millions of Americans who lack health coverage — because they're poor, or lack coverage from an employer, or are stuck between the loss of a job and eligibility for Medicare — must go without.” From the March 14 editorial:

Now that the details of the U.S. House Republican leadership's plan to “repeal and replace” Obamacare have have been fleshed out, it appears that the plan will be better for the deficit and for the well-to-do, but far worse for the millions of Americans who lack private insurance options.

That is simply is not acceptable. We urge Congress and the Trump administration to make changes in the current plan that will keep the promises they made, prior to the election, of affordable health care coverage for all Americans who need it.

The nonpartisan Congressional Budget Office estimated Monday that, under the Republicans' proposed plan, 14 million more Americans will be uninsured next year than would be under the ACA.

The number of uninsured would rise by 24 million by 2026, the CBO said, meaning that an estimated 52 million Americans would lack health insurance by that time. That compares with an estimated 28 million uninsured in 2026 under the ACA.

[...]

The Republican plan would also sharply increase insurance costs for baby boomers in their 50s and 60s by allowing private insurers to dramatically boost their premiums and deductibles.

The winners in the Republican proposal include deficit hawks, who would see an estimated $337 billion reduction in federal deficits over the next 10 years. Wealthy Americans also would benefit as the plan repeals taxes they paid to help insure low- and middle-income Americans.

In other words, the government saves money, the well-to-do get a tax break, and millions of Americans who lack health coverage — because they're poor, or lack coverage from an employer, or are stuck between the loss of a job and eligibility for Medicare — must go without.

That's not how a federal insurance plan called the American Health Care Act should work. [Herald-Tribune, 3/14/17]

Gainesville Sun: “Florida Stands To Lose Much More Than It Gains” Under The AHCA. The Gainesville Sun’s editorial board argued that the AHCA “would be especially costly for Florida,” noting that “more than 1.7 million Floridians have obtained health insurance through Obamacare” and “93 percent of them received federal aid to help pay for the plans and would suffer under the GOP proposal.” The editorial explained that, in particular, “Floridians who are older, have lower incomes and live in rural areas would fare significantly worse under the AHCA,” and the GOP’s plan to cap Medicaid spending “would hurt the 4.3 million Floridians who rely on the health program for the poor.” From the March 10 editorial:

House Speaker Paul Ryan and other Republicans are trying to force through the bill before the nonpartisan Congressional Budget Office can determine its cost and effect on coverage. But as two reports this week in the Miami Herald show, it's already clear that Florida stands to lose much more than it gains.

More than 1.7 million Floridians have obtained health insurance through Obamacare, a.k.a. the Affordable Care Act, more than in any other state. About 93 percent of them received federal aid to help pay for the plans and would suffer under the GOP proposal to provide tax credits to help people buy insurance.

Floridians who are older, have lower incomes and live in rural areas would fare significantly worse under the AHCA, according to a Kaiser Family Foundation analysis that doesn't even take into account the proposal's elimination of additional aid for very low-income residents.

The bill's spending limits on Medicaid would hurt the 4.3 million Floridians who rely on the health program for the poor. As health-care experts told the Herald, Florida's Medicaid spending already ranks near the bottom of all states so we would be stuck with low spending caps under the plan. [The Gainesville Sun, 3/10/17]

St. Louis Post-Dispatch: “There Are So Many Things Wrong With This Plan That It’s Hard To Know Where To Begin.” The St. Louis Post-Dispatch editorial board mocked the debate over the AHCA’s name, arguing that you can “call it the American Health Care Act. Call it Repulicare. … Call it Trumpcare. … Just don’t call the health care plan unveiled by House Republican leaders Monday night an improvement on the Affordable Care Act of 2010.” The editorial said the GOP proposal “pays for a tax break for the rich by taking Medicaid away from poor people, including Medicaid services for poor women provided by Planned Parenthood.” The editorial board highlighted the impact on the elderly, citing a Brookings Institution report that “says the Republican plan would fully deplete the Medicare Trust Fund by 2024, four years earlier than anticipated.” From the March 9 editorial:

Call it the American Health Care Act. Call it Republicare. Call it, as some conservative critics immediately did, Obamacare 2.0 or Obamacare Lite. Call it TrumpCare, though the White House, sensing disaster, would prefer that you not. Just don’t call the health care plan unveiled by House Republican leaders Monday night an improvement on the Affordable Care Act of 2010.

There are so many things wrong with this plan that it’s hard to know where to begin.

[...]

Liberals will hate the bill because, at its core, it pays for a tax break for the rich by taking Medicaid away from poor people, including Medicaid services for poor women provided by Planned Parenthood. It would turn Medicaid into a block grant by 2020, allowing states to triage among the poor people eligible for many programs. It eliminates all of the taxes that pay for Obamacare, including 0.9-cent higher payroll tax on income over $200,000 and a 3.8 percent surcharge on investment income in households earning more than $250,000. Over 10 years, it’s a $600 billion tax break for the wealthy.

That higher payroll tax on wealthier Americans goes to the Medicare Trust Fund, which reimburses hospitals for care given to senior citizens. The Brookings Institution says the Republican plan would fully deplete the Medicare Trust Fund by 2024, four years earlier than anticipated. Expect Democrats to make a major issue out of the threat to Medicare patients and to hospitals.

[...]

This is the opposite of responsible governance. This bill is a slapdash measure designed to fulfill the GOP’s “repeal-and-replace” promise. If it passes — and that’s far from certain given hostility on the right and left — Republicans will regret it.

For all the derision Republican leaders heaped on Obamacare, this measure keeps some of the Affordable Care Act’s more popular provisions, including guarantees that people with pre-existing conditions can be insured, that young people can stay on their parents’ policies until age 26 and that insurers can’t set lifetime limits on coverage.

[...]

The GOP bill doesn’t pay for any of this. Obamacare required healthy people and wealthy people to subsidize costs for the sick and the poor. That’s why so many conservatives hated it, but this kind of risk-pooling is how all insurance works. The GOP plan offers tax credits that will, for millions of low-income working class Americans, fall far short of what is needed to buy decent insurance. [St. Louis Post-Dispatch, 3/9/17]

Lincoln Journal Star: A “Quick Reading … Makes Clear That Health Care Coverage Would Be Rolled Back Significantly By The AHCA.” The Lincoln Journal Star editorial board noted the “stupendous amount of opposition” to the GOP health bill and argued that “one quick reading of the 123-page bill makes clear that health care coverage would be rolled back significantly by the AHCA.” The editorial cited the non-profit Voices for Children in Nebraska which declared that the GOP bill “would ‘end Medicaid as we know it,’” which would disproportionately affect Nebraska, where “one out of every three children” and “one in every two nursing home residents in the state” are covered by Medicaid. From the March 8 editorial:

For a piece of legislation that Republicans supposedly have been working on for seven years, the American Health Care Act has generated a stupendous amount of opposition.

The outrage came from everywhere -- the Republican Freedom Caucus, Democrats, conservative and liberal think tanks, and mainstream groups like the American Medical Association, the nation’s largest physician organization.

[...]

In Nebraska one out of every three children receives health care coverage through Medicaid. One in every two nursing home residents in the state is covered by Medicaid.

[...]

One quick reading of the 123-page bill makes clear that health care coverage would be rolled back significantly by the AHCA. As Voices for Children in Nebraska put it, the bill would “end Medicaid as we know it.”

The tax credits that the bill would provide are considerably lower than those available under current law. For example, according to an analysis by the Kaiser Foundation, a 40-year-old Nebraskan with an annual income of $30,000 would get a tax credit of about $3,000, compared to $4,280 under the current Affordable Care Act.

It doesn’t even come close to matching President Donald Trump’s promise to “come up with a new plan that’s going to be better health care for more people at a lesser cost.”

In marked contrast to the rollback in health coverage for vulnerable Americans was the breaks the AHCA provides wealthy Americans. The bill would eliminate more than 20 taxes, such as a 3.8 percent tax on investment income for high-income households. There’s even a tax break for health insurance executives who make more than $500,000. [Lincoln Journal Star, 3/8/17]

Star Ledger: “More People Will Die On The Street. That’s What Happens When You Cut Back Coverage In The Middle Of An Epidemic.” The editorial board of New Jersey’s Star Ledger excoriated the AHCA, calling it “Trumpcare” and saying it provides it “a gigantic tax cut [for] the wealthy” while “it guts Medicaid and leaves 14 million without health insurance … a number that will only rise.” The editorial emphasized the impact of Trumpcare on the opioid epidemic, arguing that “more people will die on the street. That's what happens when you cut back coverage in the middle of an epidemic.” The editorial noted that the GOP plan “cut[s] people off public insurance” and “eliminates Obamacare's requirement that many insurers cover substance abuse and mental health treatment,” and it characterized the AHCA’s impact on Medicaid as a “savage cut that will gut the program, no matter how they spin it.” From the March 15 editorial:

President Donald Trump and Gov. Chris Christie both promised to do absolutely everything in their power to fight the opioid epidemic.

[...]

Such compassion. But now we are facing Trumpcare: In order to give a gigantic tax cut to the wealthy, it guts Medicaid and leaves 14 million without health insurance next year, according to the Congressional Budget Office - a number that will only rise.

That's catastrophic for drug treatment, at a time when overdoses are killing more people than car accidents or gun violence. More people will die on the street. That's what happens when you cut back coverage in the middle of an epidemic.

[...]

Medicaid is the lynchpin. It is the largest payer of drug treatment services in the country by far. At the facilities Alan Oberman runs in Atlantic County, about 70 percent are on Medicaid, and the rest are uninsured and state-funded.

“Everybody thinks Medicaid is only for really poor people, but you lose your job, you're going to be on Medicaid,” he said.

His Pleasantville rehab is filled mostly with white suburbanites under the age of 35. Many single young adults will no longer be able to get treatment under the GOP plan. Because not only does it cut people off public insurance, it eliminates Obamacare's requirement that many insurers cover substance abuse and mental health treatment.

[...]

Now, Trumpcare is incentivizing them to shrink it. It puts a flat cap on federal funding that Trump says provides “flexibility.” Nonsense. This plan cuts federal spending on Medicaid by $880 billion over the next decade, according to the CBO. That is a savage cut that will gut the program, no matter how they spin it. More addicts will die, inevitably.

[...]

And yet once again, standing behind the President without making a peep, is Gov. Chris Christie. The hypocrisy is staggering. [The Star-Ledger, 3/15/17]

Asbury Park Press: “The Trumpcare Plan Republicans Are Trying To Push Through Congress At Warp Speed Would Make Things Worse. Much Worse.” The Asbury Park Press editorial board recognized that while the ACA “needs to be fixed … the Trumpcare plan Republicans are trying to push through Congress at warp speed would make things worse. Much worse.” The editorial noted that “in New Jersey, an estimated 800,000 low-income residents have obtained health insurance under Obamacare” but that the GOP plan “would eliminate the Obamacare subsidies and replace them with refundable tax credits based on age rather than income — a windfall for those who are older and affluent.” The editorial board emphasized that the plan is “certain to reduce overall coverage, result in higher deductibles and phase out Obamacare’s Medicaid expansion.” From the March 10 editorial (boldface original):

OK, we get it. Obamacare is flawed and it needs to be fixed. But the Trumpcare plan Republicans are trying to push through Congress at warp speed would make things worse. Much worse.

[...]

2. Millions will lose coverage

In New Jersey, an estimated 800,000 low-income residents have obtained health insurance under Obamacare. The plan would eliminate the Obamacare subsidies and replace them with refundable tax credits based on age rather than income — a windfall for those who are older and affluent. It would expand government assistance to many who don’t really need it instead of targeting those who need the help the most.

A 2016 study by the Commonwealth Fund and the Rand Corp. calculated that the most successful replacement scenario would produce an increase of between 15.6 million and 25.1 million uninsured Americans. A Robert Wood Johnson and Urban Institute study estimated that 66 percent of those losing coverage would have a high school education or less.

3. It will blow a hole in federal budget

A major feature of the Trump health plan is a rollback of the tax hikes on the wealthy that Obamacare had put in place to subsidize health care for lower-income Americans. The Affordable Care Act imposed an additional 0.9 percent surtax on income for Americans earning more than $200,000. An investment income tax imposed an additional 3.8 percent tax on capital gains and dividends. The nonpartisan Tax Policy Center estimated that would result in average tax cut of about $35,000 a year for the 1 percenters.

Trump campaigned on a promise that his replacement for Obamacare would provide affordable coverage for all, reduce deductibles and health care costs, produce better health care and not require any cuts to Medicaid. The Republican plan is certain to reduce overall coverage, result in higher deductibles and phase out Obamacare’s Medicaid expansion. [Asbury Park Press, 3/10/17]

News & Observer: “The GOP Plan Isn’t Even Close To President Trump’s Promises That He’d Come Up With Something Better And Cheaper And More Accessible Than ‘Obamacare.’” The editorial board of North Carolina’s News & Observer criticized the AHCA, arguing that the “GOP plan isn’t even close to President Trump’s promises that he’d come up with something better and cheaper and more accessible than ‘Obamacare.’” It noted that “cutbacks in the ACA will allow the GOP to push ahead with tax cuts for the wealthy and business, because those taxes helped fund subsidies for people enrolled in insurance under the ACA.” The editorial board suggested that “the smartest political move Republicans could make would be to vow to improve and refine and expand the ACA” and lamented that “instead, they’re going to kill it and the replacement ideas are not good.” From the March 8 editorial:

Ironically, GOP members in Congress have moved ahead despite polls showing the ACA is now popular, something that became ever more evident to those members of Congress who held town hall meetings on a recent recess. The smartest political move Republicans could make would be to vow to improve and refine and expand the ACA. Instead, they’re going to kill it and the replacement ideas are not good.

Among the aspects of the GOP plan: tax credits to help with ACA premiums but amounting to only a fraction of subsidies provided for lower-income levels under the ACA; no more mandate forcing people to buy insurance or pay a penalty, which is crucial to enrolling enough young, healthy people in insurance to compensate for the elderly, who need more care; cuts to federal money for local public health programs; no federal funding for Planned Parenthood —which provides some abortion services — and a phase-out of new funding for people who got covered under Medicaid expansion.

And surprise, surprise: cutbacks in the ACA will allow the GOP to push ahead with tax cuts for the wealthy and business, because those taxes helped fund subsidies for people enrolled in insurance under the ACA.

Republicans had to bow to one supremely popular part of the ACA, which was to protect people with pre-existing conditions. But companies will be able to charge the elderly more under the changes.

Interesting here is that the GOP plan isn’t even close to President Trump’s promises that he’d come up with something better and cheaper and more accessible than “Obamacare.” [The News & Observer, 3/8/17]

Charlotte Observer: “The Crucial Takeaway From The American Health Care Act” Is That “Fewer Americans Will Have Health Insurance.” The Charlotte Observer rejected “Republican claims that ‘access to health insurance’ is akin to having actual health care coverage” because “every American also has access to a BMW dealership – but only a relative handful can afford to buy a new expensive luxury car.” The editorial emphasized that “the American Health Care Act would make life easier for the healthy and wealthy and harder for the sick and poor” because “the richest Americans would receive millions of dollars in tax breaks as subsidies for the poor are pared back.” From the March 7 editorial:

Fewer Americans will have health insurance if the Republican alternative to the Affordable Care Act is enacted.

That’s the crucial takeaway from the American Health Care Act, because it goes to the heart of the health and financial stability of everyday Americans.

The consensus from analysts from both sides of the political divide is 10 million or more people will lose coverage under the plan, reversing a trend from the past few years that saw the nation reach its lowest uninsured rate ever.

[...]

Don’t be fooled by Republican claims that “access to health insurance” is akin to having actual health care coverage. Every American also has access to a BMW dealership – but only a relative handful can afford to buy a new expensive luxury car. That kind of thinking, though, seems to undergird the GOP plan, as evidenced by Rep. Jason Chaffetz of Utah, who suggested poor people could afford insurance if they just skipped their next iPhone purchase.

The American Health Care Act would make life easier for the healthy and wealthy and harder for the sick and poor.

Premiums and deductibles are expected to increase. The richest Americans would receive millions of dollars in tax breaks as subsidies for the poor are pared back. Corporate executives would receive increased pay with the removal of a cap on deductions.

The ACA helped extend the life of Medicare by roughly a dozen years while helping millions of senior citizens pay for prescription drugs. The GOP alternative may end up shortening the life of Medicare by half a decade or so. Planned Parenthood funding is on the chopping block, and the Medicaid expansion will be phased out.

[...]

From a political point-of-view, the American Health Care Act is nonsensical in that it solves few of the problems the GOP claimed needed to be urgently addressed. More importantly, from a humanitarian standpoint, the proposal falls well short of President Donald Trump’s promise to “cover everyone,” and it unnecessarily endangers lives. [The Charlotte Observer, 3/7/17]

Akron Beacon Journal: “Phasing Out The [Medicaid] Expansion” Is A “Very, Very Bad Idea.” The Akron Beacon Journal editorial board denounced the GOP’s plan to phase out the Medicaid expansion by 2020, claiming Republicans are “presenting states with an offer they cannot afford to accept.” The editorial quoted Gov. John Kasich, who called the proposed changes to Medicaid a “very, very bad idea.” The editorial also noted that the bill would “alter dramatically how federal money is allocated” for Medicaid, which would put “Ohio and the other states on an almost certain path to abandon the expansion.” The board underscored that “Medicaid is efficient, with lower and slower-growing costs than private insurance” and that “mess[ing] with this achievement ‘makes no sense.’” From the March 11 editorial:

Paul Ryan, the House speaker, talks about ensuring a “stable” transition for those Americans benefiting from the Medicaid expansion. His words echo the standard set by Gov. John Kasich and others who have witnessed how the expansion has advanced lives, bringing health coverage to 700,000 Ohioans. Yet House Republican leaders have a curious concept of stable. They propose ending the expansion, in essence, presenting states with an offer they cannot afford to accept.

All of it still fits the description the Ohio governor applied three weeks ago when he traveled to Washington to argue against phasing out the expansion. It’s a “very, very bad idea.”

[...]

It gets worse. The House Republican plan also proposes to alter dramatically how federal money is allocated for the program. No longer would Washington pay a set percentage of the medical bills. It would send each state a flat payment for each person who is covered. As designed, this per-capita limit would not keep pace with current Medicaid spending. Thus, the center sees states coping with another funding gap, a shortfall of $116 billion for the decade.

That’s $369 billion in total, or putting Ohio and the other states on an almost certain path to abandon the expansion.

Again, only the federal government has the financial muscle and scope to cover such an expense. At the same time, the expansion is affordable. Consider the $600 billion in tax cuts for the decade, largely flowing to wealthy households, in the House Republican plan.

More, Medicaid is efficient, with lower and slower-growing costs than private health insurance. States already have much flexibility in operating the program. If Congress wants to add room for testing ideas, go ahead as long as eligibility and quality are protected. Of the leading entitlement programs, Medicaid addresses almost exclusively the needs of the poor and vulnerable, including many with mental illness. Thus, adequacy and stability are high priorities.

Of all the flaws in the Affordable Care Act, the Medicaid expansion is not one of them. To mess with this achievement “makes no sense,” as John Kasich often and responsibly reminds. [Akron Beacon Journal, 3/11/17]

Virginian-Pilot: The AHCA Is “A Non-Starter” That Would “Balloon The Deficit, Grow The Debt And, Most Importantly, Leave More Americans Vulnerable To Catastrophic Health Care Costs.” The Virginian-Pilot’s editorial board rejected the GOP bill as a “non-starter” because it “would balloon the deficit, grow the debt and, most importantly, leave more Americans vulnerable to catastrophic health care costs.” The editorial noted that the GOP bill “would make things worse, especially for low-income Americans who earn too much to qualify for Medicaid but too little to benefit from subsidies,” noting that “there are hundreds of thousands of those folks in Virginia alone.” The editorial insisted that Republicans “should admit” what they “have proposed is worse” than the ACA “and head back to the drawing board.” From the March 9 editorial:

REPUBLICAN ARCHITECTS of the American Health Care Act — the plan to replace the flawed Affordable Care Act — managed quite a feat this week.

Their blueprint to reform health care reform appears to have united in opposition both the entirety of the Democratic Party and many in the GOP, including advocacy groups that have for years agitated for the repeal of Obamacare.

So half-baked is the measure that its authors hope to move it through committee before the Congressional Budget Office has an opportunity to confirm what most expect: that the bill would balloon the deficit, grow the debt and, most importantly, leave more Americans vulnerable to catastrophic health care costs.

It is, simply put, a non-starter, from both policy and political perspectives.

[...]

The Republican plan does nothing to address that flimsy support structure. In fact, it would make things worse, especially for low-income Americans who earn too much to qualify for Medicaid but too little to benefit from subsidies. There are hundreds of thousands of those folks in Virginia alone.

[...]

Now given a chance to govern and with both the legislative and executive branches of government in GOP hands, they have missed, and missed badly. That bodes poorly, not only for Americans who rely on ACA policies for critical care, but for the balance of GOP aspirations.

[...]

That was never good enough. What Republicans have proposed is worse. They should admit as much and head back to the drawing board. [The Virginian-Pilot, 3/9/17]