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Looking at the GOP ACA Replacement Plan
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Image courtesy of smokedsalmon at FreeDigitalPhotos.net
A number of articles came out this week discussing what the GOP put out as their replacement plan for the Affordable Care Act (ACA). The plan is in the early stages (which is honestly shocking considering they have had 7 years to work on a viable alternative), but there are several talking points they have mapped out for GOP members of Congress.
According to PBS News, the following points were part of the GOP replacement plan, and I am quoting their policy brief:
- Modernize Medicaid
- Utilize state innovation grants
- Enhance Health Savings Accounts (HSAs)
- Provide portable monthly tax credits
I was more familiar with some of these concepts than others. For example, what are these “portable monthly tax credits” and how do they work? According to the same policy brief:
Republicans want to repeal Obamacare’s expensive and rigid system of subsidies and replace them with a simple and flexible, advanceable and refundable tax credit to help Americans who do not receive insurance through their employer or a government program…
The credit is:
• Universal for all citizens or qualifed aliens not offered other qualifying insurance
• Age-rated
• Available for dependent children up to age 26
• Portable
• Grows Over Time…The credit can be used to purchase any eligible plan approved by a State and sold in their individual insurance market, including catastrophic coverage. Additionally, if an employer does not subsidize COBRA coverage, the individual can use the credit to help pay unsubsidized COBRA premiums while he or she is between jobs. If the individual does not use the full value of the credit, he or she can deposit the excess amount into a health savings account.
…The credit is not available to be used for plans that cover abortion [emphasis added].
This raises questions of whether the tax credits will really benefit all categories of individuals in the same way and at the same rate as the ACA subsidies. NPR news noted:
The elements of the plan include replacing the subsidies that help people buy insurance through Obamacare exchanges with fixed tax credits to buy coverage on the open market.
The major difference between the two is that the Obamacare subsidies increase as premiums rise so that consumers are responsible for the same premium amount, which is tied to their income. The tax credits proposed by Ryan are not tied to income but rise as a person ages and insurance rates increase.
“The important thing on the tax credits is that they’re not income adjusted and we don’t know how big they are,” Pearson [senior vice president at Avalere, a health care consulting group] says.
She says it’s unlikely they’ll be as generous as the Obamacare subsidies.
“This likely means that low-income people will have difficulty affording individual insurance,” she says.
Then there’s the point about being able to put additional money into health savings accounts. This line of reasoning has always bothered me because it feels like something that was thought up by individuals who have never had to live paycheck-to-paycheck. In order to put funds into an HSA (or an FSA, for that matter) you have to have enough income to do so. Said another way, you have to be making enough money that taking a portion of your check to set aside for potential health costs is not going to cause you financial hardship. For low-income families, that money may be needed to pay rent or put food on the table. There may not be any extra money in their paychecks to put aside in an HSA. The GOP plan would allow individual, self contributions in an HSA to jump from $3,400 to $6,550 and family contributions to jump from $6,750 to $13,100, but again, you have to have money you can easily set aside in the first place for this plan to be beneficial to you.
On modernizing Medicaid and creating state innovation grants, the NPR article noted:
The Republicans’ plan also calls for a major restructuring of the Medicaid health care program for the poor. It would repeal the Medicaid expansion that most states adopted under the Affordable Care Act, which allowed able-bodied people with incomes just above the poverty line to become eligible for Medicaid coverage.
It also noted that under the GOP plan the federal government would only pay a certain amount per person per year to the state, meaning that the state would have to come up with the remainder of the cost. This immediately begs the question as to where additional funds will come from to cover state subsidies.
This is all at a time when, as PBS News notes, “Treatment gaps persist between low- and high-income workers, even with insurance“. Low-income workers are more likely, right now, to end up in the emergency room and hospitals for treatment rather than getting preventative treatment. Part of that is likely a need for greater education on health literacy but it also has to do with the fact that low-income individuals don’t get preventative treatment because they know if a problem is found they’ll have to pay for it and the cost of getting it taken care of (such as paying for their deductibles) is something they cannot afford.
Finally, I also caught this article by NPR about the GOP wanting to return to high-risk insurance pools. As the article mentions:
The argument in favor of high-risk pools goes like this: Separate the healthy people, who don’t cost very much to insure, from people who have pre-existing medical conditions, such as a past serious illness or a chronic condition. Under GOP proposals, this second group, which insurers fear might be expected to use more medical care, would be encouraged to buy health insurance through high-risk insurance pools that are subsidized by states and the federal government.
Something like this used to exist in Minnesota, which had a high-risk pool called the Minnesota Comprehensive Health Association (MCHA). The problem is that returning to a system like the one that existed in MN could likely mean high monthly premium costs, exactly what the GOP says it’s trying to fix.
MCHA’s monthly premiums cost policy holders 25 percent more than conventional coverage, Gildemeister [an economist with Minnesota’s health department] points out, and that left many people uninsured in Minnesota.
“There were people out there who had a chronic disease or had a pre-existing condition who couldn’t get a policy,” Gildemeister says.
…And for the MCHA, even the higher premiums fell far short of covering the full cost of care for the roughly 25,000 people who were insured by the program. It needed more than $173 million in subsidies in its final year of normal operation.
That money came from fees collected from private insurance plans –- which essentially shifted a big chunk of the cost of insuring people in MCHA program to people who get their health insurance through work.
So the high-risk pools can be very costly, both to the individuals who buy into them and to the state that runs them (which means to tax-payers).
“The rub is, where that funding is going to come from?” she says. “And is the federal government or the state government willing to put up the funding needed to make some of these fixes?”
The national plan Ryan proposes would subsidize high-risk pools with $25 billion of federal money over 10 years. The nonpartisan Commonwealth Fund estimates the approach could cost U.S. taxpayers much more than that — almost $178 billion a year.
And my question is, if it’s going to cost us taxpayers so much more annually, how does that work when the GOP wants to cut taxes? How will the increased costs be sustained over time? Is this actually an economically viable option when applied on the national scale? The MN story leaves me with a lot of reason to doubt.
I’ll be following the GOP repeal-and-replacement stories closely in the future, but I must express that I have serious concerns about what they have put out initially. It seems that no matter how I look at current plans, many individuals, particularly some of the must financially vulnerable, will lose insurance due to unaffordability.
Two Weeks Since Inauguration Day (Feels So Much Longer)
(Written 2/3 but published late)
Wow, can you believe it has only been 14 days since Inauguration Day?! It feels as though these two weeks have taken months. So much has happened every single day that it has made it hard to catch one’s breath and take stock of anything.
There were so many moments in the news this week that I can’t comment on them all, but here were a few that caught my eye:
The Travel Ban
I think we have to start here. One week ago, President Trump issued an executive order that barred entry of refugees for 120 days (4 months) and immigrants attempting to enter the United States from seven key countries – Iran, Iraq, Syria, Sudan, Libya, Yemen and Somalia – for 90 days. The country rose up very quickly to denounce what many called a “Muslim ban”, particularly as it related to seven countries on the list from which immigrants would not be accepted. Questions arose as to whether Trump had left those countries out because of business ties.
Protesters rallied at airports, politicians spoke out against the ban, a federal court ordered a temporary stay, and the Acting Attorney General Sallie Yates refused to enforce the order, stating “At present, I am not convinced that the defense of the executive order is consistent with these responsibilities nor am I convinced that the executive order is lawful“. Very shortly after that, she was fired. Protests have continued and are still ongoing.
Bannon Given a Seat on the National Security Council
Really, this one is exhausting to think about so just read more here: Bannon is Given a Security Role Usually Held for Generals.
Neil M. Gorsuch Chosen to be Next Supreme Court Justice
Weirdest thing about this was Trump’s Bachelor-style announcement where he wanted to have both finalists in Washington to make the announcement that much more interesting. It seemed too much like a play for ratings. I did not watch the live-stream on Facebook but I kept up with the announcement in real-time on Twitter. Gorsuch is known to be a very conservative Justice with rulings in favor of corporations having similar rights to people (the Hobby Lobby decision) and is likely not a friend to the Roe Vs. Wade crowd, although his exact position on abortion is not perfectly clear.
Democrats Slow Down Confirmation Hearings
Every little bit of resistance helps. In most cases, the Republicans suspended committee rules and moved candidates ahead. However, it showed the clear displeasure Dems feel toward some of the nominees, most whom they think would be detrimental if appointed to their chosen offices. (You all know how I feel about Betsy DeVos, and that’s been the focus on my activism and many of my tweets this week. More on that, most likely, in a separate post).
Trump Has Less-than-Perfect Phone Calls with Australia and Mexico
My favorite response to this bit of news was this, as it expresses what most of us felt:
More could be said on all fronts, including updates on the environmental protections Trump wants to get rid of, the latest with plans to repeal the Affordable Care Act (with no clear replacement plan), the quiet activities to suppress voter rights across the country, etc., etc., but if all this hasn’t left you needing a glass of wine and a Friday night of unplugging, I don’t know what will.
Keep on keepin’ on! Keep on resisting! Keep writing and calling your Senators! (The DeVos vote will likely happen on Monday, so there’s still time to make your voice heard!) #VoteNoDevos #resist #persist
Update 2/6: Democratic Senators took to the floor to speak against DeVos. We will see if another Republican Senator does the right thing. If not, Pence will break tie with his vote, and we’ll be stuck with her.
CNN’s “The Sixties”, Connections to Present Day
Just finished watching The Sixties “The Times They Are A-Changing” episode. Anyone with Netflix should take some time to watch this series. It’s an amazing history lesson, but the similarities between activities going on then – civil rights marches, women’s rights marches and movements, LGBT movements, Latino movements, environmental protection and climate change discussion – and now are powerful to reflect on.
Rachel Maddow touched upon the similarities of “then vs. now” politically when she discussed Barry Goldwater running for President on a platform that pushed for a more conservative agenda for Republicans, one that said there was a need for less government involvement in society. Goldwater’s famous (or infamous) quote says “I would remind you that extremism in the defense of liberty is no vice! And let me remind you also that moderation in the pursuit of justice is no virtue.” This lead to extremist groups like the KKK endorsing Goldwater’s presidential bid, which in turn forced him to voice his disapproval of the group and rejection of their endorsement. (If this sounds like things we witnessed in 2016, congratulations, you’ve been paying attention).
Beyond the political similarities (like Nixon calling for a stronger “rule of law” during the turbulent year of 1968 – another great episode in the series The Sixties), the social activism during that period is something I had studied as part of my history lessons but I had not realized how many social movements were happening during that time. The women’s liberation movement discussed in “The Times They Are A-Changing” was fascinating to me. There they are in the ’60s discussing equal pay, the right for women to take charge of their reproductive health via family planning and birth control, and the long list of things women were not allowed to do before the movement (such as go to an Ivy League school, get a credit card or a bank account in her own name, or even serve on a jury). While we’ve overcome some of these hurdles, it’s astonishing we’re still arguing over reproductive rights and access as well as equal pay for equal work in 2016!
These are just some of my take-aways from watching this show. It’s worth viewing, both to remind ourselves that the United States has faced some of these present-day challenges before and also to remind us that some of these struggles have been going on for FAR too long.
We’ve come a long way since those days and yet clearly, as exemplified by recent days, have so much further to go.
Link
“Under the Collins-Cassidy bill, states could enroll people who would otherwise be uninsured in health plans providing basic coverage. These high-deductible health plans are intended to protect consumers against catastrophic medical expenses. They would cover generic versions of prescription drugs, and they would also have to cover recommended childhood immunizations without co-payments. States would contract with one or more insurers to offer this coverage.”
Their plan moves the decision to the states. It appears the available care would still push HSA-s. Mind you, you have to have money to put away in an HSA in the first place, something many can not afford to do. While this looks like it would cover people should a really bad medical situation arise, it doesn’t look like it provides much in the way of coverage for the day-to-day, year-to-year doctor’s visits that are so critical. I can’t tell how it would continue to support preventative treatment. I can’t see how costs would go down with this plan, either… if they auto-enroll individuals that may prevent healthy people from immediately leaving the pool but I would assume they’d drop out in time with no requirement to stay which would likely mean costs would increase.
Will be interesting to see if some version of a plan like this advances or if ACA is repealed outright with no clear plan for replacement.
Reflections on the Women’s March
One day after the inauguration of President Donald Trump, hundreds of thousands of women met in Washington, D.C., to march for the rights of women. It was a reminder of the power of women but also of all people to come together to take a stand for the issues that matter most to them.
While I was not present at the march, I followed it on social media for much of the late morning and early afternoon, both on Twitter and Facebook. I saw much of the Women’s March presentations on Facebook Livestream. I saw women speak and sing and display signs about the importance of women’s rights (rights to be treated as equals, to be safe from domestic abuse, to receive equal pay for equal work, to not be assaulted [“grabbed by the p__y”], to be able to make their own choices about their bodies) but also signs for many other causes: black lives matter and empowerment of all minorities, immigrant issues, clean water (from indigenous populations to folks in Flint, MI), protections for all groups (from those who want to be sure there is never a Muslim registry to the elderly lady who had been confined in Japanese internment camps during WWII), environmental protections, preserving public education, and so many other topics.
It was amazing to see how many of my friends were actively involved in the marches that took place worldwide. (News articles estimate that more than 1 million people participated in the marches, and the numbers would be even greater than that, though counting crowds is notoriously difficult to do accurately.) At the same time, there were those asking why people were marching and what would it accomplish?
I believe many felt more hopeful and empowered after the marches. I believe that many, like myself, were inspired to further action. I believe that seeing so many come together in solidarity helped those of us who were feeling as if we were alone in our concerns to know that we are not.
Did everyone feel they could be a part of this march. No. There were voices to be heard that felt like the march left out certain viewpoints (pro-life women, conservatives who felt left out of what some labeled as a “liberal march”, Black Lives Matter supporters who wonder if the white marchers would be there for them in days to come as the racial struggle in this country continues). But I believe those who listened heard the concerns of people marching. I hope the marchers in turn will continue to be active on their topics of concern while also taking the time to hear the concerns of some of those who did not feel included or fully represented. I firmly believe this activity can spark increased dialogue if we’re open to it.
Below are some of the tweets about the march: Continue reading
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