Healthcare

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How You Can Resist
How You Can Resist
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Updates
Recent Updates
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  • 5/23/2017 The Trump administration is seeking another 90-day delay from a court hearing the House's challenge to Obamacare subsidies. That removed the immediate threat of the cost-sharing subsidies being cut off, potentially triggering a collapse of the exchange markets, but gives no clarity about the future. [1] [2]
  • 5/23/2017 The president has proposed a new budget calling for huge cuts in social spending programs. Over the next ten years, it calls for cutting hundreds of billions of dollars from Medicaid, the federal health program for the poor. It also calls for cutting $192 billion from nutritional aid and $272 billion overall from welfare programs. It outlines a $12.4 billion cut to HHS's discretionary funding, with major cuts across the department.
    • Among the cuts:
      • Medicaid by $610 billion over the next 10 years
      • National Institutes of Health by $6 billion next year
      • Centers for Disease Control by $1.3 billion next year [3] [4]
  • 5/19/2017 Health insurers across the country are planning to raise their premiums (on Obamacare exchanges) because of the president's "erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues." Many state insurance regulators are growing frustrated with the confusion around insurance subsidies and mandate penalties.[5]
  • 5/19/2017 The AHCA could be up for a revote in the House. This is because the Congressional Budget Office score could show that the bill could increase the federal deficit, fail to produce savings after a decade, or fail to cut $2 billion from the deficit, all of which would violate budget reconciliation rules.[6]
  • 5/17/2017 The House held a hearing on funding for the National Institutes of Health. The Trump Administration had proposed a $6 billion cut to the NIH. Dozens of medical and research advocacy organizations have asked Secretary Price to preserve funding for the NIH.[7][8]
  • 5/17/2017 The Health and Human Services Department is allowing states to get waivers that help set up risk pools and reinsurance programs. The Obama administration usually opposed these waivers because they could undercut the ACA's (often expensive) protections. A checklist offered by the Department will help speed up state requests for these waivers.[9]
  • 5/17/2017 An analysis by the Kaiser Foundation found that 6.3 million people will be at risk if the House AHCA bill becomes law. 27 million Americans experienced a multi-month coverage gap in 2015, and 23% of that population had pre-existing conditions. Under the AHCA, these people could face significant premium hikes if their state gets a waiver that allows insurers to vary premiums by health status. These numbers are dependent on which states use waivers and how they implement them.[10]
  • 5/15/2017 Bipartisan talks were held in the Senate to discuss the future of Obamacare. Majority Leader McConnell had formed an all-Republican team to help gain the 50 votes needed for a repeal. Both parties could lose political capital in these talks, but some moderate Democrats seem to want to find common ground.[11]

Impact of American Health Care Act (Part II)
Impact of Health Care Bill Passed by the House
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The American Health Care Act (Part II) is a Republican replacement bill for the Affordable Care Act that was narrowly passed by the House of Representatives on May 4, 2017.

General Impacts[edit]

  • Unusually, this version of the bill was passed before the nonpartisan Congressional Budget Office could make a report on how many people would be covered under the bill and how much it would cost. The CBO had estimated that under the previous version of the bill, 14 million people would become uninsured by 2018, mostly as a result of repealing the individual mandate (the requirement to purchase insurance or pay a penalty). They also estimated that 21 million more people would be uninsured in 2020 and 24 million more people uninsured in 2026 than if the Affordable Care Act stayed in place, largely because of the changes in Medicaid the bill proposed.[12]
  • The bill allows states to waive (not require) rules requiring insurance companies to cover Essential Health Benefits, and rules that prevent insurance companies from charging some people more than others (known as community rating rules).[13]. This could leave sicker people, those with pre-existing conditions, with higher costs, pushing them into expensive high-risk pools (which are supposed to reduce costs for the healthier population, but cost the state and individuals a lot of money). More than 130 million non-elderly Americans have preexisting conditions (chronic illnesses or past illnesses), and under the AHCA such people could end up spending thousands more on health insurance than they did under Obamacare. If a state files these waivers, it will be easier for insurers to discriminate against people who have a history of having more health problems.[14] The average extra cost for certain health conditions can be seen here.
  • The provision that allows young adults to stay under their parents' insurance until they turn 26 is still included in the new bill.[15]

Healthcare from Employers[edit]

  • Under the AHCA, employers in states that use waivers can choose which regulations (10 Essential Health Benefits and requirements that would protect people with pre-existing conditions) they want to follow, to help lower the costs of their insurance plans. A company that operates in two states can drop protections allowed in one state, and use that same healthcare policy in another state that doesn't have a waiver. It's not clear whether employers would actually drop those protections. [16]
  • Employers will not be required to offer insurance dating back to the beginning of 2016, and small businesses won't get tax credits to help offer insurance to their employees starting in 2020.[17]

Healthcare from Medicaid/Medicare[edit]

  • One of the main ways Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Before Obamacare, Medicaid was restricted to specific groups of low-income Americans (including pregnant women, the blind and the disabled). Obamacare opened up the program to anyone below 133% of the poverty line (about $15,000 for an individual) in the 31 states that opted to participate. Allowing more people to participate in Medicaid helped lower the rates for those who were uninsured. AHCA would end Medicaid expansion in 2020 and cut the program by $880 billion [18]. Medicaid participation changes frequently because people's financial situation determines whether they are eligible. People who need to go back on Medicaid again, or for the first time, will not be able to do so after 2020.[19]
  • The per-person limits on Medicaid spending will disproportionately harm the people who need health care the most, including people with disabilities and the elderly.[20]. The government would reimburse states using a "block grant," or one lump sum, instead of per-person payments. This would allow states to kick people off care, charge premiums, and cut benefits for children.[21]
  • Phasing out the Medicaid expansion would disproportionately impact Americans with disabilities, 10 million of whom are currently covered by Medicaid.[22] The new proposal could also shift money away from schools, which receive Medicaid reimbursements for speech and occupation therapy, wheelchairs, and specialized playground equipment.[23]

Private Healthcare[edit]

  • The Congressional Budget Office has not yet estimated how the cost of privately purchased health care would change.
  • The White House and House GOP members agreed to an amendment, the Upton Amendment, that adds $8 billion over 5 years to help sicker people pay for health insurance. But this amount of money is probably only enough to cover 76,000 of the 130 million people living with a pre-existing condition. Such people are put in so-called high-risk pools, with very high insurance premiums.[24][25] The Center for American Progress estimates that the Upton Amendment will have "almost no effect".[26]

Tax Cuts for the Wealthy[edit]

  • Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes increases, leading to tax cuts of $883 billion. Most of these would benefit the wealthy, according to the Congressional Budget Office. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that.[27]
  • The bill discontinues two taxes that helped to pay for Obamacare—a Medicare payroll tax and a 3.8% tax on investment income for people who earn over $200,000 (or couples who earn over $250,000).[28]
  • The bill lets people save more of their money in tax-free health savings accounts (about twice as much as what was allowed with ACA).[29]. This allows wealthier people to get tax breaks through a pre-tax account, grow their funds tax-free, and use this money for healthcare expenses tax-free.

Vulnerabilities[edit]

A Small Majority[edit]

In the Senate, there is a small Republican majority, of only 52 Republicans to 48 Democrats. This means that Republicans can only afford to lose three supporting votes.[30]

Senate Majority Leader Mitch McConnell can try to pass the bill through "budget reconciliation," which is a simple majority vote, rather than the typical 2/3 majority required to pass legislation to overcome a filibuster. Budget reconciliation cannot be filibustered.[31]

Budget Reconciliation/The Byrd Rule[edit]

One of the process’s most important provisions is that reconciliation bills must be about budgets only, not changing laws. That's why the measure to repeal ACA's individual mandate penalties seems allowable. [32] The Byrd rule in the Senate requires that all provisions in a bill that goes through the reconciliation process have to deal with the federal budget. That means various parts of the AHCA, like gutting Obamacare regulations on insurers and allowing states to waive essential health benefits and protections for people with pre-existing conditions, could fail to qualify in the Senate. [33]

Midterm Elections in 2018[edit]

Because the bill has passed the House, most resistance efforts will now focus on the Senate. Republicans who support the bill and are up for re-election in 2018 are most likely to respond to pressure to oppose passing the bill. 9 Senate Republicans are up for re-election in 2018, and most of them come from consistently red states. The exceptions to this are Jeff Flake and Dean Heller.[34]. If you live in one of these states, call tel:202-224-3121 and ask for these senators' offices:

What to Say When You Call: "The AHCA will cause severe negative impacts on low-income people and only benefits the wealthy. I am calling to urge the senator to vote against the healthcare bill that was passed without an assessment from the Congressional Budget Office."

Time[edit]

The Senate cannot take up the vote until the Congressional Budget Office finishes its analysis of its costs, which is expected to take one to two weeks.[35]

On Thursday, May 4, Senator John Corbyn (R-Texas) said, "We're not under any deadline, so we're going to take our time." Senator James Lankford (R-Oklahoma) also said the version of the bill that the House approved is "definitely still not the final product."[36]

All Votes[edit]

See the complete list of how each representative voted [37].