Trumpcare / Obamacare
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- 1 How You Can Resist
- 2 Recent Updates
- 3 Projected Impact of GOP bill
- 4 Trump / GOP Bill
- 5 Vulnerabilities in Their Strategy
How You Can Resist
- Call your member of Congress by dialing tel:844-6-RESIST and tell them to vote against the Republican "American Healthcare Act." Find out what your member of Congress has said about the House repeal plan here.
- Find out when your Senators and US Representative are holding town halls and other Upcoming Events/Opportunities. Show up and tell them to vote against the Republican "American Healthcare Act."
- Click here to find an organization looking for volunteers.
- 3/22/2017: Political action groups funded by wealthy conservative donors Charles and David Koch have announced plans to exclude members of Congress who vote yes on the AHCA from future fundraising efforts. The Koch brothers do not believe that the AHCA goes far enough towards repealing President Obama's health care law. 
- 3/21/2017 To get more support for the AHCA, Congressional GOP lawmakers introduced a revised bill that includes four of the following changes:
- Creates a reserve fund (at least $75 billion) to help fund tax credits for older Americans. It is unclear exactly how this reserve will be spent and how much it would affect costs.
- Allows states to block-grant Medicaid, and imposes Medicaid requirements. States would receive a fixed sum of money based on what they spend on Medicaid and inflation. It would likely significantly lower the number of people enrolled in Medicaid. 
- Accelerates the repeal of Obamacare's taxes on the rich.
- Includes provision that prevents the Governor of New York (Andrew Cuomo D-NY) from passing new Medicaid costs to the counties, a provision that seeks to win over the New York GOP Congressional delegation. Currently, New York's counties are responsible for paying part of the state's Medicaid costs out of property tax revenue. This amendment limits the amount that counties would pay, shifting those costs to the state. However, it does not include large metropolitan areas (specifically New York City, which has different income taxes). , 
- 3/16/2017 The President's proposed downsizing of the federal government includes a $5.8 billion cut to the National Institutes of Health (reducing total funding to 25.9 billion), an HHS agency tasked with life-saving biomedical and health related research.
- In keeping with Trump’s “American first” theme, the blueprint calls for eliminating the NIH’s Fogarty International Center, which helps helps build scientific capacity in other countries and coordinates the work of international scientists with American researchers. 
- With few details available in the budget outline, it is unclear what kind of reorganization the administration envisions at NIH. The agency passes out more than 80 percent of its money to more than 300,000 researchers at universities across the country and abroad.
- 3/12/2017 Health Secretary Tom Price has said that nobody will be worse off financially under GOP Health Plan. He insisted that, "I firmly believe that nobody will be worse off financially in the process that we're going through," 
- 3/6/2017 The House GOP offered its changes to the ACA in the form of two bills found here and here. Since they are trying to pass the bill with simple majorities (51%) through the budget reconciliation process, they are not actually repealing the law.
Projected Impact of GOP bill
Click here to find impacts by Congressional district.
- The Congressional Budget Office estimates that 14 million people would become uninsured by 2018 mostly as a result of repealing the individual mandate. There would be 21 million more people uninsured in 2020 and 24 million more people uninsured in 2026 than if the Affordable Care Act stayed in place largely as a result of changes in Medicaid. As a result, in 2026, 52 million people would be uninsured compared to 28 million if the Affordable Care Act stayed in place. 
- The Community First Choice option is expected to end January 1, 2020.  Established by the ACA, the CFC program allows states to provide home-based attendant services to the elderly, chronically ill, and people with disabilities. The states that currently have an approved CFC program are California, Maryland, Montana, Oregon, and Texas.  The Congressional Budget Office estimates that there will be a decrease of approximately $12 billion over the next ten years.
- Hospital closures and doctor flight will decrease healthcare choice in rural areas and lead to a lower standard of care. 
- Would cut half the funding for the federal vaccines program.
- 80% of the funding for programs and education that help reduce heart disease would be eliminated.
- 100% of the money the CDC spends to help hospitals reduce infections would be eliminated.
- The Republican bill “could help push individual-plan premiums up by 30% or more next year,” according to the CEO of Molina Healthcare Inc. 
Healthcare from Employer
- Employers will not be required to offer insurance retroactive to the beginning of 2016 and small businesses won't get tax credits to help offer insurance to their employees starting in 2020.
Healthcare from Medicaid/Medicare
- The non-partisan Congressional Budget Office estimates that there will be 14 million fewer Medicaid enrollees by 2026, a reduction of about 17% compared to the Affordable Care Act. Some of the decline would begin immediately, but most would be seen after 2020. 
- The per person limits on Medicaid spending will disproportionately harm the people who need the most health care including people with disabilities and the elderly.
- Medicare's trust fund will run out in 2025 instead of 2029 which will make it impossible to provide seniors with health insurance.
- Phasing out Medicaid expansion would disproportionately impact Americans with disabilities, 10 million of whom are currently covered by Medicaid.
- Will phase out 1.3 million people who currently receive treatment for mental health and addiction services through Medicaid expansion.
- The Congressional Budget Office estimates that in 2018 and 2019 costs of health care (premiums) would be 15-20% higher than under the current law because fewer healthy people would sign up. However, by 2020 the premiums would stabilize and by 2026 the average premium would be ten percent lower. 
- One estimate finds that the bill would increase costs for the average enrollee by $1,542 if the bill were in effect today. In 2020, the bill would increase costs for the average enrollee by $2,409.
- The impact of the Republican bill would be particularly severe for older individuals, ages 55 to 64. Their costs would increase by $5,269 if the bill went into effect today and by $6,971 in 2020.
- Individuals with income below 250 percent of the federal poverty line (approximately $60,000 for a family of four) would see their costs increase by $2,945 today and by $4,061 in 2020.
- Defunding Planned Parenthood would limit options for poor women on Medicaid to receive health care and would cut off affordable abortion options for many women.  The Congressional Budget Office estimates that about 15 percent of the people who currently use Planned Parenthood would lose access to health care.
- Encourages insurers not to offer plans that cover abortion services since they can't be purchased with tax credits.
- Married Taxpayers are only eligible for tax credits to help pay for health insurance coverage if they file a joint tax return. This will harm married women in unsafe or difficult situations; By requiring married couples to file joint returns, the bill ignores very significant situations where filing jointly may not be possible or safe: including physical or mental abuse, pending divorce, or when one spouse is incarcerated.
- The "Joint Filing Requirement" would require sharing of information between a survivor and her abusive spouse. This may reveal sensitive information like a new physical address, phone number, employer and bank account. In the case of an abandoned spouse, there is no husband for the purposes of tax filing. With this repeal bill, women in these two scenarios would not be eligible for tax credits to purchase health insurance.
Tax cuts for wealthy
- The plan offers tax breaks to insurance companies that pay their CEOs more than $500,000 per year, incentivizing companies to overpay their top executives. 
- The plan eliminates a 10 percent tax on indoor tanning salons, a 2.3 percent tax on medical devices and a 0.9 percent additional Medicare tax on the wages of upper-income taxpayers.
- The plan will also eliminate a 3.8 percent tax on almost all earnings from investments. 90 percent of the money collected from this tax comes from the top 1 percent. Eliminating this tax increases the incomes of the 0.1 percent by on an average of $165,000 a year.
Trump / GOP Bill
- Starting in 2019, insurers can charge older people 5 times what they charge younger people (currently it's three times). 
- The requirement that everyone has healthcare coverage (individual mandate) or pay the IRS a fine will be repealed (including for 2016). Instead, people who go without coverage for 2 months will pay their insurers 30% extra when they try to get coverage again. 
- Eliminates the prevention and public health fund.
Healthcare from Employer
- Repeals the requirement that employers offer health care to their employees by removing financial penalties.
- Repeals tax credits for low-wage small employers starting in 2020.
Healthcare from Medicaid/Medicare
- Will continue Medicaid expansion program (where the federal government paid for states to include more people in Medicaid, which is government health care for those who can't afford it) until 2020 after which the number of people who can be added to Medicaid in the states with federal assistance will be frozen.
- Removes the requirement that Medicaid covers mental health and addiction services after 2020.
- The bill will create a per person limit for people enrolled in Medicaid where states will get a lump sum for the federal government to cover people on Medicaid.
- It includes money for states that have not expanded Medicaid will get extra money. States can use the money to help stabilize the private health care market (where people buy insurance) or to help insure high-risk populations.
- The tax credit will become age based (rather than income-based) but will be reduced by $100 for every $1,000 more someone earns above $75,000. These tax credits cannot be used to purchase a health care plan that covers abortion services. . The tax credits also don't change if you live in a place with higher health care costs.. The tax credits also don't change as health care costs increase.
- Allows people to save more money for health care costs tax-free.
- Any non-profit (including Planned Parenthood) that provides abortion services, except in the case of rape/incest or when the life of the mother is at stake, will become ineligible to receive any federal funding. They Hyde Amendment already prevents federal funds from being used to fund abortions.
- Cannot use tax credits to buy plans that cover abortion services (except in the case of rape or incest).
Same as the ACA
- Can still stay on parent's insurance until 26.
- Can't discriminate based on pre-existing conditions.
- Prohibitions on yearly and lifetime limits on coverage for private insurers (doesn't apply to Medicaid).
- Prohibitions on discrimination based on gender.
- ACA essential health benefits not changed.
- States can still create health care exchanges.
Vulnerabilities in Their Strategy
Impact on Future Legislation
CNBC reports that, " the House bill hands huge benefits to the tiny share of his voters earning the highest incomes." This complicates the Republicans' ability to gain popular support of the bill from their base. This also foreshadows the tension the tension and opposition the White House will face when proposing tax reform. 
Hurdles in the Legislative Process.
- The GOP bill may run into some hurdles in the U.S. Senate. The Byrd rule prevents reconciliation from being used to pass any measure for which the budgetary effects — “changes in outlays or revenues” — are “merely incidental to the non-budgetary components.”  The surcharge penalty paid to insurers (rather than the federal governmnet) and the budget ambiguity surrounding refundable tax credits are both possible ways to violate the Byrd rule. It has been reported that Republicans may not be able to use this approach to pass key parts of their plan including a surcharge for people who try to buy insurance after not having it for 63 days, allowing insurers to charge older people five times as much as younger people, and even the defunding of Planned Parenthood. Republicans could use the nuclear option and simply not listen to the Senate parliamentarian who makes decisions about Senate rules. This would give Democrats permission to do the same thing in the future. 
- This strategy of using Budget Reconciliation only requires 50 Senate votes but all changes to have a direct impact on the federal budget, significantly constraining what can be in the replacement plan.
- Since a full repeal of Obamacare, also known as the Affordable Care Act, would need 60 votes in the Senate to overcome a Democratic filibuster, which they did not have, Republicans have adopted a "repeal and replace" strategy focusing on repealing and replacing much of the law in Trump's first 100 days through Budget Reconciliation.
- There is Republican opposition to the health care bill. House Republicans, Mark Sanford (SC), David Brat (VA) and Gary Palmer of (AL) voted against the GOP bill in the House budget committee, and Republican governors John Kasich (OH), Rick Snyder (MI), Brian Sandoval (NV) and Asa Hutchinson (AR) sent a letter to McConnell and Ryan saying they oppose the bill.