Difference between revisions of "Healthcare"

From Resistance Manual
Jump to: navigation, search
m (moved link, cleaned up)
 
(103 intermediate revisions by 20 users not shown)
Line 2: Line 2:
  
 
== [[File:fist.png | left | 50px | How You Can Resist | link= ]] How You Can Resist ==
 
== [[File:fist.png | left | 50px | How You Can Resist | link= ]] How You Can Resist ==
*'''Call your member of Congress''' by dialing tel:844-6-RESIST and tell them to strengthen the Affordable Care Act.
+
*'''Call your Senator''' by dialing tel:844-6-RESIST and tell them to oppose repealing the Affordable Care Act.
*'''Find out when''' your Senators and US Representative are holding '''[https://townhallproject.com/ town halls]''' and other [[Upcoming Events/Opportunities]]. Show up and tell them to strengthen the Affordable Care Act.
+
*'''Find out when''' your Senators are holding '''[https://townhallproject.com/ town halls]''' and other [[Upcoming Events/Opportunities]]. Show up and tell them not to repeal the Affordable Care Act.
*Click [https://www.resistancemanual.org/People_and_Organizations here] to find an organization looking for volunteers.
+
*'''Call your Representative''' by dialing tel:844-6-RESIST and tell them how you feel about their vote on repealing the Affordable Care Act. See the complete list of how each representative voted [https://www.nytimes.com/interactive/2017/05/04/us/politics/house-vote-republican-health-care-bill.html/ here].
 +
*Find health-care organizations with [[Organizations_Working_for_Justice_and_Equity#Health_Care|volunteer opportunities]], with nationwide [[Organizations_Working_for_Justice_and_Equity#Health_Care_2|networks of groups]], and with [[Organizations_Working_for_Justice_and_Equity#Health_Care_3|information and opportunities for online activism]].
  
 
== [[File:notification.png | left | 50px | Updates | link= ]] Recent Updates ==
 
== [[File:notification.png | left | 50px | Updates | link= ]] Recent Updates ==
*'''4/20/2017:''' Moderates and hardline conservatives, who have disagreed on the AHCA since it was introduced, have found middle ground through the addition of the MacArthur Amendment. This amendment will reinstate Essential Health Benefits as the federal standard and maintain many provisions of the AHCA, such as prohibitions on discrimination based on gender and pre-existing conditions. The amendment also allows states to obtain limited waivers for Essential Health Benefits and Community Rating Rules. States must be able to prove that the purpose of the waiver is to reduce premium cost, increase health coverage, or advance another benefit of health coverage. [http://www.politico.com/f/?id=0000015b-8ab0-df96-a9db-dff115c30001]
+
*'''5/24/2017''' The new [https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf Congressional Budget Office score] for the second version of the House AHCA bill was released late this afternoon. It projects were similar to the previous score in which 24 million people would lose their coverage over a decade.  [http://www.nbcnews.com/politics/politics-news/cbo-new-gop-health-care-law-would-leave-23-million-n764286]
*'''4/14/2017:''' The Trump Administration has threatened to withhold $7 billion in cost sharing subsidies from insurers, if Democrats refuse to join healthcare talks. Democrats have promised to torpedo any bill that doesn't allocate this money as mandatory spending. [http://www.politico.com/story/2017/04/donald-trump-obamacare-subsidies-negotiate-237174]
+
*'''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. [https://docs.justia.com/cases/federal/district-courts/district-of-columbia/dcdce/1:2014cv01967/169149/41] [https://www.nytimes.com/2017/05/22/us/politics/health-care-subsidies-trump.html]
*'''4/13/2017:''' The Trump Administration released a rule on Thursday aimed at keeping insurers in the ObamaCare marketplace. It's a sign that the Trump administration will try to keep the marketplace stable while Congress works on repealing and replacing the healthcare law. Critics have said that it wil ake it harder for any people to get insurance [http://thehill.com/policy/healthcare/328751-trump-administration-moves-to-stabilize-obamacare-markets]
+
*'''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.
*'''4/12/2017:''' House Freedom Caucus Chairman Marl Meadows has suggested the possibility of Congress cutting their recess short to vote on an Obamacare repeal. Speaker Ryan has reportedly not ruled it out. [https://twitter.com/elizacollins1/status/851783431977656321]
+
**Among the cuts:
*'''4/12/2017:''' President Donald Trump says he still wants Congress to pass a health care bill before turning to tax reform - an apparent reversal from last month, when he said he was ready to move on to overhauling the nation's tax code after the repeal bill collapsed. [http://www.politico.com/story/2017/04/trump-tax-reform-health-care-237125]
+
***Medicaid by $610 billion over the next 10 years
*'''4/11/2017:'''President Trump is set to nominate 3rd Term Congressman Tom Marino (R-PA) to the Office of National Drug Control Policy, as the nation's unofficial Drug Czar. [http://www.cbsnews.com/news/pennsylvania-congressman-to-be-named-drug-czar-by-donald-trump/]
+
***National Institutes of Health by $6 billion next year
 +
***Centers for Disease Control by $1.3 billion next year [https://www.nytimes.com/2017/05/22/us/politics/trump-budget-cuts.html?_r=0] [https://www.hhs.gov/sites/default/files/fy2018-budget-in-brief.pdf]
 +
*'''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.[http://www.latimes.com/politics/la-na-pol-obamacare-trump-mismanagement-20170518-story.html]
 +
*'''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.[http://www.businessinsider.com/gop-health-care-bill-re-vote-obamacare-cbo-score-2017-5]
 +
*'''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 [[Trump_Administration#Secretary_of_Health_and_Human_Services_Tom_Price|Secretary Price]] to preserve funding for the NIH.[http://www.idsaglobalhealth.org/uploadedFiles/GlobalHealth/News/Sec%20Price%20Research%20and%20Fogarty%20Letter%20with%20signatures(5).pdf][http://appropriations.house.gov/calendar/eventsingle.aspx?EventID=394868]
 +
*'''5/17/2017''' The [[Trump_Administration#Secretary_of_Health_and_Human_Services_Tom_Price|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.[https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Downloads/Checklist-for-Section-1332-State-Innovation-Waiver-Applications-5517-c.pdf]
 +
*'''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.[http://kff.org/health-reform/issue-brief/gaps-in-coverage-among-people-with-pre-existing-conditions/]
 +
*'''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.[http://www.npr.org/2017/05/15/528449558/secret-republican-senate-talks-shaping-health-care-legislation]
  
== [[File:notification.png | left | 50px | Impact of Trumpcare Part Two | link= ]] Impact of Trumpcare Part Two==
+
== [[File:notification.png | left | 50px | Impact of American Health Care Act (Part II) | link= ]] Impact of Health Care Bill Passed by the House==
  
 +
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.
  
== [[File:notification.png | left | 50px | Threats to the ACA | link= ]] Additional Threats to the ACA by the GOP==
+
===General Impacts===
===Health and Human Services Policy and Rule Changes===
+
*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. Now that it has been completed, the new CBO score for the new AHCA (Upton Amendment included) has projected a loss of coverage for 23 million people in a decade. [http://www.nbcnews.com/politics/politics-news/cbo-new-gop-health-care-law-would-leave-23-million-n764286] It also estimates that 1/6 of the populkation will see a destabilization in their insurance markets by 2020. [https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf]
====Changes to Look Out For====
+
*'''Impacts of Essential Health Benefits waivers.'''  
'''Essential Health Benefits'''   
+
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).[http://www.politico.com/f/?id=0000015b-8ab0-df96-a9db-dff115c30001]. 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.[https://www.americanprogress.org/issues/healthcare/news/2017/04/21/431019/premium-increases-pre-existing-conditions-latest-aca-repeal-plan-state/] The average extra cost for certain health conditions can be seen [https://cdn.americanprogress.org/content/uploads/2017/04/21115927/Surcharges-for-pre-existing-conditions-by-state.xlsx here.]
*An ACA statute lays out 10 essential health benefits that are required of each insurance plan. It is up to the Health Secretary to design how it's implemented.  
+
*'''Impacts on people with pre-existing conditions and community health ratings'''
**The Obama administration largely let states decide what those essential benefits would be, but current Secretary Price could make those decisions at the federal level, requiring insurers to cover fewer services.[http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949]
+
*The provision that allows young adults to stay under their parents' insurance until they turn 26 is still included in the new bill.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]
'''Threats to Marketplaces'''
+
*This table shows what premiums will be required of single people making 175 percent the federal poverty line. It shows that the AHCA raises premiums for older, poor Americans by as much as 850%
*The Health Secretary could drop a court case [https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2014cv1967-73] '''(U.S. House of Representatives v. Burwell, 2016)'''left over from the Obama administration, a move that would cut some subsidies to more than half of marketplace enrollees. [https://fivethirtyeight.com/features/the-future-of-obamacare-is-in-trumps-hands/?ex_cid=538fb]
+
[[File:AHCA1.jpeg]]
*The Health Secretary could also loosen a mandate requiring most people to have coverage or pay a penalty at tax time. [https://fivethirtyeight.com/features/the-future-of-obamacare-is-in-trumps-hands/?ex_cid=538fb]. The administration is pretty free to exempt large groups of people from the individual mandate via "hardship exemptions."
 
**More people under these circumstances could be approved for hardships or fewer. If the administration approves more waivers, it could reduce the number of people in the marketplaces. Because of this, healthy people may start to leave in larger numbers, thus creating high-risk pools, which creates more costly coverage causing more people to drop out. [http://www.npr.org/sections/health-shots/2017/03/29/521713002/6-changes-the-trump-administration-can-still-make-to-obamacare]
 
  
'''Threats to Medicaid Rules'''
+
===Healthcare from Employers===
*The Trump appointed CMS (Centers for Medicare and Medicaid Services) Administrator, Seema Verma, has the power to oversee the shape and structure of state run Medicaid programs.[https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
+
* 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. [http://www.businessinsider.com/gop-healthcare-bill-ahca-employer-insurance-2017-5]
**The CMS has shown some willingness to approve non-traditional programs that implement a work requirement for Medicaid benefits. Such action would kick out the low-income able bodied adults who benefit from Medicaid expansion and disqualify those same adults seeking coverage from Medicaid expansion.[https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
+
*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.[http://files.kff.org/attachment/Proposals-to-Replace-the-Affordable-Care-Act-Summary-of-the-American-Health-Care-Act]
**Many adults who seek out Medicaid have a disability, a felony conviction or caregiver responsibilities. A work rquirement would make Medicare a weaker safety net.[https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
 
*Other potential waiver provisions could reduce Medicaid coverage and benefits including:
 
**requiring premiums and health-savings account contributions, moving more people to privately managed plans, and cutting benefits like the provision of medical transportation for enrollees.[https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
 
  
====Enacted Rule Changes====
+
===Healthcare from Medicaid/Medicare===
 +
*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 [[Disability Rights|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 [https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]. 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.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]
 +
*The per-person limits on Medicaid spending will disproportionately harm the people who need health care the most, including people with [[Disability Rights|disabilities]] and the elderly.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]. 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.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]
 +
*Phasing out the Medicaid expansion would disproportionately impact Americans with [[Disability Rights|disabilities]], '''10 million of whom are currently covered by Medicaid'''.[http://www.huffingtonpost.com/entry/disability-rights-donald-trump_us_582487fae4b0e80b02cefa2f] The new proposal could also shift money away from [[Educational Justice|schools]], which receive Medicaid reimbursements for speech and occupation therapy, wheelchairs, and specialized playground equipment.[https://www.disabilityscoop.com/2017/05/04/house-health-alarming-advocates/23666/]
  
'''Market Stabilization Rule''' [https://www.axios.com/final-obamacare-rule-keeps-trump-administrations-market-changes-2359686105.html] [https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-07712.pdf]
+
===Private Healthcare===
*Gives insurers more flexibility in determining the "actuarial value" of their coverage.
+
*The Congressional Budget Office has not yet estimated how the cost of privately purchased health care would change.
*Open enrollment for next year has been shortened to six weeks, instead of three months as in previous years. (Nov. 1 to Dec. 15).
+
*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.[https://www.americanprogress.org/issues/healthcare/news/2017/05/03/431827/upton-amendment-aca-repeal-bill-will-almost-no-effect/][http://www.politico.com/story/2017/05/02/health-care-republicans-obamacare-237910] The Center for American Progress estimates that the Upton Amendment will have "almost no effect".[https://www.americanprogress.org/issues/healthcare/news/2017/05/03/431827/upton-amendment-aca-repeal-bill-will-almost-no-effect/]
**People who try to sign up outside of the regular enrollment season will have to prove their eligibility.
 
**People who owe premiums from previous years will have to pay them before they can sign up for new coverage.
 
*States will be able to determine whether insurers have enough health care providers in their networks
 
  
'''Pulling Obamacare ads'''
+
===Tax Cuts for the Wealthy===
*HHS and the Trump administration quickly pulled advertisements promoting Obamacare enrollment, ads that had been effective in previous years at getting young adults to sign up for coverage. [http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949]
+
*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.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]
**It’s hard to say what effect that lower-than-expected enrollment will have on premiums directly, but the bigger problem could be the uncertainty it has created for insurers as they draft plans and premiums for next year.[http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949]
+
*The bill discontinues two taxes that helped to pay for Obamacare—a Medicare payroll tax and a [[Benefits / Tax Cuts|3.8% tax on investment income]] for people who earn over $200,000 (or couples who earn over $250,000).[https://mobile.nytimes.com/2017/05/04/upshot/who-wins-and-who-loses-in-the-latest-gop-health-care-bill.html]  
**Any time there’s uncertainty, insurers will increase premiums more. [http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949]
+
*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).[http://files.kff.org/attachment/Proposals-to-Replace-the-Affordable-Care-Act-Summary-of-the-American-Health-Care-Act]. 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==
 +
====A Small Majority====
 +
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.[http://www.nbcnews.com/politics/first-read/gop-faces-three-challenges-health-care-heads-senate-n755346]
  
===Acts of Congress=== 
+
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.[https://www.washingtonpost.com/powerpost/if-house-passes-gop-health-care-bill-a-steeper-climb-awaits-in-the-senate/2017/05/04/26a901da-30bd-11e7-8674-437ddb6e813e_story.html?utm_term=.d8e96d0e4c34]
*The United States Congress can and has create(d) legislation that will take small bites out of the ACA. The most notable was the delay of the Cadillac tax and reducing money allocated to the Prevention and Public Health Fund. [https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
 
**Such smaller changes can produce drastic downstream effects.
 
  
==Impacts of the ACA==
+
====Budget Reconciliation/The Byrd Rule====
===Insurance Coverage by Congressional District===
+
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. [http://www.dailykos.com/story/2017/3/21/1645811/-Budget-Reconciliation-Coverage-Mandates-and-the-AHCA] 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. [http://www.businessinsider.com/ahca-trumpcare-obamacare-repeal-senate-vote-obamacare-repeal-2017-5]
  
 +
====Midterm Elections in 2018====
 +
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.[http://www.washingtonexaminer.com/with-eyes-on-midterms-flake-and-heller-feel-the-pressure-from-both-sides/article/2613886]. If you live in one of these states, call '''tel:202-224-3121''' and ask for these senators' offices:
  
 +
*Jeff Flake, [[Arizona]]
 +
*Roger Wicker, [[Mississippi]]
 +
*Deb Fischer, [[Nebraska]]
 +
*Dean Heller, [[Nevada]]
 +
*Bob Corker, [[Tennessee]]
 +
*Ted Cruz, [[Texas]]
 +
*Orrin Hatch, [[Utah]]
 +
*John Barrasso, [[Wyoming]]
  
*[http://kff.org/interactive/interactive-maps-estimates-of-enrollment-in-aca-marketplaces-and-medicaid-expansion/ Number of those '''gaining''' coverage through ACA exchanges and Medicaid expansion]
+
'''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."
*[https://fivethirtyeight.com/features/obamacare-has-increased-insurance-coverage-everywhere/ Number of those who still remain '''uninsured''']
 
  
===Preexisting Conditions by Congressional District===
+
====Time====
*[https://cdn.americanprogress.org/content/uploads/2017/04/05080651/pre-existing-conditions-by-congressional-district.xlsx number of '''people with preexisting conditions''' ]
+
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.[http://www.nbcchicago.com/news/politics/Health-Care-Bill-Likely-to-Spend-More-Time-in-Senate-421414773.html]
  
===Benefits of the ACA===
+
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."[http://www.nbcchicago.com/news/politics/Health-Care-Bill-Likely-to-Spend-More-Time-in-Senate-421414773.html]
  
*About 20 million people gained insurance.[http://blogs.wsj.com/briefly/2017/01/03/5-things-things-to-know-about-the-affordable-care-act/]
+
====All Votes====
**largely the result of expanding Medicaid, the federal insurance program for people with low incomes. there’s short term threats to Medicaid if it is left as is.[https://fivethirtyeight.com/features/the-future-of-obamacare-is-in-trumps-hands/?ex_cid=538fb]
+
See the complete list of how each representative voted [https://www.nytimes.com/interactive/2017/05/04/us/politics/house-vote-republican-health-care-bill.html/here].
*The uninsured population of the US went from 16% in 2010 to 9% in 2015.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange][http://www.npr.org/2017/03/27/521441490/fact-check-trump-says-obamacare-is-exploding-its-not]
 
*15.7 million people gained access to Medicaid.[https://web.archive.org/web/20170131014400/https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/new-report-details-impact-affordable-care-act.html]
 
 
 
===Criticisms of the ACA===
 
*The law mandates that all Americans have health care. If you do not, you pay a tax penalty. Some see this as a curtailment on individual liberties. The reasoning is that if only sick people buy health insurance, premiums (how much you pay for coverage) will skyrocket, as insurance companies try to make enough money to pay everyone's health care bills. If everyone, including healthy people, buys insurance, premiums will be more stable.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/]
 
*The federal government is funding the Medicaid expansion for those newly eligible for coverage until 2020. After 2020, the federal government will only pay 90%, so states will be responsible for the rest.[https://www.medicaid.gov/affordable-care-act] There is still a significant coverage gap for people who can't receive Medicaid (see above) or exchange subsidies.
 
*For many people who buy insurance on the exchanges, deductibles (the amount you have to pay yourself for your coverage before your insurance company starts paying) has increased significantly.[http://www.npr.org/2017/03/27/521441490/fact-check-trump-says-obamacare-is-exploding-its-not][http://www.npr.org/sections/health-shots/2015/09/22/442546652/rising-health-deductibles-take-bigger-bite-out-of-family-budgets]
 
*Because of the new requirements on insurance companies, some insurance companies canceled plans that did not comply with the law, forcing people to buy plans over the exchanges.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange] Some workplaces also stopped providing insurance to their employees.
 
*Some say that the law discourages healthy people from purchasing health care, which increases premiums for those who do have health care—because they are less healthy, so insurance companies must charge more so they can make sure they can cover everyone.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange][http://blogs.wsj.com/briefly/2017/01/03/5-things-things-to-know-about-the-affordable-care-act/] Premiums have definitely increased, but not for most people purchasing through the exchanges, since subsidies have also increased.[http://www.politifact.com/truth-o-meter/statements/2017/mar/23/barack-obama/obama-no-premium-hike-vast-majority-covered-govern/]
 
*Many large insurers are beginning to stop offering health insurance plans over the exchanges. This limits choices for people who must buy insurance over the exchanges.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange][http://www.wsj.com/articles/health-insurers-pullback-threatens-to-create-monopolies-1472408338]
 
**While there were concerns in previous years that some counties would be left without an insurer, it hasn’t yet happened. Some exchanges under duress in several states like Tennessee, where 16 counties don’t have any insurers lined up to sell on the marketplaces for 2018.  The fate of the markets in those counties and a few other states depends on what Republicans in Congress do next.[https://fivethirtyeight.com/features/the-future-of-obamacare-is-in-trumps-hands/?ex_cid=538fb]
 
 
 
*Trump has said that the ACA is "exploding," meaning mostly that premium costs are going to rapidly increase, leading to a "death spiral," in which healthy people prefer to pay the penalty rather than pay for health care. This would make premiums increase even more, making more people opt out. This has not started to happen so far, and there is no good evidence that it will.[http://www.npr.org/2017/03/27/521441490/fact-check-trump-says-obamacare-is-exploding-its-not]
 
*Some say the law does not go far enough. Millions of Americans still do not have health care, and health care purchased through the exchanges is often too expensive or does not provide high quality care. Health care is still very corporate in the US, with businesses (insurance companies) making too many health care decisions for people.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/]
 
 
 
==Affordable Care Act==
 
The Patient Protection and Affordable Care Act[https://web.archive.org/web/20170118123143/https://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html], usually called the Affordable Care Act or Obamacare (they are the exact same thing), is a law passed in 2010 and signed by President Obama to increase access to health care in the US. The law includes three major parts: 1) new regulations on private insurance companies that apply to employer-provided health care plans 2) a Medicaid expansion, which gave millions more people access to free government health care and 3) state health-care exchanges, which let people buy their own health insurance.[http://blogs.wsj.com/briefly/2017/01/03/5-things-things-to-know-about-the-affordable-care-act/][https://www.thebalance.com/obamacare-explained-3306058][https://web.archive.org/web/20170118175059/https://www.healthcare.gov/quick-guide/one-page-guide-to-the-marketplace/]
 
 
 
===People Receiving Healthcare from Employers===
 
 
 
The law also changed some of the ways insurance companies operate. Insurance companies are no longer allowed to refuse to cover people or charge them more if they have "preexisting conditions," meaning that if you have diabetes, for example, an insurance company cannot refuse to give you insurance for only that reason.[https://web.archive.org/web/20170126102039/https://www.hhs.gov/healthcare/about-the-law/pre-existing-conditions/index.html] Insurance companies also cannot have annual or lifetime limits on coverage, meaning they may not stop covering someone once a certain dollar limit had been reached.[https://web.archive.org/web/20170126061044/https://www.hhs.gov/healthcare/about-the-law/benefit-limits/index.html] Premiums—how much people pay for insurance—is now much more even, as insurance companies cannot increase the price for people who will have more expensive health care needs.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange]
 
 
 
===People Receiving Healthcare from Medicaid/Medicare===
 
 
 
The law increased Medicaid eligibility to those who earn 138% of the federal poverty limit.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/] 15.7 million people gained Medicaid under the ACA.[https://web.archive.org/web/20170131014400/https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/new-report-details-impact-affordable-care-act.html] As of September, though, 19 states had not actually expanded Medicaid in their states, so not everyone who is eligible under the ACA actually has Medicaid. Such people are also not eligible for subsidies through the exchanges, because they are supposed to have Medicaid, so they are actually left without health care, in a "coverage gap."[http://kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/]
 
 
 
===People Purchasing Healthcare Privately===
 
 
 
Through the exchanges, which are organized by state, people who do not have another source of health care (through work, Medicare, or Medicaid, usually) can buy health care.[https://web.archive.org/web/20170118175059/https://www.healthcare.gov/quick-guide/one-page-guide-to-the-marketplace/] Subsidies are available to people earning less than 400% of the [https://www.healthcare.gov/glossary/federal-poverty-level-FPL/ federal poverty level], lowering the amount they have to pay.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange]
 
 
 
==CHIP==
 
'''Children's Health Insurance Program''' (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs.  CHIP is administered by states, according to federal requirements.  The program is funded jointly by states and the federal government.[https://www.medicaid.gov/chip/chip-program-information.html]
 
 
 
For more information about eligibility and applying for CHIP, please [https://www.benefits.gov/benefits/benefit-details/607 follow the link.]
 
 
 
==The State of Public Health==
 
===National Institutes of Health===
 
*The Trump Administration has proposed a 1.6 billion cut to the NIH including [http://www.nbcnews.com/health/health-news/trump-proposes-slashing-medical-research-year-too-n739761]:
 
**Take $350 million from the National Science Foundation's budget
 
**Cut $37 million from the Department of Energy's budget which allocates to significant science programs
 
**Cut $48 million from the Environmental Protection Agency's research and development budget.
 
**Cut in half the $101 million Teen Pregnancy Prevention program
 
**Reduce Food and Drug Administration staff spending by $40 million
 
**Cut domestic and global HIV/AIDS programs by $100 million
 
***And cut the Presidential Emergency Program for AIDS Relief (PEPFAR) by $242 million
 
**Completely delete the $72 million Global Health Security fund at the State Department and cut other global health programs by $90 million and $62 million for global family planning
 
===Rural Communities===
 
*The Trump Administration has altered the timetable for some visa applications through the use of the travel ban. As it is being challenged in court the decision will likely to delay the arrival of new foreign doctors.[https://www.nytimes.com/2017/03/18/us/doctor-shortage-visa-policy.html?smid=tw-share&_r=3]
 
** The U.S. Citizenship and Immigration Services has temporarily suspended “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months. [https://www.nytimes.com/2017/03/18/us/doctor-shortage-visa-policy.html?smid=tw-share&_r=3]
 
**This has and will slow the flow of foreign doctors who need to fill a need in a short time period. This is starting to have huge effects on rural communities who may depend on foreign doctors to provide treatment. [https://www.nytimes.com/2017/03/18/us/doctor-shortage-visa-policy.html?smid=tw-share&_r=3]
 

Latest revision as of 23:36, 24 May 2017

This is a collaborative knowledge base; feel free to propose edits/additions that you believe are important for others to know. Contributions will be reviewed and approved based on quality and accuracy.

How You Can Resist
How You Can Resist
[edit]

Updates
Recent Updates
[edit]

  • 5/24/2017 The new Congressional Budget Office score for the second version of the House AHCA bill was released late this afternoon. It projects were similar to the previous score in which 24 million people would lose their coverage over a decade. [1]
  • 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. [2] [3]
  • 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 [4] [5]
  • 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.[6]
  • 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.[7]
  • 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.[8][9]
  • 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.[10]
  • 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.[11]
  • 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.[12]

Impact of American Health Care Act (Part II)
Impact of Health Care Bill Passed by the House
[edit]

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. Now that it has been completed, the new CBO score for the new AHCA (Upton Amendment included) has projected a loss of coverage for 23 million people in a decade. [13] It also estimates that 1/6 of the populkation will see a destabilization in their insurance markets by 2020. [14]
  • Impacts of Essential Health Benefits waivers.

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).[15]. 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.[16] The average extra cost for certain health conditions can be seen here.

  • Impacts on people with pre-existing conditions and community health ratings
  • The provision that allows young adults to stay under their parents' insurance until they turn 26 is still included in the new bill.[17]
  • This table shows what premiums will be required of single people making 175 percent the federal poverty line. It shows that the AHCA raises premiums for older, poor Americans by as much as 850%

AHCA1.jpeg

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. [18]
  • 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.[19]

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 [20]. 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.[21]
  • 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.[22]. 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.[23]
  • Phasing out the Medicaid expansion would disproportionately impact Americans with disabilities, 10 million of whom are currently covered by Medicaid.[24] The new proposal could also shift money away from schools, which receive Medicaid reimbursements for speech and occupation therapy, wheelchairs, and specialized playground equipment.[25]

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.[26][27] The Center for American Progress estimates that the Upton Amendment will have "almost no effect".[28]

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.[29]
  • 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).[30]
  • 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).[31]. 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.[32]

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.[33]

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. [34] 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. [35]

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.[36]. 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.[37]

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."[38]

All Votes[edit]

See the complete list of how each representative voted [39].