Under the Republican American Health Care Act, 2.7 million New Yorkers would lose coverage and the state’s budget would take a $6.9 billion hit, including $2.3 billion as a direct result of an amendment that targets New York State specifically. It would be devastating to New Yorkers, and the Congressional Budget Office’s report confirms that. Just how bad? New York State Governor Andrew M. Cuomo issued this statement:
“The Congressional Budget Office’s report confirms what we already knew to be true—ultra-conservatives in Washington have declared war on New York’s health care system. What’s worse is that Republican members of our own Congressional delegation have aided and abetted in Washington’s war against New York, cutting taxes for millionaires while jeopardizing care for seniors, women, the middle class and the disabled.
“The radical Republican health plan will devastate New York’s health care system, strip 2.7 million New Yorkers of their health care coverage, and roll back the progress we have made to protect vulnerable Americans. This bill will cost New York State a total of $6.9 billion, including $2.3 billion as a direct result of the disastrous amendment introduced by Congressmen Faso and Collins.
“As radical ideologues race to impose their extremist agenda on Americans, New Yorkers say no. In New York, we will stand up for our progressive principles and protect the right to affordable and quality health care for all. I will continue to work with our Congressional delegation and New York’s health care leaders to defeat this reckless legislation.”
The American Health Care Act will leave 23 million more Americans uninsured and be disastrous for New York:
The plan will leave 2.7 million New Yorkers without health care coverage.
It will cost New York a total of $6.9 billion.
It will put at risk a total of 7 million people who rely on Medicaid services and other programs created under the Affordable Care Act.
And it threatens the entire New York State health care system, which serves 19.5 million New Yorkers.
The Collins/Faso amendment, which targets only New York, stops counties from paying a share of Medicaid. It would have a devastating effect on New Yorkers:
It will cut $2.3 billion in Medicaid funding to the State.
Steep cuts would force New York State to increase taxes, slash coverage to millions of New Yorkers, or devastate health care providers. As a result of the AHCA bill:
Hospital payments would be cut by $944 million in total
Nursing Home payments would be cut by $819 million in total
Home care payments would be cut by $734 million in total
The bill punishes New York for its support for women’s reproductive rights by threatening to take away citizens’ access to tax credits that are intended to make health insurance more affordable:
New York requires that all commercial insurance policies cover abortion services. In January, Governor Cuomo took new action to ensure that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles.
The Republican health care bill would prohibit the use of tax credits to support the purchase of insurance plans that cover abortion services.
As a result, the bill would effectively defund the Essential Plan, forcing 685,000 low-income people, half of whom are women, to lose their insurance and denying them $1.5 billion in tax credits.
In addition, roughly 143,000 lower-income New Yorkers whose income is just above the threshold for the Essential Plan, half of whom are women, would be denied $400 million more in tax credits that help them afford insurance.
This bill also includes an amendment that will enable insurers to charge more for people with preexisting conditions in some states, rolling back a key achievement of the Affordable Care Act:
In New York, 8.4 million people under the age of 65 have preexisting conditions.
The MacArthur amendment would allow states to opt out of provisions that restrict providers from raising prices on people with preexisting conditions.
Removing protections for people with pre-existing conditions will result in the sick paying high premiums and would force those who cannot afford it to lose coverage.
The health plan would also permit states to charge older people more, which would also force people who cannot afford it to lose coverage.
But here’s the thing: even though the Senate Republicans have said they are drafting its own health care law, they are still not bothering to confer with health care providers, health care insurers, patients or state and local officials. It is likely that even if the impacts are softened, any proposal which is designed to cater to healthy, young Americans (by allowing them to not buy insurance), and empower insurance companies to charge whatever they like to cover separate items like maternity, mental illness, addiction, pre-existing conditions (life is a pre-existing condition), to charge penalties for lapses in coverage and to charge older Americans up to five times what younger people pay, and no longer pay for wellness or preventive services, will result in tens of millions of Americans being unable to afford health insurance, being underinsured (making the policies useless), will bankrupt families of their ability to save for college or retirement or home ownership. Americans will find themselves trapped in horrible jobs or abusive marriages because they can’t afford to lose health insurance. It isn’t just the 20% of Americans who must purchase on the individual market: lifting the mandates will mean that employers will be free to stop offering health benefits altogether, or will require hefty pay-ins, or will offer bare-bones policies that leave people without protection and care. Children who are born with health issues will be faced with lifetime caps. A family will again face the insecurity of being just one medical emergency away from bankruptcy. Hospitals, especially in rural communities, will shut down. Tens of thousands of people a year will die prematurely and needlessly for lack of access to health care, and tens of thousands more will suffer for lack of care. Society will suffer lost productivity while paying more money to cover those who are forced to use emergency rooms for medical care, leaving the rest of us to pick up the tab.
The Republican contrived American Health Care Act would repeal the Affordable Care Act (Obamacare) which made great strides in making access to health insurance more affordable for millions of Americans and slowing the annual increases in premiums which had been rising at rates 3 to 5 times faster than inflation. Obamacare was designed to work within the for-profit health insurance industry, rather than do what every other industrialized nation does and offer universal health care. Some continued to complain that premiums and deductibles were too high, but rather than solve that problem, Republicans have sought to repeal Obamacare 60 times, going so far as to shut down the government in 2013 rather than accept a budget that provided for the subsidies that make health insurance affordable for tens of millions of Americans.
Trump has made it a defining issue to get repeal, no matter the damage or loss of health insurance which is quite literally a life-and-death issue. But the AHCA is more than just a matter of Trump’s ego, it is also about reducing taxes for the wealthiest – who are assessed a small surcharge to fund ACA – and crucial to Trump’s other massive giveaway to the wealthiest and corporations, his tax “plan.”
It’s remarkable that this act, which would completely rework health care, representing one-sixth of the US economy and impacting every single person, is being pushed through without any hearings, input from medical professionals or even health insurance companies, without scoring from the Congressional Budget Office as to its true cost or how many people would find health insurance unaffordable or inaccessible.
But Governor Andrew Cuomo spells out how AHCA would affect millions of New Yorkers, and specifically attacks an amendment foisted by two New York Republican Congressmen that exclusively targets New York:
“The Republican health care bill is an assault on women and an assault on New York. It would allow insurance companies to discriminate against Americans based on pre-existing conditions, force millions of New Yorkers to lose coverage, and slash Medicaid by hundreds of billions of dollars.
“As a direct result of the amendment introduced by Congressmen Faso and Collins, this provision alone would cut Medicaid funding for New York by $2.3 billion and cripple hospitals, nursing homes, and assisted living facilities across the state.
“Most disturbingly, this bill penalizes New Yorkers because we believe in reproductive rights and ensure by law that medically necessary abortions are covered by insurance carriers. I’m calling on all of New York’s Congressional delegation—Republican and Democrat alike—to stand up for New York values and vote against this terrible bill.”
The American Health Care Act will be disastrous for New York:
The plan will leave 2.7 million New Yorkers without health care coverage
It will cut $4.7 billion from the state’s Medicaid budget.
It will put at risk 7 million people who rely on Medicaid services and other programs created under the Affordable Care Act
And it threatens the entire New York State health care system, which serves 19.5 million New Yorkers.
The Collins/Faso amendment, which targets only New York, stops counties from paying a share of Medicaid. It would have a devastating effect on New Yorkers:
It will cut $2.3 billion in Medicaid funding to the State. When added to the $4.7 billion cost of the ACHA over the next four years, the total cost to the State would rise to $6.9 billion
Steep cuts would force New York State to increase taxes, slash coverage to millions of New Yorkers, or devastate health care providers:
Nursing Home payments would be cut by $401 million
Home care payments would be cut by $360 million
Hospital payments would be cut by $355 million
The bill punishes New York for its support for women’s reproductive rights by threatening to take away citizens’ access to tax credits that are intended to make health insurance more affordable:
New York requires that all commercial insurance policies cover abortion services. In January, Governor Cuomo took new action to ensure that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles
The Republican health care bill would prohibit the use of tax credits to support the purchase of insurance plans that cover abortion services.
As a result, the bill would effectively defund the Essential Plan, forcing 685,000 low-income people, half of whom are women, to lose their insurance and denying them $1.5 billion in tax credits.
In addition, roughly 143,000 lower-income New Yorkers whose income is just above the threshold for the Essential Plan, half of whom are women, would be denied $400 million more in tax credits that help them afford insurance.
This bill also includes an amendment that will enable insurers to charge more for people with preexisting conditions in some states, rolling back a key achievement of the Affordable Care Act.
In New York, 8.4 million people under the age of 65 have preexisting conditions.
The MacArthur amendment would allow states to opt out of provisions that restrict providers from raising prices on people with preexisting conditions.
Removing protections for people with pre-existing conditions will result in the sick paying high premiums and would force those who cannot afford it to lose coverage.
The health plan would also permit states to charge older people more, which would also force people who cannot afford it to lose coverage.
Passing the Republican-sponsored American Health Care Act, which is scheduled for a vote in the House on Thursday, March 23, would mean a 10 percent tax increase on all New Yorkers, or, if Republicans also “reform” the tax code, a 26 percent increase on middle class New Yorkers, Governor Andrew M. Cuomo warned.
What is more, hospitals in Congressmen Peter King’s and Lee Zeldin’s districts on Long Island would lose $57 million in funding.
“The American Health Care Act as drafted by the Republican Congress and amended by [Congressmen Chris] Collins and [John] Faso will devastate the New York Healthcare system,” Cuomo stated. “The Republican plan will leave 2.7 million New Yorkers without healthcare and cut $4.7 billion from the state’s Medicaid budget. This comes after the Republicans promised the exact opposite: That no American would lose healthcare and that no block grant would cut funding to the state.”
“Life has options and the hard reality is that Collins and Faso are leaving New York State with only two unacceptable choices. Either, we could pass on the devastating cuts to our hospitals, nursing homes and the 40 percent of New Yorkers who currently receive Medicaid and health benefits. Or, we would be forced to raise state income taxes – either by increasing taxes on all New Yorkers by 10 percent, or if Collins and Faso have their way in protecting only the wealthy, on the middle class by 26 percent. Any tax increase flies in the face of New York’s success in reducing spending and taxes to record lows.
“To devastate our healthcare industry will not only affect millions of lives, but disrupt one of the state’s main economic engines. Healthcare is a pillar of the New York economy.
“Make no mistake. The Republican house members are recklessly attempting to buy votes for the AHCA with an IOU to the New York taxpayers. One nonsensical suggestion is that the state should ‘find the money.’ We have cut our spending to record low limits. Five years ago we imposed a 3 percent cap on the growth of Medicaid in New York. Our hospital sector operates on the lowest margins in the country. New York’s 3 percent rate of growth is lower than most other states.
“If the federal government wants to buy votes, let them pay for it.
“It’s absurd to ask the state to pay the cost, while the same bill provides a $150 billion tax cut to the 1 percent richest Americans and Republicans in Congress also support a record $54 billion increase for the Pentagon. If they think that $4.7 billion is merely chump change, they should factor it into their own budget – propose $145 billion tax break or a $49 billion increase to the defense budget.
Hospitals in King, Zeldin Districts Would Lose $57 Million
What is more, an analysis by the New York State Department of Health shows that hospitals in the districts of Republican Congressmen Lee Zeldin and Peter King would lose millions.
The seven hospitals in Zeldin’s 1st Congressional District would lose $41.2 million in funding if the Ryan/Collins/Faso health care repeal is passed, crippling their ability to provide critical health care services for local residents and jeopardizing hundreds of jobs across the district.
Stony Brook University Hospital – $27,123,469
Brookhaven Memorial Hospital Medical Center – $5,827,691
Eastern Long Island Hospital – $673,801
John T. Mather Memorial Hospital – $2,542,069
Peconic Bay Medical Center – $1,993,305
Southampton Hospital – $1,021,658
St. Charles Hospital – $1,970,589
District Total – $41,152,582
The three hospitals in Republican Congressman Peter King’s 2nd Congressional District would lose $14.6 million in funding:
Good Samaritan Hospital of West Islip — $6,015,802 in cuts
St. Joseph Hospital — $1,253,535 in cuts
Southside Hospital — $7,319,357 in cuts
District Total— $14,588,694 in cuts
“The radical conservative ideology in Washington has declared war on New York with legislation that will devastate hospitals across the state and hurt New Yorkers,”Governor Cuomo said. “These massive cuts will cripple our hospitals and ravage the health care services on which New Yorkers rely, with $41.2 million in cuts to hospitals in the 1st District and $14.6 million in cuts to hospitals in the 2nd District alone. I urge members of the community to call their member of Congress and demand that they vote ‘no’ on this unconscionable piece of legislation.”
“If the Republican representatives are responsible to their districts, they must provide federal revenue to pay for their actions. Isn’t it their job to help – rather than hurt – their district?
“If this bill is passed as is, our federal representatives will be responsible for massive income or sales tax increases or devastating cuts to New York’s healthcare system. That is the plain reality. No political rhetoric can change it. New Yorkers will hold them accountable for their vote. This is radical conservative ideology at work rather than real public policy to help the very people of this state who elected them.”
(MINEOLA, NY) –Nassau County Democrats are raising alarms about what repealing the Affordable Care Act would mean for county residents and appealed to County Executive Ed Mangano to compile a comprehensive report that would quantify the impact on residents and the county’s budget.
Minority Democratic Leader Kevan Abrahams and Legislator Laura Curran stood with their democratic legislative colleagues, along with local healthcare advocates including Long Island Progressive Coalition and Nassau County Planned Parenthood calling upon the Nassau County Executive, commissioners, and administrators to compile a comprehensive report that measures the impact of what looks like the inevitable repeal of the Affordable Care Act (ACA).
According to a report issued by New York State’s Office of the Governor on January 4, 2017, Nassau County stands to lose $17,866,829 in direct funding which “goes directly to counties and helps to lower property taxes”.
Under the ACA, Nassau County saw a 33% decrease in the number of uninsured according to the most recent U.S. Census. The number of uninsured people on Long Island has declined rapidly over the last decade, while the proposed GOP healthcare bill will undo that work by putting 24 million at risk of losing coverage, according to the nonpartisan Congressional Budget Office. The American Health Care Act proposed by the Republican Party may affect more than 1 in 4 Nassau residents. Those at risk of coverage changes include, but are not limited to, the 204,681 Nassau seniors enrolled in Medicare and 133,324 residents who enrolled on the Affordable Care Act’s open marketplace.
“After making inroads for more affordable healthcare access, the proposed law could force counties to choose between supporting low-income residents who rely on Medicaid for health services,” said Minority Legislative Leader, Kevan Abrahams (D-Freeport).
“President Trump is leading us down a very dangerous path and County Government is going to be left holding the bag while taxpayers’ costs could skyrocket. Trumpcare is no longer a campaign talking point but an imminent threat to the financial and physical health of our community, and we must be prepared,” said Legislator Laura Curran (D-Baldwin). “Repealing the Affordable Care Act and replacing it with Trump’s alternative is going to drive a massive hole in the County budget while leaving more residents uninsured and without the benefits of preventative care. So that the County is prepared for these massive changes, County Executive Mangano, County Commissioners, and Department Administrators must immediately start preparing a report that outlines the real impact of losing the Affordable Care Act and what it will mean for Nassau taxpayers.”
Today, Nassau Democratic Legislators called upon the Nassau County Executive, county commissioners and department administrators to prepare an impact study that outlines the real impact losing the affordable care will have on Nassau County residents and the services they receive.
Such a study was just announced by Suffolk County Executive Steve Bellone and is being undertaken by county governments all over the country, Lisa Tyson, Executive Director of the Long Island Progressive Coalition, said.
“The repeal of the Affordable Care Act will deprive Long Islanders’ access to affordable healthcare that can be a matter of life-and-death. Nassau County residents deserve to know how losing the Affordable Care Act might affect their family both financially and physically,” she said.
The repeal of the Affordable Care Act. could be detrimental to citizens of Nassau most in need: low-income families, young adults, seniors and those in need of mental health care and substance abuse treatment. All these programs are at risk of being affected as the legislation currently stands.
“Repealing the Affordable Care Act will have real consequences for our community and we need to know how many of our neighbors will be affected and what costs will fall to the County. Obvious questions are whether our Medicaid costs will rise, and by how much; how increased emergency room visits will affect Nassau University Medical Center; whether the workload and costs of the County’s Department of Health will skyrocket; whether the County’s drug abuse rates are likely to soar due to diminished treatment options; the projected costs that will result; and many more. Governor Cuomo estimates that 133,000 Nassau residents (one out of ten residents) would lose coverage, and that should serve as a chilling wake-up call to every stakeholder in government and healthcare. Our taxpayers deserve to know exactly how much they will be affected by Washington’s costly decisions, and the County’s planning must start now,” said Legislator Curran.
Older residents will see a rise in healthcare premiums, with a projected 20-25% increase for those in their early 60s, given the current proposed GOP tax credit structure, which does not take income into account. For Nassau’s poor and working families, the halting of Medicaid expansion coupled with rising premiums will disintegrate any chance of affordable healthcare.
“Repealing the Affordable Care Act and defunding Planned Parenthood will mean that many women – across the country and right here in Nassau County –who receive their care at Planned Parenthood health centers won’t receive care at all. We are calling on congress to stop these political attacks, but, until they do, Planned Parenthood will leave no stone unturned in fighting back for our patients and ensuring that our doors stay open,” said PPNC President & CEO JoAnn Smith.
For Long Islander Rachel Siehs, not having healthcare at a most crucial time in her life could have been a matter of life-and-death. After Rachel was laid off from her job in October 2015 she battled the very same conflict so many do when they lose their health insurance – in this case, she gotten it from her previous employer. “I was on the fence if I should buy health insurance? I couldn’t afford Cobra. Plus, I am young and healthy and thought I could wait to start a new job and acquire insurance that way,” said Rachel Siehs. “After discussing the issue with my parents, they encouraged me to find coverage on the Affordable Care Act marketplace and thankfully I did – I was diagnosed with Hodgkin’s lymphoma only two months later and would fight cancer for most of 2016.”
Since then, Rachel, 28 years old, has successfully fought Hodgkin’s lymphoma. She was able to see doctor because she had health coverage through the Affordable Health Act. Like many Americans, she risks losing health insurance again after the repeal.
“I don’t know if I would be here today if I didn’t seek coverage on the ACA marketplace. I would start a new job in January 2016 but my health insurance would not have kicked in until April. But also, who knows if I would have scheduled the doctor appointments if I would have had to pay completely out of pocket for them. The impact is real here in Nassau. Health care is important. It needs to be well thought out and studied and shouldn’t be a rushed vote. This is people’s lives,” said Rachel Siehs of Melville.
While County Executive Mangano has already indicated his disinterest in undertaking such a study, which he decried as purely political, Governor Andrew M. Cuomo did provide some indication of the impact on New Yorkers of the American Health Care Act – 2.7 million New Yorkers would face substantial loss in their health care coverage from what they have now, while quality and availability of health services across the state would be jeopardized. Also, an amendment just introduced by Chris Collins, an upstate Congressman (and Trump spokesman) and John Fasio, which would apply solely to New York State, would ban federal reimbursement for state Medicaid funds for local governments outside of New York City, cutting Medicaid for these local governments by $2.3 billion. When added to the $4.5 billion cost of the ACHA over the next four years, the total cost to the State would rise to $6.9 billion.
Donald Trump and Mike Pence are only courting right-wing conservatives on policies that impact all Americans’ lives, including health care and women’s reproductive health.
The only ones the Trump/Pence/Ryan/McConnell Administration care about, speak to are the ultra-rightwing conservatives. This from the White House, Friday, March 10:
READOUT OF THE VICE PRESIDENT’S LISTENING SESSION WITH CONSERVATIVE LEADERS
Vice President Mike Pence and Secretary of Health and Human Services Tom Price assembled dozens of conservative leaders today at the White House to discuss the multi-faceted effort to repeal and replace Obamacare. The Vice President and the Secretary highlighted the work being accomplished through legislative and regulatory efforts to end Obamacare’s government takeover of healthcare and provide market-based reforms that will lower costs and provide more choice to Americans. They also invited conservative groups to continue offering their ideas for improving healthcare in America and agreed to keep communication channels open as the President and Congress work to fulfill the promise of repealing and replacing the flawed Obamacare law.
The following individuals participated:
Thomas Binion, Heritage Foundation
Melissa Ortiz, Able Americans
Mia Heck, ALEC
Jason Pye, FreedomWorks
Brian McManus
Matthew Schlapp, American Conservative Union
Nan Swift, National Taxpayers Union
Richard Manning, Americans for Limited Government
Grace Turner, Galen Institute
Kenneth Cuccinelli, Senate Conservatives Fund
Jennifer Butler, State Policy Network
Daniel Schneider, American Conservative Union
John McKechnie, ABA Health Savings Account (HSA) Council
Stephen Keen, National Federation of Independent Business
Lisa Nelson, ALEC
Jennifer Hatten, ABA Health Savings Account (HSA) Council
David Bozell, ForAmerica
Phil Kerpen, American Commitment
Peter Sepp, National Taxpayers Union
Timothy Chapman, Heritage Action
Bradley Close, National Federation of Independent Business
Kent Lassmam, Competitive Enterprise Institute
Jennifer Martin, Tea Party Patriots
Shonda Kalra, Tea Party Patriots
Amanda Moorhead, National Federation of Independent Business
Bill Pascoe, Tea Party Patriots
Christopher Jacobs, Texas Public Policy Foundation
Adam Brandon, FreedomWorks
Michael Cannon, CATO
Bob Carlstrom, Association of Mature American Citizens
Andy Roth, Club for Growth
Heather Curry, CATO
During the Presidents Week recess when Congressmembers are supposed to meet with constituents, I attended two jam-packed rallies focused on saving Obamacare (this followed the rallies held coast-to-coast in the days before the inauguration). In each of these, desperate people (dismissed by Republicans as “paid professional agitators”) stood up to preserve the Affordable Care Act.
While not perfect (after all, how could it be when Obama had to thread a ridiculously tiny needle to get anything passed the Republican wall of opposition), Obamacare has brought coverage to 20 million previously uninsured people, reducing the percentage of uninsured Americans to a historic low of 8.6%, allowed children up to age 26 stay on their parents’ plan, mandated coverage for preexisting conditions, ended lifetime caps, capped the amount of premium that for-profit insurance pocketed for non-patient purposes at 20% (versus 97% that Medicare spends on patient care ), instituted basic standards of coverage that included, for the first time, wellness visits, coverage for certain regular tests (mammograms, colonoscopy).
The secret sauce? Mandating coverage or else pay a penalty, but if you didn’t earn enough to pay, you would be able to get subsidies from the government Why? Because the whole thing revolved around the idea that young and healthy people would pay into the system, bringing down the insurance premium for everyone. And every policy would cover certain basics, like child birth and prostate cancer, mammogram and colonscopy (ending the higher premiums for a woman).
And it was working: in the first place because if people can go to their doctors earlier, get diagnostic tests and catch illnesses earlier, they are less expensive to treat, let alone reduce the amount of suffering while increasing a person’s productivity during their prime years.
Let’s review: before Obamacare, nearly 50 million people were without health insurance and tens of thousands of families were losing health insurance as they were losing their jobs (and homes) to the Bush/Cheney Great Recession. 20,000 people a year were dying needlessly simply for lack of access to affordable health care.
And, for years, for-profit insurance companies, with a 33% margin, were raising premiums at three to five times the CPI each year; routinely dropping doctors, denying coverage, throwing people off for “preexisting conditions.” Companies were dropping health benefits for employees.
“Preexisting condition? Life is a preexisting condition, resulting from sexual contact and will invariable end in death,” Dr Martha Livingstone, vice chair of Physicians for a National Health Program, told an overflow audience at the Universalist Unitarian Church in Huntington. “We all have a preexisting condition. We all need health care because we are human beings. How we will get it?”
Congressman Tom Suozzi, who stood in front of SRO town hall at the JCC in Plainview, and again at the Huntington health care rally, and back in January, with Kathleen Rice, at a massive health care rally, said about Obamacare, “Mend it. Don’t End it.”
The key problems with Obamacare, people complained, are high deductibles (for the cheapest plans), that premiums rose significantly (after rising at the slowest rate of increase in 50 years and mainly because of the Republican sabotage that prevented the full implementation), and that doctors, and even insurers would change (which happened before, as well).
What Republicans are proposing now, though, doesn’t “fix” any of these problems. In essence, the Republican plan favors the healthy and the wealthy, shifting the burden of payment while providing fewer benefits onto working people, low-income people and the elderly, while – and here is the added bonus – exploding the budget deficit. Millions will lose insurance; costs will skyrocket, and Republicans are ramming it through without “scoring” its impact on the budget or people.
They concocted the bill in secret, are ramming it through without proper analysis, scrutiny or debate, or even “scoring” by the Congressional Budget Office, and here’s the added subterfuge: they are repealing the elements in stages: by 2018 for the first parts (to minimize impact on midterm elections) and by 2020 for the complete repeal (to ease the way for Trump’s reelection).
The Republican plan begins with ending that “freedom killing” mandate, which is the hinge upon which access to affordable health care rests, because by requiring everyone – young, healthy people who might otherwise defray health insurance costs – to purchase, the pool is large enough to keep premiums down for everyone, while covering everything from child birth to mental health to pre-existing conditions.
Instead of a mandate, enforced with a modest tax penalty, to insure that enough healthy, young people are in the pool to lower everyone’s premium while expanding care and access even if there is a pre-existing condition, the Republican plan provides for a 30% “surcharge” if you have let insurance lapse more than 60 days. So if you have lost your job, and therefore your health insurance, and can’t pay, you will only get further and further behind.
Instead of subsidies for people who don’t earn enough to purchase health insurance, Republicans want to give tax credits, which only are beneficial if you earn enough to pay. What is more, they want tax credits not to be based on income at all, but on age, so a 60 year old would get $4000 in tax credits while a 30-year old minimum-wage worker would get $2000 –still only a fraction of the cost of a minimally basic health plan – up to $14,000 in credits for a family.
The other big idea to “afford” health care is the Health Savings Account, which Republicans have wanted forever – another scheme to bolster Wall Street donors, and provide yet another device for the wealthiest to shield income from tax. The flaw is that you need to have enough money to stash away in HSA to begin with. But suppose you get a cancer diagnosis or are hit by a car before you have accumulated sufficient funds? Or you contract some illness that blows through your HSA? Tough luck.
The GOP plan would end the Medicaid expansion – when the federal government paid 90% instead of 50% of the state’s Medicaid cost — which will result in 10 million people in 31 states losing health insurance.
Another keystone of the GOP health care con is to give states block grants – a fixed amount that has no correlation to actual need. The interesting thing is that Governors tend not to use the money for its purpose (health care for the poorest residents), but for pet priorities like lowering taxes for businesses.
The Republicans say they want to shift “power” back to the states. But states always had the ability, before, to devise their own health care plan, as long as it met basic standards of the Affordable Care Act. What states want is the ability –and the excuse – not to provide universal coverage.
Republicans will claim that their plan will continue to cover pre-existing conditions. But their idea is to stick people with pre-existing conditions into high-risk pools, which could put the cost out of reach.
Indeed, no one has bothered to mention that Obamacare capped the amount that the for-profit insurance companies could charge for non-patient services – it was at 33% (versus a 3% administrative budget for Medicare) before the ACA, which required 80% of the premium to go to patient services. That is out the window.
An added zinger, just for good, is that the plan ends federal funding for Planned Parenthood. Gotcha!
Trump proposes to cure the cost problem making it possible to buy insurance across state lines, without saying how that would actually reduce the cost of the premium, under the pretext that “competition” will lower the cost. Except that the same few companies dominate the market in most states, and like airlines, can just raise premiums as they like. Also, this would negate New York’s ability to set standards on insurance companies. And wouldn’t it also mean that New Yorkers would pay the higher premium for Southern obesity?
Most of the changes are phased in – they don’t get implemented until after the 2018 midterm elections, and Obamacare is not completely repealed until after the 2020 elections.
But what Republicans claim is the “unsustainability” of Obamacare is the result of Republicans efforts to sabotage it from day 1. And the first thing that Trump did? Ended enforcement of the mandate and issue a proposal to cut next year’s enrollment period in half allow insurance companies to easily raise deductibles, limit patients’ choice of doctors, and restrict others from getting covered mid-year — even if they have a child or lose their employer-based insurance. Insurance companies are pulling out because the Republicans are intentionally making it impossible for them to do business.
By immediately repealing the mandate as well as the taxes that support Obamacare, it is truly unsustainable and more insurance companies that are planning premium rates and participation now, will either pull out or hike up premiums to ridiculous levels because essentially, they are only insuring sick, older people.
The taxes that pay for the Obamacare health care benefits are also being immediately repealed which will explode the budget deficit, which somehow, Republicans only care about when a Democrat is in the Oval office.
And here is the stunner: the Republicans, who have worked this up in secret, without any debate or public commentary (they dismiss the millions who have come out to town halls, rallies and protests as “paid professional agitators” instead of people with real concerns), plan to shove the legislation through without even scoring by the Congressional Budget Office. They can’t say how much health insurance will cost in TrumpWorld, or how many people will wind up losing health insurance or who wind up being woefully uninsured because they can only afford a minimal policy that doesn’t actually cover anything. They can’t say how many more employers (only about half were offering health insurance benefits before ACA) will simply stop providing any health care benefit at all. That’s Freedom! That’s Choice!
“Do we want people to have socialized medicine or individual accountability, personal choice, where businesses decide?” Congressman Chris Collins (R-NY) asked hypothetically.
Obamacare did not just benefit the 30 million people who were able to afford health insurance, 20 million of them for the first time. It benefited every American who also has insurance, and every American who has Medicare, as well. And remember the complaints with Obamacare? That deductibles were too high; premiums went up significantly from the first year (except they had traditionally gone up at 3 to 5 times the CPI, without any limits). That doctors left the plan or insurance companies changed the plan to exited the exchanges? The Republican plan does not improve any of this. Instead, it returns health care to the total control of for-profit companies, who can raise premiums at will, drop doctors at will, set lifetime caps or refuse to cover certain procedures.
Health care should be a right, not a privilege reserved with the means to pay for it. But the Republican mold would create a system of unequal protection throughout the land. If you happen to live in New York State, you are likely to have better access to life saving, life-affirming care for your family than if you live in Texas.
The Republican plan is a prescription for sicker people who don’t get the checkups, early diagnosis and wellness care to prevent more serious (and costly) and deadly maladies. But they don’t care. Indeed, the rightwingers like Freedom Caucus who are howling mad at the American Health Care Act are upset that it is not draconian enough, that it is “Obamacare Light”.
In TrumpWorld, people are back at the mercy of the for-profit health insurance and health care industry, back under the thumb of employers and abusive spouses. Now that’s freedom-killing, as much as it is a death penalty.
It is as Alan Grayson said early in the Obamacare debate: “The Republican health care plan: don’t get sick. The Republicans have a back-up plan in case you do get sick … Die quickly!”
Rightwingers, conservatives don’t hate Obamacare because it smacks of “socialized medicine.” They hate it because they believe when everyone is entitled to health care, there will be a shortage of doctors, of hospital beds. They will have to wait for appointments. They fear “rationing,” not caring that to avoid that feared scenario, it means that 50 million people will be excluded from health care system altogether.
The solution to having truly universal health care is to reform the health care system – more physicians assistants, nurse practitioners, online diagnosis and triage, more early diagnosis and wellness care.
Contrary to the rightwing hysteria (death panels!) Obamacare is not socialized medicine because it bent health care into a pretzel in order to retain for-profit health insurance entities as the gatekeeper between patients and health care. But the epic failure of the Republican plan, which more than restores ultimate control over people’s lives and quality of life to for-profit companies and employers and abusive spouses, will likely result in a true universal, Medicare-for-All, single-payer system.
Trouble is, that won’t happen for decades more, and not until after hundreds of thousands of people have suffered miserably, died needlessly, prematurely, for lack of access to timely, affordable, quality health care.
