From the category archives: affordable care act
affordable care act
Let us not speak of pigs and lipstick, but simply say that the freshly tweaked GOP health care bill introduced last night still socks it to older Americans. In an attempt to throw bones to both moderate Republicans and Tea Partiers, Speaker Paul Ryan has come up with a revised bill that’s even worse than the original for seniors and “near seniors” (under 64 years of age). The Center for Budget and Policy Priorities has just released a detailed analysis forecasting higher net premiums, co-pays, and out-of-pocket costs for older Americans under the revised bill. Here is our own take on why there's nothing to like in the tweaked legislation:
Millions of seniors depend on Medicaid to cover the cost of long-term care, while low income Americans 50-64 rely on the program for basic health care. The original GOP bill cut nearly $1 trillion from Medicaid and imposed per capita caps on federal payments to the states. The revised legislation adds another insidious idea to the equation by introducing block grants, where states can decide to curtail or outright cut certain services. Per capita caps and block grants mean one thing: less funding for older patients who need medical services and long-term care - and in some cases, complete loss of coverage. For seniors, It’s two bad ideas in one bill.
The revised GOP bill does nothing to address a major problem with the original. Under the revised legislation, Insurance companies would still be able charge older Americans up to five times as much as people in their 20s (a practice referred to as “age rating”), one reason why the Congressional Budget Office estimated that 24 million people would lose coverage under the Republican plan.
Obamacare provided generous subsidies to people who couldn’t afford private insurance premiums. The GOP bill replaced those subsidies with paltry tax credits that discriminate against older patients. Paul Ryan’s tweaked version kicks the problem over to the Senate by authorizing the upper chamber to increase tax credits for older Americans… if it wants to. There’s no guarantee the Senate will actually do this, or that fatter tax credits will make it into the final bill. Once again, the revised GOP plan leaves older folks worse off.
While giving nothing to seniors, the revised bill still repeals $600 billion in tax cuts for the wealthy (and $24 billion for pharmaceutical companies) that Obamacare utilized to expand health coverage and strengthen Medicare. The tweaked bill actually sweetens the deal for the wealthy – repealing the taxes in 2017 instead of 2018.
The GOP plan still weakens Medicare through the repeal of a 0.9% tax on income over $200,000. By rescinding the tax, the GOP plan reduces the solvency of Medicare by 3 years – and the revised bill does nothing to lengthen it. Reducing Medicare’s solvency gives budget hawks an excuse to privatize and cut the program, which hurts seniors.
We don’t know whether the dressed-up GOP plan will pass the House. It’s possible that the concessions to Tea Partiers and token gestures to moderates – plus active lobbying on President Trump’s part – will allow it to squeak by. Either way, Speaker Ryan squandered an opportunity to reverse some of the damage to healthcare and long-term care for our older and most vulnerable citizens.
National Committee President Max Richtman has rightly called the GOP Obamacare replacement “a triple whammy for seniors” because of its impacts on the private insurance market, Medicare, and Medicaid. Yesterday’s report from the Congressional Budget Office confirms this grim assessment. Of the 24 million Americans who will lose health coverage over the next decade, many will be seniors and “near-seniors” aged 50-64 who can least afford to go without much needed medical care.
PRIVATE HEALTH INSURANCE
On the private health insurance front, the CBO projects that premiums will rise by more than 20% for older Americans. This is mainly because the bill allows insurers to charge older customers up to 5 times more than younger ones. At the same time, the GOP legislation yanks the financial rug from underneath older enrollees by replacing generous Obamacare subsidies with meager tax credits. According to today’s New York Times:
“The CBO estimates that the [net] price an average 64-year-old earning $26,500 would need to pay… would increase to $14,600 under the Republican plan.” – New York Times, 3/14/17
The Times reports that older American’s out-of-pocket insurance costs would also rise:
“The hypothetical older customer who could pony up $14,600 for insurance under the GOP plan would also pay substantially more out of pocket for any health care services. And changes to the requirements for health plans mean that, across the board, deductibles and cost-sharing will increase.” – New York Times, 3/14/17
The reason for the word “hypothetical” is that most older Americans would not be able to afford $14,000 in premiums, let alone rising deductibles and co-pays. Unable to pay these exorbitant prices, millions of “near seniors” (aged 50-64) will simply have to drop their health insurance during those crucial years before they are eligible for Medicare and need it most.
The GOP phase-out of Obamacare’s Medicaid expansion will also hit near seniors in the lower income brackets particularly hard. As a result of these changes, the CBO finds that people between 50 and 64 years old earning less than 200% of the federal poverty level would make up a larger share of the uninsured, from just over 10% under Obamacare to nearly 30% under the Republican replacement. To re-iterate: 30% of near seniors earning a modest income will lose healthcare coverage from Medicaid. That’s nearly one third of the lower income seniors who benefited from the Obamacare Medicaid expansion.
The GOP bill also radically restructures Medicaid by ending guaranteed federal matching funds to the states and effectively cutting $880 billion from the program over ten years. Cash-strapped states will be compelled to compensate for this shortfall by cutting benefits and eligibility for Medicaid. The CBO estimates that 14 million people will be forced off of Medicaid rolls by 2026. This is particularly bad news for seniors who rely on Medicaid to pay for long term care services and supports when their personal savings are depleted. Those seniors will either have to rely on their financially-squeezed families to pay for long term care, or be forced to forgo the care they need.
According to the CBO report, the Republican health plan achieves most of its budget savings by rescinding taxes on higher-income Americans. Unfortunately for current and future retirees, those tax revenues were helping to keep the Medicare program on a sound financial footing. By repealing a $117 billion tax on income above $200,000 a year, the GOP bill reduces the solvency of Medicare by 3 years.
In a perversely self-fulfilling prophecy, the very budget hawks who insist that Medicare needs to be “reformed” because of its solvency problems are now making the program even less financially sound. This opens the door for the “reformers” to argue even more vehemently for privatizing Medicare and turning it into a voucher program, which will hurt seniors with low or modest incomes.
REVERSE ROBIN HOOD
In reviewing the CBO analysis, a theme quickly emerges. The Republican plan rips benefits away from lower income and older Americans while rewarding upper income earners with billions of dollars in tax breaks. It achieves federal budget savings on the backs of the people who can least afford to sacrifice. The young, healthy and wealthy do better under the GOP plan. With the triple assault on Obamacare, Medicaid, and Medicare, seniors and near seniors are left in the cold. As National Committee president Max Richtman likes to say, the Republicans’ message to older Americans seems to be, “You are going to be on your own and good luck… and I'm not even sure about the ‘good luck’ part.”
We discussed Trumpcare's impact on older Americans on Facebook Live "Behind the Headlines." Watch here.
Read the National Committee's response to the CBO report here.
MSNBC’s Ali Velshi summed up the problem with the GOP’s Obamacare replacement plan succinctly: The winners are the young, the wealthy, and insurance companies. The losers are the elderly, poor, and sick. That seems like the opposite of what would be morally just – and smart policy – for the wealthiest nation on earth. Instead, the healthiest and wealthiest benefit while the sickest and most vulnerable suffer under this new plan. Our nation’s seniors, in particular, will fare significantly worse if the American Health Care Act (as it’s benignly named) becomes law, because it weakens Medicare and radically restructures Medicaid – two of the most important federal programs for the elderly. Meanwhile, the bill gives the wealthy a $600 billion tax cut over ten years.
Here are some of the most harmful facets of the GOP plan affecting seniors:
*Imposes “per capita” caps on Medicaid payments to the states after 2020, amounting to a $370 billion funding cut over 10 years. This will likely compel states to cut benefits to seniors who rely on Medicaid to pay for skilled nursing and long-term care. Standard & Poor’s estimates that 4-6 million beneficiaries will lose Medicaid coverage altogether.
*Rolls back insurance premium support for Americans in their 50s and 60s, putting their health and wellness at risk in the crucial years before they are eligible for Medicare.
*Allows insurance companies to charge older Americans up to five times more than younger enrollees, putting health coverage out of reach for millions of middle-aged Americans and younger seniors.
*Repeals a tax on wealthy Americans that was helping to keep Medicare solvent. Eliminating those taxes on high earners will reduce the solvency of the Medicare Trust Fund by at least 4 years.
The Republican plan replaces Obamacare’s health insurance subsidies with tax credits that will barely make a dent in older Americans’ premiums. Individuals between the ages of 50 to 59 would receive a tax credit of $3,500 per year; Anyone over 60 would receive a meager $4,000 per year. What’s more, the tax credits are phased out for individuals earning over $75,000 annually or $150,000 jointly. Given that healthcare premiums for a 64 year-old are projected to climb to $13,125 per year under the GOP plan, these tax credits will fall pathetically short.
Even with the tax credits, fresh analyses indicate that Americans’ out-of-pocket healthcare costs will rise under the GOP plan. In its blog, The Big Idea, today Vox concludes:
"Once the differences in tax credits are accounted for, the bill would increase costs significantly. [Higher] cost-sharing would greatly increase financial risk. If you’re now paying 50 percent of your costs, instead of 75%, a big hospital bill could be devastating.” - Vox’s The Big Idea
For all the Republicans’ griping about Obamacare premiums being too expensive, Vox estimates the average policyholders’ out-of-pocket costs will increase by $1,542 per year even if their premiums go down.
Returning to Ali Velshi’s summary of winners and losers, one can see a resemblance between the way the GOP plan health pits the young against the old, the wealthy against the less fortunate, and the healthy against the sick… and the tactics they employ in attempting to cut Social Security and Medicare. The trouble is that eventually everyone will grow old, and at some point in our lives we all will be sick. Everyone – young and old – needs affordable health care. In replacing Obamacare with this newer, more miserly plan, millions of Americans will not be able to afford the healthcare they need.
There’s a great piece in the current Money magazine by Elizabeth O’Brien about the impact of ACA repeal on seniors. The title alone makes it worth the read: “Think Changes to Obamacare Won’t Affect You? Think Again.” In this article, O’Brien lays bare the consequences of ACA repeal to seniors, who, as the title implies, may not be aware of the repercussions for Medicare.
"The Affordable Care Act contains about 165 provisions affecting Medicare, according to Medicare's trustees. These range from improving benefits for the 57 million current beneficiaries to shoring up the program’s long-term finances for future ones.”
These provisions include free wellness visits and preventative screenings for cancer, diabetes, heart disease and a host of other medical conditions – with no out of pocket costs – all of which could disappear if the ACA is repealed. Likewise with the prescription drug “donut hole,” which the ACA was closing, saving the average beneficiary $1,000 a year. As O’Brien notes, before Obamacare came along:
"More than three million beneficiaries hit the donut hole before the law took effect, and some [seniors] were forced to skip doses, split pills, or not fill their prescriptions at all due to high costs.”
Who wants to go back to seniors splitting pills or going without their medicines?
O’Brien also points out that because of the savings the ACA provided to Medicare, repealing the healthcare law will cost Medicare $802 billion between now and 2025. There’s also a strong refutation of the argument by House Speaker Paul Ryan and HHS Nominee Tom Price that Medicare is “going broke,” which they will use as a canard to cut benefits.
Most tellingly, the Republicans are gunning for tax provisions that help pay for the ACA which mainly affect the upper middle class and the wealthy. O’Brien quotes Matthew Yglesias of Vox:
"Republicans’ desire to eliminate these taxes is a big driver of their push to repeal Obamacare. Subsidizing the health care costs of working-class people is expensive, and while Democrats want rich people to pay the freight for doing it, Republicans do not."
The bottom line: seniors and millions of newly insured Americans will pay more for healthcare – or go without it entirely – so that high earners can get a tax break.
The Alliance for Healthcare security, of which the National Committee is a member, has released the latest in a series of tv spots opposing repeal of the Affordable Care Act. Watch the new ad here. It's worth the 30 seconds of your time.
This latest one is probably the most powerful of the series, which began airing in December. The opening narration pulls no punches. "Congress has taken the first step to rip apart our healthcare with no plan to replace it," says the announcer. The bulk of the ad features actual health care professionals in blue scrubs and white coats talking right into the camera about why repeal is such a bad idea.
"They don't have a plan to insure the 30 million people who will lose their healthcare," says Theresa, a registered nurse. "No plan to cure existing conditions, like cancer," says Michelle, another RN, while a third nurse states simply, "It's gonna cause pain."
The tagline is: "Tell Congress we need a plan that protects our care."
The ad is elegant, clean, and effective. Pressure from advocacy groups and negative media coverage of the repeal efforts on Capitol Hill seem to be having an impact. As the Associated Press reported today, some Congressional Republicans are starting to back away from repeal and talking more about what sounds like "repair," which is something even President Obama and Democrats had always said they would welcome. The Associated Press describes "a softer tone that comes as [the GOP's] march to fulfill a keystone campaign promise encounters disunity, drooping momentum and uneasy voters."
Last week, Congressional Republicans seemed like they were on a tear to repeal - ramrodding through a budget resolution that would defund Obamacare with the promise of a replacement bill soon after. Not anymore, apparently.
"Republicans triumphantly shoved a budget through Congress three weeks ago that gave committees until Jan. 27 to write bills dismantling the law and substituting a Republican plan. Everyone knew that deadline meant little, but now leaders are talking about moving initial legislation by early spring." - Associated Press
Seniors, especially, have a lot at stake in any repeal and replacement because of the Affordable Care Act's improvements to Medicare - including free preventative screenings and wellness exams, the closing of the Medicare Part D prescription drug "donut hole," and the extended solvency that the ACA provided to the Medicare Part A trust fund.
Let's hope that this continued ad campaign by the Alliance for Healthcare Security, and the voices of organizations like ours along with pressure from the public will convince the GOP that outright repeal without a replacement that protects the healthcare of all Americans is a really unhealthy choice.
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