Back in January, being a spreadsheet guy but not being a particularly good graphic artist, I put together a crude table which attempted to give a general idea of which groups of people the Affordable Care Act is, in general, working out for fairly well vs. which groups the ACA isn't working for, by income threshold. A couple of days ago, with details about the GOP's "replacement plan" popping up all over, I posted a similar version of the table which tried to compare the winners/losers between the two plans, and the contrast was remarkable: Nearly a complete reversal.
Last night, with the GOP's plan finally, officially revealed, I made some minor adjustments so that the two tables were more of an apples-to-apples and came up with the following:
So, it's finally here. After seven years and over 100 entries, Huffington Post healthcare reporter Jeffrey Young can finally shut down (or at least archive) his famous "JUST IN TIME!" Storify collection, which has been chronicling the endless empty promises of the Republican Party insisting that their "replacement plan" for the Patient Protection and Affordable Care Act was going to be revealed at any moment.
Yes, after seven years, it's finally here (Part 1)and here (Part 2). It has a catchier title than the ACA ("The American Health Care Act"), which is typical of Republican bills. Remember George W. Bush's "Healthy Forests Initiative", which actually opened previously protected forest areas to logging, often unnecessarily or under false pretense?See, it has the word "American" right there in the title, so it must be good, right? I'll be abbreviating tthis as "AHCA", although they're already annoying me by spelling "healthcare" as two words (I strongly believe it should be one).
Here's the stuff which supposedly can't be changed via the reconciliation process, and is therefore might not be touched...yet. That is, these are changes which would suppposedly either require 60 votes in the Senate or would require the GOP to kill the filibuster entirely to push through:
Guaranteed issue (no pre-existing condition denials)
Community rating (can't charge different people more for the same policy outside of a tight set of parameters)
The ACA's preventative benefits (I'm not sure if this list changes, but I'd imagine not)
No lifetime or annual limits on coverage (a few people have stated otherwise, but this seems to be the consensus)
Required essential benefits for every plan on the private market (ie, group or individual)
Limits on out-of-pocket costs for enrollees
Young adults 19-25 being allowed to stay on their parents' plan (I've noted before that I always suspected this would survive any repeal effort)
"Removing the lines" to allow carriers to "sell insurance across state lines" (at least not any more so than the ACA already allows them to)
The "Grassley Amendment": Congressional staffers will still have to enroll via the DC exchange in order to receive tax credits.
The 80/20 Medical Loss Ratio (requires insurance carriers to refund the difference to enrollees if they spend more than 20% of premium costs on anything other than actual, legitimate medical care)
All of the above sounds great at first glance...but again, keep in mind that for the most part this is only because they can't touch them without 8 Democratic Senators agreeing to do so...or killing the filibuster, which they could still do. That's a hell of a Sword of Damocles to be hanging over everyone's head.
OK, so what would change via the AHCA, assuming they manage to pass it with simple majorities in the House and Senate, and Trump signs it (which I'm certain he would)?
Initially, the story seemed to be about a man who railed against Obamacare while both taking absolutely no responsibility for failing to take advantage of the benefits of the law which he was entitled to and simultaneously blaming President Obama for the failure of his own GOP-controlled state to expand Medicaid under the law. Several people wrote up articles ripping Mr. Lang to shreds over his seeming hypocrisy, myself included.
In addition to all of the other horrific details which are oozing out of the House Republican's "Basement Bill" to replace the ACA, something else has been nagging at me for a few days now, but I couldn't quite put my finger on it until today.
The issue was sort of coalescing in my brain all afternoon, but it was a couple of other folks who laid it out first:
If you widen the age rating bands for health insurance and then scale the tax credit based on age, haven't you kind of done nothing?
Obviously there's no way of being 100% certain about this because the GOP still hasn't actually presented their ACA replacement bill (and in fact, have been playing a rousing game of Where's Waldo with it all afternoon), but we do have a pretty good idea of what it's gonna look like, thanks to a recent draft version of the bill which was leaked a couple of weeks back.
The Kaiser Family Foundation has crunched the numbers and compared what things look like financial assistance-wise under the ACA, the HHS Secretary Tom Price's "Empowering Patients First" bill and the recent "House Discussion Draft" bill to see how the GOP versions size up...and it's not pretty.
“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”
--― Douglas Adams, The Hitchhiker's Guide to the Galaxy
