Deplorable Care Act

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)?

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?

— Josh Barro (@jbarro) March 2, 2017

@jbarro Belated response: I've thought the same thing and asked this question. No persuasive answers.

— Margot Sanger-Katz (@sangerkatz) March 3, 2017

@sangerkatz Drat. You both beat me to the punch. If they want 5:1 bands, shouldn’t 60+ subsidies be $10,000?

— ☪️ Charles Gaba ✡️ (@charles_gaba) March 3, 2017

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.


Sometimes the joke just writes itself.

“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

via Jonathan Chait of New York Magazine:

The Center for American Progress has apparently sneaked a peek at the CBO's initial analysis of Paul Ryan and the House GOP's replacement plan for the ACA, and it's not pretty:

Last week, the House majority released an outline for repealing the Affordable Care Act, or ACA. Although the document provides no new details, it does provide enough information to evaluate the adequacy of financing, the likely policies needed to pay for new tax credits for health insurance, the likely effects on tax credit levels, and the political hurdles to such an approach. This analysis is based exclusively on numbers from the nonpartisan Congressional Budget Office, or CBO.

Here's CAP's main findings; in short, Ryan's repeal bill would....