GOP scrambles to revise Obamacare repeal bill

The most devastating passage in the CBO’s report on the Senate health bill
The CBO says “few low-income people would purchase any plan” under GOP health bill.

https://www.vox.com/health-care/2017/6/26/15876778/cbo-senate-health-bill-gop

The Congressional Budget Office has released its analysis of the Senate GOP’s Better Care Reconciliation Act, and it’s a bloodbath. The bill is expected to lead to 15 million fewer people with health insurance by 2018 — and 22 million fewer by 2026.

But the most devastating of the CBO’s conclusions can be found on page eight. There, the Congressional Budget Office says the BCRA would make decent insurance so expensive that “few low-income people would purchase any plan” at all. Here’s the section:

Under this legislation, starting in 2020, the premium for a silver plan would typically be a relatively high percentage of income for low-income people. The deductible for a plan with an actuarial value of 58 percent would be a significantly higher percentage of income — also making such a plan unattractive, but for a different reason. As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan, CBO and JCT estimate.
A bit of background is helpful. A “silver plan” is an insurance plan that covers 70 percent of a person’s expected health care costs. Obamacare’s subsidies were designed to make silver plans affordable and to limit out-of-pocket costs. The BCRA cuts Obamacare’s subsidies and designs its own subsidies around plans that cover 58 percent of expected health care costs. Those plans, the CBO estimates, will come with deductibles of around $6,000 — which means they would bankrupt many poor people before they ever got through the deductible.

On page 27 of the report, CBO offers an illustrative example. Imagine, they say, a person who makes 75 percent of the poverty line and is currently on Medicaid. The deductible would be more than half their annual income. They would be paying for health insurance that they would destroy them financially if they tried to use it.

So here is what the CBO is saying: The BCRA’s subsidies are too small to make the silver plans affordable for low-income people, and the plans it is trying to make affordable — the ones that cover 58 percent of expected costs — carry such high deductibles that low-income Americans won’t buy them because they won’t be able to afford to use them.

This, then, is what the BRCA actually does: It makes health insurance unaffordable for poor people in order to finance a massive tax cut for rich people.

But there’s much more in the CBO report worth noting. A few points:

Remember when Donald Trump bragged that “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid”? This BCRA’s savings come almost entirely from cuts to Medicaid. “Spending on the program would decline in 2026 by 26 percent” as compared to current law, CBO projects.
CBO directly rebuts Republicans who say this bill needs to pass because insurance markets are collapsing under Obamacare. Like under the Affordable Care Act, the agency projects individual insurance markets will mostly be stable, but in some areas of the country, “no insurers would participate in the nongroup market or insurance would be offered only with very high premiums.” Exactly what’s happening now, in other words.
While CBO doesn’t think the bill will lead to death spirals in most markets, it explains very clearly how the death spirals it does create will work. “Because the total subsidy per person under the legislation would be substantially smaller than under current law, the fraction of purchasers who are subsidized would fall. Among the unsubsidized population, less healthy people are more likely to purchase insurance—and the higher costs for them would put upward pressure on premiums. As unsubsidized people became a greater fraction of the purchasers, that pressure would be greater and could result in very high premiums in some markets.”
The increase in uninsurance under the BCRA “would be disproportionately larger among older people with lower income—particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level.” A lot of the people in that demographic are Republican voters.
Congressional Republicans are leaning hard on the idea that their plan brings down premiums, but it actually doesn’t. “Under this legislation, the net premium for a plan with an actuarial value of 58 percent would be smaller for younger people and larger for older people, but the net premium for a plan with an actuarial value of 70 percent would be larger for people of any age,” CBO says. In other words, premiums on decent insurance are higher for everyone, and premiums on high-deductible plans are a bit lower for the young at the cost of making them higher for the old.

nittany ram wrote:

It’s not just dems saying their health/tax-cut plan will result in deaths. Medical organizations, universities – pretty much anyone who studies it comes to that conclusion.

Might be a good place to post a lot of that stuff when people get a chance.

I will waive the usual posting fees.

https://www.americanprogress.org/issues/healthcare/news/2017/06/22/434917/coverage-losses-senate-health-care-bill-result-18100-27700-additional-deaths-2026/

Our data estimates show that under any of the scenarios we analyzed, a significant number of American lives are at stake in this debate.

New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMsb1706645#t=article

the data suggest that policies that reduce coverage will produce significant harms to health, particularly among people with lower incomes and chronic conditions.

New study finds 45,000 deaths annually linked to lack of health coverage

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

This dirty little secret is the real reason why repeal is so hard for Republicans

Greg Sargent

https://www.washingtonpost.com/blogs/plum-line/wp/2017/07/07/this-dirty-little-secret-is-the-real-reason-why-repeal-is-so-hard-for-republicans/?utm_term=.e3428c4234a9

The Affordable Care Act has widely been held aloft as one of the leading drivers of the deepening polarization of American political life — it has been bitterly fought over for years and has loomed as a great embodiment of all that ideologically divides the two parties. Yet in a strange twist, the GOP debate over repeal has actually revealed that there is a surprising amount of hidden consensus on health care.

In a nutshell, what the debate has really shown is that the passage and implementation of the ACA has given rise to a latent majority in Congress — or at least one in the Senate — that has more or less made peace with the ACA’s spending and regulatory architecture and its fundamental ideological goals, either for political or principled reasons, or for some combination of the two. The debate has forced this basic reality out into the open. And this, I think, is one key reason it is proving so hard for the GOP to repeal it.

The Post’s David Weigel has an extraordinary report on a town-hall meeting held by GOP Sen. Jerry Moran of Kansas that neatly illustrates the point. Moran is a GOP loyalist who previously headed the GOP Senate campaign arm and sits firmly in the mainstream of today’s GOP. Yet even he is having trouble supporting the GOP bill. At the town-hall meeting, there was no sign of his previous calls for repeal:

He did not describe the task facing Republicans as repeal; it was “repair, replace, whatever language people are using.”

Pressed by activists and voters, Moran said that he did not want to cut back Medicaid. “I have concern about people with disabilities, the frail and elderly,” Moran said. “I also know that if we want health care in rural places and across Kansas, Medicare and Medicaid need to compensate for the services they provide.”

After the town hall meeting, Moran told reporters the version of the GOP’s bill that he opposed put too much of Medicaid at risk.

“Medicaid, except for the extension part of Medicaid, is not really a part of fixing the Affordable Care Act,” he said. “So we’ve coupled two things, both of which are very difficult. Kansas is a place that’s treated Medicaid payments very conservative. If there are people receiving those payments who don’t deserve them, deal with that issue.”

Moran appears to mean that the GOP bill would not only phase out the ACA’s Medicaid expansion; it would also cut Medicaid funding far beyond the expansion (to the tune of $776 billion over 10 years, leaving 15 million fewer covered by the program). Moran is saying this would hurt untold numbers of people, including the disabled and sick, and suggesting that such deep Medicaid cuts would threaten to close rural hospitals. He is suggesting that, while able-bodied adults might allegedly be scamming their way onto the Medicaid expansion, this issue should not be taken to justify the deeper cuts to Medicaid. And this, as Weigel notes, unfolded in one of “the reddest parts of a deep red state.”

The bottom line is that Republicans who currently oppose the Senate bill object to it because it would roll back federal spending in a way that would hurt millions and millions of people. This includes Moran and moderates such as Dean Heller of Nevada, Susan Collins of Maine, Shelley Moore Capito of West Virginia, and Rob Portman of Ohio, all of whom have made variations of this argument. Some, such as Collins and Sen. Bob Corker of Tennessee, have even objected on the grounds that this would finance a massive tax cut for the wealthy, and that this is indefensible.

All of this is dramatically at odds with the ludicrous spin coming from GOP leaders such as John Cornyn of Texas and House Speaker Paul D. Ryan of Wisconsin, who argue that the millions left uncovered under the GOP bill will be choosing that plight, because they will have been liberated from the hated ACA mandate. To summarize, Republicans are arguing both that (1) millions won’t actually be hurt by these Medicaid cuts, either because they aren’t really cuts, or because everyone will have “access” to health care later; and that (2) if many millions of people go without coverage who would otherwise have been covered, they did so by choice.

It is true that scrapping the mandate would be a partial cause of the rise in the uninsured. But how many of the 15 million fewer covered by Medicaid would be choosing that outcome, as opposed to not being able to afford coverage on their own? The point here is that, while it is of course possible to make a principled argument against the mandate, Republicans are doing something else entirely: They are hiding behind their arguments against the mandate to evade acknowledging the true human toll their proposed Medicaid cuts would inflict. What this really means is that they are basically fine with rolling back the ACA’s massive coverage expansion to facilitate a massive tax cut for the rich, but just won’t say so out loud.

But all indications are that moderate Republican senators — and even senators such as Moran — are not fine with this outcome. And this also applies to the ACA’s provisions barring discrimination against people with preexisting conditions. As Philip Klein points out, Republicans are badly hung up on this — they are struggling to find some other way of realizing that goal while also repealing the mandate, which means they still want government to act to accomplish the same thing.

Now, these objecting senators may still end up supporting a revised GOP bill in the end, due to party pressures and other factors. But if they do, they will only justify it by pretending that a few additional last-minute dollars (in relative terms) added to the bill would put a meaningful dent in the enormous coverage loss the bill would produce, which that money would not actually do. This would mean their current objections were insincere. But right now, if we take those objections at face value, we have learned that they — and a majority of the Senate, when taken along with all Democrats — just aren’t willing to be associated with rolling back the large coverage expansion that the ACA has achieved.

…

Senate Majority Leader Mitch McConnell (R-Ky.) is now saying that if the GOP bill fails, Republicans will have to act to shore up the insurance markets. But as Juliet Eilperin and Amy Goldstein point out:

His suggestion that he and his colleagues might instead try to bolster the insurance exchanges created under the ACA is at odds with Republican talking points that they are beyond repair … Until now, both congressional Republicans and the Trump administration have contended that the “collapse” of the ACA marketplaces is a main reason to erase much of the 2010 law.

Exactly! McConnell’s concession blows up one of the biggest and most mendacious stories President Trump and Republicans have been telling about Obamacare for months.

…

Axios reports that Chris Warshaw of MIT looked at polling of all major legislation since 1990 and found:

The Republican health care effort is the most unpopular legislation in three decades — less popular than the Affordable Care Act when it was passed, the widely hated Troubled Asset Relief Program bank bailout bill in 2008, and even President Bill Clinton’s failed health reform effort in the 1990s.

It turns out cutting hundreds of billions in health spending on poor people to finance a huge tax cut for the rich is deeply unpopular, and not even Trump’s mighty Twitter feed can change it.

…

Paul Krugman runs through multiple lies and deceptions that Republicans are telling about their health-care bill, including this one:

Senior Republicans like Paul Ryan dismiss declines in the number of people with coverage as no big deal, because they would represent voluntary choices not to buy insurance. How is this supposed to apply to the 15 million people the C.B.O. predicts would lose Medicaid? Wouldn’t many people drop coverage, not as an exercise in personal freedom, but in response to what the Kaiser Family Foundation estimates would be an average 74 percent increase in after-tax premiums?

Republicans like to say the coverage loss would be the result of people’s choices once the hated mandate is scrapped. But if this is about the mandate, why the huge cuts in taxes for the rich and Medicaid?

McConnell’s Latest Health Care Bill Is Even Worse, Gutting Coverage and Raising Costs for Tens of Millions

Steven Rosenfeld, AlterNet | Report

http://www.truth-out.org/news/item/41273-mcconnell-s-latest-health-care-bill-is-even-worse-gutting-coverage-and-raising-costs-for-tens-of-millions

The latest Trumpcare bill released by Senate Majority Leader Mitch McConnell is a political dealmaker’s version of putting lipstick on a pig — taking a colossally destructive bill hurting tens of millions and dressing it up so it can win enough votes to pass.

A side-by-side comparison of the text reveals that the GOP hasn’t budged an inch in its intention to cut federal subsidies of state-run Medicaid by one-third, which will severely hit the poor, single mothers with children and seniors in nursing homes.

For those buying private insurance, in addition to ending federal Obamacare subsidies, by incorporating more deregulation from Texas Sen. Ted Cruz, anyone who is not youthful and naturally healthy will see premiums rise while what is covered in those plans will shrink. That translates into a double hit, on employers buying coverage for employees and on families and individuals facing higher out-of-pocket costs in emergencies.

McConnell’s new bill still ends Obamacare’s provisions that stopped insurers from rejecting people with pre-existing conditions, which is almost everybody over age 50. It reinstitutes lifetime coverage caps for insurers, which will leave people exposed to medical bankruptcy. And it eliminates Obamacare’s requirement that commercial insurance policies cover essential benefits, like maternity care.

“I knew this bill was unfixable. What I didn’t count on was that it would get worse,” tweeted Andy Slavitt, who ran Medicare, Medicaid and the Affordable Care Act for President Obama. “There is an even bigger endorsement of higher deductibles with new catastrophic plan provision.”

Digging deeper into McConnell’s bill, one finds apparent giveaways to try to wrest votes from Republicans who are on the fence for completely different reasons. On the furthest right, the inclusion of Cruz’s amendment will create two risk pools — one for regular policyholders and another for the very sick. People who want wide protection against chronic, catastrophic and life-threatening illnesses will be priced out of the market under the far right’s fictitious banner of giving people more “freedom.”

Also pandering to the tax-cutting and make-the-rich-even-richer wing of the party is the fact that McConnell’s latest bill preserves 80 percent of the taxes that earlier versions were going to repeal. That’s being portrayed in some mainstream media accounts as an improvement and something less than an outright giveaway, which is ludicrous. The hundreds of billions that will be taken away from Medicaid will offset these taxes.

The bill also seeks to win the support of senators from Ohio and West Virginia by putting in more money for opioid addiction treatment, and boosting state subsidies for Florida, Louisiana and other red states. It also creates a $100 billion tax break for people who open health care savings accounts, enlarging the role for those fee-skimming middlemen with an option that only people with high enough incomes can afford to establish and use. And the McConnell bill also creates another industry giveaway, a $70 billion account to shore up insurers against the economic turbulence the rest of this bill will create.

The national trade association for insurance companies is not impressed by any of this, realizing that the GOP’s “fixes” are going to turn them into the most hated industry in America — as if multitudes from coast to coast hadn’t already lost their patience with rising premiums, co-pays and deductibles before 2016’s “repeal and replace” charade. Their lobby group, AHIP, or America’s Health Insurance Plans, railed against Cruz’s proposals in lobbyist-speak earlier this week, in a press release with the sub-heading, “Policies that increase uncertainty or threaten instability should be avoided.”

AHIP concluded, “The individual market faces well-documented challenges to stability, including higher premiums, lower-than-expected enrollment, fewer plan choices, and risk pool problems in certain states and markets. Policy solutions exist to create more stability in the market by reducing premiums and attracting enrollment of younger and healthier individuals. In this context, it is important that policymakers avoid policies that threaten to further increase uncertainty or threaten stability. Such policies include opening up non-compliant plans to new enrollees, bifurcating the risk pool, or allowing plans covered by different rules to compete in the same market.”

This isn’t Bernie Sanders; this is the insurance lobby. As for Sanders, he posted a video on his Twitter page saying this GOP-created frenzy is making the strongest possible case for a national singer-payer, Medicare-for-all system. “The UK can do it, Canada can do it, France can do it, Scandinavia can do it,” he said.

Meanwhile, other Washington-based health consumer lobbyists said the time has come to trash the GOP and start bipartisan talks about creating a system that meets people’s needs. How that will happen, when the GOP wrote this bill in secret and ducked meetings with their constituents is anybody’s guess. But that is the line being offered on Thursday.

“Today’s release of the updated Better Care Reconciliation Act (BCRA) confirms what we already knew: this broken bill can’t be fixed,” said Joe Baker, president of the Medicare Rights Center. “This tweaked BCRA still ends Medicaid as we know it, and it still yanks health coverage out from under millions of Americans, including older adults, people with disabilities and those with pre-existing conditions.”

“Most Americans oppose the BCRA’s untenable cuts to Medicaid and its disregard for the families who need guaranteed, affordable health coverage,” Baker continued. “In drafting the BCRA, Senate leaders have avoided public debate, hearings and even their own constituents… The American people have asked for, and deserve, an open, bipartisan approach to making health care more affordable for everyone.”

What comes next in this process? The Congressional Budget Office will score the bill, meaning it will say how many people will be hurt by the cuts in government subsidies and coverage cuts, and how many will benefit from tax cuts and other giveaways. Then McConnell will try to bring the bill to the floor, where if necessary, he will introduce more vote-getting amendments that will not be reviewed by the CBO.