On the House Draft Plan to Repeal ACA
Posted on March 8, 2017
Endorsed by Trump, it is a pretty good effort, from their point of point of view, and in fact it has an air of inevitability.
1. They had to repeal the insurance mandates and the tax penalties on individuals and employers, because that was their only actually popular issue.
2. They had to attack Medicaid expansion, because a lot of Republican governors and legislators went on on a limb betting on its instability. So they are phasing it out gradually.
3. They had to provide an expanded tax credit for insurance to placate a whole lot of people who are going to lose coverage and/or insurance subsidies.
4. They had to provide some semblance of popular features such as must carry to age 26 and no pre-existing conditions exclusions and anti-discrimination features, so they did–but with loopholes.
5. They had to give insurance companies quite a lot to prevent them from opposing the change-over. So they get a package of goodies (for them) and baddies (for us), e.g.:
–allow catastrophe insurance (putting pressure on emergency rooms to absorb lots costs for poor people)
–30% penalty to reinsure if your insurance lapses for any reason
–repeal various taxes on insurance companies.
–replace some mandates with an (inadequately funded) high risk pool
–allow charging old people 5 times as much as young people (up from 3 times as much).
6. They also needed a sop to Big Pharma, so they repealed a tax on pharmaceuticals and devices.
7. They had to placate the antiabortionists, so:
–abortion coverage is not allowed at all.
–health organizations (not just planned parenthood) that provide any abortions or CONTRACEPTION ADVICE are entirely defunded.
8. Obeying the rule that every major Republican legislation must cut taxes on rich people, there is a completely unrelated provision to cut investment taxes.
9. Since this plan is sure to be a budget buster (whereas ACA was self-financing) they had to scrimp where they could, e,g.:
–no tax credits for high income people
–block granting Medicaid
–lower tax credits than ACA in many cases
–block granting that will lower Medicaid support
–kicking people off Medicaid permanently if they receive any temporary cash windfalls.
10. Obeying the rule that bad policy law changes should be as opaque a possible, the drafting is replete with language that says things like “change such and such a word in such and such a law to another word.” Consequently it will take a very long time to ferret out all the secret gimmicks in the law that have not yet been uncovered. Partly to limit those discoveries, the GOP plan is to push the law through as fast as possible using a device that prevents a filibuster (budget reconciliation).
As to hospitals and other service providers, it looks to me that they are going to be screwed, with some additional costs and no benefits.
They are going to have a hard time holding the 50 GOP Senators they need together on this. On the left, 4 of the 52 Republican Senators come from states that expanded Medicaid, and another 2 don’t like defunding Planned Parenthood. On the right, a few Senators are strongly opposed to a permanent tax credit for health insurance. Look for some extravagant bribes being offered to Democrats to bolt party discipline on this.
It would probably be best, for those who believe in universal healthcare, which this bill takes us even further back from, to make it very clear that any Democrat who bolts will be primaried with heavy funding.