The Dismantling of ObamaCare - Ongoing Updates.

[Justin Bilyj]

Here's the 142 page republican healthcare bill and a summary of what's in it.

-Gives subsidies illegal immigrants if they are working in the United States
-Gets rid of business and consumer mandates with no penalty
-Qualified plans don't need to provide abortion coverage unless it's to save the life of the mother
-Each state gets 15-10 Billion for uninsurables
-Cadillac tax is gone
-OTC med tax is gone
-HSA penalty tax is 10%
-Prescription tax is gone
-Medical device tax is gone
-Business owners can deduct part d expense again
-Deductible medical expenses are back to 7.5% instead of 10% AGI
-Tanning tax is gone (ironic)
-Net investment tax is gone
-HSA deductibility will be adjusted every year for COLA
-Both spouses can now make catch-up contributions to a family HSA
-60 day limitation to setting up an HSA account when first getting the plan for purposes of a current claim
-No coverage for abortion clinics
-Repeal of cost-sharing subsidy
-MLR set by states
-Grants for states battling opiod addiction (like mine)
-CHIP is reauthorized
-$5,000 app fee to create small business association health pool
-Psychiatric coverage is limited to institutionalized individuals only, and for stays up to 30 days but not to exceed 90 days

 

[STIBROKER]

I find this interesting........

-$5,000 app fee to create small business association health pool

 

[VolAgent]

I find this interesting........

-$5,000 app fee to create small business association health pool

I'm curious about that too. When and where is that fee charged? Surely not per individual/family app, so when?

 

[STIBROKER]

I'm curious about that too. When and where is that fee charged? Surely not per individual/family app, so when?

Thinking it would allow a small group of business's to form a association plan.....like local realtors.....but then what....they write their own plan....self fund...or give the association to be insured as a group with all the company's doing group plans...and also can have non compliant compay's like freedom life write the association......

 

[junkman]

No mandate, no underwriting = no carriers. Ideological bullshit. **** the repubs.

 

[hamben]

I believe the goal is to get rid of the individual market altogether ..allowing individual and small groups to buy insurance through associations. Pay a $5000 fee to become certified to sell insurance in states you choose to do business in.


This bill does nothing to control costs. Better off keeping the obamacrap tell it implodes and then starting over.

 

[RayNY]

Justin BilyJ, your summary is a bit inaccurate.

Neither ACA nor this bill give subsidies to illegal immigrants. ACA extended it to "alien legally present in the US", this bill restricts it to "Qualified Alien" (a legally present alien who also works).

The $10-15B pool is for CMS to distribute to all the states, it's not a per-state fund, and it only lasts from 2018-2021

No coverage for abortion clinics is half the story, any plan that covers abortion can't be a QHP (page 8, (d)(1)). Among other things, that means no subsidies.

You've also left out some important changes.

Medicaid is block granted. (sec 134) That's a big deal. Don't let the "Medicaid Flexibility Program" title fool you.

The block grant has a population growth limit, if a state expands too fast, the extra eligibles aren't funded. (page 92, (c)(2)(C))

Medicaid expansion is repealed. (sec 126)

States have an option to require Medicaid recipients to work in order to remain eligible, effective Oct 1, 2017 (sec 131). Being unable to find or keep a job means they'd lose their Medicaid coverage too.

Subsidies no longer based on SLCS, it's now "applicable median cost benchmark plan", which is a bare-minimum 58% AV plan (AV's down to 58% are now permitted, so we finally have the "lead tier" plans with $10,000 deductibles that we've joked about). FPL limit lowered from 400% to 350%.

They also age-banded the allowable percentages and raised them across the board. (Refer to chart on page 6). Allowable percentage increases with age, so older people are going to have to cover a larger portion of their premium, which is already higher to begin with. Maxes out over 16% of income...

Effectively, they're going to cut subsidies in half, or more, and put those people into plans with deductibles so high they can't actually use it (remember, CSR is gone under this bill).

States that exceed the average Medicaid per-capita spending will be penalized. This doesn't compensate for the difference in cost of care from state to state, and will disproportionally impact high-cost states.

No new funding proposed to cover all the removed taxes, they're relying on "monies in the Treasury not otherwise obligated". The Treasury may not have sufficient un-obligated capital, which means the money just isn't available. We'll likely wind up with a situations similar to the 87.3% Risk Corridor shortfall.

The cons may outweight the pros on this one. It's a "discussion draft", so there will likely be changes, but some of this stuff is going to piss off a lot of people.

 

[junkman]

Effectively, they're going to cut subsidies in half, or more, and put those people into plans with deductibles so high they can't actually use it (remember, CSR is gone under this bill).

The cons may outweight the pros on this one. It's a "discussion draft", so there will likely be changes, but some of this stuff is going to piss off a lot of people.

No new funding proposed to cover all the removed taxes, they're relying on "monies in the Treasury not otherwise obligated". The Treasury may not have sufficient un-obligated capital, which means the money just isn't available. We'll likely wind up with a situations similar to the 87.3% Risk Corridor shortfall.

From group data: 90% of people have claims under $5,000 so under current plans most have no claims paid by the carrier. This is especially true for those over the subsidy level who routinely buy HDHP.

People are already getting pissed off. Pass this bill and Repubs own it. Bye bye. I hope Mitch is one of the first to get booted. I hate hearing his voice.

Laffer curve has been discredited. https://en.wikipedia.org/wiki/Laffer_curve

 

[TampaHound]

I know this is not the popular view...but I don't see the Republicans getting this...or any other bill through.

Supposedly this is 1/6 of the American economy they are talking about, and times have changed since the ACA was originally put in place. Their is just to many moving pieces to be played with in such a short time period.

I think this new bill will fail...then it will be back to the drawing board. Then its the 2018 mid-terms and they will put it off again till afterward...and never get back to it.

To much of a political hot potato.

 

[junkman]

The current bill will not pass. It's easy to forget that Congress isn't stooopid or without information. They simply have other more pressing considerations - getting reelected, keeping the drug companies happy, maintaining the authority to rape and pillage, expanding the war. Healthcare is minor compared to those.