Thursday, December 29, 2016

What Working Class Americans Lose When Trump Scraps Obamacare

Republicans spent the last six years trying to repeal the Affordable Care Act (ACA), better known as Obamacare. Republicans have passed over 50 bills to repeal the ACA, since gaining control of the House in November 2010, but with Obama in the White House, those Republican Bills were nothing more than campaign rhetoric.

Republicans have warned their voters about the evils of Obamacare for years, calling it a job killer, and claiming it pushes health insurance premium costs sky high for everyone, among other evils. They promised to repeal it immediately if only their voters would vote to give them complete control of the federal government.

Republicans and Donald Trump promised voters their life would immediately improve once the healthcare law is repealed. Now they not only control the House and Senate, President-elect Donald Trump is set to take office, and the GOP may finally get its wish to repeal Obamacare.

The straight up fact is Obamacare has been a jobs program for the healthcare sector. The private sector has grown every single month since the ACA passed in March 2010, a number that Obama often touts when he defends his signature law. And many of those jobs are, literally, in health care.

More than 1 in 9 employed Americans now gets a paycheck directly from the health care industry, and that’s not counting the millions more who work in associated fields, like tech companies that specialize in health care services or the consulting firms that feed on the corporate run sector’s inefficiency.

Neither has Obamacare caused insurance rates to increase. As The New York Times pointed out,
“If you get a subsidy, and you’re willing to switch plans, you won’t have to pay these big increases. More than 80 percent of Obamacare customers get subsidies that help them pay the cost of their premiums. Those people do not pay the full cost of insurance out of their pockets, and they will not feel the full brunt of these increases, as long as there is a less expensive plan available in their market and they are willing to switch.”

The premium increase only applied to the 12 million who got their insurance through the exchange and the millions of people who bought their own insurance outside of the exchange, and subsidies offset the premium increase for 80% of people in the exchange.
The current ACA healthcare exchange enrollment numbers (as of February 2016) are roughly: 12.7 million in the marketplace, and very roughly 20 million total between all the state and federal the Marketplaces, Medicaid expansion, young adults staying on their parents plan, and other coverage provisions.

The 2016 uninsured rate remains at an all time low with the uninsured rate at 11.9% for Americans age 18 – 64 and 8.6% for all Americans. Marketplace signups didn’t see a net increase for 2016 (although many re-enrolled for the 12.7 million total enrolled), gains were made in other insurance types.

Scrapping the Affordable Care Act (aka Obamacare) will also change how health insurance works for 156 million Americans who had coverage last year through employers, as estimated by the Henry J. Kaiser Family Foundation. If you have employer health insurance, an Obamacare repeal will affect you too.

According to a new study, the repeal would come at a significant price. The Urban Institute, a left-leaning think tank, analyzed the most likely proposal from Republicans for repeal of the law and found that millions of Americans could lose their insurance if it were to pass.
"We estimate that the partial ACA repeal would increase the number of uninsured people by 29.8 million by 2019, raising the total number of uninsured to 58.7 million people - 21 percent of the non-elderly population - compared with 28.9 million people uninsured if the ACA remains in effect," said the report, which was authored by Linda Blumberg, Matthew Buettgens, and John Holahan.
And the authors said the Republican repeal plan could hit certain groups of working-class families most. "The vast majority of those becoming uninsured would be members of working families (82 percent), and more than half (56 percent) would be non-Hispanic whites," the study said. "The vast majority of adults becoming uninsured would lack college degrees (80 percent)."
Based on exit polling, many of the demographics that would be hit hardest by the repeal voted for Trump in the presidential election. According to exit poll data, non-Hispanic whites favored Trump by 20 percentage points, and non-college educated voters went for Trump by a 5-point margin. Non-college educated whites went for Trump by a 37-point margin.
In addition to banning lifetime coverage caps, the Affordable Care Act lets consumers keep children on their plans until age 26; requires companies with at least 50 employees to offer coverage; and makes preventive care, such as health screenings, flu shots, breast-feeding supplies and contraception, free to those with insurance.

Obamacare also bars insurers from denying coverage to people with pre-existing conditions. 105 million Americans had plans with lifetime limits on their health benefits before the Affordable Care Act was enacted, according to the U.S. Department of Health and Human Services, and so were locked into their current employer's group health insurance. In otherwords, employees couldn't change jobs, and if they were layoff they would loose their healh care coverage altogether.

CBO projections also predict at least 54 million non-elderly Americans will be uninsured by 2019, if Republicans who now control the federal government repeal the ACA.

The LA Times writes, a key feature of Republican plans to replace Obamacare is allowing market forces to boost innovation and competition among healthcare providers.
“Unleashing the power of choice and competition is the best way to lower healthcare costs and improve quality,” declares House Speaker Paul Ryan in his conservative manifesto “A Better Way.”

The problem with that, however, is that the healthcare industry — hospitals, drug companies, insurers — have worked tirelessly to prevent the medical marketplace from functioning with sufficient transparency and efficiency to allow consumers to benefit from classic supply-and-demand economics.

Instead, the opaque and frequently unfathomable healthcare market promotes runaway corporate greed that often can be countered only by shaming businesses into behaving fairly and responsibly.

With virtually no limits on what can be charged for medicine, drug companies have imposed a series of price increases with no seeming justification other than to enrich executives and shareholders at the expense of patients.
Obamacare repeal is a lose/lose situation for Republicans. Either they end the law and cause chaos, or they keep the law and enact a lie that will create years of uncertainty. The bill has come due for years of Obamacare lies, and Republicans will pay a heavy price no matter the course of action that they pursue -- but only if Democrats hit Republicans with these facts everyday!

Bloomberg reported on the great Republican Obamacare repeal dilemma,
“Republicans are debating how long to delay implementing the repeal. Aides involved in the deliberations said some parts of the law may be ended quickly, such as its regulations affecting insurer health plans and businesses. Other pieces may be maintained for up to three or four years, such as insurance subsidies and the Medicaid expansion. Some parts of the law may never be repealed, such as the provision letting people under age 26 remain on a parent’s plan. House conservatives want a two-year fuse for the repeal. Republican leaders prefer at least three years, and there has been discussion of putting it off until after the 2020 elections, staffers said.”
Here are some of the private health insurance industry reforms mandated in the legislation that Republicans want to repeal:
  • Health Insurers cannot deny children under age 19 health insurance because of preexisting conditions. (Reference) A ban on preexisting condition exclusions for adults took effect in 2014.
  • Small businesses got tax credits covering up to 50% of employee premiums for 2009 and 2010. (Reference)
  • Seniors get a rebate to fill the so-called "doughnut hole" in Medicare drug coverage, which severely limits prescription medication coverage expenditures over $2,700. As of 2012, 50 percent of the doughnut hole was be filled. (Reference)
  • The cut-off age for young adults to continue to be covered by their parents' health insurance is their 27th birthday. (Reference)
  • Lifetime caps on the amount of insurance an individual can have are banned. Annual caps are limited, and banned as of 2014. It says that health insurance companies can no longer tell customers that their health care coverage will be terminated because they have hit a "lifetime limit" on claims. And there are now restrictions on yearly spending limits, too. (Reference)
  • Adults with preexisting conditions may buy into the national high-risk pool, at different rates than people without them, through health insurance exchanges. While high-risk coverage is not be cheap, it is still better than total exclusion from health care access. And the high-risk pools provide some cost benefit from a wider pool of insured adults. This is a way to phase out the old "preexisting conditions" exclusions insurance companies use to use to deny health care coverage.  (Reference)
  • Free preventative care - New plans must cover checkups and other preventative care (mammograms, colonoscopies, etc.) without co-pays. All plans will be affected by 2018. (Reference)
  • No more rescission. Effective immediately, insurance companies can no longer cut someone when he or she starts filing claims for high treatment cost diseases like cancer. (Reference)
  • Insurers have less ability to change the amount customers have to pay for their plans. (Reference)
  • Authorizes early funding of community health centers in all 50 states. Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
  • Insurers must now reveal how much money is spent on overhead - All insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments. (Instead of just "administrative fee", they have to be more specific).
  • Any new plan must now implement an appeals process for coverage determinations and claims. Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when a claim for coverage is denied. (Reference)
  • New screening procedures help eliminate health insurance fraud and waste. (Reference)
  • Medicare payment protections are extended to small rural hospitals and other health care facilities that have a small number of Medicare patients. (Reference)
  • Non-profit Blue Cross organizations are required to maintain a medical loss ratio -- money spent on procedures over money incoming -- of 85 percent or higher to take advantage of IRS tax benefits.
  • Chain restaurants are required to provide a "nutrient content disclosure statement" alongside their items, so people can have an easier time making choices to eat healthy. Calories are  listed both on in-store and drive-through menus of fast-food restaurants. (Reference)
  • The bill establishes a temporary program for companies that provide early retiree health benefits for those ages 55-64 in order to help reduce the often-expensive cost of that coverage.
  • The Secretary of Health and Human Services a federal healthcare exchange Web site to make it easy for Americans in any state to seek out affordable health insurance options The includes helpful information for small businesses. (Reference)
  • A two-year temporary credit (up to a maximum of $1 billion) was in the bill to encourage investment in new therapies for the prevention and treatment of diseases.
  • The Medical Loss Ratio Provision of the Act requires health insurance companies to spend 80% of the consumers’ premium dollars they collect — 85% for large group insurers — on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they under-spend on actual medical care. (Reference)
  • The Act allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices) (Reference)
  • The Act establishes a non-profit group, that the government doesn't directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. (Reference)
  • Insurance companies can no longer deny insurance coverage because of a "preexisting" disability, or because they are, or have been, a domestic abuse victim. (Reference)
  • People in a "Medicare Gap" get a rebate to make up for the extra money they would otherwise have to spend. (Reference)
  • High preexisting condition insurance coverage rates are totally eliminated. Everyone pays the same rate the same regardless of their medical history beginning on January 1, 2014. (Reference)
  • Beginning on January 1, 2014, if you can afford insurance but do not get it, you will be charged a fee. If you opt to not buy insurance, you'll have to pay a penalty fee on your tax form, unless you just can't afford it. The Supreme Court ruled this mandate is Constitutional, as long as it's considered a tax on the uninsured and not a penalty for not buying insurance. (Reference)
  • Medicaid can now be used by everyone up to 133% of the poverty line, in those states that accept their Medicaid federal funding under ACA set terms. (basically, a lot more poor people can get insurance) (Reference)
  • Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.
  • Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need. (Reference)
  • The Act limits how high of an annual deductible insurers can charge customers. (Reference)
  • The Act establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage. (Reference)
  • The Act requires Congresspersons and Congressional staff to use the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen. (Reference)
  • If any state provides its own health insurance that gives citizens the same level of care at the same price as the Affordable Care Act, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the Affordable Care Act. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers). (Reference)

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