Thursday, February 2, 2017

GOP Agenda To Cut Seniors' Healthcare

Republicans working to repeal the Affordable Care Act are working to stick it to one of the most important voting blocks within the GOP base - Senior Citizens. Based on exit polling, many of the demographics that would be hit hardest by the repeal voted for Trump in the presidential election.

A sizable minority of Americans don’t understand that Obamacare is just another name for the Affordable Care Act, according to a Morning Consult survey. In the survey, 35 percent of respondents said either they thought Obamacare and the Affordable Care Act were different policies (17 percent) or didn’t know if they were the same or different (18 percent). This confusion was more pronounced among people age 18 to 29 and those who earn less than $50,000 — two groups that could be significantly affected by repeal.

Among Republicans, a higher percentage (72 percent) said they knew Obamacare and the A.C.A. were the same, which may reflect the party’s longstanding hostility to the law. Though Republicans were more likely to know that Obamacare is another name for the A.C.A., only 47 percent of them said expanded Medicaid coverage and private insurance subsidies would be eliminated under repeal (compared with 79 percent of Democrats), while 29 percent said Medicaid and subsidies would not be affected and 24 percent said they didn’t know. A large block of Republican voters do not understand repealing Obamacare will affect the popular provisions of the A.C.A. AARP is working to change that political equation.

AARP, the nation’s largest organization of senior citizens, with a membership of 38 million older Americans age 50 and older, announced Monday it was launching a comprehensive campaign to protect Medicare and Medicaid from the GOP's chopping block. Repealing "and replacing" the Affordable Care Act also takes big bites out of Medicare and Medicaid.
“The average senior, with an annual income of under $25,000 and already spending one out of every six dollars on health care, counts on Social Security for the majority of their income and on Medicare for access to affordable health coverage,” wrote AARP CEO Jo Ann Jenkins in a recent letter to Congress. “We will continue to oppose changes to current law that cut benefits, increase costs, or reduce the ability of these critical programs to deliver on their benefit promises. We urge you to continue to do so as well.”
The GOP's wish list for radical restructuring America's Social Security, Affordable Care, Medicare, and Medicaid benefit programs will literally destroy the quality life earned by America's retired seniors. Here are just two examples of how the GOP's restructuring goals will hit seniors hard with their repeal and replacement of the Affordable Care Act. One of those proposals would relax or eliminate the ACA’s “age bands” cap. The other would transform Medicaid into a so-called block grant.

The capping of age band pricing was among the more important changes the Affordable Care Act (ACA) mandated for older Americans who buy commercial insurance policies. Before the ACA was enacted, insurers could jack up premium prices based on the expected medical needs of new customers ― which meant, inevitably, charging older policy holders a lot more than younger ones.

The Affordable Care Act capped what insurers could charge their older and most in need of healthcare customers at no more than three times what they charge their youngest ones.

Republicans claim that relaxing or eliminating the age band cap, to again allow insurance companies to make older policy holders pay much higher insurance premium prices, would mean lower premiums for younger people. However, even if allowing insurance companies to charge higher rates to seniors would lower rates charges to younger insurees, those low rates would be much less dramatic than Republicans claim.

AARP is warning its 38 million members that relaxing or eliminating the age band cap will hit people hard just as they’re getting to the age when medical problems become more common. Such a change, the group warned, “would severely limit, not expand, access to quality, affordable healthcare.”

As for Medicaid, Republicans have wanted to convert it into a block grant since long before the ACA was enacted in 2010. The GOP goal is to "grant" or give states a block of federal money with complete control over that money and, more importantly, to reduce the program’s funding ― perhaps by a dramatic amount.

According to the Center on Budget and Policy Priorities, the most recent budget from House Speaker Paul Ryan (R-Wis.) would mean 33 percent cut in annual Medicaid budget allocations within the decade.

Republicans claim their planned cuts to Medicaid will cut billions of dollars out of the federal budget, and at the same time give healthcare spending control to governors of each state. But with so much less money to spend, state governors wouldn’t be able to finance as many benefits for as many people.

“A block grant would end the guaranteed access to care for millions of Americans who are eligible and instead provide a fixed amount of federal funding to each state for its Medicaid program, which may not take into account increases in actual cost or need,” AARP senior vice president of government affairs Joyce Rogers wrote members of the U.S. House Energy and Commerce Committee in a letter last week.

Of the 70 million Americans covered by Medicaid, more than 17 million are “low-income seniors and children and adults with disabilities who rely on the program for critical healthcare and long-term services,” Rogers said. The Affordable Care Act also expanded Medicaid, with 31 states plus the District of Columbia opting to do so.

Though block grant Medicaid goal was a just a couple of sentences in candidate Trump's healthcare proposal, it has become a key goal in President Trump's White House administration. Trump advisor Kellyanne Conway two weeks ago said Medicaid block grants would be part of the repeal and replacement of the Affordable Care Act as a way to give states more flexibility. "Those who are closest to the people in need will be administering it," she told NBC.

“We oppose the end of the guarantee and are concerned that fixed federal funding to states will result in cuts to program eligibility, services or both–ultimately harming some of our nation’s most vulnerable citizens,” AARP’s Rogers wrote. “Moving from the current Medicaid financing structure to fixed federal Medicaid block grant funding would shift costs to states and state taxpayers.”

“Block grants have been a policy idea for more than 20 years, and past proposals always translated to dramatic cuts to federal spending on Medicaid,” says Dr. Bruce Siegel, CEO of America’s Essential Hospitals, which represents the nation’s public health systems and hospitals. “Essential hospitals, which already operate with no margin on average, would have little choice but to scale back services dramatically or close, worsening access to care in already underserved communities.”

“The less you know about Medicaid, the more block grants make sense,” Jeff Myers, Medicaid Health Plans of America president and CEO. “Given that, I think the feds ultimately will abandon the idea of block grants for Medicaid and turn to other forms of state-capitated payments, which likely will be per capita caps.” “Unlike block grants, per capita caps take into account the fact that costs of care are different for the wide-ranging populations in Medicaid,” says Myers. “It’s easy to see that a 10-year-old in poverty won’t have the same medical costs as an 85-year-old senior with a disability.”

Giving so much less money to each state as a block grant pushes the planned deep cuts to healthcare services down to state governors and legislatures. Most of those cuts will surely fall on older people, particularly since the majority of spending in Medicaid goes to elderly and disabled people who use it to supplement Medicare. Among other things, Medicaid is the nation’s largest payer of long term skilled nursing care. In other words, state governors get the blame for cutting healthcare services for seniors and their families who need healthcare aid the most.

Seniors afflicted with Alzheimer's disease and other illnesses requiring long term care in nursing homes would no long receive money from Medicaid to help pay the $5,000 to $7,000+ monthly costs for that care. The children and grandchildren of those seniors will have to pay their month health care bills, or move them into their homes to provide home care themselves.

AARP is telling its members:
“Disabling conditions that affect older adults include Alzheimer’s disease, stroke, and chronic and disabling heart conditions,” the organization said in its letter. “Individuals may have low incomes, high costs, or already spent through their resources paying out-of-pocket for [long-term care], and need these critical services. For these individuals, Medicaid is a program of last resort.”
And it's not just Medicaid that's on the chopping block if Republicans repeal the ACA. Important Medicare benefits for seniors are mandated by parts of the ACA. ACA mandates no cost preventive care benefits for Medicare recipients, including flu vaccinations, mammography screenings and colonoscopies. Those who use Medicare also have access to annual wellness checks, can establish health plans with doctors, and overall lowers out-of-pocket costs for seniors.
  • Obamacare, as the ACA is commonly known, expanded Medicare’s prescription drug benefit to slowly close the doughnut hole, the term used to describe a gap in coverage. The gap is created when Medicare stops paying part of the cost of drugs, so beneficiaries have to pay full price. Once out-of-pocket costs reached “catastrophic” level, however, Medicare kicks in, paying a portion of drug costs again.
    • In 2017, Medicare beneficiaries who fall into the doughnut hole will receive discounts and savings of 60 percent on the cost of brand-name drugs and 49 percent on the cost of generics. Those savings will increase to 75 percent for both brand-name and generics by 2020, under the current law. In 2020, the coverage gap disappears completely. This year, the coverage gap kicks in when a beneficiary’s total drug costs, both his and his insurer’s, reach $3,700. The gap closes and coverage kicks in again when the beneficiary’s total costs reach $4,950.
  • Free screenings for diabetes, heart disease and cancer, as well as other preventive services, could also be cut. House Rep. Tom Price ,R-Ga., Trump’s choice to head the Department of Health and Human Services, introduced healthcare legislation in 2015 and 2016 that included axing these.
  • One of the proposals to replace Obamacare is to convert Medicaid from a guaranteed benefit to block grants, where states would get a set sum from Washington and decide how to spend it. While Medicaid provides healthcare to the poor, it has a not-so-well-known allowance: It also pays for long-term care for older people, mostly nursing home residents.
The AARP is also warning its members about the GOP's further agenda to convert Medicare into a premium support voucher program while at the same making deep cuts in the Medicare budget, and convert Social Security into private savings account program that will function like a 401K plan.

Under a premium support voucher system, the federal government would replace Medicare beneficiaries’ guaranteed benefit package with a fixed dollar amount or “defined contribution” that beneficiaries would apply toward their health care coverage. This fact sheet describes the likely impact on Medicare beneficiaries of moving to a premium support system, also known as a defined contribution or voucher system.
  • Premium support could end the promise of a guaranteed set of Medicare benefits
  • Beneficiaries in traditional Medicare could pay more
  • Premium support could shift more costs to beneficiaries over time
  • Most Medicare beneficiaries cannot afford to pay more for their health care
  • Premium support could lead to reduced access and higher risk of catastrophic out-of-pocket medical expenses for Medicare beneficiaries with lower income
  • Premium support assumes that beneficiaries are willing and able to make complex health care coverage decisions
And the AARP is not the only GOP constituency group that is going to take a very active interest in what happens to the Affordable Care Act. Republicans talk a lot about financing their schemes with changes to the tax treatment of employer health insurance. That’s bound to raise objections from both businesses and unions.

Most Republican ideas for repealing the ACA involve some combination of fewer people insured and weaker coverage for those who have insurance. That doesn’t sit well with hospitals, which end up taking losses when people who need care can’t pay for it.

Republicans can negotiate with these constituency groups to win their support, or at least perhaps their silence. But trade-offs in healthcare policy are inevitable, and every accommodation that Republicans offer to one group like the AARP, will show up as a cost for business owners, hospitals, or GOP governors.

Time is short with the midterm primary cycle starting only a year from now. The negotiations themselves are bound to take time and effort, and create plenty of embarrassing news stories on which Democrats might use against Republicans up for election in 2018 ― just as Republicans did against Democrats in 2009 and 2010, when they were crafting the ACA, which Republicans now seek to erase.

Democrats were willing to endure that bad publicity ― and, more broadly, to stick with a politically difficult process, even as it dragged out for over a year ― because making health care available to everybody had been one of the party’s most important priorities for something like three-quarters of a century.

Recent news suggests Republicans can expect a similarly difficult experience if they proceed. Already, lawmakers are getting flooded with calls and hearing from protesters worried about losing insurance. And if the polls are correct, the public suddenly feels more favorably about the ACA than it did before ― perhaps because the prospect of losing the program is making people think about the parts they like.

At last week’s party retreat in Philadelphia, during a private meeting recorded and leaked to the press, Republican lawmakers talked openly of their inability to deliver promises of better care at lower costs. Over the weekend, Rep. Dave Brat (R-Va.) practically begged his supporters to start speaking out, because town halls have gotten so difficult.

On Tuesday, in an interview with Vox, Rep. Phil Roe (R-Tenn.) admitted that rolling back the Medicaid expansion “is going to be a little harder than I thought” because so many people, in so many states, have come to depend on the program.

Republicans still have the votes in Congress to pass repeal legislation, and in Trump they have a president who would sign that bill into law. Having invested so much time in the cause, having made such concrete promises to their voters, GOP leaders will find it difficult to leave the ACA (Obamacare) mostly intact.

But seeing repeal through the legislative process will require an enormous investment of political capital and time ― as Election Day, November 2018, gets a day closer every day. That’s a high political price to pay - if Democrats can manage to execute a strategy to make them pay that high price.


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