GOP Rolls Out ACA 'Replacement' (UPDATED)

GOP Rolls Out ACA 'Replacement' (UPDATED)

I haven't read all of the two bills yet or pieced them together with other law to know exactly what's going on, but I'll give you the high-level overview of what I've gleaned from my first skim through it.

The nuts and bolts:

  • Medicaid expansion is gone, and non-expanding states will get some extra bucks as a reward for resisting the urge to cover poor people.
  • Planned Parenthood and any other nonprofit clinic providing abortion services are excluded from receiving Medicaid funds.
  • Tax subsidies are gone, too, replaced with end-of-year refundable tax credits which are lower than those provided now. This would come into effect in 2019, apparently. Tax credits are age-based, but limited to a total of $4,000 each for the oldest taxpayers, $14,000 for a family.
  • Subsidies for cost-sharing (co-payment and deductible help) are gone entirely.
  • Good news for health insurance CEOs, though! The ACA limited corporate deductions for CEO compensation to $500,000 per year. That would all now be rolled back so all the milliions they receive would be considered a deductible corporate expense, considered "reasonable and necessary."
  • Premiums for older people would increase substantially, because instead of the oldest being charged 3 times what the youngest pay, the rate would be 5 times what the youngest pay.
  • Individual mandate and the employer mandate are also gone, but instead if someone goes without coverage for 60 days, they will have to pay 130 percent of the premium rate for that year. Instead of paying a penalty to the federal government, they will pay the insurer, so it works out to be sort of a payday loan thing.
  • Limits for Health Savings Accounts and Flexible Spending Accounts are lifted, which benefits high-earners.

There's more, including a six-page entreaty requiring that lottery winners not be eligible for Medicaid, and repeal of the tanning tax.

The Medicaid expansion repeal has already sparked a rebellion from Senators Moore, Capito, Portman and Murkowski.

Senator Rand Paul doesn't like it because he thinks it's "Obamacare Lite" -- a bill that doesn't go far enough to strip health care away from Americans.

Because this is intended to be part of a budget reconciliation effort, it does not address the consumer protections contained in the ACA, so for now, the ban on pre-existing conditions exclusions and lifetime/annual caps hasn't changed.


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Here is the backdrop for this flurry of activity. In just ten days, the debt ceiling will need to be raised. Republicans are scrambling to get a reconciliation package together that will pay for the wall, increase the budget for ICE and the Border Patrol to comply with Trump's executive order, and kill more people by taking their health care away. They have to contend with the varying factions inside the Republican Party, including the Koch-funded groups, who have run out of patience waiting for their Big Tax Cut while killing folks.

These provisions are intended to be incorporated into a larger budget reconciliation bill which requires a simple majority to pass in the Senate. It remains to be seen as to whether those four Senators will make a lot of noise but consent to its passage or not. If not, this is dead in the water.

The bills have not been scored by the CBO yet, but are expected to be voted upon in their respective committees tomorrow. Assuming they're reported out of the committees, they'll head to the House floor, where a full vote will take place later this week or early next week. From there, it will go over to the Senate.

Good luck with that.

Sources:

House Ways and Means Committee legislative text
House Energy and Commerce Committee legislative text

UPDATE: I forgot one. The essential benefits package would be toast too, leaving insurers to decide what you can go bankrupt paying for.

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