Well, it is out, and it is as bad as everyone thought it would be. Paul Ryan and his Republican cronies have unveiled their repeal and replace plan for the Affordable Care Act. And, though the numbers are still not firm, it is going to be very bad for anyone who needs health care and anyone who doesn’t make about 1 million dollars per year.
And, of course, the poor, the working poor, the elderly and the middle-class will be the biggest losers. Who else is there to target? Their donor class? I don’t think so.
Some things won’t happen until 2020, because they are afraid of the consequences to their immediate political future. Things like Medicaid expansion are on the chopping block. So, the poor and the elderly will be hurt the most when this ends in 2020.
The Republican plan for Medicaid is to “block grant” Medicaid to the states. Only, they will receive less money than do today. Today Medicaid is open-ended in that states get enough money to cover the costs of the program. Instead, the Republicans want to set the bill at the number of people “on Medicaid” per state, which means a substantial cut in the program funding. That means millions of people will lose their health care under the killing of expanded Medicaid.
But, it isn’t just the poor people who get hurt under this plan. Most people who live in nursing homes get their funding through Medicaid. If that is taken away, we will have more people who cannot afford to stay in the nursing home. But, what the hell, Republicans seem to believe that since they are so old they should just die.
Then we have the case of the subsidies which help people afford to purchase health insurance. That is also going away. Instead, the Republicans say they will give “tax credits” so you can buy insurance. But, the numbers just don’t add up.
Those tax credits will range between $2,000 and $4,000 per year. Those numbers are based on age not income. Those numbers are not even close to what people need to purchase health insurance.
For example, Martha Brawley of Monroe, N.C., said she voted for President Trump in the hope he could make insurance more affordable. But having seen reports on the new plan she has become increasingly nervous. Under the ACA she pays about $260 per month for a Blue Cross plan and receives a subsidy of $724 per month to cover the rest of her premium. Under the House plan, she would receive $3,500 a year in tax credits — $5,188 less than she gets under the Affordable Care Act.
“I’m scared, I’ll tell you that right now, to think about not having insurance at my age,” said Ms. Brawley, who underwent a liver biopsy on Monday after her doctor found that she has an autoimmune liver disease. “If I didn’t have insurance, these doctors wouldn’t see me.”
The plan hurts elderly people eve more. Beginning next year, health insurance companies will be able to charge up to five times more for the elderly premiums than for younger people. Under the ACA that is capped at three times as much.
That means for people like Alan Lipsky, a self-employed consultant in Arden, N.C., the Republican plan could have a huge financial impact. Mr. Lipsky, who is 60 and whose wife is in her 50s, receives a tax credit of $2,097 a month for his family of four and pays $66 a month out of his own pocket. His family’s total annual tax credit of $25,164 would be reduced to $11,500 under the new plan, covering less than half of the total cost of his current coverage.
“I don’t think the Affordable Care Act is perfect,” said Mr. Lipsky, whose family deductible is $12,000 per year, “but at least for people like me it gives a baseline, and I’m worried I won’t have that baseline anymore. What they’re talking about is unaffordable for me.”
S&P analysis says that 64-year-old could see annual premiums increase by almost 30 percent to $13,100 on average. The tax credit for these people will be a whopping $4,000. As you can see, these people won’t be able to afford insurance if this plan becomes law.
Some of the biggest losers will be people who live in rural areas. That is because rural areas have fewer hospitals and fewer insurance plans than large cities. Before the ACA, rural hospitals were closing at terrifying rates. Since the ACA, that has been significantly reduced because rural hospitals were not seeing more uninsured people.
Then there is the dropping of the mandate that everyone will have to purchase insurance. I know a lot of people don’t like that part of the ACA, but without it, young healthy people will probably opt out of insurance altogether. That means health insurance companies will need to raise their premiums to cover the more expensive older and sick people who have coverage.
The result, said Donald H. Taylor Jr., a health policy professor at Duke University, is that people who buy coverage are sicker, causing the cost of premiums to soar. “This looks like to me adverse selection on steroids,” he said. “I don’t see how it doesn’t crater the individual market.”
There are other side effects to the plan that no one has talked about yet. Remember the Ebola scare a couple of years ago? Remember the Zika Virus scare in our country last year? Those diseases have not gone away. They are waiting for another round. Especially Zika which is just waiting for warmer weather and hungry mosquitos.
The ACA set up the Prevention and Public Health Fund to try to lower health costs by preventing diseases before they happen. Well, this fund will be slashed by $1 billion. What does it do you ask?
The CDC uses it to help states deliver vaccines, watch for infectious diseases, keep an eye out for lead in water, promote breastfeeding in hospitals, prevent suicide and watch out for hospital-associated infections. It totals $931 million for 2017.
“It really is a core activity,” said Dr. Anne Schuchat, the CDC’s acting director. But, this is just the beginning of these cuts to this program. In the 2018 budget being proposed by trump, domestic spending like this program will be cut even more.
“These funds are used to prevent diseases such as hypertension, cancer and diabetes, which are drivers of the major causes of death in the United States,” said Dr. Leana Wen, Baltimore’s health commissioner.
“They also help ensure that our nation is prepared against emerging threats such as bioterrorism and Ebola and other infectious diseases. Cutting these funds will hurt patients’ health in the short-term and compromise national security in the long-term.”
Then there is the point where the plan will allow large companies to opt out of offering health care coverage for their employees. So, if you think since you work for one of these large companies so you are safe, you are wrong. You could lose your company sponsored coverage and have to go on the open market by yourself.
When Democrats worked on the ACA, they included health insurance companies and health experts in the working groups. The Republicans have not done the same thing. They have worked on this in some dark closet in Capital Hill and no one outside a small group of people saw it before yesterday.
As a result, most insurance companies are against the bill. The problem is that the conservative wackos in the house absolutely hate it. Not because of what it does in terms of taking away health insurance coverage from their constituents, but because they say it is too “generous” and not bare bones enough.
One of the main talking points for Republicans is that we need to allow insurance companies to sell across state lines. But, what they won’t tell you is that they already can sell across state lines. The problem is that each state has their own set of rules when it comes to health care coverage. In order to sell across state lines, companies must meet those standards. If they don’t they cannot sell across state lines.
In other words, this is a perfect example of “states rights” that Republicans love so much. If they really want companies to sell across state lines, they must remove each state’s requirements. Or, they must eliminate the “state’s rights” to let insurance companies make more money.
Of course women will be hurt the most. They will see their sex become a “pre-existing condition” again and be charged more for health insurance just because they are women. Those with preexisting conditions will eventually be forced into “high risk pools” in order to keep their insurance. That means they will pay substantially more for their coverage.
Because of all of the rules protecting our water and air are being wrecked by the trump administration we will see more diseases like asthma and lead poisoning from our drinking water increase. That will also cause costs to increase.
Of course, the rich will get their tax cuts. This bill even includes a tax cut for health insurance company CEOs who make more than $500,000 per year. How the hell does that make my premiums go down?
I know that conservatives don’t like to hear this, but the real only answer to our health care coverage crisis is a one-payer system. In other words, Medicare for all. Before you all lose your minds, think about this. We pay twice as much per person for health care coverage than countries who have universal health care.
Yes, we pay twice as much per person for health care. How is this plan going to reduce that fact? It won’t. It will merely mean that more people will have to go without health care. That means our total costs will increase just like they were before the ACA.
As a result, rural hospitals will begin closing again leaving large swaths of our country without any care for the citizens. Large swaths of our country, mostly Red State areas will see health care become a luxury, not a common practice.
This is the future of our health care. The plan really needs to be called the “Americans Without Health Care Plan”. That is going to be the ultimate result. As I wrote earlier, the number one problem Republicans have seen in our country is that too damn many people have health insurance. They promised to do something about that problem, and this plan is the first step to resolve it. They won’t be hurt by it, but you will.
After seven years of bitching about the ACA and promising to “lower costs” their ultimate plan is to take away insurance from the elderly, poor, working poor, and middle-class. WOW! What a bunch of assholes.
And, the shirts keep marching along.