ACA-Lite

Update below.

There’s no graceful way to ease into this, so I’ll just dig right in.

  1. Paul Ryan

    That face you make when your eight-year plan is found wanting.

    The mandate and it’s odious and dubious ‘tax,’ have been renamed the “Continuous Health Insurance Coverage Incentive” and the payee changed from the federal government to insurance companies(!). It’s a misnomer to call it an incentive as it’s actually a disincentive for people to allow their coverage to lapse. Those who do so for a period of greater than 63 days are subject to a 30% premium penalty for the following year.* And it’s not an option for the insurance companies; they “shall” charge the penalty.

  2. The plan keeps the so-called Cadillac tax on premium insurance plans. Sure, you can have really excellent coverage, but in addition to higher premiums, you’re going to be paying the government for the privilege.
  3. Subsidies have been reinvented as refundable tax credits for low and middle income families. Leaving aside the obvious point that unless everyone receiving them is actually paying taxes (think Earned Income Credit), the need for this alone is an admission by the House GOP that under their plan, premiums are still going to be unaffordable, even for middle income families.
  4. The bill “dismantles” all of the ACA’s taxes including those on on prescription drugs, over-the-counter medications, health-insurance premiums (unless, of course, you want a plan that’s better than they think you really need), and medical devices. Here’s the “but”…it includes a 1.45% income tax increase to make up for them. This may seem like a net win to some people, but for healthy individuals whose employers pay their insurance premiums (and they are out there), this will be a tax increase.
  5. The plan does defund Planned Parenthood, but if they thought this bone would be enough to satisfy their traditional base, they are sadly mistaken. And here’s another thing: nothing under the plan would prevent insurance companies from offering abortion coverage, “…so long as premiums for such separate coverage or plan are not paid for with any amount attributable to the credit allowed under this section…” Paul Ryan has been telling us for years with regard to government funding of Planned Parenthood that money is fungible. Except for when it’s not, apparently.
  6. Under the plan, Health Savings Accounts come roaring back. Unfortunately, that’s the only nod to market-based solutions included. HSAs are great, but they aren’t for everyone and I’m left with the impression that the authors of the legislation offer them as the one-size-fits-all solution to all our problems.

Those are my specific concerns, but there are some undercurrents that I also find troubling, such as having to report my health insurance information to the IRS (disclaimer: I want the IRS abolished, not given more power over my life) and language that implies that the federal government will still be deciding what kinds of plans and coverage should or must be offered.

When the plan first became available yesterday afternoon, I was nearly apoplectic over it. Right or wrong, I expected more from House Republicans. I was especially disappointed to see my Congresswoman, Cathy McMorris Rodgers, defending this stinking pile like she was offering up filet mignon. It’s rather depressing that after eight years of talking about it, this is the best plan they could offer.

This isn’t a repeal in any meaningful sense of the word and I find it rather insulting that House Republicans would try to pass it off that way. We are not so stupid that we can’t see what’s right before our eyes and the GOP shouldn’t think for a second that the passion that inspired the Tea Party can’t be turned against them.

Update: Now we’re hearing about phases 2 and 3, which will supposedly remove state line restrictions and promote competition. You know what, GOP? I’m not buying it. You wasted your last bit of credibility with phase 1.


*I’m not an insurance expert and I’m sure as heck not a legal expert, so the language surrounding the duration of the premium penalty is confusing to me. That’s the long way of saying that I just guessed that the penalty was to be assessed for 12 months. Here’s the actual language so you can see for yourself. If you’re crazy enough to want to read it for yourself, it’s on page 62.

2017-03-07 (2)

4 Comments

Filed under Health Care, Washington

4 responses to “ACA-Lite

  1. I can not speak to all the issue you bring up and I do not agree with everything I am hearing about the replacement. I can share my knowledge of the health care system as a person on the front lines in an emergency department.
    The disincentive and I agree it is meant to discourage, may be an attempt to provide accountability and I am not sure it is the right way. The ACA was only viable if the younger working class footed the bill because they are “technically” more healthy and would not be tapping into the medical services while contributing to the pool. The younger pool has by and large opted not to follow traditional entry into medical care. They prefer not to have a primary care physician and opt for walk in clinics and telehealth venues. Don’t blame them, when you can have a telehealth visit for $40 instead of $100+ this is a financially prudent decision for them. In the long haul when a chronic health problem emerges this will not be a great option.

    HSA are the way to go for folks entering into the medical system that are healthy young or not. These fund roll over year to year and are buildable. The one draw back is that once you are no longer with the high deductible plan that provided the HSA contributions can not be made. So being able to roll those funds into another HSA would need to be permitted when a change in medical insurance has arose, such as change in employment.

    ACA repeal and replace has to be more than providing insurance. The ACA provided insurance without a means to support the influx of people ( think providers/nurses/ancillary staff) and did not do anything to drive down the cost such as pharmaceutical cost, provider reimbursement for non private insurance (currently about $0.30 to the dollar). The pharmaceutical cost should be thoroughly investigated: they have been allowed to take previously generic medications and make them not generic by simply changing delivery of the medication(example: albuterol/ProAir) . They have created shortages and decrease supply with their manipulations on how generic medications are manufactured ( example: zosyn)

    I believe to really garner a meaningful change the medical community that provides the care needs to be brought in and made part of the solution.

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