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