#1 The American Health Care Act is Largely Based on Tax Credits
The American Health Care Act proposal released March 6th relies on refundable tax credits to help individuals pay for premiums. Refundable tax credits vary with age, are to be phased-out for those with high-incomes and grow annually with inflation, according to the Kaiser Family Foundation.
There are tax credits under Affordable Care Act (ACA) that vary with family income and insurance costs as well as age, which also grow annually if premiums increase.
#2 Health & Human Services Secretary Tom Price Defends Tax Credits
According to The Hill, Price said that independents and conservatives have wanted to “equalize the tax treatment of the purchase of health coverage for folks who get it through their employer and folks who aren’t able to get it through their employer” — and the tax credits scheme in the American Health Care Act do that.
#3 Democrats Don’t See a Clear Goal for the American Health Care Act
Most democrats say they will vote against the American Health Care Act. But former Health and Human Services Secretary Kathleen Sebelius, who oversaw years of committee negotiations and implementation of ACA, probably best articulated why the bill designed by Republican leadership doesn’t work for them: “I’m not sure what the goal is here,” she told The Hill about two weeks ago.
The goal for ACA had been “insure everybody,” she said, adding “They have kept some subsidies, but I would say in sort of the wrong place to the wrong folks.”
#4 Congressional Budget Office (CBO) Estimates
On March 13th, CBO released its assessment, and determined that 24 million people would become uninsured by 2026 under the American Health Care Act — largely due to the proposed changes to Medicaid, according to The Hill.
- About 7 million fewer people would be insured through employers
- Premiums would generally increase 15 – 20 percent, due to repeal of the individual mandate but then decrease an average of 10 percent by 2026
- Costs would rise for older people, but fall for younger people
- Out-of-pocket costs, including deductibles, would likely be higher with fewer premium caps for insurers
- The deficit would decrease by $337 billion over a decade
Reaction across the public and social media caused waves of concern over loss of healthcare coverage. Fears over what will happen to seniors and the disabled, as well as low-income families and children, among a populace pressed to understand the nuances of healthcare reform and its costs have not dissipated.
While some of coverage losses would be from people choosing not to buy coverage, according to CBO, the office assumed people would also go without coverage because of cuts to Medicaid and the drop in financial assistance (subsidies) under ACA.
Not everyone agrees with the CBO estimates, of course. The National Review called the report flawed, arguing that CBO assumed that both companies and individuals would leave tax credit money “on the table.” It would be possible for companies to create plans that equal the tax credits, and people would enroll in plans that are paid for by the tax credits.
#5 Medicaid Expansion is a Thorny Component
By putting healthcare insurance regulation back into states hands, states will have to fund or whittle away at this coverage.
Medicaid, currently a shared Federal-state program has ballooned in recent years. The ACA expanded Medicaid to cover those with incomes below 138 percent of poverty level. About one-third of residents in New York state currently have coverage through Medicaid, and costs have pressed lawmakers upstate, according to The New York Times.
Today’s amendments include a work requirement for Medicaid and a new formula New York State would use to take money from counties outside of New York City to finance Medicaid in the capital (being called the “Buffalo Buyout”), according to Breitbart News.
#6 Republican Leadership May Not Have the Votes
Even with the “Buffalo Buyout,” Republicans may not have the votes tomorrow.
The Freedom Caucus is calling for elimination of minimum coverage mandates under ACA, called Essential Health Benefits, along with certain language defining a qualified health plan, according to Huffington Post.
Without these demands being met, the bill remains what Kentucky Senator Rand Paul called “Obamacare Lite.” And that’s despite President Donald Trump’s hands-on efforts to negotiate agreements in the bill with caucus members.