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- 03/09/17--21:22: _Rand Paul calls the...
- 03/10/17--07:40: _'Trying to force a ...
- 03/10/17--09:05: _One specific part o...
- 03/10/17--11:53: _TRUMP: 2017 was the...
- 03/10/17--23:53: _Here's how tax cred...
- 03/11/17--06:27: _'Trumpcare' has pas...
- 03/11/17--11:00: _PENCE: 'The Obamaca...
- 03/12/17--09:16: _'How is that fair?'...
- 03/12/17--12:06: _Trump aides attack ...
- 03/13/17--07:18: _Republicans don't u...
- 03/13/17--07:32: _The biggest test ye...
- 03/13/17--08:05: _Watch the new healt...
- 03/13/17--09:09: _TRUMP: Obamacare is...
- 03/13/17--10:01: _The GOP is on an al...
- 03/13/17--13:09: _The CBO says as man...
- 03/13/17--14:06: _The GOP's Obamacare...
- 03/13/17--14:24: _If GOP health plan ...
- 03/13/17--14:51: _'We disagree strenu...
- 03/13/17--15:34: _The GOP's Obamacare...
- 03/13/17--15:40: _PAUL RYAN: The CBO ...
- 03/09/17--21:22: Rand Paul calls the GOP's Obamacare replacement 'dead on arrival'
- Diabetes prevention
- Increasing vaccine coverage
- Education and prevention efforts for Alzheimer's disease
- Heart disease and stroke prevention
- Helping local public health officials detect and monitor infectious disease outbreaks, like measles, Zika, or bacteria that are resistant to antibiotics
- 03/10/17--23:53: Here's how tax credits would work under the GOP healthcare plan
- 03/11/17--11:00: PENCE: 'The Obamacare nightmare is about to end!'
- The change in the number of people with health insurance: The highlight of the report will most likely be the CBO's estimate of the number of people who would gain or lose coverage from the AHCA. The most likely adjustments will be due to the changes to the structure of tax credits for people to buy insurance under the new law and its changes in funding for Medicaid expansion. S&P estimated that 6 million to 10 million people would lose coverage under the AHCA, while the Brookings Institution projected up to 15 million.
- The impact on the federal deficit: One of the complaints of conservative Republicans positioning themselves against the AHCA is that the tax credits and other funding, combined with the repeal of Obamacare's taxes, would cause the federal deficit to increase.
- Cost of premiums: The second-most-expensive silver-level plan was used by the CBO to project premium growth under the ACA. In fact, despite large jumps over the past year, average premiums for 2017 are roughly in line with the CBO's original projections. How the average cost of insurance would change under the new law will be another major sticking point for opponents of the AHCA.
14 million more people would be uninsured under the law in 2018, increasing to 24 million by 2026. The CBO projected that as many as 14 million more Americans would be without health insurance under the AHCA in 2018. If possible changes to Medicaid were to go into effect, this number would increase to 24 million by 2026, the CBO projected.
"The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment — because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped," the report said. "In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law."
7 million fewer people would get insurance through their employer by 2026. The report estimated that without the ACA's penalties associated with not having insurance, fewer Americans would sign up for coverage through their workplaces. Thus 2 million fewer people would choose not to have insurance in 2020, increasing to 7 million by 2026.
"Part of that net reduction in employment-based coverage would occur because fewer employees would take up the offer of such coverage in the absence of the individual mandate penalties," the report said. "In addition, CBO and [the Joint Committee on Taxation] expect that, over time, fewer employers would offer health insurance to their workers."
- The federal deficit would shrink. The CBO, along with the JCT, estimated that the bill would decrease the federal deficit by $337 billion over the next 10 years. Roughly $880 billion would be cut from outlays because of the decrease in funding for Medicaid expansion, and $673 billion in spending would be cut because of decreases in tax credits, but that would be partially offset by a reduction in revenue from the mandate and other taxes from the ACA.
- The individual market would remain stable. The report said the individual market — that is, people getting coverage who do not have it from an employer or government program — would remain stable if the AHCA were passed. The CBO also said that the market under the ACA was stable as well. "In CBO and JCT's assessment, however, the non-group market would probably be stable in most areas under either current law or the legislation," the report said.
Premiums in the individual market would increase in 2018 and 2019 before falling because of lower enrollment. The report also estimated the effect on premiums in the individual market, saying that costs would increase in 2018 and 2019 before declining. The CBO and JCT said that provisions of the AHCA would raise premiums for older Americans "substantially" while shrinking them for younger Americans.
"The legislation would tend to increase average premiums in the non-group market prior to 2020 and lower average premiums thereafter, relative to projections under current law," the report said. "In 2018 and 2019, according to CBO and JCT's estimates, average premiums for single policyholders in the non-group market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up."
- Over 10 years, deficits would be lower by $337 billion. The plan provides big tax cuts (mostly to high earners) but its cuts to spending are even bigger, so the deficit would fall.
- The spending cuts would come mostly from spending less on Medicaid for the poor and less on insurance premium subsidies for the lower-middle and middle classes.
- Because of those spending cuts and the repeal of the individual mandate penalty for not carrying insurance, about 52 million Americans would be without health insurance in 2026 — 24 million more than under current law.
- Insurance premiums would be higher than under current law through 2019 (because healthy people would drop insurance coverage after the individual mandate is repealed) and then lower from 2020 onward (because insurers would be allowed to sell stingier plans, and because more generous subsidies for some young, healthy people would encourage them to buy insurance again).
- 03/13/17--15:40: PAUL RYAN: The CBO report 'actually exceeded my expectations'
Rand Paul had some terse words for the Republican Party's health care bill on Thursday night. The Kentucky senator called the American Health Care Act (AHCA), "Obamacare Lite," and said the legislation was "dead on arrival."
Paul's comments echo statements he and some conservative Republicans made on Wednesday in opposition to the bill.
During an interview on Fox News Thursday night, Paul also criticized a press conference House Speaker Paul Ryan gave earlier Thursday, in which Ryan used a PowerPoint presentation to defend the AHCA.
Sen. Paul was unsatisfied.
"He left out a few things," Paul said of the House speaker's presentation. "He left out that he keeps the Obamacare taxes for a year, that he keeps the Cadillac tax forever, he keeps the Obamacare subsidies, but renames them, you know, 'tax credits.'" Business Insider's Bob Bryan previously outlined key concerns some Republicans have expressed about the AHCA.
Paul argued that the Republicans' Obamacare overhaul needs an overhaul itself, and said, "this is a message for the speaker, we are withholding our vote. We want a seat at the table."
Watch a portion of Paul's remarks below:
The AHCA made some headway on Thursday, earning approval from the Energy and Commerce committee after a 27-hour fight staged by House Democrats. The House Budget Committee will consider it next.
An obscure rule in the US Senate could cause the House GOP leadership's plan to repeal and replace the Affordable Care Act to collapse.
The Byrd rule could stymie the American Health Care Act, the bill that was introduced this week by the GOP in the House, as soon as it hits the floor of the Senate, according to lawmakers and analysts familiar with the rule.
Passed in 1985, the rule makes it so any bill going through the budget reconciliation process — like the AHCA — can be blocked on the grounds that it contains an "extraneous matter" or something "merely incidental" to the federal budget.
The budget-reconciliation maneuver through which the GOP hopes to move the AHCA allows a bill that adjusts the federal budget to pass through the Senate with a simple 50-vote majority to avoid a filibuster. Any other legislation needs 60 votes to avoid a filibuster.
The issue is that a central piece of the AHCA may not pass muster under the Byrd rule.
The AHCA contains a provision that would allow insurance companies to charge a patient 30% more than their baseline premium if they had not maintained coverage during the previous year.
Put another way, if a person went 63 consecutive days without health insurance, a company could charge them more for the next year. If a person's premium would have been $200 a month but they did not maintain coverage the year before, the company could charge them $260 a month.
Since the money from the penalty would go to the insurance companies, the rule does not affect tax receipts for the federal government like the ACA's current individual mandate, in which the penalty is paid to the IRS.
The provision of the law is designed to keep people from dropping their coverage and signing up only when they're sick. But since it would not affect the budget and rather insurance companies' bottom lines, there is a case to be made that the provision is an "extraneous matter."
Democrats can lodge a complaint about the bill to the Senate parliamentarian, who is something of an arbiter of Senate rules. The parliamentarian would then make a recommendation to the presiding officer of the Senate. Technically, the presiding officer is the vice president, since they are the president of the Senate. But typically, this position is occupied by another senator, except in special cases.
Since the presiding officer would be a Republican, it's possible they could rule in favor of the AHCA's provision. But many experts question whether that would happen.
The possibility that the Byrd rule may hold up the legislation has not been lost on analysts and lawmakers.
Perhaps the most colorful description came from Republican Rep. Trent Franks, who told Bloomberg's Sahil Kapur that he was concerned about possible Byrd rule hiccups.
"The House has an untenable task of trying to craft a bill that will fit through the matrix of the Byrd rule,"Franks said. "It's essentially like trying to force a giraffe through a keyhole. If you get the job done, he looks a little differently on the other side."
National Review's Yuval Levin wrote that the Byrd rule would be a difficult threshold for the AHCA as it currently stands to cross.
"And the proposal also introduces some elements, like a 30 percent surcharge on premiums for people who haven't been continuously insured, which seem (to me) very unlikely to survive a Byrd rule challenge," Levin wrote.
Make or break
The 30% penalty is a key part of the legislation, making the potential ramifications even more significant.
Without it, there would theoretically be no incentive for people to stay in the market unless they were sick. The risk pools would, in that case, be more heavily weighted with older, sicker people who need to maintain coverage for a regular health condition.
This scenario would cause massive losses for insurance companies in the individual market beyond the current ACA losses and likely cause them to jack up premiums at an even faster rate.
In essence, the Byrd rule could be standing between, in the best-case scenario, a successful overhaul of the American healthcare system by Republicans and, in the worst case, the insurance "death spiral" the GOP has always feared.
The American Health Care Act proposed by House Republicans would slash a major public health fund, and it has doctors and public health experts worried.
The Prevention and Public Health Fund was established under the Affordable Care Act, the healthcare law better known as Obamacare, to give a boost to the funding public health agencies have to try to keep people from getting sick.
The fund supports the Centers for Disease Control and Prevention, among other groups.
Today it makes up about 12% of the CDC's budget, or about $1 billion. The CDC describes it as "the nation's first mandatory funding stream dedicated to improving our nation's public health system."
The majority of the funds get passed on to state and local public health efforts.
The American Medical Association, the American Nurses Association, and the American Lung Association all said they wouldn't support the Obamacare replacement bill, in part because of the repeal of the fund. And more than 500 public health organizations wrote a letter to President Donald Trump on March 3 calling on him to keep the fund.
Among other things, the Prevention and Public Health Fund is used to fund:
A former CDC director, Tom Frieden, tweeted his concerns about the agency losing money.
CDC works 24/protecting Americans. When it loses funds, we are all less safe. https://t.co/F4qnwhZSsN— Dr. Tom Frieden (@DrFrieden) March 8, 2017
If CDC loses prevention $: children less safe from vaccine-preventable illness, families less safe from hospital infections, food less safe.— Dr. Tom Frieden (@DrFrieden) March 9, 2017
The acting CDC director, Anne Schuchat, told The Washington Post on Tuesday that cutting the funding could have serious implications on tackling antibiotic resistance, which is a growing threat in the US.
"An outbreak can happen anywhere," Schuchat said. "It's not a red- or blue-state kind of thing. And we want to sustain the defense of Americans' health from these new emerging threats."
President Donald Trump indicated Friday he believed the Affordable Care Act, better known as Obamacare, was designed to fail when former President Barack Obama left office.
In a meeting with House GOP leaders on Friday, the president cited as proof of the law's collapse increasing premiums and fewer insurer choices in the individual exchanges where people without employer-based on government insurance can find coverage.
Trump went on to suggest this was the intent all along.
2017 "would be a disaster for Obamacare," Trump said. "That's the year it was meant to explode, because Obama won't be here. That's when it was supposed to be, get even worse. As bad as it is now, it'll get even worse."
Trump's comments echo many prominent Republicans who have said the ACA is "collapsing" or in a "death spiral."Obamacare critics have suggested that the law was intentionally designed to fail to allow Democrats to pass a single-payer healthcare system.
Up until the end of his term, Obama was promoting the successes of the ACA (such as coverage for over 20 million Americans), advocating for more people to sign up for the plans through the law's exchanges, and urging lawmakers to make changes to help stabilize the individual market.
Analysis by the Brookings Institution showed Obamacare did not qualify under the technical definition of a "death spiral" after the 2016-2017 open enrollment period.
Since the open-enrollment period, however, the Trump administration has issued regulatory changes for the ACA marketplaces and the GOP has introduced the AHCA, which has left the future of the exchanges in question.
Watch Trump's full remarks below:
Republicans hate "Obamacare," so House GOP leaders freak out whenever their health care bill is compared to President Barack Obama's law. But one reason some conservatives are branding the bill "Obamacare Lite" comes down to the tax credits to help consumers buy insurance.
Both tax credits target people who don't get health insurance from their employer or from the government. They are both available to people even if they don't make enough money to owe any federal income tax. And they are both entitlement programs — if you meet the criteria, you are entitled to the benefit.
But there are significant differences in the size and reach of the tax credits.
The Obamacare tax credits are designed to limit the share of income that people have to spend on health insurance.
The GOP tax credits are simpler, but consumers might still have to pay a large share of their income to obtain health insurance.
"These credits have long been part of the conservative health care reform ideal, supported by arch-conservatives in Congress as well as right-leaning think tanks going back for decades," according to a release from House Speaker Paul Ryan, R-Wis.
Some Republicans aren't buying it.
"I think it's Obamacare in a different form," said Rep. Jim Jordan, R-Ohio. "Let's do what we told the voters we were going to do. ... Clean repeal."
A look at how the tax credits work in each plan:
The tax credits in the Affordable Care Act are based on income and the cost of insurance premiums in a state marketplace. In general, the lower an individual's income the larger the tax credit. Also, the more expensive the premium, the larger the credit.
Here is how it works:
— You're 30 years old and single, making $23,000 a year. The average benchmark premium for a 30-year-old is $3,844 a year, according to the nonpartisan Kaiser Family Foundation.
Your Obamacare tax credit would be $2,426. You would pay $118 a month in premiums, or $1,418 for the year.
— You're 60 years old and single, making $23,000. The average benchmark premium for a 60-year-old is $9,191 a year.
Your Obamacare tax credit would be $7,773. You, too, would pay $118 a month in premiums.
Obamacare also provides subsidies that can reduce out-of-pocket expenses such as annual deductibles and copayments.
Obamacare tax credits are available to people making as much as 400 percent of the poverty level. For an individual, that's $46,680. For a family of two, that's $62,920, and for a family of four, it's $95,400.
House GOP Plan
The credits range from $2,000 to $4,000 depending on age. Older consumers get larger credits. The tax credits are capped at $14,000 for a family.
Income is not a factor in the size of the tax credit, though they are phased out for individuals making more than $75,000 and for married couples making more than $150,000.
Using the previous examples: the 30-year-old making $23,000 would be eligible for a $2,500 tax credit — slightly more than under Obamacare. That would lower the cost of the annual premium to $1,344.
Also, lower premiums could be available for younger people under the Republican plan because it makes changes in current insurance rules that favor older customers.
The 60-year-old making $23,000 would get a $4,000 credit — less than under Obamacare. That would increase the annual premium to $5,191.
Also, premiums could go up for older adults because the GOP bill allows insurers to charge more as people age and become more susceptible to health problems.
Under the GOP plan, a 60-year-old making $70,000 would still get a $4,000 credit. Under Obamacare, this person is not eligible for a tax credit because they make too much money.
President Donald Trump, in the first significant test of his legislative clout, sought to reassure the public — and maybe himself — about the future of the healthcare bill he has now firmly put himself behind.
"Despite what you hear in the press, healthcare is coming along great. We are talking to many groups and it will end in a beautiful picture!" Trump tweeted Wednesday.
In a wild week, the future of America's healthcare system suddenly became a bit clearer — and a lot messier at the same time — with the introduction of the GOP's American Health Care Act.
The bill would repeal and replace huge swaths of the Affordable Care Act, better known as Obamacare, and affect millions of Americans' health insurance. It has earned the support of House Speaker Paul Ryan and Trump, who have both touted the law as a necessary step to saving the "collapsing Obamacare."
While the GOP leadership's bill has made a steady advance through Congress, there are a number of potentially fatal challenges awaiting the AHCA in the next few weeks — starting with their own caucus.
Since the Monday night introduction of the bill, the AHCA has passed two major procedural hurdles towards being signed into law.
The bill was approved by the House Ways and Means and Energy and Commerce committees after a process called "markup." The markups allow House lawmakers to add amendments to the bill and debate its potential effects.
While Democrats staged marathons in both committees to delay the AHCA or add amendments altering the law — Ways and Means argued the bill for roughly 18 hours, while Energy and Commerce went around 27 hours — the AHCA ultimately passed along unscathed.
The bill must next go to the House Budget Committee for mark up before it is sent to the full House for a vote.
Attacks from inside the House
While the AHCA is moving through the committees, some of its most outspoken criticism has come not from Republicans' opponents, but from within the party itself.
On the one hand are conservatives in both the House and Senate, who have attacked the bill for being too soft and not fully repealing the ACA. This camp believes that the tax credits for people to buy insurance are an entitlement that will lead to a worsening federal deficit.
Sen. Rand Paul is in the camp. He has been on a crusade against the AHCA over the past week, attacking it repeatedly in the press and advocating for a simple ACA repeal bill instead.
"There's one thing that has united Republicans in when we won the House, in 2014 when we won the Senate, and in 2016 when we won the White House. This doesn't divide Republicans, this brings us together, and that is complete repeal, clean repeal,"Paul said at a press conference on Wednesday.
Members of the conservative House Freedom Caucus have also opposed the law due to the tax credits. Freedom Caucus leader Rep. Mark Meadows even said that he would vote against the law because he believes it will cause health insurance premiums to rise.
On the other end of the party are Republicans who are worried that the AHCA goes too far in its rollback of Medicaid expansion funding.
The funding in the ACA has allowed 34 states and the District of Columbia to expand the government program to people making up to 138% of the federal poverty level.
Most of the concern for this provision comes from the Senate. Four senators wrote a letter to Senate Majority Leader Mitch McConnell just hours before the release of the AHCA saying they would not support any legislation that would affect Medicaid funding.
Additionally, Sen. Tom Cotton of Arkansas, a long-time Trump supporter, tweeted on Thursday morning that the Medicaid provision made the bill un-passable in the Senate and that Republicans should just "start over" on the law.
"House health-care bill can't pass Senate w/o major changes," Cotton tweeted. "To my friends in House: pause, start over. Get it right, don't get it fast."
In addition to lawmakers, a number of outside groups have taken shots at the new healthcare bill.
Conservative groups that have been opponents of Obamacare for years attacked the bill after its release for not going far enough in gutting the ACA.
Heritage Action, Americans for Prosperity, Club for Growth, the Cato Institute, and more took to calling the legislation "Obamacare lite."
"This is bad politics and, more importantly, bad policy," said Michael Needham, the CEO of Heritage Action, in reaction to the bill's introduction.
Trump met with the leaders from six major groups on Wednesday night in an attempt to assuage their concerns. Not only did Trump argue for the AHCA — according to a source with knowledge of the meeting, the president also told those assembled that his backup plan for healthcare, should the new bill fail, would be to let the Obamacare insurance exchanges collapse and blame Democrats.
Many industry groups also took up the fight against the GOP's bill.
Medical groups, from the American Medical Association to the American Academy of Family Physicians, decried the legislation's rollbacks of Medicaid expansion funding and smaller tax credits that could restrict coverage for many Americans.
Insurers also lodged complaints. America's Health Insurance Plans — an interest group representing insurers including Cigna, Humana, and Anthem — recommended changes to the law, as did Blue Cross Blue Shield.
Finally, the conservative media also turned on the AHCA. Right-wing news sites like Breitbart and conservative pundits like Ann Coulter charged it was too weak and did not follow through on the GOP's promise of a full ACA repeal.
"7 Reasons Why Obamacare 2.0 Is All But Guaranteed to Impose Crushing Costs on Voters, Hurt Trump’s Base, And Hand Power Back to the Democrats," blared a headline Friday on Breitbart, which until recently was run by White House chief strategist Steve Bannon.
Big issues going forward
With the strong opposition coming from so many sources, it is clear that the AHCA has big political, procedural, and public relations problems to overcome.
Politically, the biggest problem appears to be the Republican split on Medicaid expansion reform. While Cotton and others have been fighting for a lighter touch in the changes, conservatives have become even more emboldened in their quest to cut its funding.
The Republican Study Committee, another conservative caucus in the House, has recommended that the cutoff date for Medicaid expansion funding in its current form be moved up to the end of this year instead of after 2019, a position that is at odds with more moderate members of the Senate. Ryan and especially McConnell must wrangle their members to get the party on board with one plan or another.
The procedural issue come from the Senate's Byrd Rule. Since the AHCA is taking a path known as budget reconciliation — which only needs a simple majority to pass the Senate and avoids a filibuster — all parts of the law must pertain to the budget.
A penalty in the AHCA that would allow insurers to charge Americans who do not maintain continuous coverage in the prior year more in premiums does not impact the budget, some analysts and lawmakers believe.
"The House has an untenable task of trying to craft a bill that will fit through the matrix of the Byrd rule,"Rep. Trent Franks said. "It's essentially like trying to force a giraffe through a keyhole. If you get the job done, he looks a little differently on the other side."
The reckoning of America's healthcare future comes at a critical time — one at which people may be warming up to the law Republicans have so long promised to repeal. Polls have shown Obamacare at its highest popularity point — and so far, most Americans do not seem to be fans of the repeal process.
With midterm elections next year, the process has a familiar feel to 2009, when Democrats tried to shepherd through their healthcare law. Anything the Republicans do now could affect their control over Congress.
Trump seems to know it.
He said Friday: "This is the time we're going to get it done. We're working together. We have some great results. We have tremendous spirit. And I think it's something that is just going to happen very shortly."
Vice President Mike Pence delivered a strong endorsement Saturday morning of the GOP's replacement bill for the Affordable Care Act, which was introduced earlier in the week by House Republican leadership and supported by President Donald Trump.
Pence, who spoke to constitutents in Kentucky, highlighted some of the pitfalls of Obamacare, including rising premiums and a lack of carrier options.
"The Obamacare nightmare is about to end," Pence said as he kicked off his address. He went on to outline some of the bill's primary proposals, such as expanding health savings accounts, providing tax credits to individuals to go towards their healthcare costs, and repealing the individual and employer mandate.
He also underscored two popular Obamacare conditions the GOP intends to keep in its replacement plan: the pre-existing conditions mandate, and the stipulation that allows children to remain on their parents' insurance plans until the age of 26.
However, under the GOP's new plan, while insurance companies would not be able to deny coverage to those with pre-existing conditions, it would penalize lapses in coverage with a premium hike of 30% as a means to discourage people from waiting until they are sick to purchase health insurance.
Pence spoke at length about reforming Medicaid as it currently stands. The GOP's replacement bill includes Medicaid block grants and would also kick lottery winners off the Medicaid program. It would also give place Medicaid regulation largely in the hands of individual states.
"We'll give states like Kentucky the freedom and flexibility with Medicaid to meet the needs of your most vulnerable in the way that works here in Kentucky," Pence said. He added that the bill would give states the chance to reform and regulate Medicaid so that it would "better serve the underprivileged" in each state.
According to a poll released in February by the Kaiser Family Foundation, a nonpartisan health policy organization, majority of Americans support the Medicaid expansion implemented by the ACA.
65% of Americans surveyed in the poll said that Medicaid, the government-run health program, should continue largely as it exists today, despite Republican proposals to change the program.
Under the ACA, Medicaid became available to more than 11 million new people than it was available to before, and states who adopted the Medicaid expansion received federal funds to assist with the program.
"Obamacare has failed the people of Kentucky, it's failed the people of America, and Obamacare must go," Pence concluded.
Pence's pitch to Kentucky came on the heels of Kentucky Sen. Rand Paul's forceful rebuke of the replacement bill, which he and other conservatives argue doesn't go far enough to repeal the ACA.
"House leadership plan is Obamacare Lite," Paul tweeted. "It will not pass. Conservatives are not going to take it."
Sen. Paul, who has been a staunch opponent of the ACA since its implementation and has worked to repeal it multiple times in the past, is against the provision of tax credits, as well as the few ACA stipulations the GOP's proposal leaves in place.
Sen. Paul and members of the ultra-conservative House Freedom Caucus announced earlier in the week that they would be introducing legislation that would repeal Obamacare in its entirety.
After Sen. Paul and other congressional Republicans spoke out against the GOP's replacement bill, Trump tweeted, "I feel sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!"
ABC anchor George Stephanopoulos on Sunday grilled the new director of the Office of Management and Budget over Republicans' plan to replace the Affordable Care Act, known as Obamacare.
In an interview on "This Week," Stephanopoulos pressed Mick Mulvaney over whether President Donald Trump was walking back his wildly ambitious campaign promises to repeal Obamacare while replacing it with a plan that offered more coverage at a cheaper price while not making cuts to Medicare or Medicaid.
"So far, the independent analyses of your bill show that 6 to 15 million Americans are going to lose their coverage they now have under Obamacare, and there will be about $370 billion less in federal funding for Medicaid for the next 10 years," the anchor said. "So how do square that impact with the president’s promises?"
Mulvaney argued that the analyses of the effects of the replacement plan introduced last week by House Republicans, called the American Healthcare Act, overestimated the positive impact of Obamacare, saying struggling insurance markets in some states may not increase coverage.
He added that when he was a member of Congress, he purchased healthcare through one of the exchanges.
"I was on Obamacare when I was in the House. My family deductibles were over $15,000 a year. Other folks who don’t make as much money as I did were on the exact same plan. Do you think they could afford to go to the doctor? That’s what we’re trying to fix — not coverage for people, not coverage they can't afford, but care they an afford."
Stephanopoulos continued to press the new OMB director. He cited analyses from the nonpartisan Joint Tax Committee, which has concluded that the bill will provide hundreds of billions in tax cuts to Americans making over $1 million annually, and the interest group AARP, which said the legislation would force older Americans and people who make less to pay more for insurance.
"How is that fair?" Stephanopoulos asked.
Mulvaney dismissed the estimates, arguing that the AARP was "not in the business of fixing things" and instead was "trying to protect their own self-interests to and to raise money."
"That's the same group, AARP, that did the television ads of a guy that looks a lot like Paul Ryan pushing granny off the edge of a cliff back when we first started talking about budgetary reforms back in 2010. And my guess is that the millions of emails that that group and other groups are sending out today have a little 'click here to donate' button at the bottom," Mulvaney said.
The exchange became heated after Mulvaney disagreed with the point that critics claimed the plan was a "massive transfer of wealth from lower-income Americans to upper-income Americans."
"Millions are going to be paying more and the wealthy are going to be getting a tax cut. But let me move on now to the state of the union," Stephanopoulos said.
"George, I’m sorry — I won’t let you move on from that," Mulvaney interjected. "I mean, you’re taking that as if it’s gospel truth. That’s the argument of a group of people who don’t like the bill. So we repeal the taxes in Obamacare. It’s what the Republicans have done from the very beginning. The fact that certain groups will pay less tax is not central to the issue. We’ve done this in a fashion that allows the people who cannot afford healthcare now to get it."
The two continued to spar over the president's promise, which Mulvaney claimed would expand "care," but may not extend "coverage."
"Those who are getting subsidies right now, they’re going to be getting fewer. The tax credit is going to be worth less than the subsidies and insurance companies are going to be free, under your bill, to charge older Americans more," the ABC anchor said.
"You’re falling into the exact same trap I talked about at the opening of this segment. You’re worried about getting people covered," Mulvaney said, before Stephanopoulos cut him off.
"The president said he wanted everyone covered, sir. The president said that," Stephanopoulos interjected.
"He wants everybody to get care. And that’s what we are doing," Mulvaney replied.
"That’s not what he said. The president said he wants to everyone covered," Stephanopoulos said.
Following the bill's introduction last week, many politicians and groups from the right and left sides of the political spectrum panned its proposals.
While the bill is likely to face universal opposition from Democrats in both chambers of Congress, it is unclear whether it even has the necessary Republican support to pass.
Many members of the House Freedom Caucus, a coalition of the most conservative members of the House, have publicly opposed the current version of the bill, arguing that the bill does not adequately eliminate some of the tax credits imposed by Obamacare.
Some Senate Republicans like Sen. Tom Cotton voiced similar concerns with the bill, arguing that not only was it moving too fast through the House, but that it also risked an electoral backlash for Republicans if it passed.
"I'm afraid that if they vote for this bill, they are going to put the House majority at risk next year," Cotton said on "This Week" on Sunday.
He added: "We should take a pause, try to solve as many as the problems on both Medicaid and the individual insurance market in this bill in the House, and then allow the Senate to take its work up."
Watch a clip of the exchange below, via ABC:
WASHINGTON (Reuters) - Aides to U.S. President Donald Trump on Sunday attacked the credibility of the nonpartisan agency that will analyze the costs of a replacement for Obamacare, as the White House sought to quell opposition from many Republicans.
The Congressional Budget Office, which provides official estimates of the budget impact of proposed legislation, is expected to issue a report as early as Monday that will assess the healthcare legislation put forth by Republican House of Representatives leaders.
The report could influence sentiment toward a bill that is already under fire from both Democrats and many conservative Republicans, especially if it suggests the legislation would reduce the number of Americans with health coverage or that it would worsen U.S. budget deficits.
In a series of television interviews, White House budget director Mick Mulvaney and top White House economic adviser Gary Cohn said that the CBO is focusing on the wrong metrics with the estimates it will provide on the number of people who are insured. Cohn and Mulvaney said CBO should instead should analyze whether patients can actually afford to go to a doctor.
"I love the folks at the CBO, they work really hard, they do, but sometimes we ask them to do stuff they're not capable of doing, and estimating the impact of a bill of this size probably isn't the - isn't the best use of their time," Mulvaney told ABC's "This Week" program.
Speaking on Fox News, Gary Cohn, director of the White House National Economic Council, said: "We will see what the score is, in fact in the past, the CBO score has really been meaningless."
"They've said that many more people will be insured than are actually insured. But when we get the CBO score we'll deal with that," Cohn said.
The Trump administration's criticisms of the CBO are unusual. Prior administrations, both Republican and Democratic, have steered clear of attacking the credibility of the agency, which many lawmakers regard as a neutral arbiter. The CBO's current director, Kevin Hall, was appointed by Republicans in 2015.
Republicans have long opposed Obamacare, formally called the Affordable Care Act, on the grounds it was government overreach and led to higher insurance premiums. The 2010 law, Democratic President Barack Obama’s signature legislation, provided 20 million previously uninsured Americans with health coverage.
The credit rating agency Standard & Poor's has estimated 6 million to 10 million people could lose health insurance coverage under the Republican plan.
Senator Bernie Sanders, who ran for president in 2016 as a Democrat, said it was "cowardly" for Republicans to proceed with a healthcare bill without CBO estimates, telling CBS' Face the Nation show: "This is a disgrace."
In recent weeks, Trump administration officials and Republican lawmakers have criticized what they said were overly optimistic estimates from the CBO of the number of Americans who would sign up for health insurance on government-run exchanges.
CBO estimated in 2013 that 22 million people would be purchasing insurance through the exchanges in 2016. But only 10.4 million were signed up for these plans by the middle of last year, according to Department of Health and Human Services data.
The House Republican legislation would scrap tax penalties for Americans without health insurance, roll back an expansion of Medicaid insurance for the poor, and replace Obamacare's income-based subsidies with a system of fixed tax credits to help people buy private insurance on the open market.
Last week, ratings agency Standard and Poor's estimated that 6 million to 10 million people could lose coverage if the Republican plan passes.
Cohn also disputed the notion that millions of people on Medicaid, the government health care system for the poor, would become uninsured as Obamacare's expansion of the program is rolled back over a period of years. He said that many of these people would be transitioned into new private and employer-sponsored plans that would become more affordable under the Republican plan.
House Speaker Paul Ryan, the Republican plan's top backer in Congress, said he is "certain" that the CBO will show a reduction in the number of Americans with coverage.
"You know why? Because this isn't a government mandate," Ryan told NBC's Meet the Press.
But conservative Republicans said they could not support the plan without significant changes. Republican Representative Jim Jordan of Ohio, a founder of the conservative House Freedom Caucus, said it does not go far enough to meet Republicans' promise to kill Obamacare.
"We told them we were going to replace it with something that would bring down the cost of insurance. That's what we told them," Jordan told Fox News Sunday. "This legislation that the speaker's brought forward doesn't do that."
Cohn and Mulvaney also said that the Trump administration was open to changes in the bill.
Republican Senator Tom Cotton of Arkansas said the plan as written would not pass the Senate and could put the Republican House majority at risk.
"I believe it would have adverse consequences for millions of Americans and it wouldn't deliver on our promises to reduce the cost of health insurance for Americans," Cotton said.
(Reporting by David Lawder; additional reporting by Doina Chiacu; Editing by Caren Bohan and Grant McCool)
To the extent that the Republicans urging people — in advance — not to pay too much heed to the nonpartisan Congressional Budget Office's analysis of the GOP's healthcare-reform plan have a point, it is this: Some pieces of legislation have more uncertain effects than others.
This bill, with novel provisions (such as its 30% premium penalty for people who drop and then restart health-insurance coverage) will have uncertain effects on the health insurance markets. Therefore, CBO's analysis of how much it will cost and how many people it will cover — like anybody’s analysis — will be speculative to a significant extent.
This, however, is a reason to take more time working on the proposal to try to establish its effects — not a reason to rush headlong into enacting it without having any idea what it might do.
Republicans in the administration and outside it plainly have no idea what their plan will do to health-insurance premiums or government expenditure, let alone to the fraction of Americans who go uninsured. It's not as if President Donald Trump's Office of Management and Budget has its own rigorous estimates of the plan's coverage effects to challenge CBO's.
Republicans are guessing. And whatever the limits of the CBO's methodologies, they are superior to guessing.
If you don't know what a bill will do, you might want to assemble a lot of experts to provide testimony on its likely effects so you can tweak its provisions. Instead, Republicans held zero hearings on this legislation and are trying to rush as quickly as possible from introduction to enactment.
Even if you were ideologically committed to the broad framework of this plan (and, let's be honest, nobody is actually ideologically committed to this framework; it's a compromise everybody hates) you should want an analytical process to fine-tune its provisions.
For example, the proposal would impose that 30% premium penalty on people who have gaps in insurance coverage. The purpose of this provision is to encourage people to maintain coverage even if they are healthy while still repealing the individual mandate, to which many Republicans have an ideological objection.
But why is the penalty 30%? Why not 20%, or 40%? Why does it run for one year, not more or less?
Nobody seems to know exactly where the 30% figure came from. Avik Roy, a conservative health-policy expert, speculates that it comes from estimates promulgated by insurers, on earnings calls and elsewhere, about how much more expensive it is on average to cover someone who buys coverage during a "special" enrollment period versus during regular open enrollment.
If you ask health-policy experts about this provision, you won't find any consensus about what this provision will do, let alone whether it is a good idea.
Some think it will cause a "death spiral"— once they drop coverage, healthy people would wait until they get sick to buy coverage, instead of paying the 30% penalty. But sick patients who know they will have high costs will buy despite the penalty. The preponderance of sick customers would force insurers to raise premiums, which would further discourage healthy people from buying coverage, which would require even higher premiums, and on and on.
That is, even if 30% is a good estimate today of the cost difference between a regular customer and one who develops an unscheduled need for insurance (and I would note, Avalere Health's estimates are lower), it won't be a good estimate anymore after you impose the penalty.
Some other experts think this proposal might work about as well as the existing individual mandate to discourage people from dropping coverage in the first place. It's hard to say — the existing mandate has its own weaknesses, and this policy would put us in uncharted territory.
"How high should the penalty be, and how well will it work?" seem like questions you might want to get a better read on before passing the law, if you cared about what the law would do to consumers.
The only reason to rush like this is that you don't care what the law's effects are — you are unconcerned about how many people end up with insurance coverage, how much the government has to spend on premium subsidies, or whether the premium penalty causes a death spiral.
From a political perspective, it makes little sense to be unconcerned about these matters. If lots of people lose coverage, and lots of people who keep coverage end up paying higher premiums, and lots of insurers exit insurance markets because they’re having trouble keeping healthy people in their coverage pools, those facts will impose significant political costs on Republicans who vote for the law.
But from an ideological perspective, there is a reason Republicans don't care. Their revealed value set is that they care almost entirely about the taxes imposed to pay for healthcare benefits.
Their plan would repeal most of the taxes imposed by the Affordable Care Act, and unlike the coverage provisions, the effect of repealing those provisions can be (indeed, already has been) scored with good precision by the Joint Committee on Taxation.
We know with a fair bit of precision what the Republican plan would do on the tax side: It would give a large tax cut to the wealthiest Americans. And that's all some Republicans need to know.
The American Health Care Act, the Republican bill to overhaul the US healthcare system, could face a serious test as early as Monday.
The nonpartisan Congressional Budget Office is expected to release its score for the GOP's legislation to repeal and replace the Affordable Care Act, the healthcare law better known as Obamacare, to estimate the budgetary and coverage impact of the new AHCA.
The CBO score will help estimate the long-term effects of the AHCA compared with its baseline estimates under the ACA, typically looking at the effects over 10 years.
While Republican leaders have cast doubts on the importance of the CBO score, the nonpartisan office was the most accurate predictor of the effects of the ACA.
Here are some key details to look out for in the CBO report:
The CBO score is not a perfect indicator — changes to the legislation as it goes through various committees, as well as legal challenges, can roil its estimates. It does, however, give a look at how the current iteration of the law could change the insurance industry and healthcare for Americans.
John Oliver wants to teach President Donald Trump about problems with the AHCA — the Republican replacement for Obamacare. He's running an ad that will play during "Fox & Friends", a show that Trump watches. "The bottom line is a lot of the things Trump promised on the campaign trail are not in the bill because the AHCA is being presented as a budget bill," Oliver said, "which can simply be passed by a Senate majority. Anything that's a non-budget policy change needs 60 votes to beat a filibuster.
President Donald Trump on Monday defended the GOP's plan to replace the Affordable Care Act, comparing Obamacare's increasing popularity to that of the president after whom it is named.
"The press is making it look so wonderful, so if we end it, everyone is going to say, 'Oh, remember how great Obamacare used to be? Remember how wonderful it used to be? It was so great,'" Trump said.
"It's a little bit like President Obama: When he left, people liked him; when he was here, people didn't like him so much. That's the way life goes. That's human nature."
Recent polls have shown that Obamacare has hit its highest popularity point while appetite for repeal has shrunk. This is similar to Obama's approval ratings, which hit their highest levels in his last few months in office.
The president also reiterated his talking point that pushing the American Health Care Act — the bill to repeal and replace Obamacare — was not the best political choice for Republicans.
"And the Republicans are, frankly, putting themselves in a very bad position — I tell this to Tom Price all the time — about repealing Obamacare, because people aren't going to see the truly devastating effects of Obamacare," Trump said, referring to the health and human services secretary. "They're not going to see the devastation in '17 and '18 and '19 — it'll be gone by then."
Additionally, Trump touted the AHCA as a way to unleash creativity among insurers in the types of plans they offer.
"You'll have plans that no one is even thinking of today," Trump said. "We will have plans that today no one is even thinking about, because the market is going to enforce that with millions and millions of people wanting healthcare."
Trump also promised that the plan would "bring down the cost of care," but said it would "take a little while to get there" if the law were enacted.
The meeting, held with a group of Americans who had been hurt by the increasing costs of Obamacare, comes as Trump and Republicans try to build support for the AHCA after early criticisms from across the political spectrum.
Republican leaders from Congress and the Trump administration are in the midst of a whirlwind campaign to sell their replacement plan for Obamacare to the American public even as groups from both sides of the political aisle have come out against the law.
Top administration officials and their allies — House Speaker Paul Ryan, Health and Human Services Secretary Tom Price, top economic adviser Gary Cohn, and the director of the Office of Management and Budget, Mick Mulvaney — all gave interviews defending the American Health Care Act on Sunday and Monday.
The interviews seemed to hit three major GOP narratives about the AHCA: the current law, the Affordable Care Act, is failing; the new law will fix this; and the GOP will come together around the AHCA despite initial misgivings from some in the party.
'Obamacare is collapsing'
Ryan, in an interview with CBS' "Face the Nation" on Sunday, repeated his oft-used line that Obamacare was coming apart at the seams.
"Obamacare is collapsing," Ryan said. "If we just did nothing, washed our hands of the situation, we would see a further collapse of the health-insurance markets. So we feel an obligation to step in front of that collapse and replace this law with one that works, that has more freedom."
Ryan's comments echoed what Trump has said since the campaign, telling supporters that the politically smart thing would be to let the law collapse and blame the Democrats. Instead, Trump has said, Republicans would replace the law before that happens.
"We came into office with an insurance plan that doesn't work," Cohn said. "Obamacare just is not working."
'Nobody will be worse off'
At the same time, the media blitz is aimed at pushing back on criticisms of the law from conservative and liberal lawmakers as well as from activist groups on opposite ends of the political spectrum and industry groups.
Price, for his part, told NBC's Chuck Todd that the law would not negatively affect Americans' finances, despite independent analyses showing that millions of people would most likely see their financial assistance to buy insurance go down.
"I firmly believe that nobody will be worse off financially in the process that we're going through, understanding that they'll have choices that they can select the kind of coverage that they want for themselves and for their family, not the government forces them to buy," Price said.
In addition, as reported by Business Insider's Maxwell Tani, Mulvaney emphasized the different between "care" and "coverage" during an interview on ABC's "This Week," another frequent emerging talking point in support of the AHCA.
Republican leaders have long argued that even though approximately 20 million people have insurance specifically through Obamacare's various provisions, that does not mean they can get access to "care" because of high deductibles and shrinking insurance networks.
"I was on Obamacare when I was in the House,"Mulvaney said. "My family deductibles were over $15,000 a year. Other folks who don't make as much money as I did were on the exact same plan. Do you think they could afford to go to the doctor? That's what we’re trying to fix — not coverage for people, not coverage they can't afford, but care they can afford."
'That's how legislation works'
Additionally, administration representatives suggested that despite concerns and lawmakers within the GOP coming out against the bill, the AHCA would eventually get passed.
Ryan said the concerns from conservative and moderate Republicans were just part of the normal legislative process.
"People are going to try and negotiate,"Ryan said. "People are going to say, 'I wish we could do this — let's do that.' That's how legislation works. Negotiations and compromises occur when you are writing law. And what we are seeing and hearing is just that."
Cohn also hinted that the White House was open to suggestions from conservatives and could be willing to compromise on some aspects of the AHCA.
"Chris, I think the president has been very open and transparent on the issue that he's been willing to accept improvements to the bill," Cohn said.
For his part, Trump chimed in on the issue on Monday morning, tweeting that the plan would be accepted by members of the GOP.
"Obamacare is imploding,"Trump wrote. "It is a disaster and 2017 will be the worst year yet, by far! Republicans will come together and save the day."
The Congressional Budget Office on Monday estimated that as many as 24 million more people would be uninsured and that the federal budget deficit would shrink by more than $300 billion over the next decade under the Republican healthcare bill.
The findings came in a much-anticipated report detailing the possible effects of the American Health Care Act, the GOP leadership's plan to repeal and replace the Affordable Care Act.
The report estimated the effects of the AHCA in several areas, including coverage totals, the federal deficit, and the cost of premiums in the individual market.
Here's a rundown of the major findings:
Critics of the law had pointed to the CBO score as a way to better understand the potential effects of the AHCA on the federal budget and the US healthcare system.
In a statement after the release of the report, House Speaker Paul Ryan, the Wisconsin Republican, focused on the projected premium decreases, saying it proved that the AHCA could be successful:
"I recognize and appreciate concerns about making sure people have access to coverage. Under Obamacare, we have seen how government-mandated coverage does not equal access to care, and now the law is collapsing. Our plan is not about forcing people to buy expensive, one-size-fits-all coverage. It is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down. That's what this report shows. And, as we have long said, there will be a stable transition so that no one has the rug pulled out from under them."
On the other hand, Senate Minority Leader Chuck Schumer, the New York Democrat, focused on the increase in the number of uninsured people.
"The CBO's estimate makes clear that Trumpcare will cause serious harm to millions of American families," a statement from Schumer said. "Tens of millions will lose their coverage, and millions more, particularly seniors, will have to pay more for healthcare. The CBO score shows just how empty the president's promises, that everyone will be covered and costs will go down, have been. This should be a looming stop sign for the Republicans' repeal effort."
The White House and proponents of the AHCA have spent much of the past week casting doubts on the CBO score in an attempt to blunt the widely expected blow from the report.
In a press conference last week, White House press secretary Sean Spicer said, "If you're looking at the CBO for accuracy, you're looking in the wrong place." Other White House surrogates, such as National Economic Council Director Gary Cohn and Office of Management and Budget Director Mick Mulvaney, criticized the CBO's accuracy in interviews on Sunday.
The AHCA passed the House Energy and Commerce Committee and Ways and Means Committee on Thursday, and it is scheduled to be considered by the House Budget Committee on Wednesday.
The Congressional Budget Office on Monday released its report on the American Health Care Act, the healthcare bill proposed by House Republicans.
The CBO estimated that under the Republican healthcare bill as many as 24 million more people could be uninsured and the federal budget deficit would shrink by more than $300 billion over the next decade.
As part of the report, the nonpartisan agency also detailed its estimates for what premiums might look like under the proposed legislation.
The net premiums — that's accounting for tax credits — for different age groups might look quite different under the proposed AHCA compared to the Affordable Care Act.
Under the AHCA, premium tax credits would solely account for age, rather than factoring in both age and income as it exists under the ACA. The effect, according to the CBO, is that older people with lower incomes would see a significant increase in their net premiums.
House Republicans like to say their health plan is all about offering Americans choices. So what does it say about those choices if 52 million Americans, offered health insurance in the market designed to Republican specifications, will choose to buy no insurance at all?
The broad strokes of the Congressional Budget Office analysis of the plan are this:
Democrats will point to the insurance coverage loss number — 24 million more Americans without insurance — as evidence that this bill is terrible.
Republicans will respond that if people were only buying insurance because of the individual mandate, what's so great about that? The goal isn't to force people to buy coverage — it's to give them choices so they can do what they like.
The big problem with the "choice" argument is this: If their plan is all about choices, how come they couldn't come up with choices that appeal to those 52 million Americans who won't buy coverage under their plan?
There are a lot of people who don't like the insurance plans offered to them. But the number of people who would say, in the abstract, "I would prefer not to carry health insurance," is very small. They want to be offered health insurance that they find to be a good value.
In practice, people who go uninsured under the Republican plan will do so for one of two reasons.
One is that they won't be able to afford to buy an insurance plan. In some cases, insurance under this plan will be eye-poppingly expensive: Even after a tax credit, CBO estimates a single-coverage premium of $14,600 for a 64-year-old — even if his or her income is as low as $26,500.
Other people will go uninsured even though they could afford to pay for insurance because they will decide the available insurance does not provide a good value.
Under the Affordable Care Act, many people complain about high deductibles and co-payments that mean their health insurance does not seem to actually pay for the healthcare they need. This proposal would lead to even more "cost-sharing"— which is to say, higher co-payments and deductibles.
That is, the CBO report says that, for tens of millions of Americans, the only choices that would be available under the GOP proposal are insurance plans they won't have the money to pay for, or insurance plans they won't believe are worth buying.
That is a poor outcome for a healthcare policy that is supposed to be all about "choice."
Health and Human Services Secretary Tom Price and Office of Management and Budget Director Mick Mulvaney attacked to the Congressional Budget Office's report analyzing the effects of the American Health Care Act.
The report estimated that 14 million more people would be uninsured in 2018 under the AHCA compared to the current Affordable Care Act — and that number could increase to 24 million by 2026.
"We disagree strenuously with the report that was put out," Price said. "We believe that our plan will cover more individuals at a lower cost and give them the choices that they want for the coverage that they want for themselves and their family not that the government forces them to buy."
Price said it would be "virtually impossible" for 14 million to lose their coverage next year, because that is higher than the number of people enrolled on the ACA's individual exchanges.
"You just look at the numbers, there are 8, 9 million people on the exchange currently. I'm not sure how they're going to get to 14 million," Price said, adding its "just not believe able."
As of the open enrollment period that ended in January, 9.2 million were signed up through the federal exchange on Healthcare.gov, with more on the state-based exchanges. The CBO report, additionally, also estimated that number based on the number of people that would not sign up for employer coverage without the threat of the tax penalty from the ACA's individual mandate.
Mulvaney did tout the CBO's analysis of the legislation's effect on healthcare premiums. The report estimated that while premiums on the individual exchanges will increase over the next two years, they will subsequently decrease since the burden of increased costs will fall on older Americans, adjusting the risk pool to be cheaper for insurers.
View their comments below:
HHS Secretary Price: "We disagree strenuously" with CBO report https://t.co/ZmRmdpvkwo— NBC News (@NBCNews) March 13, 2017
Ohio Gov. John Kasich's response on Sunday, when asked about the House Republican proposal to overhaul the system established by Obamacare, perhaps exemplifies why the bill is going to be so hard to pass.
In an interview with Kasich on NBC's "Meet the Press," host Chuck Todd presented a clip of Vice President Mike Pence speaking to an Ohio TV station. He said the AHCA would provide Ohio with "the resources and the flexibility ... to offer our most vulnerable citizens even better coverage."
Todd asked Kasich if Pence was right, to which the Republican governor answered bluntly.
"No, he's not right," Kasich said.
Kasich’s main gripe with the AHCA: a radical rollback of Medicaid, the government-run health program that provides insurance primarily topregnant women, single mothers, the disabled, and seniors with low incomes.
Under the ACA, eligibility for Medicaid was expanded to include any adult living under 138% of the federal poverty level — an income of $27,821 for a family of three in 2016. It's up to states to decide if they want to participate. States that expanded Medicaid under the new ACA requirements received federal funds to do so.
Thirty-two states and the District of Columbia have chosen to participate, leading to more than 11 million new people nationwide gaining coverage, a number that continues to grow.
The AHCA features a significant rollback to the Medicaid expansion. Here’s how:
1. The bill ends the government's commitment to providing funding for the expansion population, leaving it to states to provide funding if they so desire. The vast majority of expansion states do not have the funds to keep the program as is.
2. While expansion adults will be allowed to remain covered, states will no longer be able to enroll additional people under the expansion rules after 2020.
The Congressional Budget Office on Monday released a report estimating that the changes would likely result in a loss of 14 million people from the Medicaid rolls by 2026.
That's not likely to be popular with the public or politicians in expansion states that will suffer the brunt of those coverage losses.
For instance, 65% of Americans said Medicaid should continue largely as it exists today, despite Republican proposals to change the program, according to a tracking poll released late last month by the Kaiser Family Foundation.
Governors in charge of expansion states, 16 of which are Republican, have also been in favor of retaining the expansion. Many have acknowledged the program's importance to their states in recommendation letters solicited by Republican congressional leaders.
Kasich has been the most vocal.
As he argued on Sunday, the Medicaid expansion has provided healthcare to more than 700,000 people in Ohio alone, many of whom suffer from mental illnesses, substance abuse disorders, or have chronic diseases.
The expansion has been a literal life-saver for the state, as it faces the brunt of the nation's opioid crisis. Ohio suffers third-highest drug-overdose death rate in the country, with 29.9 deaths per 100,000 people, and it has seen an explosion in demand for substance-use treatment in recent years. The Medicaid expansion has provided substance-abuse treatment to 108,000 people.
"Thank God we expanded Medicaid, because that Medicaid money is helping to rehab people," Kasich said last month after signing a bill targeting Ohio's opioid crisis.
While Kasich stopped short of defending Obamacare as a whole on Sunday, he reiterated his unequivocal support for the Medicaid expansion.
"Don’t kill Medicaid expansion," Kasich told Todd. "Here's what we're talking about. If you're drug addicted, if you're mentally ill, you have to consistently see the doctor. From what I see in this House bill, the resources are not there."
Ohio is far from the only state that would be affected. Of the 10 states with the highest drug-overdose death rates, only Tennessee and Utah opted out of the ACA's Medicaid expansion.
About 1.29 million people in the US are receiving treatment for substance use disorders or mental illnesses thanks to the Medicaid expansion, according to research conducted by Harvard Medical School Health Economics professor Richard Frank and New York University dean Sherry Glied.
The changes to Medicaid funding and eligibility aren't the only ways the AHCA could affect the opioid crisis. The bill also proposes to eliminate "Essential Health Benefits" from certain Medicaid plans. The "Essential Health Benefits" are a series of services required to be in all health plans, one of which is mental health and substance use treatment. Prior to the Affordable Care Act's implementation, mental-health and substance-use treatment tended to be "sparsely covered" by Medicaid providers, Frank told Business Insider.
The loss in Medicaid funds resulting from the AHCA, combined with the elimination of those benefit requirements, would create a fraught choice for states.
"The states then have a choice: They can continue to take on those responsibilities and pay for it out of their own budgets, or, if they are under pressure, they have to scale back," Frank told CNN. "Historically, states have been loath to cover substance abuse treatment."
If the AHCA does become law and the Medicaid expansion is phased out, Ohio, Pennsylvania, and West Virginia, among other states suffering the brunt of the opioid crisis, will be ill-suited to handle the loss in funds, government officials and treatment experts say.
Pennsylvania is suffering a $600 million budget shortfall as of December and could go as high as 1.7 billion by July, according to the Pittsburgh Post-Gazette. Pennsylvania Republican State Rep. Gene DiGirolamo told Business Insider recently that there are "no extra dollars" to insure residents or provide addiction treatment to those who lose coverage because of an ACA-repeal. The situation is equally dire in West Virginia.
"I'm really, really worried about what's happening in Washington. And I say that as a Republican," DiGirolamo said.
Republicans in the expansion states have taken notice.
On the same day House Republicans unveiled the AHCA bill, four Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado, and Lisa Murkowski of Alaska — released an open letter to Senate Majority Leader Mitch McConnell denouncing the possible overhaul of Medicaid. Meanwhile, a group of Republican governors are reportedly working on a proposal that preserves the Medicaid expansion while fulfilling other Republican objectives, like cutting costs.
With a vote as contentious and split down party lines as the AHCA will be, four Republicans voting against the bill would likely doom it.
House Speaker Paul Ryan said on Monday that he was "encouraged" by the Congressional Budget Office's report on the American Health Care Act, the GOP's bill to repeal and replace the Affordable Care Act.
In an interview with Fox News' Bret Baier, Ryan sought to downplay that the report showed 24 million more could be uninsured under the AHCA.
The Wisconsin Republican said the estimates were better than he expected.
"If you read this entire report, I'm pretty encouraged by it, and it actually exceeded my expectations," Ryan said.
The House speaker also immediately cast doubt on the estimates for the number of uninsured. He said the reason the uninsured rate would increase was because of the repeal of the ACA's individual mandate, which he said would get people — willingly — out of the market.
"Of course they're going to suggest that if we don't make people do something they don't want to do, they're not going to do it," Ryan said.
The CBO report also showed that because of the AHCA's adjustment in tax credits given to consumers, the number of people who would drop out of the individual health-insurance market — the market for those without coverage through an employer or the government — would eventually cause premiums to decrease after 2019.
"What I'm encouraged with is once our reforms kick in what the CBO is telling us is it's going to lower premiums, it's going to lower premiums 10%," Ryan said. "It stabilizes the market, it's a $1.2 trillion spending cut, a $883 billion tax cut, and $372 billion in deficit reduction."
The CBO said that it projected that the market would be stable under the current ACA system and the AHCA.
Health and Human Services Secretary Tom Price and Office of Management and Budget director Mick Mulvaney also attacked the report on behalf of the Trump administration after it was released.