The Long and Winding Health Insurance Road: Don’t Panic

Take a deep breath and follow the advice of The Hitchhiker’s Guide to the Galaxy “Don’t Panic”. The Affordable Care Act remains the law of the land.

While the Republicans passed an irresponsible mess of a bill “The American Health Care Act” (217-213) that some did not bother to read without any information from the Congressional Budget Office on the financial impact or the number of Americans who will lost health insurance coverage, this is not a law yet. Republican Congressman Chris Collins admits to CNN’s Wolf Blitzer that he did not read the entire GOP health care bill before signing off on it and instead, relied on his staff. Paul Ryan even stated in 2009 (referring to the Affordable Care Act” that “I don’t think we should pass bills that we haven’t read and don’t know what they cost“. And yes, this is squarely on the Republican House Members and Speaker Paul Ryan as no Democrats voted for this and some brave Republicans voted no. See how every member voted on the AHCA.

It is now up to the presumed Adults in the Washington Room to review and either pass this Bill or come up with their own Bill. The Senate cannot vote without a “score” from the Congressional Budget Office. Senator Lindsey Graham on this ““But any bill that has been posted less than 24 hours — going to be debated three or four hours, not scored — needs to be viewed with suspicion,” he said, noting that the House vote came without an assessment from the Congressional Budget Office on the latest version’s price and impact.” This sentiment was shared by Senator Lamar Alexander who chairs the Senate Health Care Committee, “We’re writing a Senate bill and not passing the House bill, we’ll take whatever good ideas we find there that meet our goals.” See Senate GOP rejects House Obamacare bill.

Republicans hold just 52 votes in the Senate. Vice President Mike Pence, a Republican, could vote to break a tie. Therefore, it would only take 3 Republic Senators to vote No to keep this Act from passing the Senate considering that the odds of a Democrat voting yes are significantly less than getting hit by an asteroid at the same time as you win the lottery, theoretically possible but highly unlikely. Many Senate GOP members have expressed skepticism about the AHCA.

This is what’s known as a “reconciliation” bill, which means it will be protected against filibusters and will need only a simple majority to pass. However, the Senate’s Byrd Rule requires that it must only involve budget related changes and cannot include policies that have no fiscal, impact among other requirements (See: The Byrd Rule and It’s Effect on Health Reform: A Short Guide). It must also lower the deficit.

It’s entirely unclear what the Senate parliamentarian — an unelected official who singlehandedly makes major decisions on the reconciliation process — will allow, and what Mitch McConnell and Senate Republicans will do if the parliamentarian turns what the House has done into Swiss cheese by stripping various provisions from it.

It does make sense to know what you’re voting for and what the impact will be. And that is not a political statement, it’s a statement of responsibility. All indications are that the Senate is going to come up with their own Bill. If the Senate does come up with their own Health Insurance Bill, it will then have to through a reconciliation process with the House and then that reconciled Bill would have to pass both the House AND Senate AND be signed by President Trump. Given the divide between House Republicans, and what the comments are from the Senate, there is no certainty a reconciled Bill could be passed. So what can you do? You can sign the petition that I’ve started at Change.org “Introduce a practical and fair health insurance solution” that asks Senator Graham, Speaker Ryan,President Trump and other Senators to adopt the principles of the Health Insurance Roadmap and put in some real improvements to the Affordable Care Act. If you agree, please forward this newsletter and/or the petition to everyone you know and to your legislators. It’s time to take a stand and provide sensible, truly affordable health insurance to all Americans.

Here’s a list of what the American Health Care Act does:

  • Previous CBO scoring of this resolution estimated that it would lead to 52 million additional Americans going without health insurance by 2026, while only cutting about $150 billion from the federal deficit.
  • Individual states will be allowed to opt out of certain requirements of the Affordable Care Act. This includes restrictions on charging individuals more for insurance if they have pre-existing conditions, or mandates that insurance providers in that state must cover the ten “essential” health benefits as defined by the ACA. This is is big deal since over 26% of Americans (about 52 million adults under the age of 65) have a pre-existing health condition and the majority of those conditions are not their fault. In fact, The Department of Health and Human Services in 2011 estimated the number of Americans with conditions that could result in insurance denials at 129 million. The ratio of those with such conditions rose sharply with age — from about 35% of Americans 18 to 24 to 86% of those 55 to 64. See if you and your family would have qualified under the old Medical underwriting guidelines from Blue Shield of California. These are similar to guidelines that were used by other health insurance companies.
  • States that opt out would be able to create high-risk pools. However, before the ACA only 35 states had such high risk pools. only a small fraction of eligible people in those states were actually enrolled, and almost all of these programs had exclusions or restrictions on pre-existing conditions. A high-risk pool that does not include such restrictions may attract a larger number of Americans. A 2008 estimate from the nonpartisan Tax Policy Center calculated that a nationwide high-risk pool would require more than $1 trillion over ten years. , see High-Risk Pools For Uninsurable Individuals .
  • ncreased premiums for older Americans. Current under the ACA, insurers could charge older people no more than 3 times what they charge younger people. Under the AHCA, insurers would able to increase the charges to older people to 5 times that of younger people.
  • The employer mandate is removed. This is the requirement that larger employers provide qualifying coverage to full-time workers.
  • The individual mandate would removed. This is the requirement that most Americans have some form of health insurance with the goal that this would provide a balanced risk pool.
  • A refundable tax credit would be provided, based on age and income, of between $2,000 to $4,000 to individuals (capped at a total of $14,000 per family) who do not have access to government health insurance programs or an offer from any employer; are a citizen, national or qualified alien of the United States (and are not incarcerated) who purchase qualifying insurance on their own. Currently, veterans who are eligible for benefits through the Department of Veteran Affairs would not be eligible for these tax credits, even if they don’t want or have VA benefits.
  • Medicaid expansion would be terminated in 2020. Medicaid would also lose more than $800 billion in funding over 10 years. Medicaid would be converted to a block granted program which means that there is only a fixed amount of money per state rather than per person. So it’s unlikely that there will be sufficient funds. This would be the biggest change to medicare since it’s inception in 1965.
  • Defunds Planned Parenthood and prohibits subsidies being on plans that cover abortions (currently an essential benefit). No matter how you feel about a woman’s right to choose, that should be separate from the issue that Planned Parenthood provides a lot more services than just abortion such as access to birth control, pre-natal care, have babies and qualify for medicaid along with other family planning services. Yes, this is a third rail, however, this need to be discussed. Whether abortion is legal or illegal, they will still take place, however, if they are illegal it will be back to the days of less than quality facilities and practitioners putting women who choose an abortion at risk. And again, whether or not you agree, it is currently the law of the land and that should be respected along with a woman’s right to choose.
  • Tax cut for the wealthy from the Los Angeles Times: The bottom line is that the repeal of the ACA’s tax provisions, would provide the wealthiest taxpayers with an immediate tax cut totaling $346 billion over 10 years. Every cent of that would go to taxpayers earning more than $200,000 a year ($250,000 for couples).
  • Remove the limits on annual contributions to flexible spending accounts.
  • Increase the limit on Health Savings Accounts so that they are equal to the sum of the annual deductible and out-of-pocket expenses permitted under a high deductible health plan.
  • Over-the-counter medications would be eligible for purchase through tax-advantaged savings plans like flexible spending accounts and health savings accounts. Yes, this one is a good thing, however, it is limited to those who have one of those accounts.

Jimmy Kimmel had an emotional monologue about the impact of having a baby born with severe health issues requiring open heart surgery and why having health insurance was so important not just for him, but for everyone, not just those who can afford it. Watch the video and think about this being your child. I know this feeling, my son was diagnosed with Type 1 Diabetes which is a severe chronic illness (a virus) that is caused either by genetics or by some environmental factor. Just like Jimmy Kimmel’s kid, my son’s illness happened randomly and without health insurance, our costs to manage his diabetes care would be crippling and under the American Health Care Act, he would most likely not ever be able to get health insurance except possibly through an employer. However,allowing states to define “essential health benefits” could weaken ACA protections against catastrophic costs for people with employer coverage nationwide.

In the short term, health insurers focused on 2018 unknown for Obamacare market. It is very important the government continues to fund the cost-sharing subsidies that help individuals pay for care. More to come next week on the status of the ACA which is still the law of the land.

As Ghandi said “You must be the change you want to see in the world”. It starts with you and it starts with me. Let’s do this for ourselves, our children, our extended families, our friends and for those we have not yet met.

The Bottom Line:

If you want to help make a positive change, please sign the petition “Introduce a practical and fair health insurance solution” at Change.org (click).

Please share your thoughts. And if you like this post, please forward it to friends, family and colleagues. Thanks for reading.

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