Governors wary of Medicaid cost shift in Senate health bill

Adjust Comment Print

The Republican Senate's draft of the American Health Care Act (AHCA), the effort to repeal and replace the Affordable Care Act (ACA), was revealed to the public this week after it was negotiated in secret. This week he called for a health plan "with heart".

If the bill is signed into law, millions of low-income and working-class Americans stand to feel the effects most acutely. This includes nearly two-thirds of people in nursing homes. Republicans also want to change the way the federal government calculates payments to the states starting in 2025, reducing the federal government's contribution to the states.

More significantly, ends Medicaid's longtime status as an open-ended entitlement, with Washington paying a share of what each state spends. Reducing federal support for these people would guarantee agonizing decisions for state officials in the future. When the CBO releases its projections for the Senate bill next week, the projected Medicaid impacts may well be even worse. And like the House bill, it would restructure Medicaid, imposing per capita spending caps. Uses a less generous inflation adjustment than House bill. The so-called individual mandate - aimed at keeping insurance markets solvent by prompting younger, healthier people to buy policies - has always been one of the GOP's favorite targets. The more precious the metal, the better - but more expensive - the coverage. In 2017, policyholders only have to pay up to $7,150 a year for services covered under the essential health benefits provision. States can not seek waivers that would allow insurers to charge more based on health. The Senate Republicans' plan puts a lid on that by rolling back the Obama-era expansion of the program and then granting states a set amount of money for each person enrolled. In a couple of weeks, the Senate bill might be moot and Congress may have to start all over if Republicans can't get their members on the same page.

He also chided Democrats for indicating they wouldn't support the Republican-crafted plan. But bronze plans have an average deductible of almost $6,100. Cost-sharing subsidies are explicitly extended through 2019, an important detail that should help calm insurance markets. At a time when there are more seniors than ever entering the Medicare program, they will need as many doctors as possible to treat them.

House GOP bill: Loosens the age restriction so insurers can charge older adults up to 5 times more. They could be included in another Senate Bill.

-Repeal a tax penalty on larger employers not providing health insurance to workers, saving them $171 billion over the next decade.

Neither the House nor Senate bills end the American Medical Association's monopoly on doctor certification via control of medical schools, the Food and Drug Administration monopoly on approving new drugs, or the government-created state-by-state insurance monopolies. Each state has expanded Medicaid and has a GOP senator. Especially for a public hospital system already spending $648 million a year - almost half its budget - on uncompensated care.

Former Arizona Gov. Jan Brewer, a Republican who surprised her party when she made a decision to expand Medicaid four years ago, is urging Congress to save the expansion, which has provided coverage to 400,000 Arizonans. Obama's health law enacted an additional 0.9 percent payroll tax on wages above $250,000 for married couples and above $125,000 for individuals. Democrats are uniformly against it, saying its true goal is cutting almost $1 trillion in taxes over the next decade, mostly for corporations and the richest families in America. The Senate Bill, however, eliminated those taxes. That will price more people out of the health insurance market. However, they must collect a separate premium, strictly segregated from taxpayer funds.

The GOP president also, as he frequently does, labeled Democrats as "obstructionists", and offered some free political advice.

In 2017, the average deductible for a silver plan is just under $3,600, according to Health Pocket, an insurance shopping site.