The proposed American Healthcare Act, part 1 of the GOP trilogy, may get support from the moderate wing of the Democratic party to put it over the top.
If you didn’t know that this bill was proposed by the GOP, you might think that it was ACA version 2.0 from a Democratic lead house.
Lets review the key components of the bill:
1) Maintains – No Pre-Ex, No decline, Age 26, Essential benefits through 2019, Unlimited Lifetime benefits.
2) Cuts Taxes: (Ok this part is conservative) Eliminates the shared responsibility payment for individuals and employers, eliminates additional taxes retroactively to 12/31/2015
3) Expands assistance: to Singles making up to $75,000 and families to $150,000. This could double the number of people receiving help.
4) Insurance companies will like it because they can charge those who were uninsured a 30% penalty on premium when they enroll. If they can make a profit, competition will grow.
5) Increases caps on HSA’s. – Up to the maximum out of pocket amount of your eligible plan.
6) Increases Medicaid funding for the next 2 years by over 10% giving States more direct control on how to use the money.
7) $100 Billion in market Stabilization funding for States.
What it didn’t do and enemies of part 1 that wont be there.
1) It didn’t impose the “across State-lines” clause. This would get the ire of insurers.
2) It didn’t impose cost controls on Drugs. Pharma likes it.
3) Insurance companies like it.
4) It didn’t eliminate cost sharing for those above the 100% FPL who have reduced deductibles and out of pocket until 2020.
The criticism of the bill down deep in the long term provisions that cut reimbursements for Medicaid after 2020, much like we have had since the 1996 Balanced budget amendment for Medicare. Each year Congress has to vote to push out the cuts to Medicare that were called for in the 1996 bill. This is likely to draw the criticism of the Hospitals and AMA worried about years 2020 and beyond.
Aside from the worry in 2020 and beyond, the loudest critics of The American Healthcare Act, with specifics, appear to be the Conservative Groups in the House and Senate. They specifically and accurately, attack the bill as reducing income to the treasury and continuing the entitlements, even increasing the entitlements with Medicaid, over the next 2 years from current ACA mandates. If moderate democrats don’t help to pass this bill, there will likely be compromises with the conservatives to make the bill less palatable to progressives.
Although the 2016 elections seems as though it just ended, the 2018 cycle is just beginning. A “NO BILL on health reform” from this Congress would likely be devastating to Democrats in 2018. A “NO BILL” in the spring of 2017 virtually assures continued chaos in the private sector health insurance in 2018. Another year of escalating prices and reduced access will assign blame directly to Obamacare, not to the Republicans. With 25 of the 34 Senate Seats up for election in 2018 aligned with Democratic votes, a 50/50 split in 2018 could make the next session significantly more conservative. If a bill is passed and it fails to deliver, it gives some hope for the Democrats to blame the Republicans. The Democrats would need to pick up 3 seats, 28 of 34 in 2018 to shift the needle. That is highly unlikely.
When Nancy Pelosi infamously said on March 8, 2010, days before the March 21, 2010 passage of Affordable Care Act. that “we should pass the bill to find out what is in it”, she may have been speaking to the unintended consequences that would require adjustments in the future. Republicans never gave Democrats a chance to fix it. This may be the best, and only, chance that the Democrats have to influence the direction of Obamcare 2.0.
For assistance contact:
Mark H. Gurda President- Castle Group Health Inc.
Mark Gurda x 1201
Mark Zisook x 1202
Jeff Greenberg x1206