Friday, May 5, 2017

Text of Health Care Bill Passed by the House and My Summary

Here is a link to an official summary and full text of the Health Care Act of 2017 that the House passed.

SUMMARIES are here:

Clic on the drop down box to read the second summary.



Here is my summary of the key provisions of the bill

The bill eliminates funding for the Prevention and Public Health Fund that invests in programs to improve health and restrain the rate of growth of health care costs.  This fund currently provides about 12% of the funding for the Centers for Disease Control and is an important funding mechanism for public health departments.  The CDC’s former director, Tom Frieden, said that if the prevention funding is lost, “Americans will be at greater risk from vaccine-preventable disease, food-borne infections, and deadly infections contracted in hospitals.”

The bill eliminates funding for Planned Parenthood for one year.

The bill fazes out funding for the Medicaid Expansion between now and 2020 and eliminates the requirement that Medicaid provide “Essential Health Benefits”-- ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, preventative and wellness services, and pediatric services.

The bill changes and limits the Federal funding for Medicaid.  Instead of picking up the full cost, the Federal Government will now provide a fixed amount per enrollee or a block grant.  States will have to make up the difference or limit enrollment.  Long term this may result in a substantial cut in the number of people eligible for Medicaid that states can cover.  Millions who might otherwise be covered with Medicaid will have no health insurance.

If a person seeking insurance in the individual or small group market has a break in coverage (no health insurance) for more than 62 days in the previous year, then the Republican laws says insurance companies MUST charge them 30% extra for their insurance for a period of one year.

Beginning in 2020, health insurance benefits no longer must conform to actuarial tiers (e.g., silver benefits, gold benefits, etc.)  These “actuarial tiers” provide a comparison of how good a plan is relative to the approximate amount of a person’s health care expenses the plan will cover.  The least expensive Bronze plan under Obamacare has an actuarial value of 60%-in other words covers about 60% of an average enrollees health expenses.  Under the Republican plan, Health insurance companies could offer much less generous plans—for example, a Coal Plan that would cover 10% or less of the average person’s health expenses.  See more about the actuarial tiers here:

Insurance companies may charge older individuals up to five times more than younger individuals.  The current ratio is three times more.  People over 60 would pay much more than under Obamacare for the same level of coverage.  People in their 20s would pay less.

The fine for not having health insurance is reduced to 0% or $0.00 compared to 2/5% and $695 under current law.  This is the Republican way of eliminating the Individual Mandate.  The mandate remains, but the fine is $0.

The bill repeals almost all taxes imposed by Obamacare designed to pay for the cost of the program. Eventually, whatever is left of Obamacare will be starved for lack of funding.

The bill ties tax subsidies (really advanced tax credits) for the purchase of insurance strictly to age without consideration of the actual cost of insurance for an individual in a market and/or the individual’s income and ability to pay.  Individuals in their 20s are eligible for a $2,000 supplement.  The supplement increases by $500 per age bracket (people in their 30s get $2,500 but to a maximum of $4,000 for individuals in their 60s.  The supplement is reduced by 10% for individuals with a Modified Adjusted Gross Income over $75,000 ($ 150,000) for couples.  Supplements are limited to $14,000 per year per family and the maximum amount the five oldest individuals in the family (husband, spouse and dependents) are eligible to receive based upon age.  Older Americans will find their out-of-pocket cost for health insurance on the individual market increase dramatically.  For example, the CBO in scoring an earlier version of the Republican plan said the out-of-pocket cost of premiums after the subsidy for a 64 year-old with an income of $26,000 a year could rise from $1,700 to $14,000, making the insurance unaffordable.

The bill allows states to request a waiver from Obamacare requirements for insurers to cover everyone at the same price regardless of pre-existing conditions and the requirement to offer Essential Health Benefits (see above).  While insurers in states with the waiver would still have to cover people with pre-existing conditions, they could charge those individuals substantially more thus, in effect, making health insurance unaffordable for them.  States would be required to set up High-Risk pools to cover people with pre-existing conditions who can’t afford insurance.  The bill provides around $138 billion dollars through 2026 to help these Waiver states pay for the costs of these High-Risk pools, thus holding down premiums for people with pre-existing conditions who are forced into these pools.  Note: State High Risk Pool have not worked in the past because the funds provided to insurers to hold down the cost of premiums for individuals with pre-existing conditions did not keep up with the ever increasing costs of the pools.  States with waivers could also allow health insurers to once again place annual and/or lifetime limits on the amount policies would pay.

THAT’S IT FOLKS.  The elderly and the poor are going to take it on the chin.

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