Updated Trumpcare Bill Will See 41 Million Americans Be Health Care Losers

Sick people would probably have to pay more under the health bill passed by the House, the Congressional Budget Office reports. Credit Ozier Muhammad/The New York Times

The Senate now has a clearer sense of the 41 million Americans who would lose under the health bill the House sent them by Donald Trump and the Republicans. It also got a startlingly direct message from government analysts about how destabilizing one of the House ideas could be.

The Congressional Budget Office published its assessment of the House health bill on Wednesday, and warned that a last-minute amendment made to win conservative votes would result in deeply dysfunctional markets for about a sixth of the population. In those places, insurance would fail to cover important medical services, and people with pre-existing illnesses could be shut out of coverage, the budget office said.

It found that about half the country would face thinner coverage for people who buy their own insurance, as it would be unlikely to include mental health and addiction treatment services, maternity care or rehabilitation services. Medical deductibles would also increase.

As in the original version of the bill, winners would include people who are young, healthy and earn higher incomes. They would be better off, assuming they didn’t develop serious health problems. The bill makes big cuts to taxes on payroll and investment income for those earning more than $200,000, and provides more subsidies to buy insurance for people earning between about $50,000 and $150,000. On average, premiums for health plans people buy for themselves would decline over the 10-year period, as coverage becomes less generous.

The report was sharply critical of the idea that sicker patients could be protected in a system that allowed insurers to charge them higher premiums. In the minority of states it predicted would pursue broad waivers of Obamacare’s insurance regulations, the office said that sick customers would face far higher prices and many would be priced out of the market altogether.

The bill would save the federal government $119 billion in a decade.

The largest savings would come from cutting Medicaid and reducing tax credits for middle-income insurance buyers.

Projected cumulative change in deficit, in billions

Because Republicans are using a special legislative process to avoid a filibuster in the Senate, the bill had to comply with special rules. They include saving the federal budget at least $2 billion over 10 years.

An initial version of the bill would have saved the federal government $337 billion over a decade, and a subsequent version would have saved half that amount. House Republicans pulled an earlier bill from the floor because they did not have enough votes to pass it.

In the final bill, however, lawmakers added more spending in various areas to get enough votes to pass, including $8 billion over five years to help cover insurance costs for people with pre-existing conditions.

One of the bill’s most expensive items is a provision that would eliminate about $600 billion in taxes imposed under the Affordable Care Act, including taxes on investment income, prescription drugs and indoor tanning.

23 million more Americans will be uninsured in 10 years.

The budget office projected that in 2018, the number of uninsured would increase to 41 million and would continue to grow. In 10 years, it would become closer to what it was before the Affordable Care Act, President Barack Obama’s signature health law, took effect.

Number of uninsured

People with Medicaid coverage would take the largest loss. In a decade, 14 million fewer people would be enrolled in the program.

The C.B.O. estimates that the increase in the number of uninsured would be disproportionately larger among older people with low incomes.

Cost of insurance could rise more than nine-fold for some older people with low incomes.

The House bill included last-minute amendments that let states seek changes to certain insurance regulations.

The C.B.O. estimates that premiums could go down about 10 to 30 percent for people in states that make moderate changes to these regulations. This is largely achieved by offering skimpier plans and pricing out the old and sick from the insurance market.

Senate leaders, aware of the criticism already leveled at the House bill, say they are writing their own bill. This analysis is likely to offer guidance in where they will and won’t want to go.

Read the complete articles in the New York Times here and here.

House Republicans reveal bill to repeal and replace Obama’s healthcare law


‘Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare,’ Paul Ryan said despite health advocates’ criticism of bill. Photograph: J Scott Applewhite/AP

American Health Care Act would shrink government role in healthcare and could leave more people without insurance despite Trump administration promises.

Called the American Health Care Act, the bill would eliminate the individual mandate, which required Americans to have health insurance or pay a fine; cut the number of people insured under Medicaid; and allow insurance companies to charge the elderly up to five times more than the young.

The bill would require insurers to cover so-called pre-existing conditions, but would allow them to add a 30% surcharge to premiums if people go without insurance for too long.

“The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance,” said House speaker Paul Ryan. “It protects young adults, patients with pre-existing conditions, and provides a stable transition so that no one has the rug pulled out from under them.

“Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare. This will proceed through a transparent process of regular order in full view of the public.”

But several Republican senators remained skeptical. Republicans have a 52-48 majority in the Senate. Assuming all Democrats hold firm in opposition to the Republican bill, three defections would be enough to deny Obamacare repeal a majority.

The legislation has not been fully scored by the congressional budget office and debate in the House will proceed without members having a clear accounting of the mechanics of implementing it. Senator Bill Cassidy of Louisiana, who has proposed his own Obamacare alternative, expressed skepticism about the lack of this information.

“What I would say is I would want to know the score, what is the coverage, what is the cost absolutely,” said the Louisiana Republican. He added that proceeding without this policy detail “seems problematic”. Cassidy added: “I am trying to be diplomatic.”

Other issues in the Senate for the House bill include the proposal to roll back the expansion of Medicaid under the Affordable Care Act. Four Republicans senators, Rob Portman of Ohio, Cory Gardner of Colorado, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska wrote publicly that they could not support the draft bill’s current provisions to eliminate the expansion of a program that provides healthcare to the working poor.

Read the complete article on The Guardian web site.