Surely you jest, I hear. I am aware the vast majority of my fellows derive their information regarding the American Health Care Act (AHCA) from sources other than the actual bill. I note it is especially prevalent to obtain information from sources which support one's preconceptions.
Please, allow me to share what H.R. 1628, the American Health Care Act of 2017 actually says.
First: "Subtitle B--Medicaid Program Enhancement ". When I use the term enhance I generally mean to intensify or increase in quality, value, power, etc; improve; augment. Here is how the term is used in the ACHA. "(Sec. 111) The bill amends title XIX (Medicaid) of the Social Security Act (SSAct) to limit the state option for a participating-provider hospital to preliminarily determine an individual's Medicaid eligibility for purposes of providing the individual with medical assistance during a presumptive eligibility period. The bill lowers, from 133% to 100% of the official poverty line, the minimum family-income threshold that a state may use to determine the Medicaid eligibility of children between the ages of 6 and 19. In addition, the bill reduces the Federal Medical Assistance Percentage (FMAP) for Medicaid home- and community-based attendant services and supports. "
Let's flesh that out. For a single person the federal poverty line is $12,060, for a party of 4 it is $24,600. Currently, Medicaid eligibility is determined to be a threshold income of 133% of the poverty line, $16.039.80 and $32,718 respectively. The new threshold for Medicaid eligibility will be 100% of the poverty line. That act will result in at least a few people losing access to medical care. Of course, a culling of the herd is occasionally necessary.
"Under current law, any alternative benefit plan offered by a state Medicaid program is required to provide specified essential health benefits. The bill eliminates this requirement beginning in 2020. ("Essential health benefits" include 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.) "
One would think that services identified as essential would be required. Let us not be so hasty. 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, all "essential" will not be required to be provided. I am confident that plans which don't provide these essential services will have substantially reduced premiums. It seems, though, if you don't require any of the services mentioned, you really have no need for medical insurance.
"In addition, the bill eliminates the requirement for up to three months of retroactive coverage under Medicaid. Under current law, a state Medicaid program must provide coverage for up to three months prior to an individual's application for benefits if the individual would have been eligible for benefits during that period."
'Cause let's face it, poor sick people are just a burden.
"Subtitle C--Per Capita Allotment for Medical Assistance
(Sec. 121) Under current law, state Medicaid programs are guaranteed federal matching funds for qualifying expenditures. The bill establishes limits on federal funding for state Medicaid programs beginning in FY2020. Specifically, the bill establishes targeted spending caps for each state, using a formula based on the state's FY2016 medical assistance expenditures in each enrollee category: (1) the elderly, (2) the blind and disabled, (3) children, (4) adults made newly eligible for Medicaid by PPACA, and (5) all other enrollees. With respect to a state that exceeds its targeted spending cap in a given fiscal year, the bill provides for reduced federal funding in the following fiscal year. In addition, the bill: (1) requires additional reporting and auditing of state data on medical assistance expenditures, and (2) temporarily increases the FMAP with respect to certain data reporting expenditures."
Just to clarify, if my state determines to provide care for the elderly, blind and disabled, children, et al., and exceeds a federally mandated maximum, not only will that excess amount not be matched by federal funds (fair enough) but the next year my state will be penalized with a reduction in federal funding. However, the administrative portion of the program will receive an increase in funding to ensure control of fraud and waste.
"(Sec. 133) Health insurers must increase premiums by 30% for one year for enrollees in the individual market who had a break in coverage of more than 62 days in the previous year. States with programs under this bill to provide financial assistance to high-risk individuals or stabilize health insurance premiums in the individual market and states participating in the Federal Invisible Risk Sharing Program may apply for a waiver to allow health insurers, for individuals with a break in coverage, to vary premiums based on an individual's health status instead of increasing premiums by 30%."
Let's all say "cha-ching". Well, maybe not all of us, especially those subject to a 30% premium increase. One of the largest complaints regarding the ACA is premium increases. Now, we have insurance companies not only allowed but required to increase premiums. How would you describe this? How about usurious, unconscionable, greedy?
"
(Sec. 134) Beginning in 2020, health insurance benefits no longer must conform to actuarial tiers (e.g., silver level benefits).
(Sec. 135) The bill increases the ratio by which health insurance premiums may vary by age, from a three to one ratio to a five to one ratio. This ratio may be preempted by states.
(Sec. 136) States may apply to the Department of Health and Human Services (HHS) for waivers to increase the ratio by which health insurance premiums may vary by age and to waive the requirement for insurance to cover the essential health benefits.
These waivers and the waiver to allow premiums to vary by health status do not apply to health plans offered through the CO-OP program, multi-state plans, plans the federal government makes available to members of Congress and their staff, or plans under PPACA provisions that allow state flexibility. "
Just to make clear, as an insurance provider I am no only constrained to a 3:1 variance in my premiums levied but can now exercise a 5:1 variance. You have to admire the success of the insurance lobby. They did fail to make this applicable to plans made available to members of Congress and their staff.
"(Sec. 204) This section repeals the penalties for individuals who are not covered by a health plan that provides at least minimum essential coverage (commonly referred to as the individual mandate). The repeal is effective for months beginning after December 31, 2015"
Who needs penalties when you have mandatory 30% premium increases?
"(Sec. 213) This section repeals the additional Medicare tax that is imposed on certain employees and self-employed individuals with wages or self-employment income above specified thresholds."
Yeah, 'cuz that 0.9% surcharge on wages over $200,000 was a burdensome tax.
"Subtitle B--Repeal of Certain Consumer Taxes
(Sec. 221) This section repeals the annual fee on branded prescription pharmaceutical manufacturers and importers.
(Sec. 222) This section repeals the annual fee imposed on certain health insurance providers based on market share."
These were consumer taxes only in the sense the cost was no doubt added to the product I purchased. By that reasoning, I should recognize a reduction in cost assuming this bill becomes law. How quickly do you think this will be noticeable?
"Subtitle D--Remuneration From Certain Insurers
(Sec. 241) The section repeals a provision that prohibits certain health insurance providers from deducting remuneration paid to an officer, director, or employee in excess of $500,000. "
Please, someone explain to me how this will have a positive affect on my access to and ability to afford health care.
That concludes my summary of the AHCA. However, as a bonus, here's some comment from the Congressional Budget Office. CBO and JCT estimate that enacting the American Health Care Act would reduce federal deficits by $119 billion over the coming decade and increase the number of people who are uninsured by 23 million in 2026 relative to current law. 03/23/2017
As posted on the website of the House Committee on Rules on March 22, 2017, incorporating manager’s amendments 4, 5, 24, and 25.
No doubt reducing the deficit by any amount is a good thing. It's just an added benefit when you can do it on the backs of the sick, poor, uneducated, weak, disabled, young, elderly and disenfranchised. Surely we can find more than 23,000,000 million of them.
Whaduyathink?
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