Yeah, but can I keep my doctor? | FRAY 005 Health Care Alert

What is the AHCA and what does it do? A six minute brief on both sides of the issue.

A New Proposal For Health Care In America

Congressional Republicans officially released their plan to repeal and replace Obamacare. The American Health Care Act (AHCA) would usher in big changes to health care for millions of Americans. President Obama’s famous promise for the Affordable Care Act (ACA), “if you like your doctor, you’ll be able to keep your doctor,” was later judged to be Politifact’s 2013 Lie of the Year. President Trump now says “this is the time we’re going to get it done.” Will the AHCA fulfill his promise? How will the AHCA affect you?

Today, we explore the nuts and bolts of the bill and our writers discuss its possible effects on health care. First, here’s a high-level look at how the AHCA contrasts with its predecessor, the ACA.

For the private insurance market, the AHCA proposal seeks to:

• Rescind individual and employer mandates (Ways & Means Committee, Secs. _05 & _06).
• Allow insurance companies to add a 30% surcharge for one year when selling a plan to individuals uninsured for more than 63 days in the previous year, beginning in 2019 (Energy & Commerce Committee, Subtitle D, Sec. 133).
• Replace ACA subsidies with tax credits based on age for uninsured individuals with yearly income under $75,000 (if filing individually) or $150,000 (if married filing jointly). The credits may not be used to pay for any plan covering abortion care (W&M, Sec. _15).
• Create a $15 billion annual fund available for state-led efforts to stabilize the market or lower patient costs (especially for high-risk or very sick patients) (E&C Subtitle D, Sec. 132).
• Repeal most ACA taxes, including the premium tax credit, small business tax credit, tanning tax, medical device tax, health savings account tax, Medicare Hospital Insurance tax, and net investment tax, all effective in 2020 (W&M, throughout).
• Delay the ACA’s tax on “Cadillac” plans until 2025 (currently scheduled for 2020) (W&M, Sec. _07).
• Change the ACA-mandated charging limit for older adults (3x the premium of younger people) to 5x the premium of younger people (E&C Subtitle D, Sec. 135).

For the Medicaid program, the AHCA proposal seeks to:

• Restructure Medicaid to place per-capita limits on federal funding starting in 2020. This creates a ceiling on Medicaid spending for each state based on the number of past enrollees (E&C, Subtitle C, Sec. 121).
• End Medicaid expansion, effective in 2020. Allow states to enroll new people in the expansion program through 2019. Those insured under the expansion may remain in the program after 2020, so long as they do not have a break in eligibility (E&C, Subtitle B, Sec. 112).
• Stop requiring Medicaid programs to provide the same essential health benefits as exchange plans, effective in 2020 (E&C Subtitle B, Sec. 112(c)).
• Eliminate federal funding for Planned Parenthood by freezing Medicaid payments to clinics for all services for one year (beginning upon passage) (E&C, Subtitle A, Sec. 103).
• Change Medicaid eligibility standards to disallow lottery winners, repeal retroactive eligibility (three months prior to application), and eliminate interim coverage for immigrants still collecting documentation (E&C Subtitle B, Sec. 114).

The bill was released on March 6, kicking off a Congressional debate on health care:

• On March 8, two House committees, Ways & Means and Energy & Commerce, met to review and amend the bill (NPR).
• The bill does not yet have a cost report and score from the nonpartisan Congressional Budget Office (CBO). Committee Democrats objected to the lack of a cost report during markups. Senate Majority Leader Mitch McConnell also called for the process to wait for a CBO score (Washington Post).
• Both House committees approved the bill, without change and along party lines, after marathon sessions lasting through Wednesday night into Thursday. Trump also met with concerned conservative leaders (CNN).
• Several influential conservative leaders believe that the AHCA does not go far enough to undo Obamacare. They question the accelerated pace for this process and ask for additional unspecified changes regarding Medicaid expansion and proposed tax credits, fearing that the AHCA amounts to a new entitlement program (Washington Post).

And that’s where we stand today. Now we ask our opinion writers to react to the AHCA.

CONSERVATIVE OPINION

by Kevin Hedrick

For the past eight years, Obamacare has been central to every federal election. The ACA was so repugnant that it inspired the Tea Party movement and put a major halt to President Obama’s agenda. GOP leadership made it clear that the only barrier to repeal was a Democratic president.

Conservatives have long held that what ails our health care system is too much government manipulation. Heavy government manipulation is the opposite of the consumer-driven economics that most conservatives believe increases competition and lowers costs. You have not experienced consumer-driven health care in the United States unless you’ve opted for elective procedures such as LASIK surgery. With Obamacare, the level of manipulation increased significantly, most notably by mandating consumer activity. Obamacare has not delivered on its two main promises: lower costs and coverage for everyone.

Speaker Ryan’s AHCA bill does not represent conservative principles. Except for giving states more flexibility and not funding care at Planned Parenthood, the AHCA and Obamacare are practically the same: same subsidies, same individual mandate, and same big spending. Senator Rand Paul is right to call this “Obamacare Lite.”

A 2015 Obamacare repeal attempt, HR 3762, was the practice run for a reconciliation repeal bill. That bill adhered to the Byrd Rule and more completely dismantled Obamacare than the AHCA would. There are other bills this session offering repeal, including S. 106 ObamaCare Repeal Act and S. 222 Obamacare Replacement Act. Rather than pushing through any bill that can pass a simple majority, Congress owes it to the American people to have a substantial debate on health care and what the government’s true role should be.

PROGRESSIVE OPINION

by Alexis Cole

Government has a moral imperative to protect the health of its citizens.

Ensuring universal access to affordable, high-quality health care — a right declared by the World Health Organization and supported by the Universal Declaration of Human Rights (UDHR) — is an obligation of all UDHR adoptees, including the United States.

The Affordable Care Act (ACA), the result of a year-long legislative process of debate and compromise, was a big step forward in access to care. Now, Republicans want to gut the ACA through a wholly partisan, secretive effort to fast-track legislation that even conservatives don’t support. Rather than offer meaningful reform, the GOP proposes a massive tax cut for the wealthy at the expense of Medicaid and reproductive care.

The GOP plan directly attacks our poorest citizens. It would decimate Medicaid, which currently serves over 70 million Americans, by ending expansion and shifting to per capita federal funding. After pushing millions out of Medicaid, the plan further destroys the safety net by defunding Planned Parenthood. In many areas, Planned Parenthood is the only preventive care provider available for already vulnerable populations, like people of color, the LGBTQ community, and young people.

After these attacks on health care, the plan is primarily a massive tax cut for the wealthy disguised as “health reform.” It redistributes $600 billion to the wealthiest Americans. Among the cuts is a crushing blow to Medicare, speeding its insolvency. The plan breaks many promises made by President Trump, such as not touching Medicare or Medicaid and providing “insurance for everybody.” Instead, this proposal only serves the healthy and wealthy, while reducing coverage, weakening protections, and increasing costs for everyone else.

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