The GOP Healthcare Bill

[Love Mountain]

The GOP introduced a healthcare bill and Donald Trump seems likely to sign it.
Here's an easy link to download the full text of the bill.

The Republicans call it the American Health Care Act. What does it do?

1. Changes in Medicaid

• Medicaid expansion is a state option. Eliminates options to extend coverage to adults above 133% after December 31st, 2019. Eliminates the ACA enhanced Medicaid match rates.
• Medicaid financing is converted to a per capita cap in 2020. (This is a huge change. Will cover more later)
• Repeals Medicaid Disproportionate Share Hospital (DSH) cost cuts (originally introduced in ACA).
• Provides $10 billion over 5 years (2018-2022) to non-expansion states for safety-net funding.

2. Changes the structure of subsidies.
3. Does away with the individual mandate, but replaces it with a penalty by forcing higher premiums when you buy coverage again.
4. Axes the taxes on the rich that were introduced to pay for the ACA.
5. Strips federal funding for Planned Parenthood.

I'll update this post as I read the actual text of the bill. Sorry, but between work, pleasure, family, and the wifey I didn't have the time to immediately read the 60 pages. Or the massive amount of condensed information already published by think tanks, media, or the like. As I get more information I'll update this OP.

Trump supports this bill
Rand Paul hates it
Will this pass? Will it not? I'm not sure.
Here's an interactive tool from the Kaiser Family Foundation, a non-partisan think-tank that specializes in healthcare, that lets you compare the American Health Care Act[AHCA] to the Affordable Care Act[ACA] and some other proposals made over the years.
Here's an interactive USA county map showing who would get larger tax credits under the AHCA vs the ACA.
CBO Report now up

I want this thread to be entirely focused on discussion of healthcare reform. I understand that there are politics involved and talking about them is unavoidable, but please make efforts on relating this to the healthcare debate. I'll try to respond to good points raised, but if it's a low-effort partisan rant, I'm gonna ignore it.

Edit: Apologies, I know I said I'd keep this updated, but a pile of work that I've been procrastinating is finally becoming due. Q1 is coming to a close and I've been severely procrastinating on my reporting. Between staying up late smashing games and going to work in the morning I don't have as much space for doing a lot of the nitty-gritty, but I haven't given up on this yet.

[Prodromos]

Will this thread be for discussing health care in general, including comparisons to other countries, or just for this specific bill?

Anyway I'm highly against it. Rather than get the government out of health care, these Republicans think they can run government health care better than Democrats can. Bush redux.

[Love Mountain]

Will this thread be for discussing health care in general, including comparisons to other countries, or just for this particular bill?

It's an open field.

Anyway I'm highly against it. Rather than get the government out of health care, these Republicans think they can run government health care better than Democrats can. Bush redux.

This is exactly it. There is a case to be made for free market healthcare. Not in my opinion, but I'm not an academic and many academics certainly think free market healthcare is feasible. However, the Republicans are trying to pass Obamacare Lite. Idealists like Rand Paul will lambast it and say it doesn't go far enough. Liberals will mock Republicans for demonizing Obamacare but doing a version of it once they had the power. So far I don't see anything but a total loss for Republicans. A net loss almost for sure, but I haven't read the bill fully yet so who knows? Maybe there is something redeemable here.

[RangerGxi]

This is exactly it.

The Republicans have a problem. Obamacare is hated but much of what makes up Obamacare is universally loved by the American people.

https://www.nytimes.com/2017/02/07/u...-the-same.html

[swabian]

*snort* do tell

[Love Mountain]

*snort* do tell

There's a link in the OP to do just that. Click on the interactive tool to compare the ACA to everything else. It has a nice table that lists the talking points of the ACA.

The Republicans have a problem. Obamacare is hated but much of what makes up Obamacare is universally loved by the American people.

https://www.nytimes.com/2017/02/07/u...-the-same.html

Universally is quite a bit of a stretch. I also highly doubt that most people even understand the things the ACA does, nevermind how it does it. Even I don't know everything about the ACA.

[swabian]

Yeah, sure. Thanks for the hint

[empr guy]

It's a total turd, no way McConnell/Ryan even want to get it passed. It's going to gut medicaid and medicare right in time for 2020, and is being attacked by every other political group (Including AARP, possibly the most powerful lobbying group in the country) already before the inevitably awful CBO score comes out. It's a watered down ACA except it's going to cost more and cover less, nobody is happy with it. I'd bet the plan is to withdraw this eventually and lament how their brave repeal and replace was blocked and they couldn't do anything about it.

Sukiyama's summary isn't bad, so I'll just add a few things;

The premium increase is 30% for one year if you're not covered for 2 months. So the government is going to force private companies to increase prices for certain customers ( on what legal basis?), I haven't seen how is this not going to completely screw people applying to jobs that cover insurance.

They want to replace subsidies with tax credits based on age instead of income, which not only makes no sense but now people who can't afford healthcare are expected to pay out of pocket until those credits arrive (and are payable to insurance companies anyways), why not just keep lower subsidies?

They removed funding from plans that cover abortion, (a nice partisan jab), and don't require plans to offer certain things like the ACA did which isn't fundamentally bad. The example that always comes up is the 60 year old woman paying for maternity leave coverage, safe to say she won't be using it and could save some money. I'm not a healthcare expert but I'd think cutting the required health benefits from 10 to a smaller number would be better then just letting companies offer whatever. I've only ever seen no requirments advocated by people that want Americans to buy plans that cover very little so insured stats go up.

Want to charge seniors ~25% more, which is what attracted AARP's ire. (currently seniors can be charged 3x more then youth, new plan wants to charge 5x) The idea here is that seniors use up more medical resources so they would get price gouged if there were no limits, now prices for them go down while rising for younger people. It's hard to say where the sweet spot is for pricing ratios, but that combined with medicare cuts and reduced subsidies would be really nasty.

Obligatory tax breaks and benefits for the rich and wealthy (especially insurance company CEO's) while phasing out funding for high risk pools, in addition to cutting medicaid, which is going to take away healthcare from millions of people.

[tgoodenow]

I've only found information online (haven't read the bill) but I haven't seen any information addressing some of the main fixable cost drivers for insurance plans. Specifically, exorbitant profits by big pharmacy companies, fraudulent lawsuits against doctors, use of emergency medicaid by illegals leading to unnecessarily long stays in hospitals when other solutions should be available, competition across state lines, and other wastes in the system.

This just looks like Obamacare lite with no real solutions and can kicking to me.

[Derpy Hooves]

I personally like the sound of Rand Paul's plan, specifically the point about people forming healthcare associations so they can do collective bargaining. It seems to have worked before, but apparently those were gutted by regulations, monopolies, and collusion

[Elfdude]

Collective bargaining with healthcare was seen as anti-free market and the only things like it were gutted by conservatives.

With regards to this bill I find it astonishing that a revenue neutral or deficit reducing law (affordable care act) is being lauded as worse than a law which will increase the deficit and insure less people all in the name of giving the rich more money. I hope those poor and middle class republicans love giving the rich more money because this is exactly what it does.

[Derpy Hooves]

@elf, tell me more, I am genuinely interested. If collective bargaining is done privately, I don't see how it would be anti-free market.

[RedGuard]

Seems like an attempt to put a bandaid on a leaky dam. Ryan and McConnel know this wont be passed. But they can try and pass a unpassable bill and have it fail and then look back and say "See...we tried to fix Obamacare." Then they'll try and pass a repeal with a narrow majority and it wont pass the house. Then the law will just fall apart which will be the same as repealing it. Only this will result in a cataclysmic loss for the Republicans in 2018, because a sizeable chunk of that 20 million, vote.

Its crazy after 8 years the Republicans have come out with this document.

[Elfdude]

@elf, tell me more, I am genuinely interested. If collective bargaining is done privately, I don't see how it would be anti-free market.

https://en.wikipedia.org/wiki/McCarr...93Ferguson_Act

Head down the rabbit hole there. Antitrust exemptions for insurers are a bit frustrating to be honest, has a lot to do with the cost of healthcare.

[Derpy Hooves]

Well I am generally pro-anti-trust.

[ABH2]

The only silver lining here is that it took the Dems a year to cobble together the ACA and it required massive bribes to get their own party to go along with it. So, there's still hope something better will come along.

But what's being suggested here is pretty awful. The only slight positive is doing away with the the individual mandate...but only to replace it with mandatory rate hikes. This is simply not what any of these clowns promised the electorate that put them into power. It's a combination of abject cowardice from people who live inside the DC bubble and believe the that the NYT's and CNN publish.

The Republican plan makes even less sense than the ACA economically. It's even more 'free unicorn' than what the Dems tried to sell.

[RedGuard]

But what's being suggested here is pretty awful. The only slight positive is doing away with the the individual mandate...but only to replace it with mandatory rate hikes. This is simply not what any of these clowns promised the electorate that put them into power. It's a combination of abject cowardice from people who live inside the DC bubble and believe the that the NYT's and CNN publish.

What did you really expect the President's plan to be? What did you think the Republicans were going to offer? They've never had a plan for healthcare. How does a party that literally wants to pay for nothing but the military and police come up with a plan that would replace a 3.5 trillion dollar law. I think the people deluding themselves into thinking that Trump would actually fix the ACA are worse than those that see no wrong with the ACA. The only thing Republicans can ever agree on is rolling back government programs not implementing them.

[ABH2]

I think the people deluding themselves into thinking that Trump would actually fix the ACA are worse than those that see no wrong with the ACA. The only thing Republicans can ever agree on is rolling back government programs not implementing them.

You seem to operate with the ingrained assumption that healthcare needs to be a government program of some kind. Returning to a time before the ACA would be better. Ideally, they'd go with something like Paul's plan or something that removes even more barriers to competition and things that would lift the artificial limits on the supply of healthcare in this country. The Republicans have had competing healthcare reforms on the table for 8 years with the only issue being that they never seriously formed any consensus.

A more free market will never provide universal coverage. But government getting out of the way can and will lower healthcare costs. And one of the dirty secrets that no one wants to acknowledge is that there are plenty of Americans who don't want health insurance to begin with and many have legitimate reasons for that. And many more do not want nationalized healthcare or single payer. They don't want Trumpcare anymore than they want Obamacare. If the Republicans were half as radical and ideological and extreme as they've been painted by the hostile media over the last 8 years, they'd have acknowledged this and actually offered up a market based system. Not more regulation and entitlements.

This is a rare instance when I'm in agreement with the critiques provided by the progressive posters here. This is the Republicans trying their hand at managing the market and creating more government largesse.

It's also wrong to say that the Republicans are any less divided on this than the Dems were. Obama insisted and promised single payer and couldn't even get the Dems on board with that. He had to offer a lot of pork barrel spending to get his own party on board with the ACA act. Not to mention employ a parliamentary trick to pass it. It was only after the fact that they all pretended to love the thing, and they had little choice in the matter. They had to own it.

I also don't think you can call this the 'President's' plan. Trump quite clearly isn't a policy guy and I've seen nothing to indicate his fingerprints are on this much, though he's now endorsed it. My guess is that Trump simply cares about passing something so he can check the box. A bit like Obama, really.

Regardless, this Republican plan is unworkable and will be a disaster if it were actually implemented.

[RedGuard]

Paul's plan is even worse, giving people free tax money anywhere from Jan 31st( the date by which all W-2s must be mailed) to February 27th(the day you are likely to receive your refund per the IRS website), 30 days too late for open enrollment season. Not to mention millions of people who need healthcare most owe the IRS back taxes and the 5,000 dollars would just go to paying the government again, otherwise it is literally free money.

300-1400 dollars a month based on income from the government to help pay for healthcare would be a lot more helpful than a year end tax credit.

[ABH2]

300-1400 dollars a month based on income from the government to help pay for healthcare would be a lot more helpful than a year end tax credit.

Yes...this is called an entitlement. As opposed to Paul's tax credits which allow people to get their own money spent back. Which is what the Paul bill sought to avoid. The creation of a new one. Paul's plan is flawed, but if you are looking for a more market based solution to healthcare, it's the best brought to the table at the moment. If you aren't looking for that, you won't like it.

Beyond that, it's highly unlikely we'll see the feds implement simple healthcare vouchers anytime soon. That's not how things work in Washington. Like most of what they do, they desire bureaucracy and they desire to disconnect voters from the price of their own decisions. Someone isn't going to just get some cash to pay their premiums. We're going to get federal funds subsidizing and driving up the cost of healthcare further.

Not to mention millions of people who need healthcare most owe the IRS back taxes and the 5,000 dollars would just go to paying the government again, otherwise it is literally free money.

I'm legitimately interested in the basis for this claim.