Posted on 02/24/2017 1:06:42 PM PST by SeekAndFind
Politico reports today that a leaked draft of the GOP’s Obamacare replacement plan shows the House is not fiddling around the edges but moving toward full repeal and replacement of the law.
The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high-risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020.
The replacement plan would have no individual mandate. Instead, there would be a penalty of 30% for those who fail to maintain coverage. So people who wait until they get sick to sign up, as has been happening under Obamacare, will pay more. In place of the subsidies, the new plan would offer people tax credits of $2,000, with people over 60 getting double that amount. As for Medicaid expansion, states would have the option to continue it but federal support would end by 2020.
All of this is still going to cost a lot of money. The plan to cover those costs boils down to something similar to the Cadillac tax:
According to the document, there’s only one single revenue generator to pay for the new tax credits and grants. Republicans are proposing to cap the tax exemption for employer sponsored insurance at the 90th percentile of current premiums. That means benefits beyond that level would be taxed.
And while health care economists on both sides of the aisle favor tax-limits along those lines, politically it’s a hard sell. Both businesses and unions fought the Obamacare counterpart, dubbed the Cadillac tax.
The devil is in the details with proposals like this. The insidious part of the Cadillac tax was that it was designed to gradually ratchet down and eliminate the tax exemption for all employer sponsored insurance. We’ll see whether the GOP proposal has a similar design.
But if the GOP does anything close to what is described above then former Speaker Boehner was wrong when he suggested yesterday that the GOP would only wind up fixing Obamacare rather than repealing and replacing it. Removing the mandate and the subsidies ends the structure of the exchanges. I suspected the GOP might do that and then leave Medicaid expansion in place, but it sounds like they are going to end federal support for that as well. So this is not shaping up to be a repeal in name only.
Politico notes that the document is still preliminary since the GOP is waiting on scoring from the Congressional Budget Office. Depending what that scoring looks like, the shape of the replacement bill could still change significantly.
My thoughts exactly
Without getting the cost end of the equation under control, anything that replaces Obamacare is going to be hideously expensive, too. The way they bill with the sneaky out of network specialists that you’ve never heard of, procedures that were never requested, it’s totally out of control. Add in masses of people who are not going to pay meaning that those who do have to foot the bill and it’s going to be expensive. The entire medical industry is inflated beyond all reason because of this. Aging boomers with full coverage aren’t going to be around a whole lot longer, that’s what they’re hanging their hats on as it stands. There’s a collapse coming. Better get on top of it now. Later generations are as a whole not nearly the cash cow and are in no mood to get nailed.
Any mandate or penalty is unconstitutional and hampers the market. The federal government has no business in the field of Medicine or in the field of Insurance. Efficiency and access will increase directly with government withdrawal.
sounds like Tom Prices plan.
Wait till they start taxing your healthcare insurance to fund it. Then we'll see how good you think it is.
We have those clinics, they’re called community clinics and funded by a combination of local, state, and federal funding, plus charitable contributions. They’re the most cost effective way of providing primary care to the poor, and they get like no publicity.
Unfortunately, we also have a law, left over from the days when our cultural norm was that you only went to emergency rooms in an emergency, that requires an ER to treat anyone who shows up with anything without cost when they can’t pay for it. If that legislation doesn’t get narrowed down and liability limited so an ER can offer a 24 hour “drug store-type” low cost primary care office and refer those with the sniffles to it, health care costs are not going to be reduced.
It is unconstitutional. Being a citizen of the US doesn’t require a tax to be paid to the marble walls of government.
I think the pre-existing condition problem stems from the non portability of work based coverage. if you lose your job and try to get insurance with a condition, the plan may not cover your current issues. people will wait and not sign up until sick is not a pre-existing condition per se but should be handled by a risk pool. I think car insurance puts you in a high risk pool initially if you haven’t had it for a period of time
As soon as there are people who opt for first-aid type health care combined with boosting their immune systems and a healthy lifestyle, the market will respond. I'd wager that after ten years or so of that option, people who choose it would be just as healthy as those who choose to be slaves to the health care -insurance - big gov "solutions".
That person who loses their job and has a pre-existing condition would have to sign up for the government policy to be immediately covered.
Sorry, but I LIKE THE PLAN. In a perfect world, the federal government would be limited to the military, border protection, and federal courts - roughly 20% of what the government spends now.
...and Republicans would be lucky to come in ahead of the Green Party in the 2020 Presidential election.
In the REAL WORLD we need to pull out of Obamacare in a way that will not make Trump hated by 95% of the country (50% is bad enough)...and I think this goes a long way towards that goal.
30% of what?
The new way if you did not have health insurance by employer or other means.... you have a window of time to buy something..... if you don’t ... if you try to get insurance at a later time there’s a 30% penalty in cost increase...
So like car Insurance you been driving around without car insurance when you do get it you might get nailed with a premium penalty for the fact that you were driving uninsured
This I guess would allow you that if you were between jobs and you don’t have health insurance you can wait till you get your new insurance of your new job
If you reject part “B” or part “D” Medicare when it is first available to you then you pay more for it when you do take it. The penalty is Constitutional.
Interstate competition is needed, too.
That is not so much a penalty as a result of you being older and therefore probably more expensive. That is a penalty the way a rise in price for McDonald’s hamburgers is a penalty and the buying of Part B or D is a voluntary action. You don’t have to pay if you don’t buy the service.
That is not so much a penalty as a result of you being older and therefore probably more expensive. That is a penalty the way a rise in price for McDonald’s hamburgers is a penalty and the buying of Part B or D is a voluntary action. You don’t have to pay if you don’t buy the service.
Free Market.
Tort Reform.
Do not allow drug or instrument companies to pay doctors.
No foreign degrees accepted except from select first world countries.
Publicly elected medical boards.
Publicly elected state bar association disciplinary committees.
Drain the swamp.
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What’s the problem with those who refuse to contribute to the insurance pool being charged more when they show up demanding to use it? The alternatives are pre-existing condition exclusion, the current mandate system, or forcing the rest of us to pay the costs of the irresponsible. Those claims paying pools don’t fill themselves.
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Means user pays, in instances as you suggest. Any further subsidies should come from charity, not the point of a gun.
Else, false dichotomy. Get govt OUT entirely. All the way down to allowing hospitals to kick out the non-ER, sue for payment, etc....then the ‘rest of us’ don’t need worry about picking up the tab.
Pre-existing != ‘insurance’. Risk pools, charity, etc. but let’s not conflate the two.
Politico posted the bill. This bill will do absolutely nothing to reduce health care costs.
Your system’s fine, except you need to make a decision about those who choose not to buy insurance, then suddenly need health care but can’t afford it. Care is provided by people, and those people are entitled to be paid for their services, so you can either stick the taxpayers with the cost for it, indenture the family, or leave the guy laying in the gutter.
The last option’s a hard sell, so the most likely solution for that situation is some combination of charity and teaching hospitals, which was the foundation for Medicaid back in the day.
Maybe you could build in a low cost catastrophic policy that those who chose to go the first-aid route could buy. They’d have to get really sick to use it, but it’d keep them out of the county hospital if something really expensive happened.
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