Tuesday, May 9, 2017

Healthcare & now what ?

In an interview on "This Week," Stephanopoulos asked the speaker why the AHCA, House Republicans' replacement for President Barack Obama's Affordable Care Act, (1)>>would allow states to opt out of mandating insurers not raise costs for Americans with preexisting conditions. As legislation to dramatically overhaul the Affordable Care Act neared a vote in the Republican-controlled U.S. House of Representatives, critics said that Speaker Paul Ryan, R-Wis., was hypocritical in how he brought a revised bill to the floor. In March, a bill known as the American Health Care Act was pulled from the floor by GOP leaders because it didn’t have enough votes to pass. That was considered a major defeat for both congressional Republicans and President Donald Trump, who had campaigned on the repeal and replacement of President Barack Obama’s far-reaching health care law.George Stephanopoulos grilled House Speaker Paul Ryan on Sunday over the American Health Care Act, which narrowly passed the House of Representatives on Thursday.The version of the AHCA that passed in the House included an amendment that gives states the option to waive out of the Obamacare mandate that prevents people from preexisting health conditions from being charged higher coverage prices. The bill now heads to the Senate, and it is unclear if that amendment will remain.When Stephanopoulos pointed out that even if the AHCA didn't take away coverage from those with preexisting conditions, it enabled insurers to charge them more, Ryan countered that such provisions wouldn't apply to people who retained continuous coverage — or coverage without any gaps — to which Stephanopoulos noted that people often lose coverage, and its not their personal choice. Ryan responded that the state programs that receive the waiver would sufficiently cover people with pre-existing conditions. 
Just "how" bad is it when you compare Obamacare?
The New Version of the Healthcare Bill is not anything new . Its a watered down " revision" of the AHCA . If you all recollect that original bill passed in 2009 had over 3000 pages of legislation . The Democrats pushed it trough without any consideration . Obviously President Obama did not know what was in the law since he told the public that (2)>>"YOU CAN KEEP YOUR DOCTOR" . Sometimes history repeats its self .Well that didn't take very long. The cases of celebratory beer were still slightly chilled when the Cook Report delivered some very bad news.  The Cook Report does say out that 18 months is a very long time in politics and a lot can happen in between now and November 2018 but it's worth noting that this swing is before the public really knows what's in this bill. Republicans made sure to hide it as long as possible and ram it through as quickly as possible to avoid scrutiny.  AARP, an organization representing millions of older Americans sent a letter sent to members of Congress prior to the U.S. House vote on the American Health Care Act Thursday, executive vice president and chief advocacy officer Nancy LeaMond said the legislation would be a step backward in the health care reform debate and could result in higher premiums or a loss of health care for many older Americans. The group was critical of the amendment put forward by Michigan Congressman Fred Upton, R-St. Joseph, that would add $8 billion over five years to assist those with pre-existing conditions in states that seek waivers under the Republican health care plan as currently proposed. The Republicans never had the 60-vote majority in the Senate to completely repeal the Affordable Care Act. Instead, they used a budget reconciliation bill to dismantle the spending and revenue portions of the ACA. They tried to repeal the middle-class subsidies, end the Medicaid expansion, eliminate Obamacare taxes and abolish the individual mandate. If the bill does not add to the debt over the next 100 years, it only needs a 51-vote majority to pass.The AHCA does not remove many non-budgetary elements of Obamacare. These include lifetime and annual limits on coverage and limits on annual out-of-pocket costs.President Trump had backed the bill on March 6 to replace ObamacareThe bill would also strip $880 billion for Medicaid — part of an effort to phase out the very Medicaid expansion under Obamacare that helped millions of people get healthcare — which House Speaker Paul Ryan has said would allow states to determine their own Medicaid needs without "micromanaging" from the federal government,That, however, would only shift the burden of costs for people on the federal Medicaid rolls elsewhere — or leave those people without insurance entirely. FOR those of us who have (3)>"EMPLOYER BASED INSURANCE " . I would howl .  As the Wall Street Journal reports, some policy experts are concerned that the House Republican bill would allow large employers to offer benefits in line with the requirements in any state — including states that choose to make their benefit standards skimpier under Trumpcare. Among the 24 million people the Congressional Budget Office predicts could lose their health insurance under the House Trumpcare proposal are 7 million who currently have insurance provided by their employer. The CBO predicts that more employees would choose to forego coverage and boost their paychecks, which would make it harder for employers to keep offering plans.  The ripple effects would be massive. Whether you're on private health insurance, Medicare, or Medicaid, this bill would have an impact. There's no way the nation's healthcare system could not be sent into turmoil when 24 million people lose coverage and care. Because of the Medicaid cuts and the erosion of Medicare that includes, we could end up in an even worse crisis than we were in before Obamacare passed. Employers provide insurance for several reasons.  It is a way to provide tax-free benefits, thus a dollar of insurance is move valuable to an employee than an extra dollar of pay.  For many employers offering insurance is require in order to attract workers to join the company.  It is also part of keeping their workforce healthy and available to work.   It is probably pretty rare for a company to give cash in-lieu of taking insurance for the same reason the mandate exists.  Healthy employees would drop out leaving only the older and chronic employees in the pool and resulting in much higher premiums.   In the end the problem for employers is the same as the rest of us.  Healthcare costs have been rising much faster than inflation, meaning that this benefit is becoming a larger and larger percentage of employee compensation.  The result has been the same as what has happened on the exchanges.  Higher deductibles and out-of-pockets, greater cost sharing for employees, etc.  At some point employers will cry uncle and stop offering this benefit.  Trumpcare will just speed up the day that this happens.

We can defeat it in the Senate, if you call the Capitol Hill switchboard at (202) 224-3121 and contact your Senators.

(1)>>would allow states to opt out of mandating insurers not raise costs for Americans with preexisting conditions. The CBO had reviewed the original bill, and in doing so, it found that the measure would lead to an additional 24 million Americans being uninsured by 2026, compared to the number who would be uninsured if the current law was still in force.Critics said Ryan and House Republicans were hypocritical for voting on a new version without a new CBO score, and they pointed to Ryan’s past comments as evidence. (2)>>"YOU CAN KEEP YOUR DOCTOR" . The BEST President Obama flub . It's also notoriously equated with George W Bush I's " Read MY LIPS NO NEW TAXES" . PRESIDENT BARACK OBAMA: "So let me begin by saying this to you and to the American people: I know that there are millions of Americans who are content with their health care coverage; they like their plan and, most importantly, they value their relationship with their doctor. They trust you. And that means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what. My view is that health care reform should be guided by a simple principle: Fix what's broken and build on what works. And that's what we intend to do." (President Barack Obama, Remarks To The American Medical Association National Conference , Chicago, IL, 6/15/09). (3)>"EMPLOYER BASED INSURANCE ". So big employers — which are typically always looking to lower the cost of providing health care — could choose the most lenient state-level standards to make their overhead costs cheaper.  Under the House bill, large employers could choose the benefit requirements from any state—including those that are allowed to lower their benchmarks under a waiver, health analysts said. By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation [Stephanie Armour and Michelle Hackman, “GOP Health Bill Jeopardizes Out-of-Pocket Caps in Employer Plans,” Wall Street Journal, 2017.05.04].

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