ACHA review

Here are a few lowlights of the AHCA Congressional Budget Office score. I’ll try to keep this non-technical.

  • Medicaid is still getting changed from an entitlement that is responsive to changing needs to a block grant
  • 23 million people will lose coverage compared to current law projections
  • The MacArthur/Upton waivers are expected to destroy the individual markets that cover 15% of the country
  • Most of the premium decreases are due to older and sicker people being priced out of the market
    • Real easy to have low premiums when you don’t cover anyone who is likely to need services
  • Pre-existing condition protection is effectively destroyed by splitting the risk pool.

Relevant tweets below the fold:
Read more



Medicaid in the President’s budget request

The Department of Health and Human Services accidentally leaked their own budget this evening. Bob Herman at Axios saved a copy. The biggest aspect of the budget is it laid out another $600 billion dollars in cuts to Medicaid and CHIP over ten years in addition to the $820 billion in Medicaid cuts in the AHCA.

Between these two documents Medicaid would lose 47% of its federal funding over a decade.

Loren Adler at Brookings thinks the cuts would be to tie the AHCA block grants to no more than inflation rate growth without regard to population or case mixture. As the Baby Boomers retire, more of them will require nursing home care that is currently paid for by Medicaid but there would be no federal money.

This is a budget wishlist that pits old people versus kids, the disabled against the pregnant and state budgets against upper income tax cuts in the federal budget.

Call Congress and give them an earful.



Call and visit Congress today

The vote for the AHCA in the House is scheduled for sometime around 1:00pm today.

Call your Congressional office today.

If you are in the DC Area there is a protest at the Hill at noon time.

If you are out and about, see if you can visit your Congressional district office to let them know that a vote for the AHCA will result in their names added to an Arya Starkesque mantra.



The Republican Health Care Plan: ER’s For The Poor

In their ongoing effort to make America sicker and to ensure that more Americans die before their time, Trump and his Republican party have decided to spend more money to cover fewer people less well in Florida:

The shift involves funding that the federal government provides to help hospitals defray the cost of caring for low-income people who are uninsured. Under a deal with the State of Florida, the federal government has tentatively agreed to provide additional money for the state’s “low-income pool,” in a reversal of the previous administration’s policy.

The Obama administration balked at providing more money to help hospitals cope with the costs of “uncompensated care” for people who could be covered by Medicaid. If Florida expanded Medicaid eligibility, the Obama administration said, fewer people would be uninsured, and hospitals would have less uncompensated care.

This is, of course, not a health care policy. It’s simply the latest accomplishment in the fundamental goal of Republican politics since 2009:  anything the Black guy did must be undone.

“Florida is just being paid by taxpayers not to expand Medicaid,” said Andrew M. Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services from March 2015 to January of this year. “The low-income pool is essentially a slush fund,” Mr. Slavitt said, “and it’s a really inefficient way to pay for medical care.”

But hey, maybe it could it work, right?

Come on! This is the Florida Republican establishment we’re talking here.  If it ain’t nailed down, it’s getting stolen:

Two House Democrats from Florida, Debbie Wasserman Schultz and Kathy Castor, said that after receiving the commitment of federal funds, the Florida Legislature was now moving to adopt a budget that includes cuts in state Medicaid spending. “It’s outrageously irresponsible,” Ms. Wasserman Schultz said.

Ms. Castor said that “it would be more efficient to expand Medicaid so people would have coverage, rather than running up huge bills at hospitals that need to seek reimbursement from the low-income pool.”

Ladles and Jellyspoons:  your modern Republican party.  It’s better to pay more money to achieve less than it is just to make government work with the tools it has.  There is no compromise with these folks.

Ni shagu nazad!

Image: Sebastian Vrancz, Soldiers plundering a farm during the Thirty Years’ War, 1620

ETA:  Sorry, David, for poaching on your patch!



The Feds, tightening and 2018

Just an interesting thing to note for the 2018 elections.

The Federal Reserve is in a tightening cycle (for what reason, I’m not sure as the data does not support a need to tighten). If the short term interest rates are above neutral, that means the economy will be worse than it otherwise would have been. A bad economy is bad for incumbent parties that hold all responsibility (see 2010 for Democrats).

So



Time to call Congress

The AHCA has more lives than a serial killer in a horror movie franchise.

The House Freedom Caucus has an agreement to make the bill worse by allowing states to completely opt out of guarantee issue and essential health benefits.

Steven Dennis of Bloomberg has a good fast analysis of the changes:

Most of the House Freedom Caucus is most likely on board with this bill. That reduces the firm no’s that are not in the HFC down to about 20. The No’s from March need to hear from you again. The unknowns and the shaky yeses need to hear from you.

They also need to be reminded of the following:

There is a minimal blocking coalition of Republican representatives who sit in seats that voted for them and Hillary Clinton. Time to remind them that they can’t survive an electorate that is nine points more Democratic in 2018 than it was in 2016. They know that, but let’s remind them.

So time to call Congress again.

I am convinced that any Republican only health care bill will either pass by 3 votes or fail by at least 15 votes.



Third time’s a harm

The Huffington Post has the outline of yet another Republican healthcare deal:

he deal, brokered between House Freedom Caucus chairman Mark Meadows (R-N.C.) and Tuesday Group co-chairman Tom MacArthur (R-N.J.), would allow states to get waivers eliminating the so-called community rating provision ― the rule that prohibits insurers from charging higher premiums to people with pre-existing conditions. In order to obtain the waiver, states would have to participate in a federal high-risk pool or establish their own, and satisfy some other conditions.

In exchange for that conservative concession, the amendment would reinstate the Essential Health Benefits that were already taken out of the bill ― though, again, states could waive those provisions as well if they were able to show that doing so would lower premiums, increase the number of people insured, or “advance another benefit to the public interest in the state.”

What does this mean?
Read more