March 6, 2017 (San Diego) The replacement of the Affordable Care Act (ACA) was released this afternoon. First off, this is not an alternative to the ACA. It marks up the bill. Second off, it also has a back door weakening of the Social Security Act of 1937.
From the Bill:
SUNSET OF ESSENTIAL HEALTH BENEFITS REQUIREMENT.—Section 1937(b)(5) of the Social Security Act (42 U.S.C. 1396u–7(b)(5)) is amended by adding at the end the following: ‘‘This paragraph shall not apply after December 31, 2019.’’
What does this mean? It eliminates benchmark benefits under the ACA, including preventive screenings, like mammograms for women. The section also includes, since it has been expanded over the years, services to pregnant women.
It will also end the ability for senior citizens to get into a skilled nursing facility or intermediate services as part of the program. It also provides some prenatal services, and children healthcare. Especially children who have lost parents and are eligible for Social Security as orphans. Or women who are eligible as widows.
What else does this markup of the ACA do?
The bill will remove the all but popular with the public requirement for people to carry health insurance but will maintain the obligation of insurance companies to accept anybody. The bill had that requirement since it was the only way it could work. If you have only a high-risk pool, it will raise your rates, copays, and other incidentals. The only way to keep the rates low is to have a pool that includes younger and healthier individuals.
Given that they are eliminating preventative health care under the Social Security Act, we expect this to eliminate preventive health care for all groups.
They do more than just that.
The subsidies will be gone and will be replaced with tax credits that are far less generous than those subsidies. They are also age-based, with fewer benefits as people age. It will also create Health Savings Accounts and will end the Medicaid expansion in 2020. Medicaid will not be open-ended but will have limits. However, they will allow children to remain on their parent’s insurance until they are 26.
It preserves the most popular features of the ACA while removing what makes the ACA work.
20 million people have benefited from the ACA. We are expecting to see a decline in insured people. This will likely affect those in rural areas particularly hard, as well as those living in deep red states. Many of them voted for Trump in the general election.
We could see severe consequences, including driving insurance companies completely out of business. Fewer providers mean we will have more expensive insurance, potentially no providers mean no coverage.
Public Health will be affected, as fewer people covered, more people who will depend on emergency rooms. We could see an epidemic, especially if companies leave all facets of the market. We may even see companies leave the private employer provided the marketplace. How could an epidemic happen? People who have no access to care will not seek medical care until well after they have spread disease. The monitoring by public health officials of populations will be lessened, which can lead to a very serious human-made disaster.
It will also raise the cost of health care since people who have no insurance will be left with emergency rooms as their only source of healthcare. It will also make health care so expensive that most people will not be able to afford it. Those with chronic diseases, like for example Diabetes, might as well die. The cost of things like Insulin without insurance is prohibitive. So people will die.
The medical system, as set in this markup, is either intended to fail, miserably.
The Freedom Caucus in the House will not like this at all. It does not go far enough. Moreover, we already know that Senator Rand Paul of Kentucky has called this Obamacare Lite. It does not go far enough.
Representative Justin Amash called it Obamacare 2.0 on Twitter
Then there Republican Senators Rob Portman (Ohio), Shelley Moore, (West Virginia), Cory Gardner (Colorado), and Lisa Murkowski (Alaska) sent a letter to Leader Mitch Mcconnell voicing their concerns. All these states saw significant expansions of Medicaid. They want stability for the Medicaid expansion.California
Organizations like the Club for Growth are critical, while Democrats have managed to get some pushback.
We have also to point out that the Sate of California is considering a state-based single payer system. This State Senate Bill is a response to this. California was considering such a move before the implementation of the ACA and will use the lessons learned with Covered California in the write up of this bill.