House Narrowly Passes “Trumpcare”

May 4. 2017 (WASHINGTON) The House passed the American Health Care Act, dubbed “Trumpcare,” very narrowly. They needed 216 votes to pass it, they got 217. It was a party line vote. The next step for this legislation will be the Senate, where we expect to hear a lot about reconciliation. This means that they will use the Byrd Rule, named after former Virginia Senator Robert Byrd. This rule disallows extraneous matters from being considered in the bill. Meaning, no you could not attach spending for AMTRAK as a rider to whatever the Senate hashes.
Now, consequences of this bill are as follows, going from the Congressional Budget Office score on the bill that failed last month.

  • First off, over 10 years 24 million people are expected to lose their insurance. This is not a minor issue.
  • Preexisting conditions. The previous bill removed all protections, this one transfer them to high risk pools.
  • The Deficit will go up, according to the CBO

Impacts on California accoprding to the Berkeley Labor Center

  • The impact would be felt most in California counties with high Medi-Cal enrollment. Of the seven medium- to large-sized counties in which more than 10 percent of the population relies on the Medi-Cal expansion, six already suffer from high unemployment.
  • Each of these high-impact counties is estimated to lose thousands of jobs on net with a partial ACA repeal: Fresno (6,000), Kern (5,000), San Bernardino (12,000), San Joaquin (4,000), Stanislaus (3,000), and Tulare (3,000).
  • Los Angeles County is expected to lose 63,000 jobs.
  • An ACA repeal would especially harm workers in the healthcare industry, which is estimated to lose 135,000 of the 209,000 eliminated jobs.
  • Many other industries would also be adversely affected by an ACA repeal, including healthcare suppliers and local businesses such as restaurants and retail outlets where healthcare workers spend their income

The American. Association for Retired People (AARP) has this to say about these pools, which have failed in the past.

State high-risk pools may sound like a good idea but, in reality, they are fraught with problems. One of the biggest lessons learned from experience with state high-risk pools: They bring steep premiums that put coverage out of reach for millions. In the past, monthly premiums in state high-risk pools could be up to 200 percent higher than in the individual (nongroup) market. Consequently, only a small fraction of those with preexisting conditions could afford to buy a plan. Yet, these premiums — high as they were — only covered about half  the amount needed to pay enrollee claims. Most states tried to close the financial gap through taxes on providers and government subsidies, but even those efforts proved insufficient. We project that if states return to pre-ACA high-risk pools in 2019, as proposed, high-risk pool premiums for people with preexisting conditions could be as high as $25,700 annually.[1]

Another problem with state high-risk pools was that they typically offered skimpy coverage. For example, people who bought insurance through high-risk pools in nearly all states that offered them had to wait between six and 12 months before their preexisting conditions were covered. In addition, many had annual dollar limits on coverage for prescription drugs and behavioral health services.
The AHCA would provide $100 billion over nine years to fund — among other things — state high-risk pools. This level of funding is woefully inadequate to meet the need. One study estimates that it would cost at least $178 billion a year to adequately fund high-risk pools today. In the current policy environment, it is unlikely that the federal government will provide the necessary funding to make state high-risk pools work for the millions of people with a preexisting condition.

They are not the only ones to point to these problems. The Consumer Union says that these polls will put those who are the most vulnerable at risk. There is a good reason for this. Putting only high-risk patients in the pool raises the costs, to the point that those costs will be so high to be nearly astronomical. In other words, they will become unaffordable.


One carrot President Donald Trump gave to moderate Republicans to get their vote was $8 billion dollars to go to that pool, which is woefully inadequate over the course of a year, let alone the multiyear funding it is supposed to cover.
It will also cut Medicaid funding to states and would allow states to force the able-bodied to work. After 2020 states will no longer receive any enhanced funding for Medicaid. Nor will it allow states that have not joined to do so. It will also allow insurers to charge an “age tax,” charging more money for those who are older for their insurance.
However, the bill will allow children to stay on their parent’s insurance until they are 26. It also removes the taxes in the bill, and it will incur savings
As to taxes:

One of the taxes targeted in the repeal bill is a 3.8 percent tax on investment income, like capital gains. The other is a 0.9 percent surcharge on the Medicare taxes imposed on high-income earners — individuals making more than $200,000 a year and married couples filing joint returns who earn more than $250,000 a year. That brings the Medicare tax levied on that income up to 3.8 percent as well.

The tax repeal would solely benefit wealthy Americans because the taxes were imposed only on the wealthiest. The increases were passed in 2010, when capital gains rates were near historical lows. During the George W. Bush administration, Congress cut the rates to 15 percent from 20 percent. With the 3.8 percent tax imposed by the Affordable Care Act, the top capital gains rate stands at 23.8 percent for the wealthiest Americans. That still makes the rate lower than it was for most of the 1970s, 1980s and 1990s.

While the House can go home and claim victory, they can also expect a rowdy reception. The ACA is more popular now than it has ever been, and with the new version of the bill not scored, we can expect serious consequences.

Democrats will use this in the 2018 congressional races and will tattoo this to the forehead of Republicans. While the ACA needed reforms, this will remove insurance from people who have never before had it. The most affected will be the same people who voted for President Trump in November.

California however, is in a special situation. With the advancement of Senate Bill 562, authored by State Senator Toni Atkins, the state is moving closer to a single payer system. Given that the AHCA gives that autonomy to the states, the State Legislature will continue to debate this move. It would mean that California if passed, would become the first state with a single-payer system covering all residents in the state. The bill, as currently presented, does not have a high-risk pool, partly because California already tried that experiment and it failed.
The previous version of this story misidentified the bill number.


The second edit, we are adding an embed of Senator Toni Atkins statement to the Chamber this morning in Sacramento. She is the sponsor of the single health care bill in California.


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