The effects of a repeal of ACA

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Supporters of the Affordable Care Act have been emboldened recently by several developments that suggest repealing the health care law could inspire a tremendous backlash and spook Republicans in Washington, who are badly at odds with one another, into full retreat.

President-elect Donald Trump, who previously undermined congressional repeal efforts by insisting that Republicans replace and repeal the law simultaneously, pledged on Saturday the replacement would provide “insurance for everybody.”

That same day, Representative Mike Coffman of Colorado became a symbol of GOP jitters when he sneaked away from a regular constituent meeting that was overrun with people alarmed by the repeal effort. And on Tuesday morning, a Congressional Budget Office analysis found that the GOP’s repeal legislation would strip insurance from 18 million people in one year, and deny insurance to millions more over the ensuing decade..

Obamacare Just Had a Very Good Week. That Doesn’t Mean the Law Is Any Safer. | New Republic

During the 2016 campaign, Trump promised a health plan that covers everyone. He staked out a position that was decidedly different from his Republican rivals during the primaries. "I am going to take care of everybody," Trump told 60 Minutes in an interview in the fall of 2015. "I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now." Trump staked out a similar position in Republican primary debates, getting into a heated exchange with Sen. Ted Cruz (R-TX) over government funding of health coverage. “We’re going to take care of people who are dying on the street,” Trump said at that debate, seemingly-staking out a position far to the left of his opponents. In March, after all these promises, Trump released his health care plan: “Healthcare reform to make America great again.” I read it, and it didn’t look anything like what Trump had promised. Trumpcare repeals Obamacare’s coverage expansion (both the subsidies for private coverage as well as the Medicaid expansion), and allows insurers to go back to refusing to sell coverage to those with pre-existing conditions. Repealing Obamacare would leave an additional 22 million people uninsured, the Committee for a Responsible Federal Budget analysis estimates using Congressional Budget Office projections. These people would mostly be losing coverage they get through the health law's marketplaces and its Medicaid expansion.

Donald Trump promises “insurance for everybody.” We’ve seen this con before. - Vox

“[The Canadians] pay 50 percent less for the same exact medicine that we buy in Vermont or in America. We know why: The power and wealth of the pharmaceutical companies have bought the United States Congress,” Sanders said. EpiPens, for instance, cost twice as much in the US as in Canada. The depression drug Abilify is more than six times as much in the US as in Canada. Drug companies have scored record profits as the cost of prescription drugs has soared year over year by about 18 percent, according to the Huffington Post.

How Cory Booker went from progressive hero to traitor in under 2 days - Vox

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There is one fact that is both central to the debate over repealing the Affordable Care Act yet strangely absent from explicit discussion about it. One of the main ways the ACA makes health insurance affordable is by providing families earning less than 400 percent of the poverty line (i.e., less than $85,000 for a family of three or less than $47,550 for a single person) with tax credits to defray the cost of purchasing insurance.

Giving people money helps make things more affordable. President Obama and the congressional Democrats who wrote the law didn’t find the money for those subsidies hidden in a banana stand — they did what Democrats like to do when paying for things and raised taxes on affluent families. Republicans do not like this idea.

They dislike the idea of raising taxes on wealthy households so much that back in 2011, they pushed the country to the brink of defaulting on the national debt rather than agree to rescind George W. Bush’s high-end tax cuts. In December 2012, they tried to insist that they wouldn’t let Obama extend the portion of the Bush tax cuts that everyone (including rich people) got unless he also extended the tax cuts that only rich people got.

All of which is to say that despite Democrats’ occasional protestations of bafflement as to why the GOP would so uniformly oppose a market-based approach to universal health care that Mitt Romney happily adopted in the mid-aughts in Massachusetts, there’s no real mystery here. Subsidizing the health care costs of working-class people is expensive, and while Democrats want rich people to pay the freight for doing it, Republicans do not.

The hidden reason Republicans are so eager to repeal Obamacare - Vox

The study released on Thursday focused on two Obamacare taxes that target the wealthiest households in the country but have virtually no effect on middle and lower-income Americans. One is a 0.9 percent federal Hospital Insurance tax increase on individuals with incomes above $200,000 and couples with incomes above $250,000. The other is a 3.8 percent Medicare tax on “unearned income” that wealthy Americans derive from capital gains, dividends and royalties.

The top 400 highest-income taxpayers -- with average annual incomes of more than $300 million each -- would receive an estimated average annual tax cut of $7 million as part of the repeal, according to the study of Internal Revenue Service data.That would result in a $2.8 billion a year loss in tax revenue to the Treasury.

Roughly 160 million households with incomes below $200,000 would get nothing from the repeal of these two taxes, according to the report. Meanwhile, the repeal of Obamacare would effectively raise taxes on about seven million low-and-moderate income families that currently qualify for health insurance premium tax credits under the federal tax code. Those credits, which can be used to purchase private health insurance policies through government-run marketplaces, will be worth on average $4,800 this year.

Repealing Obamacare $7 million tax cut for the rich - Business Insider

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Hmm, interesting. From FTAlphaVille

Finally, fresh from a poll by NBC and the Wall Street Journal, Obamacare has just reached its peak popularity:
[img=590x0]https://image.webservices.ft.com/v1/images/raw/https%3A%2F%2Fftalphaville-cdn.ft.com%2Fwp-content%2Fuploads%2F2017%2F01%2F18204604%2FObamacare-590x310.png?source=Alphaville[/img]

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Here is why the Republicans want to abolish Obamacare:

Despite characterizing themselves as the party of fiscal conservatism, Republicans are planning on pushing through a legislative agenda under President-elect Donald Trump that will cause the deficit to balloon. These include an important method for repealing the Affordable Care Act, namely a budget resolution that will add $9 trillion to the debt by 2026. The actual Affordable Care Act repeal will eliminate more than $1 trillion in revenue that had been acquired through taxes included in the bill in order to maintain a balanced budget. Finally, Republicans are considering passage of a spending bill in excess of $1 trillion to complete unfinished Cabinet budgets, one that is expected to include allocations for expensive Trump proposals like a wall on the U.S.-Mexican border. “One of the things that we’re focusing on is getting people back to work, is economic growth,” House Speaker Paul Ryan said to reporters on Tuesday. “You can’t ever balance the budget if you don’t get this economy growing.” In 2011, though, Ryan had said, “The country’s biggest challenge, domestically speaking, no doubt about it, is a debt crisis.”

Deficits don’t matter (again)! Paul Ryan promotes Congress’ upcoming spending binge - Salon.com

It's simple

The Affordable Care Act (ACA), which President-elect Donald Trump and the Republican-controlled Congress have vowed to repeal, was crafted to overcome two basic problems in the provision of health care in the United States. First, the costs are incredibly skewed, with just 10 percent of patients accounting for almost two thirds of the nation’s healthcare spending. The other problem is asymmetric information: Patients have far more knowledge about the state of their own health than insurers do. This means that the people with the largest costs are the ones most likely to sign up for insurance. These two problems make it impossible to get to universal coverage under a purely market-based system.

The Economics of the Affordable Care Act

If you want to cover these people you will often have to subsidize them as many simply can't afford to buy the healthcare in a market based system as insurers will devise all kinds of methods to keep them out, limit spending on them or charge huge premiums. 

Obamacare did this by:

• Ending discrimination by insurers so they can't keep sick people out, limit spending on them or charge them hugely higher rates
  
• To limit the adverse selection problem (only sick people insuring themselves), the individual mandate was set, everybody needs to buy insurance
  
• But not everybody can afford it, hence the subsidies. 
  

It's the latter which so riles Republicans, as it's redistribution to which they have an ideologically (and financier) driven objection.

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He wasn't going to deprive people of health care insurance, right? He wasn't going to cut Medicaid, right.. Hahaha.

There's much in health care policy that divides Republicans. But there's one major idea that unites them: block grants for Medicaid. It’s in the budget proposal that House Budget Chair Rep. Tom Price, Trump’s pick to run Health and Human Services, released this year. It was in Trump’s own health care platform during the campaign. And it is what Trump advisor Kellyanne Conway was talking about on television news shows this weekend as the administration’s preferred path forward.

In its simplest form, turning Medicaid into a "block grant" simply means handing control of the program — and the funding for it — over to the states. But in all these plans the details reveal something else, too: a massive cut to Medicaid spending that could throw tens of millions of people off the program. To understand how that works, you need to understand the unusual way that Medicaid works..

Donald Trump’s plan to cut Medicaid spending, explained - Vox

White House counselor Kellyanne Conway confirmed on Sunday that Trump’s proposed Obamacare replacement would convert Medicaid into a block grant program. This would take its administration out of the hands of the federal government and put states in charge, with potentially disastrous consequences. Further details are, presumably, forthcoming.

But in the meantime, there’s plenty of research out there on prior Medicaid block grant proposals. When the Center on Budget and Policy Priorities analyzed a 2014 block grant plan crafted by House Speaker Paul Ryan (R-WI) (then the chair of the House Budget Committee), it found that would result in a 26 percent cut to Medicaid and the Children’s Health Insurance Program by 2024. It’s difficult to figure out exactly how many people would lose coverage as a result

Kellyanne Conway just confirmed Trump wants to eliminate health coverage for millions

But of course they'll just lie about the effects, and when the media exposes that, they will just blast the media as liars..

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The President doesn't want you to sign up for healthcare insurance..

President Donald Trump has taken a bold step to wreck the Affordable Care Act, the healthcare law better known as Obamacare.

According to Politico's Paul Demko, the new administration has pulled all advertisements for Healthcare.gov and has frozen efforts by the Department of Health and Human Services to encourage people to sign up for plans through the ACA.

The pulling of ads includes those that have already been paid for and placed, according to Politico. For the 2015-2016 open-enrollment period, HHS spent about $35 million on ads encouraging people to sign up.

Americans without health insurance through their employer or Medicare or Medicaid can sign up for plans through the ACA's public exchanges through January 31 for a 2017 plan.

Typically, the run-up to deadlines is accompanied by a significant uptick in sign-ups. As Politico reported, this is especially true for young people, who are needed to balance the risk in the individual market pools.

Trump has maintained that the law will "collapse on its own." But projections from the nonpartisan Congressional Budget Office indicate that the number of people enrolled will continue to increase and eventually stabilize, not go into the "death spiral" as Republicans predicted.

The end of the open-enrollment period is crucial because the share of total enrollees who are ages 18 to 34 increases substantially during that time.

This is important because the pools in some states have been filled with an outsize number of older and sicker people over the past few years, causing many large insurers to lose money on the exchanges.

Trump freezes Obamacare spending advertisements - Business Insider

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This is where you get when you play fast and loose with people's lives

From Vox

Leaked audio reveals Republicans are in utter disarray on Obamacare repeal

A Washington Post scoop shows there’s no consensus yet on even the most basic details.
Updated by Andrew Prokopandrew@vox.com  Jan 27, 2017, 3:10pm EST

When congressional Republicans went off to Philadelphia for a retreat this week, they hoped to make at least some progress toward a consensus about how to proceed with repealing and replacing Obamacare.

However, secret recordings of closed-door discussions at the retreat obtained by the Washington Post’s Mike DeBonis reveal that the party remains divided, uncertain, and deeply concerned about how to move forward.

It’s long been clear that there are a great many unsettled questions regarding the legislative and policy details of the GOP’s repeal effort. These include:

• How quickly should repeal go into effect?
  
• What, exactly, would the replacement be — can Republicans come up with a replacement that would be affordable for sick people who need insurance?
  
• Should Obamacare’s Medicaid expansion be repealed?
  
• Should the rest of Medicaid be transformed into a “block grant,” program as Paul Ryan has long supported, which would almost surely mean major reductions in the number of people it serves?
  
• Should an Obamacare repeal bill also defund Planned Parenthood?
  
• Does Donald Trump’s administration have a plan, or can his aides offer any more specifics about what they want policy-wise?
  

The Post’s report reveals that every single one of these questions remains completely unsettled, and that at least some within the party have grave concerns about all of them.

Republican House members representing blue states appear to be particularly worried. Rep. Tom MacArthur of New Jersey worried about pulling “the rug out from under” people covered by Obamacare, Rep. Tom McClintock of California warned that the GOP would own “the market we’ve created ... lock, stock and barrel,” and Rep. John Faso of New York said defunding Planned Parenthood in a repeal bill would mean “walking into a gigantic political trap” that could end up with “millions of people on social media” protesting repeal.

Meanwhile, Trump’s top domestic policy staffer, Andrew Bremberg, is quoted speaking in only the vaguest banalities and broadest strokes, offering no substantive guidance whatsoever besides saying that HHS Secretary nominee Tom Price is a “compassionate” guy and a good doctor.

There is no master plan
All in all, the leaked recording should inspire confidence in Democrats about the politics of Obamacare repeal, which seems like far from a sure thing at this point.

Though “repeal and replace Obamacare” is a simple, clear, crisp campaign slogan, in practice it’s incredibly complicated. A plethora of different committees, many different factions of the party, powerful interest groups, activists, and many other players all have to end up agreeing on one specific plan and advance it through a political gauntlet. (To enact a full replacement, at least eight Senate Democrats would probably have to be won over too.)

Yet even the most very basic points about exactly what should be repealed and what it should be replaced with remain unsettled at this point. And even though the proposal’s current vagueness means Republicans in Congress don’t have to defend any specific points that are unpopular, they’re clearly worried already. Check out DeBonis’s piece for more details.

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Who says you have to be consistent..

One Obamacare talking point you often hear from Republicans is that it inappropriately imposed a national, one-size-fits-all solution, wherein states should be allowed to develop policies on healthcare that best meet their residents' needs and desires.

Another talking point you often hear is that health insurers operating in any state ought to be able to sell policies to residents of any other state.

This is called "interstate sale," and it would mean that health insurance would be regulated by the state where it is sold, not necessarily the state where the insured person lives.

As Republicans fret over how to repeal and replace the Affordable Care Act amid President Donald Trump's ascension to office, it would be possible for them to develop a policy approach that aligns with one of these principles — but not with both.

Republican plans to repeal, replace Obamacare have contradiction - Business Insider

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Of course, anyone concerned whether he or she will still have healthcare insurance must be a paid activist from the 'far left'...

One of the reasons Brat is avoiding his constituents is because he’s convinced himself that they’re paid activists. “I had one woman on my Facebook say she was going to get up in my grill,” he told the Richmond Times-Dispatch, using the same line as he did at the meeting. “There’s paid protesters…paid activists on the far left, not my Democratic friends I go to church with.

They’re being paid to go around and raise havoc.” Brat didn’t offer any context as to who he thinks is paying these protesters, nor did he seem to acknowledge that they are his actual constituents. Perhaps incredulous that there’s such energy opposing their ideas, conservatives are increasingly claiming that liberal protesters must be paid.

Residents of Virginia’s 7th District are right to be concerned about what Brat will do with their health care. His Obamacare alternative is a bill that creates health savings accounts, a plan that will primarily benefit the rich and do little to help people with major medical expenses they cannot afford.

Anti-Obamacare congressman won’t hold town halls because ‘the women are in my grill’

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Even with the looming threat of a repeal, more and more Americans say they support the Affordable Care Act (ACA), better known as Obamacare. A poll released by Public Policy Polling on Thursday showed that 46% of Americans now support the ACA, while 41% oppose the law. Additionally, PPP found that 62% of people polled wanted to keep the ACA and make changes to the existing law, while only 33% wanted it repealed and have the US "start over with a new healthcare law."

Polls: Obamacare getting more popular - Business Insider

Despite increasing popularity Republicans are likely to sabotage it:

The Republican plan to repeal and replace the Affordable Care Act, better known as Obamacare, has introduced a high level of uncertainty in the health insurance market, and the CEOs of major insurers are concerned about the future. Over the past few weeks, several insurance executives have expressed concern and uncertainty about their business strategy regarding the ACA's individual insurance exchanges.

The exchanges, where people who are not covered through their employer or Medicaid or Medicare can buy insurance, are a key part of the ACA that's being targeted by the GOP's repeal strategy. Because Republican lawmakers are still in the midst of repealing the law and have not laid out a cohesive plan for replacement, insurance executives are taking a cautious look into the future. Insurers are nervous "We have no intention of being in the market for 2018," Aetna CEO Mark Bertolini said during his company's earnings call on Tuesday.

"Currently, where we stand, we'd have to have markets worked up ... prices worked up for April 2017 to apply, and there is no possible way that we'll be able to do that given the unclear nature [of where] that regulation is headed." Insurers must submit plans, including premium prices, for the 2018 plan year to federal and state regulators in April 2017. Given the short turnaround, it may be even harder to get insurers to commit to offering plans on the exchanges in 2018.

Health insurers freaking out about Obamacare repeal uncertainty - Business Insider