Because that's not at all intentionally confusing …
So reading some analysis of the proposed GOP health insurance plan has been a bit confusing, but a few points stand out:
1. Mandates change to "personal responsibility" — Which sounds fine and upstanding and all-American, but ends up inevitably breaking the system (again), as (a) the pool of people who will desperately keep their coverage will tend to be the ones who actively need it (people who are sick), and (b) people who think they are invincible and will never get sick (mostly younger and not-sick-now people) will then pay insurance companies (not the government) a big penalty to get insurance again once they do get sick.
This is akin to what we had before, only without the pre-existing condition thang, but it still incents poor behavior, punishes those who engage then in it, and lets conservatives piously declare that the folk who find themselves unable to afford to get back into insurance (and get the care they need) were irresponsible and should therefore be punished for it (along with their families).
2. A lot of pet stuff is hidden in the details — Such as defunding Planned Parenthood (no organization can receive federal health care funding for anything if they, through separate funding streams, perform abortions), and making private insurance coverage for abortion a thing of the past. I'm sure that will make a lot of conservative people very happy and lead to a lot of death and misery for others, so win-win, right?
Neither of those provisions are really part of insurance reform, but, hey, if they can be hidden in the margins over a bigger debate, why the heck not?
3. Hey, let's break Medicaid! — The GOP's pet scheme for a long time — turning Medicaid into a block grant program — show up here, right on schedule. Rather than saying, "Hey, under Medicaid the state and feds will pay whatever is needed for your regulated care," now it's "Hey, now the federal government will pay $X per person to your state, and if you run out of money, I guess you die." Oh, boy!
Federal Medicaid expansion subsidies will continue to the end of 2019, and then be frozen. See above.
4. Favorite ACA things are still in there (sort of) — The things from the ACA that people really seemed to like — removing pre-existing condition restrictions and lifetime caps on coverage — are still alive, for the moment. On the other hand, insurance companies will once again be free to sell massively stripped down policies — no mental health care, no maternity care, no hospitalization coverage — to people for (relatively) cheap, which means that those who actually need that care (and can predict that they will) will end up paying more (because the risk pool is more concentrated) — and people who suddenly find themselves needing something they didn't think they'd need will find themselves paying through the nose for it.
5. Needs testing is out, age testing is in — Why peg support for getting insurance to income (who can afford it) when you can change it over to age (older people can clearly pay more for their insurance, right)?
6. But let's be sure to cut taxes! — Because the wealthy need to spend less on high end health care stuff so everyone else can spend more.
The AHCA is not a radical repeal. Some argue, with justification, that it's more of Obamacare 2.0, only with crappier funding, bad incentives, fewer covered, and tax cuts for the wealthy. Um … yay?
The Congressional Budget Office (CBO) hasn't scored this for financial impact or how it would affect coverage, and it sounds like the GOP ("Obamacare was rammed down our throats too fast for people to know what it did!") are going to fast-track this right past them. On the other hand, there are already enough grumblings and mumblings from the Senate, and from conservative Republicans in the House, and from some Republicans from Medicaid-expanded states, and, of course, the Democrats, that it's not clear if what's been proposed by the House GOP will survive intact (except for the abortion stuff, because, c'mon).
It's a definite step backwards. Not as far as the status quo ante the ACA, but clearly designed to promote individual responsibility (force bankruptcies and ER visits), save money (cut taxes), and look like Something Is Being Done (destabilizing the system and cutting back on social welfare programs). None of which should come as a surprise coming from the GOP.
Suggested reading:
http://www.vox.com/2017/3/6/14829526/american-health-care-act-gop-replacement
http://www.vox.com/policy-and-politics/2017/3/6/14838122/republican-health-bill-obamacare-replacement
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-repeal-20170306-story.html
https://www.theatlantic.com/health/archive/2017/03/no-mandate-youre-the-mandate/518784/?utm_source=atlgp
The American Health Care Act: the Republicans’ bill to replace Obamacare, explained
The GOP bill would roll back key Affordable Care Act programs in a big way.
Someone did the math on the 30% penalty. It's only for a year, so it turns out that it's actually a pretty good deal (if you're young and healthy) to not buy insurance until you really need it. You can save thousands of dollars. It's risky of course. If it's something like an auto accident, you'd better sign up on the way to the hospital (I wonder if ambulance companies will offer that as a service?), but it as an incentive to get health insurance, it's DOA.
A note on the odds of this passing – it is being moved through the budget reconciliation process and so will not be susceptible to filibuster and will only require a simple majority.
Updated modest proposal: Deport poor sick people.
I need to dig into the "block grants for states" part of this. Here in California, KFI talk radio host Bill Handel (conservative on most things except health care) speculates that California may use its block grant to set up some sort of single payer system. However, as Handel notes, there are a lot of varieties of single payer.
(And there's always the chance that California may take the block grant and use it to improve health by building a bullet train from Modesto to Fresno.)
+Kee Hinckley It's not clear to me, reading the proposal information, how those rates will be structured overall, so 30% for someone who was scraping pennies and to paying for insurance up front, may be a show stopper right there. Esp. if "hospitalization" is in a more expensive policy (since it will no longer be a required part of all policies).
In short, the only folk hurt are the folk who most need it.
+John Wehrle As noted in some of the articles, the budget reconciliation thang means they only need a simple majority to pass, yes, but it also limits the kind of shenanigans they can put through, so there's that.
More interesting is where there are Republicans (at both fringes) balking at the plan, and the likelihood of a raft of amendments for various purposes.
We'll see.
+John E. Bredehoft One of the touted "advantages" of block grants is that they allow the "incubators of democracy," the states, to screw around with the money however they want (maybe with some limits — I'm not sure the money could be peeled away for the high speed rail or massage chairs for state legislators). Some of those things may be helpful, others not.
The actual "advantage" is that it allows the funding to be capped, and that cap to be reduced or allowed to founder under inflation with an easy shrug and a grin.
+Dave Hill Oh definitely. The 30% penalty is only a good deal for people with savings. Basically it's like having a high deductible.
It seems like "previously uninsured" just became a pre-existing condition.