{"id":132995,"date":"2017-03-07T11:27:33","date_gmt":"2017-03-07T18:27:33","guid":{"rendered":"http:\/\/hill-kleerup.org\/blog\/2017\/03\/07\/morphing-the-aca-into-the-ahca.html"},"modified":"2017-03-07T11:27:33","modified_gmt":"2017-03-07T18:27:33","slug":"morphing-the-aca-into-the-ahca","status":"publish","type":"post","link":"https:\/\/hill-kleerup.org\/blog\/2017\/03\/07\/morphing-the-aca-into-the-ahca.html","title":{"rendered":"Morphing the ACA into the AHCA"},"content":{"rendered":"

Because that's not at all intentionally confusing …<\/p>\n

So reading some analysis of the proposed GOP health insurance plan has been a bit confusing, but a few points stand out:<\/p>\n

1. Mandates change to "personal responsibility"<\/b> — 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<\/i> get sick.<\/p>\n

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).<\/p>\n

2. A lot of pet stuff is hidden in the details<\/b> — Such as defunding Planned Parenthood (no organization can receive federal health care funding for anything<\/i> 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?<\/p>\n

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?<\/p>\n

3. Hey, let's break Medicaid!<\/b> — 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!<\/p>\n

Federal Medicaid expansion subsidies will continue to the end of 2019, and then be frozen. See above.<\/p>\n

4. Favorite ACA things are still in there (sort of)<\/b> — 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.<\/p>\n

5. Needs testing is out, age testing is in<\/b> — 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)?<\/p>\n

6. But let's be sure to cut taxes!<\/b> — Because the wealthy need to spend less on high end health care stuff so everyone else can spend more.<\/p>\n

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?<\/p>\n

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).<\/p>\n

It's a definite step backwards. Not as far as the status quo ante<\/i> 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.<\/p>\n

Suggested reading:<\/p>\n

http:\/\/www.vox.com\/2017\/3\/6\/14829526\/american-health-care-act-gop-replacement<\/a>
http:\/\/www.vox.com\/policy-and-politics\/2017\/3\/6\/14838122\/republican-health-bill-obamacare-replacement<\/a>
http:\/\/www.latimes.com\/business\/hiltzik\/la-fi-hiltzik-obamacare-repeal-20170306-story.html<\/a>
https:\/\/www.theatlantic.com\/health\/archive\/2017\/03\/no-mandate-youre-the-mandate\/518784\/?utm_source=atlgp<\/a><\/p><\/blockquote>\n

\n
\n
\n<\/a>
\nThe American Health Care Act: the Republicans’ bill to replace Obamacare, explained<\/a><\/span>
\nThe GOP bill would roll back key Affordable Care Act programs in a big way.\n<\/p><\/blockquote>\n

View on Google+<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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 … Continue reading “Morphing the ACA into the AHCA”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","_seopress_robots_follow":"","_seopress_robots_imageindex":"","_seopress_robots_snippet":"","_seopress_robots_primary_cat":"","_seopress_robots_breadcrumbs":"","_seopress_robots_freeze_modified_date":"","_seopress_robots_custom_modified_date":"","_seopress_robots_canonical":"","_seopress_social_fb_title":"","_seopress_social_fb_desc":"","_seopress_social_fb_img":"","_seopress_social_fb_img_attachment_id":0,"_seopress_social_fb_img_width":0,"_seopress_social_fb_img_height":0,"_seopress_social_twitter_title":"","_seopress_social_twitter_desc":"","_seopress_social_twitter_img":"","_seopress_social_twitter_img_attachment_id":0,"_seopress_social_twitter_img_width":0,"_seopress_social_twitter_img_height":0,"_seopress_redirections_value":"","_seopress_redirections_enabled":"","_seopress_redirections_enabled_regex":"","_seopress_redirections_logged_status":"","_seopress_redirections_param":"","_seopress_redirections_type":0,"_seopress_analysis_target_kw":"","_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[106],"tags":[],"class_list":["post-132995","post","type-post","status-publish","format-standard","hentry","category-plusposts"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":30488,"url":"https:\/\/hill-kleerup.org\/blog\/2012\/10\/05\/romneys-sick-joke-about-being-sick-and-getting-insurance.html","url_meta":{"origin":132995,"position":0},"title":"Romney's Sick Joke (about Being Sick and Getting Insurance)","author":"***Dave","date":"Fri 5-Oct-12 8:45am","format":false,"excerpt":"Krugman takes Romney to righteous task for misleading debate viewers, once again, on what his \"plan\" would do regarding pre-existing conditions.'What Mr. Romney actually proposes is that Americans with pre-existing conditions who already have health coverage be allowed to keep that coverage even if they lose their job \u2014 as\u2026","rel":"","context":"In "~PlusPosts"","block_context":{"text":"~PlusPosts","link":"https:\/\/hill-kleerup.org\/blog\/category\/blogging\/plusposts"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":29107,"url":"https:\/\/hill-kleerup.org\/blog\/2012\/08\/02\/protecting-the-health-insurance-companies.html","url_meta":{"origin":132995,"position":1},"title":"Protecting the Health Insurance Companies","author":"***Dave","date":"Thu 2-Aug-12 10:44pm","format":false,"excerpt":"Two observations on Rep. Flake's comments:1. \"If individuals are allowed to access health care services only when they are sick or injured, there is no reason for anyone to have insurance.\" Yes, which is the reason for the individual mandate. \u00a0Did you miss the last couple of years, Congressman?2. \"If\u2026","rel":"","context":"In "~PlusPosts"","block_context":{"text":"~PlusPosts","link":"https:\/\/hill-kleerup.org\/blog\/category\/blogging\/plusposts"},"img":{"alt_text":"","src":"https:\/\/images0-focus-opensocial.googleusercontent.com\/gadgets\/proxy?container=focus&gadget=a&resize_h=100&url=http%3A%2F%2Fthinkprogress.org%2Fwp-content%2Fuploads%2F2012%2F08%2FFlake_1335206280-300x200.jpg","width":350,"height":200},"classes":[]},{"id":27692,"url":"https:\/\/hill-kleerup.org\/blog\/2012\/05\/01\/the-problem-is-insurance-isnt-really-insurance-any-more.html","url_meta":{"origin":132995,"position":2},"title":"The problem is, insurance isn't really insurance any more","author":"***Dave","date":"Tue 1-May-12 3:34pm","format":false,"excerpt":"Medical insurance is not a way to deal with the risk of outrageously expensive catastrophic medical needs. It's the way to deal with -- the only thing that still enables access to -- all our medical needs.Once upon a time, health insurance was a way of dealing with extraordinary medical\u2026","rel":"","context":"In "~PlusPosts"","block_context":{"text":"~PlusPosts","link":"https:\/\/hill-kleerup.org\/blog\/category\/blogging\/plusposts"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":134766,"url":"https:\/\/hill-kleerup.org\/blog\/2017\/09\/19\/remember-used-jack-insurance-rates-got-sick.html","url_meta":{"origin":132995,"position":3},"title":"Remember when they used to jack up your insurance rates when you got sick?","author":"***Dave","date":"Tue 19-Sep-17 4:15pm","format":false,"excerpt":"Welcome to the Graham-Cassidy bill, the last ditch (for 2017) effort by the GOP in the Senate to Repeal-and-Replace the ACA with something that isn't so ... well ... likely to help people stay solvent and\/or alive. A provision of the new Trumpcare bill gaining steam among Senate Republicans \u2014\u2026","rel":"","context":"In "~PlusPosts"","block_context":{"text":"~PlusPosts","link":"https:\/\/hill-kleerup.org\/blog\/category\/blogging\/plusposts"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/hill-kleerup.org\/blog\/wp\/wp-content\/uploads\/2017\/09\/unnamed-2.png?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":38893,"url":"https:\/\/hill-kleerup.org\/blog\/2013\/09\/30\/obamacares-so-confusing.html","url_meta":{"origin":132995,"position":4},"title":"Obamacare's\u00a0so CONFUSING!!!!","author":"***Dave","date":"Mon 30-Sep-13 8:24pm","format":false,"excerpt":"That's the current mantra\u00a0from the Anti-ACA Right (along with \"Better the Government Fall than People with Pre-Existing Conditions Retain Coverage,\" but let's leave that aside for the moment). \u00a0And yet, USA Today managed to decipher the ACA\u00a0on one page (with big graphics and lots of white space) this last week,\u2026","rel":"","context":"In "~PlusPosts"","block_context":{"text":"~PlusPosts","link":"https:\/\/hill-kleerup.org\/blog\/category\/blogging\/plusposts"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":133348,"url":"https:\/\/hill-kleerup.org\/blog\/2017\/04\/26\/meanwhile-back-at-the-health-insurance-reform-brouhaha.html","url_meta":{"origin":132995,"position":5},"title":"Meanwhile, back at the Health Insurance Reform brouhaha","author":"***Dave","date":"Wed 26-Apr-17 7:48am","format":false,"excerpt":"House GOP folk are floating a major amendment to the AHCA they failed to get passed a few weeks back. 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