[NYAPRS Enews] Highlights of US Senate GOP Healthcare Proposal

[Harvey Rosenthal]

NYAPRS Note: Here's what we've been able to glean from various accounts about the healthcare bill the US Senate proposed yesterday. See next 2 NYAPRS E News postings to see how the impact of the bill is expected to have on Americans with disabilities and addictions and in New York State.

*         While the House bill is called The American Health Care Act, the Senate bill is called the Better Care Reconciliation Act.

*         The nonpartisan Congressional Budget Office is in the process of assessing the Senate's draft bill and expects to release its budget score on the bill "early next week."

*         The proposal will have to go through numerous changes within both the Senate and the House to ultimately pass both houses and be sent to the White House for final approval.

*         The bill strikes the biggest parts of the health care law, ends Medicaid as an open-ended entitlement and gives states the ability to waive the health law's insurance requirements.

Key Features


*         Pre-existing conditions: The plan would keep the Affordable Care Act requirement that insurers accept everyone and charge the same rates, with few exceptions. But it would allow states to waive other insurance requirements, including rules for what benefits insurers must cover, that could weaken protections.

*         Insurance subsidies: Obamacare's premium subsidies, which are available to people between the poverty level and four times that threshold, would be continued for two years. Eligibility would then be scaled back slightly to 350 percent of the federal poverty level and extended to more low-income people who don't qualify for Medicaid. Similar to Obamacare, the subsidies would be pegged to income. But the benchmark plan for determining subsidies would be less generous than Obamacare's.

The bill would also extend for two years Obamacare's cost-sharing subsidies, which help insurers pay medical bills for low-income customers. President Donald Trump has threatened to cut off those payments, which health plans said could destabilize the individual insurance marketplaces.

*         Individual and employer mandates: The health law's mandate that most people buy insurance or pay a penalty would be eliminated. So would the requirement for mid-sized and large companies to provide coverage to workers.

*         Older customers could be charged more: Insurers would be allowed to charge older customers five times more than younger ones for the same health plan. Under Obamacare, that ratio is three-to-one.

*         Medicaid expansion: Boosted federal payments to states that expanded their programs to low-income adults would continue for three years. Starting in 2021, enhanced federal payments would then be rolled back over three years to traditional Medicaid funding rates. Thirty-one states and Washington, D.C., have expanded their Medicaid programs under Obamacare.

*         Traditional Medicaid: The program covering low-income kids, pregnant women, the elderly and people with disabilities would no longer be an open-ended entitlement. Starting in 2020, states could choose between receiving a block grant from the federal government or a set payment based on the number and type of enrollees. The payments would slightly increase each year, but starting in 2025, the growth rate would be lower than what the House bill prescribes. Certain populations would be carved out from the payment caps.

*         Taxes: The bill would eventually repeal most of Obamacare's taxes, including the surtax on high earners investment income and a Medicare Hospital Insurance surtax on the rich. It would also end some industry taxes, such as those on medical devices and health insurers.

*         Abortion: Subsidies could no longer be used to purchase health plans that cover abortion. Medicaid funding for Planned Parenthood would be cut off for one year.
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Winners And Losers From The Senate Repeal Bill

THE WINNERS
The wealthy: The bill would strike Affordable Care Act taxes on high earners, particularly a levy on investment income that fell on married couples with more than $250,000 of adjusted gross income and single filers with more than $200,000 of adjusted gross income. It also nixes a Medicare Hospital Insurance tax on incomes above $250,000.
The young and healthy: The plan focuses on lowering premiums by allowing states to cut some of Obamacare's major insurance rules that help protect sicker patients but also drive up the cost of coverage. For instance, states could cut mandated coverage of emergency care and substance abuse treatment. Younger and healthier people with fewer health care needs would be able to buy skimpier health insurance.
GOP governors who fought Obamacare: Republican governors who sought less federal oversight and more state control over their insurance markets will get tremendous leeway under waivers in the Senate bill. The Senate plan would roll back requirements about what insurers must cover and expedite state applications seeking more flexibility. For instance, governors would no longer need permission from their legislatures to obtain waivers.
Some health industry groups: Medical device makers, health insurers and tanning establishments, among others, would see the eventual elimination of ACA taxes on their products or services - although some of those taxes may be kept temporarily to pay for parts of the plan. Major provider groups, however, including the American Hospital Association, have come out forcefully against the Senate bill, while many other industry groups were still reviewing the plan Thursday afternoon.

THE LOSERS
Poorer, older insurance consumers: The Senate plan, like the House bill,would allow insurers to charge their older customers up to five times as much as younger customers for the same health plan. That's an expansion of the so-called age band in Obamacare, which allows insurers to charge older customers no more than three times as much as younger ones. In two years, the Senate plan would also eliminate a key subsidy program that helps cover out-of-pocket medical bills for low-income consumers.
People struggling with addiction: The bill rolls back the federal government's generous funding for Medicaid expansion, which has been a major source of substance abuse treatment amid the opioid epidemic. The Senate draft earmarks $2 billion for opioid treatment in 2018 - compared to the House's provision of $15 billion over 10 years for mental health, substance abuse and maternity care. The Senate bill does loosen some restrictions on Medicaid funding of long-term treatment for people with substance abuse and mental health issues.
Planned Parenthood and its clients: The women's health organization, a frequent GOP target for defunding, would be cut out of the Medicaid program for one year. However, this provision could be problematic for moderate Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, and Republicans can't afford to lose more than two votes.
Public health agencies: The draft kills the ACA's $1 billion Prevention and Public Health Fund in 2018, one year earlier than the House-approved health bill. The fund makes up roughly 12 percent of the Centers for Disease Control and Prevention's budget and has been used to address public health threats, including the Zika virus outbreak, as well as for preventive health services and immunization programs.
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