After all these years, the GOP has finally released their full repeal and replace plan. By “GOP”, I mean certain insiders who seem to have missed the mark. Here’s Paul Ryan’s statement
“Obamacare is rapidly collapsing. Skyrocketing premiums, soaring deductibles, and dwindling choices are not what the people were promised seven years ago. It’s time to turn a page and rescue our health care system from this disastrous law. The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with pre-existing conditions, and provides a stable transition so that no one has the rug pulled out from under them.
“Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare. This will proceed through a transparent process of regular order in full view of the public. I want to thank all of our members who have contributed their ideas, especially Chairman Walden and Chairman Brady, as well as Secretary Price and the Trump administration, for their commitment to keep this promise and get this right.â€
Reading the entire bill, color me not impressed. Nor are many Republicans. Senator Rand Paul called it Obamacare Lite. Justin Amash referred to it as Obamacare 2.0. Many others are slamming the bill, as well.
Key talking points from the GOP are
- Dismantles the Obamacare taxes (a thumbs up in the bill’s favor is getting rid of all the taxes)
- Eliminate the individual and employer mandate penalties (more in a minute)
- Prohibit health insurers from denying coverage (had to keep this. Should have had a section on insurers not drastically increasing premiums/deductibles or dumping people who’ve been paying for insurance for actually using it)
- Help young adults access health insurance (keeping the part about staying on parent’s insurance till 26. Good idea)
- Establish a Patient and State Stability Fund (entitlement time. But, this is still needed for the short term as Ocare is wiped away)
- Modernize and strengthen Medicaid (Medicaid expansion. Still needed till Ocare is wiped away)
- Empower individuals and families to spend their health care dollars the way they want and need by enhancing and expanding Health Savings Accounts (HSAs) (still need to get rid of all caps on these)
- Help Americans access affordable, quality health care by providing a monthly tax credit—between $2,000 and $14,000 a year—for low- and middle-income individuals and families who don’t receive insurance through work or a government program. (some are calling this another entitlement, and that government is still too involved)
Back to the mandate penalties portion, there’s this (starts on page 61)
Obviously, the point here is to disincentivize those who would not have health insurance, then get sick and want to purchase. However, this is almost worse than the Ocare mandate. Let’s say you change jobs: the typical occurrence is that you are not eligible to sign up for the company health insurance until you’ve been there for 90 days. Sure, you could purchase COBRA for a month. It’s not cheap. What if you are out of work for several months or more? Can you afford more expensive insurance? For all intent purposes, this is a mandate and a penalty, just like with Obamacare.
If it was more like 6 months, or had a measure for waivers, it would be fine. Regardless, what this requires, per the legislation, is that you file a form with The Government stating you had insurance without a 63 day gap. Weren’t Republicans protesting against this kind of thing?
The employer mandate is wacked, though, as is the specific language for the individual mandate.
The NY Times has an interesting breakdown of what is kept, what’s changed, and what’s repealed.
How about that “Cadillac tax?” That is kept around
A number of Obamacare taxes would be repealed, including the Medical Device Tax and health insurance taxes, but the Cadillac tax would be restored after 10 years to comply with the Byrd Rule, allowing Republicans to pass the measure using budget reconciliation.
Of course, they can always wack that tax at some point in the future.
The plan would stop giving Planned Parenthood federal taxpayer money for one year. This is silly. It alienates certain GOP squishes, like Susan Collins, while being nothing more than patronizing Republican voters, as it is only one year. Planned Parenthood makes enough money on their own as a private business, and shouldn’t be subsidized by the federal government. Instead, they could have done something like reimbursing for services rendered, except for abortion.
Speaking of abortion, the bill itself pretty much starts out by diving in to the abortion debate and stating that federal money will not be used for abortions, except in certain cases, such as rape, incest, and the health of the mother. Health exclusions do not include “I want to continue partying and having irresponsible sex, so I’m sad.”
Right now, overall, this plan is not particularly good. Is it better than Ocare? Yes. Does it fully repeal Ocare? Yes. Does it involve the government in our health insurance decisions? Yes. Mandate and penalty? Yes. Does it utterly forget about other GOP ideas, like allowing cross state purchasing of health insurance? Sure does. Does it forget to create a pathway to get people out of the Ocare exchanges and into private insurance in an orderly fashion? Yes. Does it reduce the things that government requires insurance plans to offer? Only back to pre-Ocare days.
Is this a work in progress or what the House and Senate will be forced to vote on? We’ll see. Now that it is out, the usual pattern is to tweak proposed legislation. We’ll have to see if this happens.
UPDATE: Trump tweets
This jibes with some rumbles I’m hearing, in that the bill was crafted in a manner so that it can be pushed through the Senate on a 50+1 vote in a manner that would do away with any sort of filibuster, perhaps reconciliation, in the same way Ocare was passed. Once it is in place, there are other bills which will institute more free market solutions which minimize federal government involvement in our health insurance and health care.
Of course, this is the GOP. Can we trust the Establishment to do this?
Crossed at Right Wing News.
Read: House Republicans Release Health Plan Or Something »
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