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Sunday, March 12, 2017

Trumpcare Versus Obama Care-What You Need To Know

How the Republican Healthcare Act Compares to the Affordable Care Act

The Republican plan, euphemistically referred to as Trumpcare addresses insurance and not improvements in healthcare delivery. Insurance is NOT health care. This analysis examines how the proposed healthcare plan in House Bill 277 differs from the Affordable Care Act, known as Obamacare. For information on ACA improvements in health care at the patient level, refer to the link below.[1]  This article cites credible sources from nonprofit entities or government agencies and only facts are used, not false proclamations.

Criteria
Obamacare
Trumpcare

Medicaid Coverage is medical insurance for low-income folks

Eligibility Standards
Expanded eligibility for Medicaid to 138% of the federal poverty level; 32 states opted to expand coverage, increasing access to healthcare for 11 million people.[2]
Beginning in 2020, repeals the Medicaid expansion, allowing existing Medicaid participants to remain, but with the inability to re-enter later if you lose your eligibility; Millions would lose their medical insurance. (Gunja, 2017)
Mental Health Benefit

Mandate
Expanded to include mental health parity, to increase access to health treatment for mental conditions under the essential benefit provisions of the ACA. (Kirsten Beronio, 2013)
Insurance companies would no longer have to offer mental health benefits under insurance contracts.
Substance Abuse Treatment

Mandate
Plans were required to offer coverage for substance abuse treatment, comparable to other illnesses and it is estimated 5 million people have used this benefit. (Kirsten Beronio, 2013)
Insurance companies are not required to offer treatment for drug addiction, which is problematic given the national crisis in opioid addiction, currently killing 91 people a day. (Centers for Disease Control and Prevention, 2016)
Employer Insurance

Mandate
Required employers to offer medical insurance within standardized benefit levels, or pay a fine.
Employers will no longer be required to offer medical insurance for their employees and no fines will be levied. Small business tax credits, to help businesses offer medical insurance are cancelled in 2020.
Impact on Individuals in Insurance Exchanges
Required pooled rates, which were spread across age bands, not individual levels; creating more affordability. (Jost, 2016)
Insurance companies can age rate, to increase pricing toward older participants (those most likely to need more health services). Cost sharing provisions which helped low income people are eliminated.
Taxes to fund the plan
Follow the link to a previous article which detailed the taxes.[3] Most sectors of the healthcare system contributed to taxes to fund the provisions of the Affordable Care Act which is self-funding.

Would eliminate most of the taxes except the “Cadillac Healthplan Tax”, lower capital gains for the top 2.5% of income earners, and charge all employees covered on insurance plans through their employers, a Value-Added Tax (like the Canadians charge on services).
Women’s Healthcare

Mandates
Mandated insurance plans cover birth control and women’s gynecological exams annually.
Defunds all Planned Parenthood Services and removes the requirement to provide wellness services or birth control.
Financial Impact on Individuals
Older low income people had greater subsidies so they could buy medical insurance.
Older low income folks will pay thousands more per year for medical insurance. Young people will pay less for insurance, but since there are no penalties for not participating enrollment will decline, eroding the overall viability of insurance exchanges.
Employer Provided Medical Plans
Employers can deduct the full cost of their medical and other benefit plans and employees are not taxed on these benefits.
Eliminates the tax advantage for employers which will cause the cancellation of many health plans across the nation because this is a very expensive benefit for employers to offer. Example, your employer pays $12,000 in insurance plan premiums for you, these would now be taxable as income to the employee and nondeductible to the business.
Individual Penalties for Not Participating

Tax Laws
Proof of insurance is required at income tax filing. A tax penalty up to $695 per adult ($2,085 family) is due unless you qualify for one of the many exemptions, which include your inability to afford insurance.
No requirement to have medical insurance, but if your coverage lapses, you will pay a penalty (up to 30%) upon re-enrollment regardless of your income. The penalty would be meted out by the insurance company.
Medicaid Funding
Affordable Care Act provides additional subsidies to states for the expansion of Medicaid, to increase insurance coverage and access to medical care across the nation.
Republican plan wants to cap any federal Medicaid contribution to a flat amount per person, without cost-of-living increases and not based on actual plan costs.


A quick analysis of this doomsday health insurance scheme, eliminates most incentives, especially for the bottom 25%-of-income-households and a swath of the middleclass, to obtain medical insurance. By removing the tax incentive for employers to provide health plans more Americans will lose medical insurance through their employment, throwing more people into the chasm of the uninsured. By removing the tax credits for small firms, fewer of those will be able to offer medical insurance to their workers. And the piece de resistance of this Trump sanctioned health plan is to further destabilize the insurance exchanges, by removing the accountability requirement that residents have medical insurance. Plus, allowing the insurance companies to eliminate or reduce specific medical conditions will harm treatment for public health needs. Older individuals will face steep premium increases as the Republican plan allows insurance companies to charge older Americans up to five times what they charge the younger ones. In other words, back to business as usual for the insurance industry, where they can eliminate an entire “class” of people from their contracts and of course, charging those most in need significantly higher premiums.

Finally, there isn’t one thing about this “plan” that addresses the improvement of health care, lowers the cost of your health care treatment, or encourages transparency and accountability from any of the price gouging suppliers. More to come on the provisions which will impede consumer protections and create road blocks on price and quality transparency for consumers. Of course, can we really expect anything else from an administration which felt ethics classes were unnecessary, and refuses to allow adequate time for public comment on a bill which would be so harmful to people?

For the best interactive tool to see how you would fare under the Republican Health Plan, follow the link below to the nonprofit, Kaiser Family Foundation site and search for your age and county to get your tax credit information. The Republican plan only provides tax credits based on age, not on income, with a phase-out at $75,000.[4]

And this is the healthpolicymaven signing off wishing you fully informed consent for any medical procedure, contract, or act. Roberta E. Winter is a former insurance broker and healthcare consultant,  who has been devoted to healthcare reforms since 2002 and is the author of https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972 .

References

Centers for Disease Control and Prevention. (2016). Drug Overdose Deaths Continued to Increase in 2015. Health and Human Services, Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Retrieved March 12, 2017, from https://www.cdc.gov/drugoverdose/epidemic/index.html
Gunja, S. R. (2017, March 7). Why Millions Would Lose Coverage Under the Medicaid Expansion Changes in the House Affordable Care Act Repeal Bill. To the Point-Quick Takes on Health Care Policy and Practice. Retrieved March 12, 2017, from http://www.commonwealthfund.org/publications/blog/2017/mar/why-millions-would-lose-coverage-under-affordable-care-act-repeal-bill
Jost, T. (2016). Affordability: The Most Urgent Health Reform Issue For Ordinary Americans. Health Affairs.org. Health Affairs . Retrieved March 12, 17, from http://healthaffairs.org/blog/2016/02/29/affordability-the-most-urgent-health-reform-issue-for-ordinary-americans/
Kaiser Family Foundation.org. (2017). Tax Credits Under the Affordable Care Act Versus the American Health Care Act. The Henry J. Kaiser Family Foundation. The Henry J. Kaiser Family Foundation. Retrieved March 7, 2017, from http://kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/
Kirsten Beronio, R. P. (2013). AFFORDABLE CARE ACT EXPANDS MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS AND FEDERAL PARITY PROTECTIONS FOR 62 MILLION AMERICANS. Health and Human Services.gov, Office of the Assistant Secretary for Planning and Evaluation. U.S. Department of Health and Human Services. Retrieved March 12, 2017, from https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans




3 comments:

Anonymous said...

The proposed changes are frightening. No where do they address the cost of care, the fact that drug companies are making billions, that we have doctors who practice to avoid law suits and that sometimes, spending tens of thousand to stay alive for a few more days at the end of your life is not going to change the inevitable.

The US is the only industrialized nation that does not have a one payor system that covers all of its citizens. We are less healthy and pay more for the care and coverage than anywhere in the world. How is it that Americans always think their system is better when the proof says otherwise? Americans on the whole need to WAKE UP and realize they have to pay for coverage their whole life and that will make it affordable. If you want to own a car or house you pay a little each month. We have more requirements to insure out homes and cars than our bodies. Why do we think that paying for healthcare should be any different than auto and home insurance. It is the concept of spreading risk over a large pool of people and over a longer time.
It might take a decade for things to get better if we force everyone to pay a little into the pot throughout their lives, but they will. It is called the economy of scale. Otherwise, if you chose to go without insurance,accept that you need to sell your home, car, empty your bank account or pay for the rest of your life if you get ill. Americans cannot have it both ways and until they realize that, the healthcare system as it stands now will be a mess no matter who is in the White House.

healthpolicymaven said...

Thanks for taking the time to comment on such an important issue. Comments help stimulate conversation among a broader audience, something the Republicans have been loathe to do.

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