Affordable Care Act revision, Part 3

The GOP leadership and the President resisted the analysis of the Congressional Budget Office, but realized that their repeal and replace agenda is dead in the water unless they make some changes. The Republic in action : )

As a result of the Congressional Budget Office analysis, the GOP health plan will need to be revised before it has a chance of getting out of the House and into the Senate. House Speaker Paul Ryan plans to make some changes with healp from the White House and the U S Department of Health and Human Services.


REFERENCE

1. GOP Senators Say House Health Bill Won't Pass Without Changes, by Kristina Peterson, Michelle and Louise Radnofsky, The Wall Street Journal, Mar 14, 2017
2. Republicans are flirting with class warfare in their health care bill, by Henry J Aaron, Brookings, Mar 13, 2017
3. The CBO shows there is no rational justification for the GOP health plan, by Eitorial Board, Mar 13, 2017
4. Affordable Care Act revisions would reduce insured numbers by 24 million, CBO projects, by Amy Goldstein, Elise Viebeck, Kelsey Snell and Mike DeBonis, The Washington Post, Mar 13, 2017
5. Patient-Centered Medical Home Checklist,

Affordable Care Act revision, Part 2

Rob from the poor, give to the rich?

(Note: this is my translation of House GOP health bill adds up to big tax cut for the rich, by Stephen Ohlemacher and Ricardo Alonso-Zaldiver into a graphic)

The President and the GOP have endorsed a plan to repeal and replace the Affordable Care Act. Part of this plan includes cutting the taxes that fund the program. This will reduce ACA revenues by $600 billion over the next decade.  $500 billion of these tax revenues will be 'distributed' as follows:

1. Savings of $158 billion for high-income individuals and families. 90% of this money will benefit earners in the top 1% who are making making $700,00 or more. The other 10% will mainly benefit earners in the top 5%.
2. Tax savings of $117 billion for individuals earning over $200,000 and married couples earning over $250,000. This action will drain the Medicare trust fund and violates President Trump's promise not to damage Medicare
3. By lowering the medical out-of-pocket health deduction threshold from $10,000 to $7,500, $35 billion will be kept by taxpayers.  The average medical deduction for American families earning less than $100,000 is about $7,500. Over $100,000 the itemized deductions exceed $10,000, thus the main beneficiaries will be earners in the upper 20%.
4. Savings of $145 billion on market share fees for health insurers.
5. Savings of $25 billion in fees for pharmaceutical companies and importers
6. Excise tax savings of $20 billion for medical device makers and importers
7. A savings of $400 million for insurance companies by repealing $500,000 limit on the amount of an executive's pay that the health insurance companies can deduct.

House Ways and Committee chair, Rep. Kevin Brady said that despite the lost tax revenue the overall bill will not add to long term budget deficits.  (This made me wonder if he expects to be uninsuring more Americans as a way of saving money . . . and I got my answer Monday!)

I did a lot of reading putting this graph together and came away with three things:

1. I agree with Sen Ron Wyden of Oregon,, "This bill sends a loud and clear message. Tax cuts for special interests and the wealthy matter more that your health care." Thus my snarky title, 'Rob from the poor, give to the rich'.  But, the truth be told, it was the wealthy's money to begin with.
2. The people who are struggling voted for Trump because he promised them work; they didn't vote for him to repeal the Affordable Care Act. It's not 'his' 59 million voters who don't earn as much as a member of Congress ($174,000) who are invested in repealing Obamacare; it's the 5% who own 63% of the country's wealth who want to get out from under Obamacare.
3. The Affordable Care Act is working as a way to provide health insurance for our poor and as a means to redistribute our wealth.  If Congress is going to improve the health insurance aspect, they will need to be circumspect about changing the rules and they will need to build confidence among the private insurers. If they are going to go about redistributing our wealth,  they need to identify the "elephant on the table" and deal with it.

REFERENCES:

1. House GOP health bill adds up to big tax cut for the rich, Stephen Ohlemacher and Ricardo Alonso-Zaldiver, Associated Press, Mar 7, 2017
2. Tax credits work differently in 'Obamacare' and GOP plan, by Stephen Ohlemacher, WMTW News 8, Mar 11, 2017
3. $250,000 a Year Is Not Middle Class, by Bryce Covert, The New York  Times, Dec 28, 2015
4. Who Are the Top 1% Income Earners?, by Financial Samurai, updated 2017
5. What Percent Are You?, by Andrew Van Dam, The Wall Street Journal, Mar 2, 2016
6. Making a killing under Obamacare: The ACA gets blamed for rising premiums while insurance companies are reaping massive profits, by Angelo Young, Salon, Oct 28, 2016
7. Healthcare shocker: These insurers are making money on Obamacare, by Michael Hiltzik, Los Angeles Times, Apr 27, 2016
8. Opinion: I'm a former health insurance CEO and this is what Obamacare repeal will do, by J B Silvers, MarketWatch, Jan 4, 2017
9. Better Off Before Obamacare?, by Olga Khazan, The Atlantic, Nov 14, 2016
10. The True Cost of Healthcare, by David Belk, MD and Paul Belk, MD, 2016
11. Pharma: an industry shaped by shareholder value, by Dan Bobkoff, Marketplace, Jun 15, 2016
12. Millions might lose health coverage? Not to hear Republican leaders tell it, by Philip Bump, The Wasington Post, Mar 12, 2017
13. The Average National Income Tax Deduction, by Tom Streissguth, Chron, 2010 data
14. Average Itemized Deductions, by Eric Scott and Brenda Au, 2011 data
15. The one tax graph you really need to know, by Ezra Klein, The Washington Post, Sep 19, 2012
16. How Does the ACA Individual Mandate Affect Enrollment and Premiums in the Individual Insurance Market?, by Christine Eibner and Evan Saltzman, Rand Health, 2015
17. 2017 Tax Guide, by Bankrate
18. Pharmaceutical industry gets high on fat profits, by Richard Anderson, BBC News, Nov 6, 2014
19. Key Facts about Uninsured Population, Kaiser Family Foundation, Sep 29, 2016
20. The House GOP Health Plan Makes Obamacare Look Good, by Alan S Blinder, The Wall Street Journal, Mar 13, 2017
21. CBO Sees 24 Million More Uninsured, $337 Billion Deficit Cut With GOP Plan by Stephanie Armour and Kristina Peterrson, The Wall Street Journal, Mar 13, 2017
22. Wealth inequality in the United States, Wikipedia
23. Tax Savings from Repealing Obamacare, by Kevin Drum, Mother Jones, Mar 21, 2017

Unaffordable Care Act, Part 1

So I did some research into the Affordable Care Act and the Republican repeal and replace strategy. Boy, talk about com-pli-cat-ed!

After some reading, it boils down to:

1. Is the Affordable Care Act working?
2. How much does it cost America?
3. What's wrong with the Affordable Care Act?
4. What are the benefits of the Affordable Care Act?
5. Will the Republican replacement plan work better than the Affordable Care Act?
6. How much does the Republican replacement plan cost?
7. How do the alternative Republican plans affect me? 
8. How do the alternative Republican plans affect America?
9. Has public opinion about the ASA changed?

It doesn't look like I made it less complicated, but here goes:

1. Is the Affordable Care Act working?

• Yes it is according to a New York Times 2014 article, but its not perfect.  Gallup did a 2016 survey that showed the number of uninsured had decreased, but there are still quality and cost concerns.

2. How much does it cost America?

• When the Congressional Budget Office estimated the cost for the first 10 years (FY2010-FY2019), they calculated a debt reduction of $143 billion.  When they recalculated in 2012 for an 11 year period (FY2012-FY2023), they calculated a debt increase of $1.252 trillion. 

3. What's wrong with the Affordable Care Act?

• It's complicated
• The penalty tax is hard to understand
• Plans were canceled for 1 million people because the health insurance companies didn't comply with ACA's ten essential health benefits
• Medicare reimbursement changed from a fee-for-service to a value-based payment creating a painful transition for the hospitals
• All medical records must be computerized
• Health care costs could increase over the short term as many people receive preventive care for the first time
• Families lose some tax deductions for uninsured medical costs
• Higher income families pay additional Medicare taxes (affects 1 million individuals and 4 million couples who make more than $200,000 and $250,000 respectively)
• Between 3 and 5 million people lost their company-sponsored health care plans.
• Health care and health insurance companies pay additional taxes to help pay for ACA benefits

4. What are the benefits of the Affordable Care Act?

• The ACA lowers cost by making health insurance affordable
• The ACA lowers cost by emphasizing prevention
• The ACA lowers cost by improving how healthcare itself is delivered

5.What does the Republican ACA repeal and replace plan do?

• It keeps some of the changes that Affordable Care Act implemented.  Senator Rand Paul quipped that it sounds like Obamacare Lite based on media reports.
• It does away with individual mandate, which is a requirement that most American obtain and maintain health insurance or pay a tax penalty.  It's a way to help pay for the ACA, providing about $64 billion for the first 10 years. 
• Instead of a individual mandate tax to encourage people to stay insured, insurance companies will be allowed to levy a 30% surcharge for a year on the premiums to people requesting to be re-insured.
• Income-based subsidies would be replaced with age-based tax credits that may be less generous to people with low income. These tax credits could be perceived as entitlements.
• The Medicaid expansion to include additional low-earning Americans would continue until 2020.  After that state adding Medicaid recipients would no longer be federally funded.
• The federal-state Medicaid program would be changed from open-ended federal financing to a limit based on enrollment and costs in each state

6. How much will the Republican replacement plan cost?

• The plan does not include any price tags.  It was released without a Congressional Budget Office score.
• CNN published a Jan 2017 article that provides some financial insight saying that a full repeal will cost $350 billion over the next decade. 

7. How do the alternative Republican plans affect me? 

• The Washington Post published an interactive article on Jan 17, 2017 that let you see how the various Republican plans to replace Obamacare could affect you.  Hopefully they will do a new one to address the plan submitted Mar 6, 2017 and I'll provide a link.

8. How do the alternative Republican plans affect America?

• It keeps some key features of the ACA, like giving more help to lower-income Americans and Medicaid expansion
• It will leave millions uninsured
• It would cut taxes on the wealthy

9. Has public opinion about the ACA changed?

• Yes.  Since the Affordable Care Act was implemented in 2010, public opinion has shifted according to a 2015 survey by CBS News

Bottom line, the Affordable Care Act is working but needs to be improved. The repeal and replace plan that the Republicans presented this week includes many of the ACA's provisions.  The driving force for repealing it seems to be trumped up Republican pride.  The American people cannot afford to pay $350 billion to assuage partisan pride.  Congress and the President need to get their act together and improve the Affordable Care Act.  

REFERENCES:

1. Is the Affordable Care Act Working?,  by Margot Sanger-Katz, Abby Goodnough, Reed Abelson, Anemona Hartocollis, Sabrina Tavernise, and Robert Pear, The New York Times, Oct 26, 2014, 
2. Uninsured Down Since Obamacare; Cost, Quality Still Concerns, by Nader Nekvasil, Gallup, Aug 29, 2016
3. How much Did Obamacare Cost?, by Kimberly Amadeo, the balance, Jan 12, 2017
4. What is Wrong with Obamacare? by Kimberly Amadeo, the balance, Feb 4, 2017
5. House Republicans Release Obamacare Repeal and Replace Plan, by Dan McCue, Courthouse News Service, Mar 6, 2017
6. Republicans unveil bill to repeal and replace Obamacare, by Lauren Fox and Deirdre Walsh, CNN, Mar 7, 2017
7. Fully repealing Obamacare will cost $350 billion, by Tami Luhby, CNN, Jan 4, 2017
8. How the Republican plans to replace Obamacare could affect you, by Kim Soffen and Denise Lu, The Washington Post, Jan 17, 2917
9. Republicans' Obamacare replacement bill: The winners and losers, by Tami Luhby, CNN, Mar 7, 2017
10. The American Health Care Act: The Republicans' bill to replace Obamacare, explained, by Sarah Kliff, Vox, Mar 6, 2017
11. Republicans' Obamacare repeal plan would cut taxes on the wealthy, by Brian Faler, Politico, Mar 6, 2017
12. Poll: Obamacare and the Supreme Court, by Sarah Dutton, Jennifer De Pinto, Anthony Salvanto, and Fred Backus, CBS News, Jun 22, 2015
13. Lawmakers take up Obamacare revision without an independent scorekeeper, by Karen Tumulty and Max Ehrenfreund, The Washington Post, Mar 8, 2017

Is there something we can learn from other countries about how to manage an effective and efficient system?:

• World Health Organization Ranking: The World's Health Systems, The Patient Factor, Mar 12, 2017 

"Heard" of President Trump's faux gnus fearing a faux coup?

REFERENCES:

• Trump and Republicans see a ‘deep state’ foe: Barack Obama, by David Weigel, The Washington Post, Mar 7, 2017
• Smoke and mirrors: how Trump manipulates the media and opponents by Alan Yuhas, The Guardian, Jan 18, 2017
• This is the single worst quote in the entire Trump wiretapping mess, by Chris Cillizza, The Washington Post, Mar 7, 2017 

Pope Trump

For a few years I've been concerned about how political thoughts had become beliefs.  Why else would sensible men and women who represent us stay locked in partisan stalemates instead of working together to solve the myriad of problems that we face.

Today my concerns have been justified by our President.  His thoughts become his tweets, his tweets become his beliefs, and his beliefs seem to become his reality.  Unfortunately, because he is our President, his "alternative fact" based reality effects the workings of our government, and, as Senator Sanders points out, America's standing in the world. The paradox is, I think he wants to make our government work but he seems to be getting in his own way.

My cartoon today is where my thoughts went after reading Dana Milbank's It's the Truth According to Trump, Believe It!.



Reference:

• by Dana Milbank, The Washington Post, Mar 6, 2017: It’s the truth according to Trump. Believe it.

• by Nikita Vladimirov, The Hill, Mar 7, 2017: Sanders defends his view that Trump is a liar

• by Daniel W Drezner, The Washington Post, Mar 7, 2017: Strategy 101 and the Trump administration

"Heard" of President Trump's fake gnus?

REFERENCE:

• Trump’s charge that he was wiretapped takes presidency into new territory, WP, Mar 5, 2017
• Tapping Trump?, by Julian Sanchez in Just Security, Mar 4, 2017
• FBI Asks Justice Department to Rebut Trump's Wiretap Claims,  by Aruna Viswantha and Ted Mann in The Wall Street Journal, Mar 5, 2017
• Ten More Questions for President Trump, by Benjamin Wittes in Lawfare, Mar 5, 2017
• Wiretapping allegations accomplished what Trump wanted – but may backfire bigly, by James Hohmann in Washington Post, Mar 6, 2017
• As Trump keep doubling down down down, eventually either he hits bottom or we do, by Tom Toles in Washington Post, Mar 6, 2017
• When Sean Spicer says Trump was 'very clear,' he probably wasn't, by Callum Borchers, The Washington Post, Mar 14, 2017
• DOJ Blows Wiretap Deadline, Asks Intelligence Committee for More Time, by Betsy Woodruff and Tim Mak, The Daily Beast, Mar 13, 2017