Thursday, May 4, 2017


Today the House passed by a 1 vote needed majority a Health Care revision law which must now go to the Republican controlled Senate for its approval. There is some question that there will be enough Republican objections to defeat the bill in its present form.

My opinion is that there will be a substantial premium increase for those that need insurance the most; the elderly who can least afford high insurance costs, as well as those with chronic or congenital disorders. The elderly on fixed income may have two choices; (1) no supplemental insurance relying on Medicare with its restrictions on providers and services, or (2) accepting a “cheap” policy with also limitations on providers (panel members only) and treatments. Costs will be contained by these patients not seeking or receiving the care they need. That includes skipping medications.

Here are the key measures in the House bill: (From NBC News)

  • Mandates: It guts the IRS requirement in Obamacare that people with purchase health insurance or face a fine.
  • Tax credits: The bill replaces subsidies for people to purchase insurance in the individual market in the Affordable Care Act based on income with refundable tax credits based on age. The impact is that it will provide more people with assistance but with fewer dollars, especially for the older Americans.
  • Medicaid: The Medicaid expansion is frozen immediately and in two years the states can start to adopt either a block grant for the program or a new formula based on population instead of need. In an attempt to make the bill more conservative, work requirements have been added for most able-bodied recipients who aren't pregnant or caring for a child under 6.
  • High risk pools: The bill provides $130 billion to states over ten years for high risk insurance pools to cover the most expensive to insure. A new amendment by Rep. Fred Upton of Michigan adds an additional $8 billion to assist people with pre-existing conditions.
  • State waivers: States can obtain waivers so insurers don't have to offer robust benefits packages that include maternity care and mental health coverage. Waivers can also be obtained to charge sicker people and people with pre-existing conditions more. Those people would most likely then go into the high risk insurance pools.
  • Taxes: It repeals every Obamacare tax including the .9 percent tax on couples making more than $250,000 and a 3.8 percent tax on investment income.
  • Health Savings Accounts: The measure increases the allowable contribution limits of Health Savings Accounts
  • Other: It keeps the Obamacare provision that people under the age of 26 can stay on their parents' insurance.

Other comments about this plan; 

· "Trump care eviscerates essential health benefits," such as maternity care and prescription drug coverage, said House Minority Leader Nancy Pelosi, D-Calif., "... and guts protections for people with pre-existing conditions."
  • · The current House bill would not fully repeal the 2010 Affordable Care Act, but it would kill major elements of that Democratic law. For example, the American Health Care Act would nix the requirement that most Americans purchase insurance, but it would keep in place a provision allowing younger Americans to stay on their parents' health plans until age 26.
  • · The Republican proposal would repeal the ACA’s tax credits, which are based on income and the cost of health insurance in their local market, and replace those with less generous tax credits based on age. The bill would also phase out Obamacare's Medicaid expansion starting Jan. 1, 2020.
  • · The most contentious element centered on how to deal with patients who have pre-existing conditions, such as cancer, asthma, or diabetes. The Affordable Care Act bars insurance companies from discriminating against those with pre-existing conditions. The GOP bill would weaken that protection by allowing states to seek a waiver for insurance companies to charge people with pre-existing conditions higher premiums than other consumers.

The greatest fault with “Obama Care” was that it turned a people friendly profession into a “for profit" oriented business dominated by insurance carriers and conglomerate hospital and provider enterprises. Although I could not “practice” under ACA this iteration will be worse.

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