March 08--The House Republicans' plan to replace the Affordable Care Act has set off seismic tremors, with some saying the new legislation will mean more uninsured Americans while others maintain it doesn't go far enough to replace a deeply flawed and collapsing health care program.
Ultimately, it's unclear if the new American Health Care Act truly represents a solid blueprint alternative to the ACA or, more likely, a work in progress.
The GOP plan, unveiled Monday without specifics on its cost or its impact on the rolls of uninsured, steers health care down a more conservative/free market path. The bill could come to a vote as early as next week.
The proposed alternative to what became known as Obamacare eliminates the requirement that everyone buy insurance, shifts from income-based federal subsidies for low-income enrollees to age-based refundable tax credits, and switches Medicaid funding to per capita block grants with a cutback on new enrollments after 2020.
According to an analysis by the Kaiser Family Foundation, younger people with higher incomes would get larger tax credits under the House plan, and older people with lower incomes would receive larger tax credits under President Barack Obama's Affordable Care Act.
Gov. Tom Wolf in a statement Tuesday said the Republican bill "would roll back years of progress that drastically reduced Pennsylvania's uninsured rate and expanded coverage for seniors, the disabled and those seeking treatment for a substance use disorder."
The state's insurance commissioner, Teresa Miller, said the bill "may offer the illusion of more affordable care, but let's be clear -- this proposal shifts more financial burden directly to consumers and onto state budgets."
Although premiums may be lower, she said in a phone media briefing Tuesday afternoon, "The consumer would get less out of the plan" because consumers would pay more to cover deductibles, copayments and coinsurance."
Sen. Rand Paul, R-Ky., called the House plan "Obamacare Lite," saying it is rife with taxes and entitlements. "What conservatives want ... is for a clean repeal," he told Bloomberg Politics, adding that he believed that the House bill was "dead on arrival."
For insurers, the House plan does address two key concerns:
Under the Affordable Care Act, some people were enrolling in a marketplace plan just long enough to get needed care and then dropping out. The House plan would allow insurers to slap on a 30 percent premium surcharge when the people re-enroll.
Secondly, insurers would be able to charge older, less healthy people up to five times more than their younger, healthier counterparts for the same coverage. Under the ACA, they can charge only three times more, which critics said discouraged younger, healthier adults from participating because of the higher premiums.
In addition, the House legislation hands insurance executives a bonus, eliminating the ACA's $500,000 cap on the business deduction that an insurer can take on executive salaries.
But the GOP bill also eliminates the individual mandate designed to balance the risk pool, instead penalizing those who let coverage lapse with the surcharge.
Ms. Miller questioned "whether this mechanism will bring younger and healthier people into the risk pool," further destabilizing the insurance market.
She also noted that many of ACA's problems came in the individual marketplace plans, which have seen significant premium increases but represent only about 5 percent of all of those who have a health insurance plan.
Other parts of the Affordable Care Act, such as Medicaid expansion, have helped Pennsylvania achieve historically low numbers of uninsured, she said. Ms. Miller is concerned that the House proposal would undo some of that progress.
"People who are wealthier and healthier will fare better under this proposal," she said.
"Since tax credits will no longer be income-based, but age-based, people who are low-income and have the most difficulty affording coverage will no longer get the level of assistance they get under the ACA."
Steve Twedt: firstname.lastname@example.org or 412-263-1963.
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