The big health policy news this week was the revelation of the new GOP “repeal and replace”/Trumpcare plan, which has been named the American Health Care Act or AHCA.
Vox.com’s Sarah Kliff explains how some of the biggest proposed changes would work:
“In 2020, enrollment in the Medicaid expansion will “freeze” and states with no longer be able to sign new enrollees up for the program. Legislators expect that enrollment would slowly decline, as enrollees’ incomes change and they shift off the program…
On the surface, the tax credits for the oldest Americans seem the most generous. People in their 60s, for example, get twice as much help as those in their 20s….But under the Republican plan, insurers would be allowed to charge the oldest Americans five times as much as the youngest Americans. Their financial help would not scale nearly as much as their premiums would.”
I liked this “high yield” layout from the NYTimes of what the GOP plan will keep, change, or get rid of from Obamacare.
Conservative health policy expert Avik Roy weighed in on the plan in Forbes:
“Leading House Republicans have included a number of transformative and consequential reforms in their American Health Care Act, the full text of which was published Monday evening. But those reforms are overshadowed by the bill’s stubborn desire to make health insurance unaffordable for millions of Americans, and trap millions more in poverty.”
A much longer and more detailed description of the plan’s features in Health Affairs:
“In summary, the legislation’s tax cuts will be very attractive to wealthy Americans and health insurers and providers, who would get a trillion dollars in tax breaks. It could cause consternation for Medicaid recipients and state Medicaid programs, which would see federal funding for Medicaid steadily diminish, potentially thinning out coverage. The legislation could be bad news for recipients of current tax credits who are older, sicker, and poorer, and who live in areas where care is expensive.”
And from Andy Slavitt, CMS director under Obama:
“Despite President Trump’s stated goals of covering at least as many people as the ACA, with more affordable policies, the plan put forward by the House on Monday would cut coverage for millions and make it more expensive for millions more.”
Atul Guwande on ACA repeal, and replacement by “Trumpcare”:
“Now Republicans in Congress are facing the wrath of constituents who don’t want to lose those gains. Conservatives have had to back off from their plan to repeal Obamacare now and worry about replacement later. Instead, they must grapple with what they have tried to ignore: the complexities of our health-care system, especially in the four vital areas of employer-sponsored coverage, Medicaid, the individual insurance market, and taxes.”
Conservative health care policy expert Lanhee Chen makes the case for the GOP Obamacare replacement proposal:
“This is always the tension at the core of conservative health reform. On the one hand, I think you will have lower premiums. But those come, in some cases, with products where there is more expense for the consumer on the front end. Part of that is by design. We want a system where consumers have a better handle on the cost of care.”
Another “rave review” of the AHCA by libertarian-leaning policy commentator Megan McArdle:
“You’re not exactly seeing enthusiastic cheers from the journalists who opposed Affordable Care Act, of which I am one. See? This is me, emphatically not cheering. If such a thing is possible, I am actively failing to cheer. […] So who does like this thing? Well, um, I guess rich donors and the taxes-uber-alles wing of the conservative movement.”
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