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patriotsnet · 3 years ago

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How Many Republicans Voted For Affordable Care Act

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How Many Republicans Voted For Affordable Care Act

Regulatory Action To Destabilize The Aca

House votes to repeal Affordable Care Act

When GOP lawmakers failed to repeal the ACA in 2017 , the Trump administration started looking for ways to chip away at the law via regulations instead. As mentioned above, the administration has opted to significantly reduce the federal funding that was being used to help people enroll in plans offered through the exchanges. But there have also been some regulations that have further undermined the ACA-compliant markets, mainly by making it easier for people to enroll in plans that dont meet the ACAs requirements for individual and small group coverage.

In June 2018, the Trump Administration finalized regulations that allowed self-employed people and small businesses to join association health plans without having a commonality of interest or a purpose for the association other than obtaining health insurance. This regulation has been struck down by a federal judge and although the case is being appealed, the Department of Labor has confirmed that association health plans based on the 2018 regulations cannot currently be marketed to sole proprietors and small businesses.

The Trump administration has issued regulations that allow employers to reimburse employees for the cost of individual market coverage. In addition, employers have the option of reimbursing employees for excepted benefits via an excepted benefits health reimbursement arrangement.

Eliminating Health Care Penalties

The Affordable care Act, required most Americans to be enrolled in Health Insurance since it was made affordable, otherwise a penalty would be induced. Effective 2017, congress attempted to eliminate financial penalties that were related to complying with the mandated law that every individual needs to be enrolled in Health insurance, this law however did not become effective until 2019. This policy is still valid, the penalty for having no health insurance was reduced to 0$. Individual mandates effects the decisions made by individuals regarding healthcare in that some people will not enroll since health insurance plans are no longer mandatory.

On March of 2020, the nation has undergone a global pandemic, however, several Republican-led states and the Justice Department are making the case for invalidating the ACA. This will cause at least 60 million people to not be able to afford being hospitalized, or treated which increased the number of COVID-19 cases nationwide.

A Final Vote Isn’t The Whole Story It’s Like Researching Your Ancestry And Going No Further Back Than Your Mother And Father

The day after she was one of three;Republican;senators to vote against;her party’s proposal to repeal chunks of the Affordable Care Act, Susan Collins of Maine posted a press release that said:;”Democrats made a big mistake when they passed the ACA without a single Republican vote. I don’t want to see Republicans make the same mistake.”

It was a nice nod in the direction of bipartisanship. But it also perpetuates a deceptive narrative, repeated often by Republicans,;that they were completely excluded from the process that resulted in Obamacare. While it is true that no Republican voted for the final bill, it is blatantly untrue that it contains no GOP;DNA. In fact, to make such an assertion is like researching your ancestry and going no further back than your mother and father.;

Not only were Republican senators deeply involved in the process up until its conclusion, but it’s a cinch that the ACA;might have become law months earlier if;the Democrats, hoping for a bipartisan bill, hadn’t spent enormous time and effort wooing GOP senators only to find themselves gulled by false promises of cooperation. And unlike Majority Leader Mitch McConnell’s semi-secret proceedings that involved only a handful of trusted colleagues, Obamacare, until the very end of the process, was open to public scrutiny.

More:Spare America a do-over on health care. Seize the bipartisan moment.

POLICING THE USA: A look at;race, justice, media

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Republicans Win Fewer Votes But More Seats Than Democrats

Republicans controlled the post2010 redistricting process in the four states, and drew new lines that helped the GOP win the bulk of the House delegation in each. Republicans captured 13 of 18 seats in Pennsylvania, 12 of 16 in Ohio, nine of 14 in Michigan, and five of eight in Wisconsin. Added together, that was 39 seats for the Republicans and 17 seats for the Democrats in the four proObama states.

The key to GOP congressional success was to cluster the Democratic vote into a handful of districts, while spreading out the Republican vote elsewhere. In Pennsylvania, for example, Republicans won nine of their 13 House seats with less than 60% of the vote, while Democrats carried three of their five with more than 75%.

One of the latter was the Philadelphiabased 2nd District, where 356,386 votes for Congress were tallied. Not only was it the highest number of ballots cast in any district in the state, but Democratic Rep. Chaka Fattah won 318,176 of the votes. It was the largest number received by any House candidate in the country in 2012, Democrat or Republican. If some of these Democratic votes had been unclustered and distributed to other districts nearby, the party might have won a couple more seats in the Philadelphia area alone.

The Closest House Races of 2012

NARROW DEMOCRATIC WINNERS

Vulnerable Gop Senators Vote To Protect Affordable Care Act From Trump Lawsuit

Six Republican senators, five of whom are up for re-election in 2020, sided with Democrats on Thursday in a procedural vote to block the Trump administration from supporting a lawsuit that would dismantle the Affordable Care Act.

Why it matters: The final vote on the motion was 51-43, failing to reach the necessary 60-vote threshold to pass. But the move by Senate Minority Leader Chuck Schumer forced several vulnerable GOP senators to go on the record on whether they support the lawsuit, which could strip protections from pre-existing conditions for millions of Americans.

The state of play: Sens. Susan Collins , Joni Ernst , Cory Gardner , Martha McSally and Dan Sullivan all voted with Democrats and are facing close re-election fights. Sen. Lisa Murkowski also voted in favor.

Sens. Steve Daines , Thom Tillis and David Perdue are facing tough re-election races, but voted against the motion.

Flashback: All six GOP senators who supported Thursday’s bill voted for the 2017 tax bill that set the latest Supreme Court challenge to the Affordable Care Act in motion.

Of note: Four of the Republicans to break rank were women nearly half of the nine female GOP senators in Congress.

While Murkowski is not up for re-election until 2022, she opposed President Trump on quickly confirming a Supreme Court judge to replace the late Justice Ruth Bader Ginsburg and has publicly opposed the Trump administration on several occasions.

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Changes Required By The Affordable Care Act In 2011

A provision goes into effect to protect patients choice of doctors. Specifics include allowing plan members to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an obstetrician/gynecologist , and ensuring access to emergency care.

Young adults can stay on their parents insurance until age 26, even if they are not full-time students. This extension applies to all new plans.

All new health insurance policies must cover preventive care and pay a portion of all preventive care visits.

A provision goes into effect that eliminates lifetime limits on coverage for members.

Annual limits or maximum payouts by a health insurance company are now restricted by the ACA.

The ACA prohibits rescission when a claim is filed, except in the case of fraud or misrepresentation by the consumer.

Insurance companies must now provide a process for customers to make an appeal if there is a problem with their coverage. ;

NOTE: In January,;2011:;eHealth publishes 11 guides on the top;child-only health insurance coverage;that examined differences in implementation in numerous states.

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Poll Finds Startling Difference In Vaccinations Among Us Republicans And Democrats

A Washington Post-ABC News poll has found a startling difference between Democrats and Republicans as it relates to COVID-19;vaccination.;The poll found that while 86% of Democrats have received at least one COVID-19 vaccine shot, only 45% of Republicans;have.

In addition, the survey found;that while;only;6% of Democrats said they would;probably;decline;the vaccine, 47% of Republicans;said they;would;probably not;be inoculated.;

The poll also found that;60% of unvaccinated Americans believe the U.S. is;exaggerating;the dangers of;the;COVID-19;delta variant,;while;18% of the unvaccinated say the government is accurately describing the variants risks.

However, 64% of vaccinated Americans believe the government is accurately describing the dangers of the;delta variant.

Iran fighting COVID 5th wave The variant is having a;global impact.;Irans;President;Hassan Rouhani;has warned that the country is on the brink of a fifth wave of;a COVID-19 outbreak.;The;delta variant of the virus, first;identified;in India, is;largely;responsible;for the;rising number of hospitalizations and deaths in Iran, officials say.

All;non-essential businesses have been ordered;closed;in 275 cities, including Tehran, the capital.;Travel has also been restricted between cities that are;experiencing;high infection rates.

Reports say only about 5% of Iranians have been vaccinated.;

The Number Of Times Every Senate Republican Voted To Attack Preexisting Condition Protectionstheir Rushed Supreme Court Confirmation Will Be The Latest

How Senate Republicans’ ‘skinny repeal’ bill failed

The coronavirus has underscored how important it is that the American people have comprehensive, high-quality, and affordable health coverage.;More Americans than ever are;relying;on the Affordable Care Act for coverage; and yet, President Donald Trump and Republican attorneys general are suing to take away this critical lifeline in the middle of the pandemic. If the ACA is repealed, more than 20 million Americans could lose health coverage and 135 million could lose critical protections that prevent insurers from denying people coverage or charging them more for having preexisting conditions such as diabetes, cancer, and even COVID-19.

This case will be heard by the U.S. Supreme Court just one week after the election, which is why the president and Senate Republicans are rushing to install another rubber stamp for their political agenda following the passing of Justice Ruth Bader Ginsburgdespite just four years ago having opposed filling a Supreme Court vacancy during an election. This rushed confirmation push is;opposed;by the American people and comes while voting in the election is already underway.

This analysis provides a comprehensive look at how many times Senate Republican incumbents have voted to weaken the ACAs protections for preexisting conditions and makes clear why voters do not trust their efforts to push through a lifetime appointment that would put Americans health care at risk.

Table 1

Recommended Reading: How Many Republicans In The Us Senate

Opposition To Obamacare Becomes Political Liability For Gop Incumbents

In the 2014 elections, Republicans rode a wave of anti-Affordable Care Act sentiment to pick up nine Senate seats, the largest gain for either party since 1980. Newly elected Republicans such as Cory Gardner in Colorado and Steve Daines in Montana had hammered their Democratic opponents over the health care law during the campaign and promised to repeal it.

Six years later, those senators are up for reelection. Not only is the law still around, but its gaining in popularity. What was once a winning strategy has become a political liability.

Public sentiment about the ACA, also known as Obamacare, has shifted considerably during the Trump administration after Republicans tried but failed to repeal it. Now, in the midst of the COVID-19 pandemic and the ensuing economic crisis, which has led to the loss of jobs and health insurance for millions of people, health care again looks poised to be a key issue for voters this election.

Reminder: Obamacare Passed Without A Single Republican Vote

Back in 2009 and 2010, Democrats controlled the White House and the U.S. House and U.S. Senate. President Obama, Senate Majority Leader Harry Reid and then House Speaker Nancy Pelosi rammed Obamacare through without a single Republican vote.

The Washington Post said of the Obamacare fight at the time It has inflamed the partisanship that Obama pledged to tame when he campaigned for the White House and has limited Congresss ability to pass any other major legislation.

In December 2009, the U.S. Senate voted 60 to 39 for Obamacare. The Washington Post reported The Senate bill passed without a single GOP vote.

In March 2010, the U.S. House voted 219 to 212 for Obamacare. 34 House Democrats and all of the House Republicans voted against Obamacare. The NO votes were the only bipartisan votes.

President Obama signed the Patient Protection and Affordable Care Act on March 23, 2010.

President Obama embraces HHS Sec Kathleen Sebelius and House Speaker Nancy Pelosi after signing the health insurance reform bill, March 23, 2010.

Democrats ignored the plans offered by Republicans at the time including the House GOP plan drafted by Rep. Tom Price and The Patients Choice Act of 2009introduced by U.S. Senators Tom Coburn, M.D. and Richard Burr and U.S. Representatives Paul Ryan and Devin Nunes .

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Isans Are Split On The Supreme Court Overturning The Aca

In June 2020, the Trump administration issued a brief asking the U.S. Supreme Court to overturn the ACA. The brief was filed in support of an ongoing challenge to the ACA by a group of Republican attorneys general in California v. Texas, a case that challenges the legality of the ACA in light of the zeroing out of the individual mandate penalty in the 2017 Tax Cuts and Job Acts. The death of Supreme Court Justice Ruth Bader Ginsburg on September 18 and the possibility of the Senate confirming a new Justice appointed by President Trump before the presidential election has brought heightened attention to the potential outcome of this case and the future of the ACA. In October 2020, a majority of the public said they do not want to see the Supreme Court overturn the 2010 health care law, and eight in ten said they do not want to see the ACAs protections for people with pre-existing conditions overturned. There are partisan differences on both questions, with the majority of Democrats and independents saying they dont want the Court to overturn the ACA or pre-existing condition protections. However, among Republicans, three-fourths say they want to see the ACA overturned, but two-thirds say they do not want to see pre-existing condition protections overturned.

Figure 2: Majorities Do Not Want Court To Overturn ACAs Pre-Existing Condition Protections, Republicans Want Entire Law Overturned

Russia Sanctions Headed To Trumps Desk Will He Sign

Some GOP senators worried the measure would go back to the House, where leaders would put it on the floor, pass it and send it to Trump who has said he would sign whatever lands on his desk when it comes to Republican-passed health care legislation.

Before the vote, at 10:43 p.m. ET, Trump was rooting them on in a tweet: Go Republican Senators. Go!

Afterward, it was a different story, with the president tweeting at 2:25 a.m. ET that those who voted no had let the American people down.

Its somewhat ironic that McCain was the one to derail what seemed like a sure Trump victory . After all, Trumps comments about the former prisoner of war were among the earliest to land the then-candidate in controversy.

Hes not a war hero, Trump said in 2015 of McCain. He was a war hero, because he was captured. I like people who werent captured. Hes been losing so long he doesnt know how to win anymore.

That was likely never lost on McCain.

Read Also: When Did The Parties Switch Platforms

Recommended Reading: Donald Trump Republican Or Democrat

Actions To Hinder Implementation

Under both ACA and the AHCA, CBO reported that the health exchange marketplaces would remain stable. However, Republican politicians took a variety of steps to undermine it, creating uncertainty that adversely impacted enrollment and insurer participation while increasing premiums. Concern of the exchanges became another argument for reforms. Past and ongoing Republican attempts to weaken the law have included:

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Requirements For Health Plans And Insurers

See also: Health insurance policy cancellations since Obamacare

Coverage

The Affordable Care Act prohibited individual market insurers from denying coverage to people with pre-existing conditions. This policy is known as guaranteed issue. Guaranteed issue regulations had already existed for insurers selling employer-sponsored health plans, and the ACA extended this rule to the individual market as well.

The law also required insurers to allow young adults to stay on their parents’ health insurance plans until age 26. Insurers were also required to allow people in the individual market to renew their health plans each year unless they did not pay their premiums.

Benefits

The ACA required individual and small group health plans that were offered both on and off the exchanges to cover services that fall into 10 broad benefits categories, called essential health benefits:

Ambulatory patient services

Rehabilitative and habilitative services and devices

Prescription drugs

Mental health and substance use disorder services, including behavioral health treatment

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric services, including oral and vision care

Premiums

The ACA placed restrictions on the way individual and small group insurers set a plan’s premiumThe amount a consumer is required to pay for a health insurance plan. Premiums are usually paid monthly, quarterly or annually.:

Medical loss ratio

Stabilization programs

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statetalks · 3 years ago

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Why Republicans Want To Repeal Aca

Why Republicans Wouldn’t Actually Repeal Obamacare

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It would be a political disaster, but it hasn’t yet stopped them from trying.

Last week, in a bold example of their governing prowess, congressional Republicans took their 62nd vote to repeal the Affordable Care Act, and this time they actually passed it through both houses and sent it to President Obama to be vetoed. Naturally, they were exultant at their triumph. Speaker Paul Ryan admitted that there is as yet no replacement for the ACA, but they’ll be getting around to putting one together before you know it. The fact that they’ve been promising that replacement for more than five years now might make you a bit skeptical.

What we know for sure is this: If a Republican wins the White House this November, he’ll make repeal of the ACA one of his first priorities, whether there’s a replacement ready or not. To listen to them talk, the only division between the candidates is whether they’ll do it on their first day in the Oval Office, in their first hour, or in the limo on the way back from the inauguration.

But I’ve got news for you: They aren’t going to do it, at least not in the way they’re promising. Because it would be an absolute catastrophe.

Now imagine that ten million people, the number signed up for private coverage through the exchanges, all had their coverage simultaneously thrown into doubt. Think that might cause some bad press for the party and the president who did it?

What Does The Existing Law Do

The Patient Protection and Affordable Care Act, known as Obamacare or the ACA, was the largest overhaul of the US healthcare system since the 1960s.

It aimed to eventually slow the growth of US healthcare spending, which is the highest in the world.

Obamacare intended to extend health insurance coverage to the estimated 15% of Americans who lacked it and were not covered by other health programmes for the poor and elderly.

The law created state-run marketplaces – with websites akin to online shopping sites – where individuals can compare prices as they shop for coverage.

Some of the more popular provisions include:

Children can stay on their parent’s healthcare plan until age 26

No one who is sick or has a medical condition can be denied insurance

Companies can no longer charge women more than men

Businesses with more than 50 full-time employees must offer health insurance

#2: Partisans Are Split On The Supreme Court Overturning The Aca

Figure 2: Majorities Do Not Want Court To Overturn ACAs Pre-Existing Condition Protections, Republicans Want Entire Law Overturned

Democratic Resistance To Obamacare

Republicans are not the only ones calling for reform or replacement of the Affordable Care Act. The National Review cited a Washington Post/ ABC News survey done not long after the act went into effect that said party support for the act only amounts to about half of Democrats polled. According to the article, 56 percent of those surveyed were concerned about their personal health care under the new law. One Democratic contender put it this way: Obamacare is extremely problematic. It is expensive. It is a $500 billion cost than we originally anticipated. Its cutting into Medicare benefits, and its having companies lay off their employees because they are worried about the cost of it. That is extremely problematic. It needs an enormous fix.

Republican Views On Obamacare

The Republican Partys view on the Patient Protection and Affordable Care Actcommonly known as Obamacareis that its implementation was less about providing healthcare to millions, and more a result of power as the government sought to expand its reach over one sixth of the economy. The party claims that Obamacare has resulted in an attack on the Constitution of the United States because it requires U.S. citizens to purchase health insurance, and its impact on the health of the nation overall has been detrimental. The party is in agreement with the four Supreme Court justices who dissented in the ACA ruling. The justices stated, In our view, the entire Act before us is invalid in its entirety. As of 2012, the partys stance was that Obamacare was the result of outdated liberalism, and the latest in a series of attempts to impose upon the people of America a euro-style bureaucracy to micromanage all aspects of their lives. One of the partys biggest issues with Obamacare is its unpopularity among the peoplewhen polled on the subject, pluralities and even majorities often state they do not like the law.

The Acas Protections Changed Public Opinion In Its Favor Republicans Are Keeping Up

For more than a decade, the Affordable Care Act has been the Republican Partys nemesis. As it was first debated in Congress in 2009, when it was enacted in 2010 and through the next six years of implementation, Republican leaders rallied supporters by vociferously opposing it and calling for repeal. The Trump administration and states controlled by Republicans remain hostile to the ACA.

But the coronavirus pandemics fast-moving destruction has pushed Republicans to rely on Barack Obamas signature law to respond to the crisis, even taking action to strengthen it. The law, as written, requires that Americans who have recently lost jobs and insurance coverage to be permitted to enroll in its insurance marketplace, and they are doing so in swelling numbers. Meanwhile, Republicans recently backed that increased federal funding for a critical part of the ACA: Medicaid for lower-income people. And Trump administration regulators have used their authority to insist that insurance plans pay for coronavirus tests as an essential health benefit under the ACA a Republican target in the past.

Our research shows that this about-face cannot be explained by the pandemic alone. The partys rank-and-file and many other Americans have shifted to supporting the ACA and expanded government payments for health care. The pandemic is giving Republicans cover to follow changing public opinion.

Republicans have spent 10 years trying to kill the Affordable Care Act

What If It Is Repealed

If Obamacare is repealed and not replaced with an alternative, the government would see a huge increase in the deficit because the repeal would devastate Medicaid, according to Healthline.com. The federal government currently provides states with 90 percent of their Medicaid funding through the ACA provisions. If Obamacare is repealed, states will not receive that funding. Insurance companies could rescind coverage of people with pre-existing conditions and raise premiums. It is feasible that millions of people could lose their coverage. Hospitals and healthcare providers would be affected because they would have fewer patients with insurance. Premiums and deductibles could go up. Those are depressing forecasts.

Some people, however, support the repeal believing things will be fine. They say the federal government should not be involved in healthcare, and that if Obamacare was repealed the states would take over the insurance exchanges and Medicaid. They believe in a self-leveling effect in which the insurance companies would go back to offering more variety in coverage and individuals would have choices. The problem with the scenario, however, is Medicare. The healthcare system for those 65 and older is what moves the healthcare industry. Reforms should be made, including giving people an opportunity to simply refuse it. These changes would bring the free-market principle back into healthcare and should drive costs down.

Trumps Executive Action Could Erode Marketplace Built Under Obamacare

Attempts to repeal portions of the Affordable Care Act have failed in the past several months, leading President Donald Trump to issue an executive order expanding access to cheaper, less comprehensive health care plans.

The order, signed on Oct. 12, instructs federal agencies to remove certain limitations on “association health plans” and expand the availability of short-term health plans, both of which can skirt certain minimum coverage requirements included in the Affordable Care Act and state laws.

These changes will not immediately take effect; federal agencies will have to figure out how to act on Trump’s directions.

The executive action orders agencies to explore ways in which the government can expand access to short-term health plans, which are available to individuals on a three-month basis and meant for people who are in-between health care coverage plans. Under the instructions, association health plans would be allowed to sell plans across state lines; those plans allow small businesses to band together to create cheaper health care plans that offer fewer benefits.

The order was intended to create more options for individuals seeking health insurance and help stimulate competition among insurers. Some health policy advocates worry that it could disrupt the insurance marketplace in a way that would drive up health care costs for elderly individuals and people with medical conditions.

It will be months before changes are seen in the marketplace.

Younger Americans Could Get Cheaper Plans

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Obamacare was designed so that younger policyholders would help subsidize older ones. That would change under the Republican bill because it would allow insurers to charge older folks more.

This means that younger Americans would likely see their annual premiums go down. Enrollees ages 20 to 29 would save about $700 to $4,000 a year, on average,according to a study by the Milliman actuarial firm on behalf of the AARP Public Policy Institute.

Those under age 30 would also get a refundable tax credit of up to $2,000 to offset the cost of their premiums, as long as their income doesnt exceed $215,000 for an individual.

The GOP tax credits would also likely be more generous than Obamacares subsidies for these folks. For example, a 27-year-old making $40,000 a year would receive $2,000 under the GOP plan, but only gets a $103 subsidy from Obamacare, on average, a Kaiser analysis found.

Also, the bill keeps the Obamacare provision that lets young adults up to age 26 stay on their parents insurance plan.

Trumps Promise To Repeal Obamacare Is Now In Limbo

President Donald Trump expressed disappointment after Republican lawmakers’ failure to muster enough votes to repeal Obamacare placed one of his loftiest campaign promises in limbo.

A series of defections by Senate Republicans scuttled two separate efforts to dismantle the sweeping U.S. health care law put in place by Trump’s predecessor, President Barack Obama.

“We’ve had a lot of victories, but we haven’t had a victory on health care,” Trump told reporters July 18, as it became clear the latest Republican legislative efforts would fail. “We’re disappointed.”

A slim margin of error constrained GOP efforts to repeal and replace Obamacare and forced a delicate balancing act between the party’s conservative and moderate members.

But defections by Sens. Jerry Moran of Kansas and Mike Lee of Utah on July 17 brought to four the number of Republican senators to publicly oppose the bill , effectively killing the repeal-and-replace plan. Senate leadership could only afford to lose two Republican votes for passage.

Senate Republicans then turned their attention to a measure that would repeal major parts of Obamacare over two years, in theory buying lawmakers enough time to agree on a replacement plan before the Affordable Care Act, often called Obamacare, was largely dismantled.

“I did not come to Washington to hurt people,” Capito said in a statement. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”

What Would Trumpcare Look Like Follow Gop’s ‘choice And Competition’ Clues

Eliminating the penalty also caused insurance premiums to rise, says Sabrina Corlette, director of the Center on Health Insurance Reforms at Georgetown University. “Insurance companies were getting very strong signals from the Trump administration that even if the ACA wasn’t repealed, the Trump administration probably was not going to enforce the individual mandate,” she says. Insurance companies figured that without a financial penalty, healthy people would opt not to buy insurance, and the pool of those that remained would be smaller and sicker.

So, even though the $0 penalty didn’t actually go into effect until 2019, Corlette says, “insurance companies in anticipation of the individual mandate going away and in anticipation that consumers would believe that the individual mandate was no longer going to be enforced priced for that for 2018.” According to the Kaiser Family Foundation, premiums went up about 32%, on average, for ACA “silver plans” that went into effect in early 2018, although most people received subsidies to offset those premium hikes.

Republicans Are Still Trying To Repeal Obamacare Heres Why They Are Not Likely To Succeed

Conservatives are still trying to repeal the Affordable Care Act even after the Republican-majority Congress failed to overturn the law in 2017. A coalition of conservative groups intends to release a new plan this summer. The groups will reportedly propose ending the laws expansion of Medicaid and convert Medicaid funding into block grants to the states. And just last week the Trump administrations Justice Department argued in a legal filing that key provisions of the law its protections for persons with preexisting conditions are .

Why are Republicans still trying to undo the ACA? We argue in a forthcoming that the laws political vulnerabilities and Republican electoral dynamics drive conservative efforts to uproot it.

In the past, conservatives have thrown in the towel

As politicians and political scientists both know, the can never be taken for granted. Even so, the duration and intensity of conservative resistance to the ACA is historically unusual. The ACA is a moderate law, modeled on that Republicans once supported, such as insurance purchasing pools. Whats more, many red states refuse to accept the ACAs funding to expand Medicaid to more of their citizens such as , which has a large number of uninsured residents even though you would think they would want those federal benefits.

So why is the ACA still politically vulnerable?

The answer lies partly in the way the program was designed.

Is repeal likely?

Nicole RapfogelEmily Gee

If The Affordable Care Act Is Struck Down Tens Of Millions Of Americans Would Lose Coverage And Protections For Pre

As the public health and economic toll of the coronavirus pandemic becomes more grim with each passing day, Republicans are doubling down on their decade-long effort to repeal the Affordable Care Act. Democrats, meanwhile, are working to shore it up by introducing legislation to lower costs, expand coverage, and strengthen protections for those with pre-existing conditions.

The White House this week is expected to file legal briefs officially asking the Supreme Court to end the ACA, even as more than 40 million Americans have filed for unemployment benefits since March. As many as 27 million Americans could lose their employer-sponsored health insurance during the pandemic, according to an estimate from the Kaiser Family Foundation.

The legal briefs, which are expected to be filed on Thursday, come as part of a case brought by a coalition of 18 Republican-led states that are suing to repeal the ACA. The case has the support of President Donald Trump, who said in May that he wants to terminate the ACA, even as it becomes a potential lifeline for millions of newly uninsured Americans.

Passed in 2010 under President Barack Obama, the ACA was the most comprehensive healthcare legislation enacted in decades. Studies havefound that it saved tens of thousands of lives and billions in healthcare costs.

Under the ACA:

Some within the GOP have acknowledged the dangers of trying to take away healthcare coverage during a pandemic leading into an election.

Why Does Trump Want To Repeal Obamacare

President Trump has called Obamacare an incredible economic burden, and claims that it has tragically but predictably resulted in runaway costs, websites that dont work, greater rationing of care, higher premiums, less competition and fewer choices.

Republicans have opposed the reforms since they were first proposed at the start of Mr Obamas presidency in 2009.

Right-wing politicians described the law as a job-killer despite a 9 per cent rise in health care sector employment since the act was implemented.

GETTY

They object to the states intrusion into the private affairs of businesses and argue that firms have been burdened with too many costs.

President Donald Trump waves as he walks with first lady Melania Trump and son Barron during the inauguration parade.

Groups Opposing The American Health Care Act

Over 50 organizations oppose the proposed healthcare plan that will make Americans will pay more for less. The list includes nurses, doctors, hospitals, teachers, churches, and more. You can see a few here:

AARP: AARP opposes this legislation, as introduced, that would weaken Medicare, leaving the door open to a voucher program that shifts costs and risks to seniors.

Before people even reach retirement age, big insurance companies could be allowed to charge them an age tax that adds up to thousands of dollars more per year. Older Americans need affordable health care services and prescriptions. This plan goes in the opposite direction, increasing insurance premiums for older Americans and not doing anything to lower drug costs.

On top of the hefty premium increase for consumers, big drug companies and other special interests get a sweetheart deal.

Finally, Medicaid cuts could impact people of all ages and put at risk the health and safety of 17.4 million children and adults with disabilities and seniors by eliminating much-needed services that allow individuals to live independently in their homes and communities. Although no one believes the current health care system is perfect, this harmful legislation would make health care less secure and less affordable.

AARP stands ready to work with both parties on legislation that puts Americans first, not the special interests.

That just wont do.

That is, above all, why physicians must be involved in this debate.

National And State Level Coverage Losses

Because the economic crisis stemming from the pandemic is driving millions of people onto coverage programs supported by the ACA, CAP estimates that approximately 3 million more people stand to lose coverage from the health care repeal lawsuit than the 20 million previously estimated. According to a March 2019 analysis by the Urban Institute, full repeal of the ACA would cause enrollment in Medicaid and the Childrens Health Insurance Program to fall by 22.4 percent and enrollment in individual market coverage, including for the ACA marketplaces and other insurance people purchase on their own, to drop by 35.4 percent.

The economic stress of the pandemic has pushed the United States into a recession. The Congressional Budget Office projects that the unemployment rate in the second and third quarters of this year will average 15 percent higher than it was during the Great Recession. At an unemployment rate of 15 percent, 17.7 million people would lose employment-based health insurance coverage, according to a recent report by the Urban Institute. With access to ACA coverage options, most of these people would find new forms of insurance. Urban estimates that 8.2 million would end up with Medicaid/CHIP coverage, and 4.3 million would gain coverage through the ACA marketplaces or other private coverage. About 5.1 million would remain uninsured.

Table 1

#3: Most Say It Is Important That Pre

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If the Supreme Court overturns the ACA, a host of provisions could be eliminated, including the laws protections for people with pre-existing medical conditions. These provisions prohibit insurance companies from denying coverage based on a persons medical history and prohibit insurance companies from charging those with pre-existing conditions more for coverage . The July 2019 KFF Health Tracking Poll found that a majority of the public says it is very important for many of the ACA provisions to be kept in place, including the guaranteed issue provision and community rating . While partisans divide over the importance of keeping many provisions of the ACA in place, majorities of Democrats, Republicans, and independence say it is very important to continue each of these protections for people with pre-existing conditions.

Figure 3: Most Say It Is Important That ACA Provisions Remain In Place

How Likely Is It That The Affordable Care Act Will Be Repealed And Replaced

Concerned United States citizens want to know how likely is it that the Affordable Care Act will be repealed and replaced. Though speculative, the answer to the question is not an impossible one. The repeal of the Affordable Care Act, also known as ACA or Obamacare, is a subject that is under much scrutiny.

Trump Signs Executive Order On Obamacare; Impact Unclear

On his first day in office, President Donald Trump signed an executive order that gave federal agencies broad authority to defer or delay any part of the Affordable Care Act that costs anybody any money.

More formally, the order tells agencies they can “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications.”

That’s a mouthful, but what does it mean, and how far does it go to repeal Obamacare?

Larry Levitt, senior vice-president at the respected and neutral Kaiser Family Foundation, said in a series of tweets that while the impacts are unclear, it shows the administration is “moving to unwind the Affordable Care Act, but it won’t be immediate.”

Levitt added, “One sure outcome is it creates uncertainty for insurers at a critical time.”

Health care analyst Sabrina Corlette at Georgetown University echoed Levitt’s point.

“For insurers already uncertain about their future in the Affordable Care markets, the uncertainty this executive order generates doesn’t help,” Corlette said. “At a minimum they’ll have to factor it into their 2018 premiums, which are due to be filed by May 3 in most states.”

But that hasn’t happened yet.

Gridlock In House Stalls Trump’s Pledge To Repeal Obamacare

As a candidate for president, Donald Trump said that “real change begins with immediately repealing and replacing the disaster known as Obamacare.”

On March 24, the nation learned that it’s not happening immediately. And the road forward isn’t clear either.

Capping a frenzied week of negotiations between three House Republican factions — the party leadership, the hardline conservative House Freedom Caucus, and members of the more moderate, pragmatic wing of the party — House Speaker Paul Ryan, R-Wis., announced that he would not bring the American Health Care Act to the floor for a vote, as he had planned.

That March 24 announcement came one day after the floor vote had been pushed back to allow for last-minute changes and arm-twisting, and half a day after Trump had issued an ultimatum to House Republicans — pass the bill or he’ll move on.

In the run-up to Ryan’s announcement, vote counting by media outlets had concluded that the House GOP would lose too many votes to pass the bill if it tried.

“We came really close today, but we came up short,” Ryan said at a press conference. “I will not sugarcoat this. This was a disappointing day for us.”

For members on the party’s right flank, the American Health Care Act left in place too much of the infrastructure of the Affordable Care Act, President Barack Obama’s signature health care law and the target of intense Republican opposition for seven years.

source https://www.patriotsnet.com/why-republicans-want-to-repeal-aca/

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janekira2 · 3 years ago

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What today’s Supreme Court ruling on ACA means for consumers, insurers and states

The Supreme Court upheld the Affordable Care Act today in a 7-2 ruling. The court dismissed a challenge to the law, noting that the states and individuals who were trying to overturn the ACA did not have standing.

This is the third time the ACA has survived challenges in the Supreme Court. In 2012, the ruling was 5-4, and in 2015, the ruling was 6-3. These cases have all had varying arguments and merits, but it’s noteworthy that although the court has become more conservative over the last decade, the justices have increasingly favored the ACA.

In this year’s case, some legal analysts had speculated that the court might overturn the ACA’s individual mandate but allow it to be severed from the rest of the ACA. That approach would have upheld the ACA as well, but the court simply dismissed the whole case. (This thread from Nicholas Bagley is a great summary, if you’re interested in the specifics.) So nothing has changed: The ACA remains intact, and the general consensus is that it’s here to stay.

Is this decision the end of legal challenges to the ACA?

That doesn’t mean the Affordable Care Act won’t continue to face legal challenges — a case that’s currently under consideration in Texas takes aim at the ACA’s requirement that health plans fully cover the cost of certain preventive care. But that case does not seek to overturn the ACA itself, and it appears unlikely that the Supreme Court would take up any other case that might aim to do so.

What does this decision mean for consumers?

There was a collective sigh of relief this morning among people who are enrolled in Medicaid under the ACA’s expanded eligibility guidelines, as well as those who purchase their own individual/family health insurance and rely on the ACA’s premium tax credits, cost-sharing reductions, guaranteed-issue rules and coverage for pre-existing conditions, and essential health benefits.

According to a recent analysis by Charles Gaba, more than 10% of all Americans are covered under Medicaid expansion, ACA-compliant individual/family health plans, and Basic Health Programs, all of which stem directly from the ACA.

As we’ve explained during prior legal and legislative challenges to the ACA, the law provides a vast array of additional consumer protections that extend to most Americans in one way or another. But the people who are most likely to feel a sense of relief today are those enrolled in coverage that either wouldn’t exist or wouldn’t be accessible to them without the ACA. The anxiety about losing health coverage is no longer hanging over these Americans.

Premium subsidies will continue to be available, and the subsidy enhancements provided by the American Rescue Plan will continue to be in effect throughout 2022 – and possibly longer, if Congress acts to extend them.

If you’ve been on the fence about enrolling in individual/family coverage during the special enrollment period that’s currently ongoing in nearly every state, you can now enroll with confidence. And the same is true about signing up for 2022 coverage when open enrollment starts in November.

And although today’s ruling was on a lawsuit that hinged around the individual mandate and penalty, nothing has changed about the ACA’s requirement that most people maintain health insurance: There continues to be no federal penalty for not having health insurance, as has been the case since 2019. (If you’re in California, Massachusetts, New Jersey, Rhode Island, or the District of Columbia, there’s still a penalty for going without health insurance.)

What does the decision mean for health insurers?

Insurers that offer individual/family health insurance have been displaying increasing confidence in the ACA for the last few years. After fleeing the marketplaces/exchanges in 2017 and 2018, insurers started to join or rejoin the marketplaces in 2019. That trend continued in 2020 and 2021, and we’re already seeing more insurer participation in the initial 2022 rate proposals that have been submitted by insurers in several states.

The case that the Supreme Court dismissed today was initially filed in early 2018, so the legal threat to the ACA has been in the background throughout those three years of increasing insurer participation in the ACA-compliant insurance market.

Although insurance companies — and the actuaries who set premiums — tend to be quite averse to uncertainty, the individual market has proven to be profitable for insurers in recent years (after being unprofitable in the early years of ACA implementation). Insurers’ increasing willingness to offer plans in the marketplace is testament to that, despite the uncertainty that the lawsuit created over the last few years. Now that there’s no longer a pending legal threat to the ACA, we might see even more insurers opting to join the marketplaces or expand their existing coverage areas.

What does the decision mean for states?

Although many states have enacted laws designed to protect consumers in case the ACA had been overturned, there’s no getting around the fact that they rely heavily on federal funding that’s provided under the ACA. Without that funding, most states would not have been able to maintain the ACA’s Medicaid expansion or affordability provisions for self-purchased health insurance.

There’s no longer a threat to the funding, which might make states more likely to push forward with additional consumer protections tied to the ACA. Among the most obvious is Medicaid expansion in the 13 states that have not yet accepted federal funding to expand Medicaid eligibility under the ACA.

The American Rescue Plan provides two years of additional federal funding to states that newly expand Medicaid. So far, Oklahoma is the only state making use of that provision, and the state had already planned to expand Medicaid this year as a result of a ballot measure that Oklahoma voters passed last year.

To be fair, the other 13 states have rejected Medicaid expansion year after year, including during the 2020 and 2021 legislative sessions that took place during a global pandemic. Without a change to the makeup of their legislatures, most are likely to continue to do so. But now that the Supreme Court has upheld the ACA yet again, states that newly expand Medicaid can do so without a lingering worry that the federal funding might be eliminated.

It’s also possible that more states might consider reinsurance programs that make use of the ACA’s 1332 waiver provisions. But that would also depend on whether the American Rescue Plan’s subsidy enhancements are extended beyond 2022. Reinsurance programs make coverage more affordable for people who don’t receive premium subsidies. Before the ARP eliminated the “subsidy cliff” for 2021 and 2022, the lack of affordability for households earning a little more than 400% of the poverty level was a very real problem.

But that’s not currently an issue, as those households qualify for subsidies if the benchmark plan would otherwise cost them more than 8.5% of their income. If Congress extends that provision, reinsurance programs would help very few enrollees (and they can also harm subsidized enrollees in some areas, since they reduce the size of premium subsidies). State legislatures will need to keep an eye on how this plays out at the federal level, but without an extension of the ARP’s subsidy structure, we can expect to see more states pursuing 1332 waivers for reinsurance programs in the next few years.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

The post What today’s Supreme Court ruling on ACA means for consumers, insurers and states appeared first on healthinsurance.org.

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theculturedmarxist · 4 years ago

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Obama ran on a bunch of promises that he didn’t end up keeping, and one of them was the Affordable Care Act and the promise to both reform health insurance and provide universal healthcare. He provided neither, “expanded” coverage by implementing tax penalties for lack of coverage, giving subsidies for some and subsidizing the cost of expanding medicare coverage to the working poor (which states had to opt in to), creating a “marketplace” for people to buy their plans, and precluded insurance companies’ “pre-existing conditions” scam. It reformed nothing, increased the price of insurance and healthcare, and led to the closing of many hospitals throughout the country.

What’s more, Biden wasn’t even in favor of it.

In contrast, Mr. Biden’s plan is not a mandate for universal health care. The Delaware senator outlined a less revolutionary system that would make the government responsible for catastrophic medical bills over $55,000 and would expand the SCHIP bill to cover every child in America. People over age 55 would be able to buy into Medicare as well. With a price tag of $90 to $120 billion, it’s not far off from those proposed by Hillary Rodham Clinton and John Edwards.

Again, the two Democrats were on opposite sides regarding the touchy subject of health care for illegal immigrants. Mr. Kucinich wants to offer complete health care for everyone, no question, period. Mr. Biden’s plan excludes undocumented immigrants, except in emergency cases. “Instead, deal with it through immigration bills, not health care,” he said.

One of Mr. Biden’s main concerns is the disproportionate number of minorities who are under-insured — through no fault of their own, he asserts. Rather it’s a result of socioeconomic differences and the fact that uninsured people today are descendants of uninsured generations of people, he said, doing a little clean-up duty after the Washington Post published controversial comments about minority parents.

And he also said some dumb shit about letting states “experiment with healthcare reform first,” or in other words, for them to keep doing what they’ve been doing and then maybe do something at some hypothetical future point.

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The ACA should really show you what the Democrats are all about: promise little, deliver less. They had complete control of the executive and legislative branches and ostensibly a much more sympathetic supreme court, and what did they do? Spent two years haggling with Republicans in the name of “bipartisanship” only to pass a broken bill that basically helped the health insurance industry the most. On paper it extended coverage to 20 Million more people, but even if we’re taking that number at face value that’s hardly “100 fold.”

I really don’t understand what the fuck is wrong with you and everyone else that thinks this huckster is or has ever been a good person, or that he has or has ever had the slightest interest in helping you or anyone that wasn’t one of his millionaire or billionaire campaign backers.

#biden #joe biden #healthcare reform #universal healthcare #nothing will fundamentally change

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patriotsnet · 3 years ago

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How Many Republicans Voted For Aca

New Post has been published on https://www.patriotsnet.com/how-many-republicans-voted-for-aca/

How Many Republicans Voted For Aca

Why Is The Aca Misunderstood

House Republicans Pass Bill To Repeal And Replace ACA

Oftentimes, how Obamacare is discussed and framed has led to misunderstanding of the ACA.

The legislation is a series of provisions, opening up a marketplace of different tiered plans from which citizens can choose. Its not a health insurance plan in and of itself, the way some anti-ACA-leaning media outlets tend to depict it.

When asked why there tends to be so much confusion over what exactly Obamacare is, John McDonough, DrPH, MPA, a professor of public health practice in the Department of Health Policy & Management at the Harvard T.H. Chan School of Public Health and director of executive and continuing professional education, said its because American healthcare is confusing to begin with.

Ask Americans to explain Medicare and or Medicaid, and you will observe at least as much befuddlement as with the ACA. Our U.S. healthcare system is the most complicated and impenetrable to understand and make sense of on the planet, McDonough told Healthline.

He should know. McDonough was there at the beginning.

He worked on the development and passage of the ACA in the role of a senior advisor on national health reform to the U.S. Senate Committee on Health, Education, Labor, and Pensions.

In the early days around 2010, when people would complain to me that they didnt understand the ACA, I would ask them politely how well they understand the U.S. health system in general, he said.

Affordable Health Care For America Act

This article is part of a serieson

The Affordable Health Care for America Act was a bill that was crafted by the United States House of Representatives of the 111th United States Congress on October 29, 2009. The bill was sponsored by Representative Charles Rangel. At the encouragement of the Obama administration, the 111th Congress devoted much of its time to enacting reform of the United States’ health care system. Known as the “House bill, HR 3962 was the House of Representatives’ chief legislative proposal during the health reform debate.

On December 24, 2009, the Senate passed an alternative health care bill, the Patient Protection and Affordable Care Act . In 2010, the House abandoned its reform bill in favor of amending the Senate bill ” rel=”nofollow”>reconciliation process) in the form of the Health Care and Education Reconciliation Act of 2010.

Obamacare Survives After Supreme Court Rejects Latest Republican Challenge

The Supreme Court ruled against Texas and other Republican-led states seeking to strike down the Affordable Care Act in its latest test before the nation’s highest court.

The top court voted 7-2 to reverse an appeals court ruling that had struck down the law’s individual mandate provision.

Two of former President Donald Trump’s court picks, Justices Brett Kavanaugh and Amy Coney Barrett, joined the majority in rejecting the Republican effort.

President Joe Biden praised the ruling as a major victory and vowed to expand Obamacare.

The Supreme Court ruled 7-2 on Thursday against Texas and other Republican-led states seeking to strike down Obamacare in the law’s latest test before the nation’s highest court.

The court reversed an appeals court ruling that had struck down the law’s individual mandate provision. Chief Justice John Roberts and fellow conservative Justices Clarence Thomas, Brett Kavanaugh and Amy Coney Barrett joined Justice Stephen Breyer’s opinion, as did Sonia Sotomayor and Elena Kagan.

Breyer said Texas and the other states that challenged the law failed to show they were harmed by it.

“Neither the individual nor the state plaintiffs have shown that the injury they will suffer or have suffered is ‘fairly traceable’ to the ‘allegedly unlawful conduct’ of which they complain,” Breyer wrote.

Biden also vowed to expand Obamacare, a central promise of his presidential campaign.

The Supreme Court agreed in March 2020 to hear the case.

“What a day,” he added.

Don’t Miss: Congress Denies Funding For Benghazi

Rep Christopher H Smith Of New Jersey

Smith is the only remaining Republican representing New Jersey, after Democrats flipped four seats in the Garden State in the midterms. Smith voted against the GOP health care plan in 2017. He also broke with his party on the tax overhaul, along with other lawmakers from high-tax states. Smith is not a DCCC target and is running for re-election in a district Trump carried by 15 points in 2016. Inside Elections rates his race Solid Republican.

Fact Check: How Many Gop Senators Voted To Repeal Obamacare

By Sara Reynolds

The United States Senate voted three times in July to repeal all or part of the Affordable Care Act]. All of the measures failed. Commenting on the apparent change of position among Republicans who voted against repeal on July 26, Senator Ben Sasse claimed, With just one exception, every member of the Republican majority already either voted for repeal or explicitly campaigned on repeal.

Is Sasse correct? Did every current Republican senator, except one, previously vote for or campaign on repeal of the Affordable Care Act?

Yes. With the exception of Sen. Susan Collins , all 49 current Republican senators who were in office in 2015 voted that year to repeal elements of the ACA . Seven Republican senators who were in office in 2015, including Collins, voted against a similar bill on July 26, 2017.

Senators John Neely Kennedy and Todd Young , both elected in 2016, campaigned to repeal the ACA. Sen. Luther Strange , appointed in 2017 and currently running in a special election, has also campaigned on repeal. All three senators voted to repeal the ACA on July 26.

Recommended Reading: Who Is Right Republicans Or Democrats

Rep Denver Riggleman Of Virginia

The Virginia freshman, a member of the hard-line Freedom Caucus, explained his vote partly as one to protect pre-existing conditions, which he said hit close to home for me and I campaigned on continuing healthcare coverage for those affected.

The healthcare system is broken and Obamacare is a major part of the problem, but we should proceed with caution as we try and fix it. This resolution certainly doesnt help solve the problem, but hopefully will allow us to have a productive discussion on healthcare, he said in an emailed statement.

Trump carried Rigglemans 5th District seat;by 11 points in 2016. Riggleman defeated Democrat Leslie Cockburn by 7 points last fall in a race that got some national attention. Democrats are not targeting him in 2020. Inside Elections rates his race Solid Republican.

Russia Sanctions Headed To Trump’s Desk Will He Sign

Before the vote, at 10:43 p.m. ET, Trump was rooting them on in a tweet: “Go Republican Senators. Go!”

Afterward, it was a different story, with the president tweeting at 2:25 a.m. ET that those who voted no had “let the American people down.”

It’s somewhat ironic that McCain was the one to derail what seemed like a sure Trump victory . After all, Trump’s comments about the former prisoner of war were among the earliest to land the then-candidate in controversy.

“He’s not a war hero,” Trump said in 2015 of McCain. “He was a war hero, because he was captured. I like people who weren’t captured. He’s been losing so long he doesn’t know how to win anymore.”

That was likely never lost on McCain.

Read Also: When Did The Parties Switch Platforms

Democrats Sought To Put Gop Colleagues On Record With Symbolic Vote

Democratic congressional campaigns have already made health care an early focus of their 2020 messaging, and House Democrats bolstered that effort Wednesday with a symbolic vote that sought to once again put Republicans on record on the issue.

Eight Republicans sided with Democrats on the nonbinding resolution, which the House adopted, 240-186.;The measure condemned;the Trump administrations support for invalidating the 2010 health care law in its entirety.;The Department of Justice, in a new filing last week, backed a Texas judges decision to strike down the law.;

Three Republicans; New Yorks;Tom Reed and John Katko and Pennsylvanias Brian Fitzpatrick had voted in January to authorize the House general counsel to intervene in the lawsuit to defend the health care law. All three also voted for the resolution Wednesday.

One Democrat 15-term Minnesota Rep. Collin C. Peterson bucked his party and voted against the resolution. Hes one of the last Democrats remaining in the House who opposed the 2010 health care law and is likely the last Democrat who can hold his heavily agricultural 7th District seat.

Democrats were otherwise united in supporting the resolution, and the Democratic Congressional Campaign Committee launched positive Facebook ads touting their vulnerable members votes to protect families with pre-existing conditions.

Also watch:;What if we switch to a single-payer health care system?

What The Aca Means For You

The 139 Republicans Who Voted Against Certifying The Election Have Faced No Consequences

The Affordable Care Act is perhaps the greatest overhaul ofthe US health-care system, and it will provide coverage for over 94% ofAmericans. In addition, one of its key reforms includes health coverage for adultswith pre-existing conditions, which generally had not been available up untilnow.

These great changes in health-care insurance can benefit you and your loved ones. However, it is still essential to find the best plans at the best price to ensure your family is properly covered.

To learn about the specific Obamacare-compliant health insurance plan options available to youplus see if you are eligible for a government subsidy to help pay for a plancompare ACA-compliant health insurance plans with eHealth today.

Also Check: Senate Dem Vs Rep

Schumer: ‘we Can Work Together Our Country Demands It’

Until the end, passage on the Health Care Freedom Act, also dubbed the skinny repeal, was never certain. Even Republicans who voted for it disliked the bill.

The skinny bill as policy is a disaster. The skinny bill as a replacement for Obamacare is a fraud. The skinny bill is a vehicle to getting conference to find a replacement, Sen. Lindsey Graham, R-S.C., said at a Thursday evening news conference hours before the vote alongside fellow Republicans McCain, Ron Johnson and Bill Cassidy, before the details were released.

The skinny repeal was far from Republicans campaign promise of also rolling back Medicaid expansion, insurance subsidies, Obamacare taxes, and insurance regulations.

Many Republicans who did vote for it said they were holding their nose to vote for it just to advance the process into negotiations with the House of Representatives.

The legislation included a repeal of the individual mandate to purchase insurance, a repeal of the employer mandate to provide insurance, a one-year defunding of Planned Parenthood, a provision giving states more flexibility to opt out of insurance regulations, and a three-year repeal of the medical device tax. It also would have increased the amount that people can contribute to Health Savings Accounts.

Leigh Ann Caldwell is an NBC News correspondent.

Watch Sen John Mccain Cast ‘no’ Vote On ‘skinny’ Repeal

It isn’t clear what comes next, but the collapse of some insurance markets around the country serve as an incentive for Republicans and Democrats to hold hearings and fix the problems with health care.

Most Republicans never embraced the different iterations of legislation they crafted, nor the process by which it was constructed. Even on the last-ditch effort at a bare-bones bill, Republicans couldnt reach agreement. Over the past two days, many rejected a plan that would have partially repealed and replaced Obamacare and a measure that would have just repealed it. The repeal vote was the same bill that passed the Senate and the House in 2015 when former President Barack Obama vetoed it.

Sen. Lisa Murkowski, R-Alaska, stood against every version of the legislation even in the face of immense pressure. The Trump administration threatened to withhold federal resources from Alaska because of her opposition, according to the Alaska Daily News. Murkowski herself said the next day in response to the report that she would not characterize it as a “threat.”

“I sat there with Senator McCain. I think both of us recognize that its very hard to disappoint your colleagues,” Murkowski told NBC News after the vote. “And I know that there is disappointment because it was the three votes that Senator McCain, Senator Collins, and I cast that did not allow this bill to move forward. And that is difficult.”

“John McCain is a hero and has courage and does the right thing,” Schumer said.

You May Like: How Many States Are Controlled By Republicans

When Did Obamacare Start

The timeline of key events leading up to the passage of the Obamacare law began in 2009. Here is a list of those events, along with key provisions that went into place after the law was enacted.

Speaker of the House Nancy Pelosi and a group of Democrats from the House of Representatives reveal their plan for overhauling the health-care system. Its called H.R. 3962, the Affordable Health Care for America Act.

;Massachusetts Senator Ted Kennedy, a leading supporter of health-care reform, dies and puts the Senate Democrats 60-seat supermajority required to pass a piece of legislation at risk.

;Democrat Paul Kirk is appointed interim senator from Massachusetts, which temporarily restores the Democrats filibuster-proof 60th vote.

;In the House of Representatives, 219 Democrats and one Republican vote for the Affordable Health Care for America Act, and 39 Democrats and 176 Republicans vote against it.

In the Senate, 60 Democrats vote for the Senates version of the bill, called Americas Healthy Future Act, whose lead author is senator Max Baucus of California. Thirty-nine Republicans vote against the bill, and one Republican senator, Jim Bunning, does not vote.

Actions To Hinder Implementation

Don’t Miss: How Many States Are Controlled By Republicans

Rep Pete Stauber Of Minnesota

The freshman flipped a longtime Democratic seat;in northeast Minnesota that Trump had carried by 16 points in 2016. Its a largely white, working-class district, where Trumps populist appeal resonated. The former Duluth police officer ran a campaign ad last year about his son Issac, who has Down syndrome, and he talked about the importance of insurance companies covering pre-existing conditions. Democrats are not targeting this seat in 2020. Inside Elections rates the race Likely Republican.

Why Supporters Pushed For The Bill

The PPACA addresses the needs of the 46 million uninsured Americans;

strengthens the Medicare system by closing the donut hole in prescription coverage, and cutting waste and fraud while guaranteeing preventive care without co-pays;

provides health insurance to low-income children;

funds cutting-edge research into cures for diseases;

gives patients the clout to challenge the decisions of health insurers and;

increases access to care by making it impossible for insurers to shun the sick.

In the past, insurers either refused to cover patients suffering from pre-existing conditions, or charged them unaffordable premiums. As House Speaker Nancy Pelosi noted shortly before the legislation passed: “If you’re a woman that’s a pre-existing condition; if you’re a woman of child-bearing age and you’ve had children that’s a pre-existing condition. If you can’t have children, it’s a pre-existing condition. If you have a C-section, it’s a pre-existing condition. A victim of domestic abuse, it’s a preexisting condition.”

Under the PPACA, Americans would no longer have to worry about being denied insurance. Pelosi urged her audience to “Think of an economy where people could be an artist or a photographer, a writer without worrying about keeping their day job in order to have health insurance. Or that people could start a business and be entrepreneurial and take risks, but not be job-locked because a child has a child has asthma or diabetes or someone in the family is bipolar “

Read Also: Is Trump A Republican Or Democratic

The House Votes To Repeal Obamacare

Republicans overcame an embarrassing early failure to pass their replacement for the Affordable Care Act with few votes to spare. Now, they await the political fallout.

For House Republicans, the burden of an unfulfilled campaign promise had simply become too much to bear alone.

And so on Thursday, after an embarrassing early failure and weeks of fits and starts, a narrow GOP majority passed legislation to partially repeal and replace the Affordable Care Act that even many of its supporters conceded was deeply flawed. The party-line vote was 217-213, with 20 Republicans voting against. The bill now goes to the Senate, where its fate is uncertain at best.

The American Health Care Act scraps the Obamacare mandates that people buy health insurance and that employers provide it, eliminates most of its tax increases, cuts nearly $900 billion from Medicaid while curtailing the programs expansion, and allows states to seek a waiver exempting them from the current laws crucial prohibition against insurers charging higher premiums to people with pre-existing conditions. Conservatives complained that the bill did not fully repeal the 2010 law, while moderates blanched at its cuts to Medicaid and its weakening of its most popular consumer protections.

Attempts To Change Or Repeal

Schumer slams GOP senators in vote to protect ACA

Read Ballotpedia’s fact check »

The Affordable Care Act was subject to a number of lawsuits challenging some of its provisions, such as the individual mandate and the requirement to cover contraception. Four of these lawsuits were heard by the United States Supreme Court, resulting in changes to the law and how it was enforced. In addition, since the law’s enactment, lawmakers in Congress have introduced and considered legislation to modify or repeal parts or all of the Affordable Care Act. Finally, between 2010 and 2012, voters in eight states considered ballot measures related to the law. This section summarizes the lawsuits, legislation, and state ballot measures that attempted to change, repeal, or impact enforcement of parts of the law.

Also Check: How Many States Are Controlled By Republicans

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anayahinckley · 4 years ago

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pip insurance nj is the most important thing for you when it comes to your car insurance in Florida. Call us at to make changes to your life insurance policy. Helpful life insurance agents, who can assist you in servicing your policy, are just a phone call away. For all other policies, call or log in to your current , , or policy to review your policy and contact a customer service agent to discuss your jewelry insurance options. Purchased Mexico auto insurance before? With just a few clicks you can your insurance policy is with to find policy service options and contact information. Call us at to make changes to your life insurance policy. Helpful life insurance agents, who can assist you in servicing your policy, are just a phone call away. For all other policies, call or log in to your current , , or policy to review your policy and contact a customer service agent to discuss your jewelry. pip insurance nj. You can buy a plan at your state’s health insurance exchanges, or via your online insurance plan catalog. In general, it’s a good idea to have health insurance��it’s better to have a good excuse than get care together with only health insurance. The problem is, most people in the US pay between $150 and $500 for insurance on their own. (The same as the above) They also pay a high amount on their insurance, so it’s easy for them to get out of it too early and become uninsured—which is when it gets really expensive. When you’re an adult, you might need health insurance, but it’s a very difficult and expensive proposition to buy. There are on the Marketplace, so if you can afford to buy your own insurance, just make sure your spouse is covered by an existing insurance policy. In most cases, most people in the US pay at least a . But if you. pip insurance nj. The State’s health insurance exchanges should be set “OFF” if for tax purposes, as states have the right to “tax” it as a result of a single person owning health insurance. The state of Arizona, for example, allows the individual to choose whether or not to pay the health insurance tax for a person, as long as the individual pays the premiums, and will have access to coverage if possible. The Arizona exchange and the public option system are not eligible for tax exemption during the next presidential election. These features can affect whether the Affordable Care Act, or a similar policy can be considered affordable enough. The Affordable Care Act (ACA) made a number of changes to health insurance premiums as of 2014, but it didn’t change the quality of health care for the large percentage of Americans who receive federal subsidies or other private health insurance. In 2014, for example, Arizona used the federal marketplace to purchase health insurance, though most insurers and consumers received coverage.

Cheap Car Insurance Companies for Drivers with Poor Credit

Cheap Car Insurance Companies for Drivers with Poor Credit: It’s a common misconception that car insurance companies penalize people with poor credit rather than drivers with good scores. The bottom line is that if you don’t have a clean driving record, the insurance rates you receive may be substantially higher than the rates you get on the cheap markets. In fact, if you have a , you will have a more difficult time finding and maintaining an affordable price. You can contact NerdWallet’s for current information. Most U.S. states mandate that drivers with poor credit fill out an (PIP). This form of insurance pays out if the driver is involved in a car accident with an uninsured motorist, and if the PIP is not enough to pay for the costs of a legal proceeding. Because there’s no such thing as “poor credit,” the only circumstances in which you may be sued for are if your . If you have poor credit, this may be.

Cheap Car Insurance Companies for Adding a Teen Driver

Cheap Car Insurance Companies for Adding a Teen Driver to Your Policy After you meet a few criteria, a driver’s education course can be a great way to save money on your car insurance. Whether you want to start your own insurance company or you just need to know all the ins and outs surrounding the car, you’ll need to know the to have the right insurance coverage. The following table showcases various ways to save on your car insurance. Check it out before buying, but take a look in detail – you’ll find out the average cost of car insurance falls from 3% to 11% for married men, with a little over $1,500 a year on average! Why Car Insurance Rates for Women Why do your insurance rates fall? Why do you ever pay as much as men? The simple answer is that a good driving record will come in handy. When insurance companies take on more risk then, the number of claims their agents are going to incur means more companies do invest in drivers with.

Largest Car Insurance Companies in New Jersey

Largest Car Insurance Companies in New Jersey In NJ, the largest insurance companies in the state are in New Jersey: 14% 100% All 50% New Jersey residents can save $130 by comparing multiple quotes & reading The cheapest car insurance company in New Jersey is still to be known. The cheapest company for a driver age 55 may not have to be the same. New York, New Jersey, and New Jersey are very similar, though both cities have quite distinct auto insurance.

What Is No-Fault Insurance/PIP?

What Is No-Fault Insurance/PIP? PIP is a type of insurance coverage for drivers injured in a car accident. Most states restrict No-Fault insurance. This means that if you’re in an accident with someone who carries no insurance, your auto insurance will pay for your medical bills and other expenses. This coverage will also protect you if you’re in a car accident with a driver with no insurance. It doesn’t cover all people injured in the accident. You may still be able to sue the at-fault driver for your medical bills and lost wages. Most states have a maximum of $75,000 in property damage liability. This covers property damage to a new car after an accident. If you are injured in a car accident and your car isn’t functional, we would recommend a Medical Payments policy. This is designed to mitigate the financial burden on the at-fault driver’s insurer. Many insurers offer MedPay as an add-on to an auto policy..

Choosing Health Insurance over PIP Insurance

Choosing Health Insurance over PIP Insurance may save you money and hassle, but it might get you a lump sum of money from your health insurance company. So, if you take a health insurance policy out on the 15th of each month, the insurance company may not pay. That would leave you paying the full cost of medical expenses, as well as any medical bills that come your way. If you’re looking for an easy way to save money on health insurance, it can be done (albeit at a cheaper price): Simply enter your ZIP code. You’ll enter your ZIP code into the FREE medical insurance price comparison tool and will compare quotes from the best health care insurance companies. There are tons of health insurance sites on the internet that can help you save money and get more out of an otherwise inexpensive health insurance policy. You may not realize it, but there are a lot of websites that sell cheap health insurance. To some extent you might even want to do you first thing tomorrow to take the first bite of your.

What Does No-Fault Insurance Cover?

What Does No-Fault Insurance Cover? Well, it does provide that you don’t ever have to file a lawsuit against one’s insurance company, even if it’s for damages. If you have no insurance now, you’ll not know where to turn if you don’t already have one. I am a now a teacher, employee, and owner of . I work full time at University of North North Carolina and has over 100 years of his and more. This article will discuss two major areas of no-fault insurance where there might not be enough of a difference in the cost of benefits. If you have a low-cost auto insurance, then you’re in luck. As the company that provides no-fault auto insurance, U.S. Auto Insurance is the auto insurance provider of choice for North Carolina. If you have good credit, have had a or can afford on your own.

Penalties for Driving Without Auto Insurance

Penalties for Driving Without Auto Insurance in NJ: A 2013 study by the Mobile Institute found that an uninsured motorist with no insurance pays an average of $3,000.00 for damages resulting from an accident and $3,500.00 for damages resulting from an accident on Sept. 30, 2018. In New York, uninsured motorist would pay an average of $6,100.00 for $60,000 in damages, a price level lower than the other states average. In New York, a driver that has no insurance could face an average of $3,000.00 for damages if they are found at fault for a car accident. A driver’s car insurance rates can also be affected by the terms of the policy, as it will depend on the policy specifically. Insurance is written to cover cars and vehicles that are owned by a driver but not listed on the policy. If a policy does not explicitly include a car, it is likely that a driver will not be.

Going After Insurance When You Do Not Have Your Own

Going After Insurance When You Do Not Have Your Own Insurance We will be using our state’s financial experts to help you manage your assets and decide if you should continue . Our experts will help you determine exactly when your policy expires and provide you with the best protection. We understand the intricacies of the law regarding a claim. Our expert professional staff will help you find options like : Whether you need help filing your state auto insurance suit or other court matters, we have experience and expertise in this area. Contact a licensed Florida lawyer today. The state, with a population of 11 million, is the most populous state in the U.S. of America, as well as the largest insurance market in South America. However, just how well does it hold up in the claims process as well? While it may be a little bit more robust, claims history is something that we are not able to do much about this issue, because it’s been an ongoing feature of the state’s policies. The fact that you may have to.

Car Insurance in New Jersey

Car Insurance in New Jersey will get a boost from a top insurer. Aides to New Jersey Insurance Council (NJINS) represent over 2,700 members to make this important advocacy of our insurance community dynamic. It is a time to start by calling for an amendment put in place in 2017 to allow New Jersey Insurance Council (NJINS) to be required to report the premiums, coverage amounts and returns to New Jersey Insurance Council (NJINS) whenever the time is past. This amendment currently has been approved by the NJINS in order to increase the power and influence of community based insurance agencies. If you are currently looking for a new policy to add to your car (or any other vehicle) insurance plan, you may be able to take advantage of a variety of options. Here are some of the most popular options. AIG offers a selection of insurance products, including: If you drive a car, you probably expect to buy auto insurance to help cover expenses, but how are car insurance? In these situations, a.

Uninsured/Underinsured Motorist Coverage

Uninsured/Underinsured Motorist Coverage Drivers who do not have auto insurance will have to insist on paying for their own damages. PERSONAL INJURY Coverage In case of an accident for bodily injury CUSTOMER PROTECTED In some states, it is illegal to drive any motor vehicle unless insured or operated by a licensed party. COLLISION & TRANSPORT COVERAGE Drivers convicted for having the driver s license suspended may also be caught failing to show proof of insurance. This was the practice for nearly the entire period of time. LIMENSISTS/RECEKTICAL INJURY Coverage In the event of an accident for which someone was injured, a driver’s vehicle may need to be paid to rehabilitate the injured person. CUSTOMER ASSISTORS If a driver s auto bill for damages incurred by another driver or property insurance company arises out of an.

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noahwells1990 · 4 years ago

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medical insurance tennessee

BEST ANSWER: Try this site where you can compare quotes from different companies :insurancefinder.xyz

medical insurance tennessee

medical insurance tennessee is a bit different than , a private insurance company that is only available to people who own a policy with them. It offers various types of insurance products, ranging from the basics of liability insurance to extra protection, including coverage for home repairs, personal belongings and liability against vandalism, or liability during or after an accident, and for medical care. It even offers a lot of online tools to help you choose the right one for your needs. The company has a wide selection of tools, a wide selection of websites and tools for users to get an idea of how much insurance costs and the features it offers. I was in a car accident many years ago…but it still drives… I think I did have in 2002, it was pretty easy to get someone around who is claiming to work at one of their jobs. We got into an accident last year, but they were okay. I had been just towing and was covered in the other vehicle. They say you can file a claim as. medical insurance tennessee. You won’t find for free! If you don’t own any cars now, and you don’t live with an adult children, you don’t have car insurance until you’re in college, and they can’t go free unless someone helps them with an accident. But in the end, you get the short answer: car insurance. In college, students can still drive on public roads, but if you didn’t borrow your sister’s car, would you still be covered under the student’s insurance? Let’s explore the details of student insurance: If you do not , you do not have to buy car insurance. If you live with your ex-girlfriend, and you don’t own a car, you should consider the student car insurance. Although students at colleges and universities do need car insurance for students, it is generally a good idea to keep this on your financial life. Most colleges. medical insurance tennessee, this program offers a $1 million policy to individuals on the health insurance exchanges covering coverage for a single medical expense. In Texas, a woman and her young child may buy health plans through the Texas Exchange in exchange for tax credits that allow for greater personal flexibility for them under certain circumstances. If all women and children in Texas apply for employer-funded health insurance, then all applicants apply regardless of income level or family size. This program provides a $1 million in individual tax credit to an individual on the individual health insurance exchange covering coverage for a single medical expense. An applicant in Texas who has enrolled in a individual employer-funded plan (i.e., one that covers two individuals with 50% of the household contribution) must show proof of insurance prior to January 1, 2011, to be enrolled. In order to use this tax credit to purchase health coverage, an individual must demonstrate that the individual s income exceeded 50% of the poverty line and that they meet the definition of a low income.

Get health insurance in Tennessee

Get health insurance in Tennessee Get free quotes from multiple insurance companies to compare Get low-cost health insurance quotes in Knoxville, Knoxville, Chattanooga, Nashville and other rural Tennessee cities. Get health insurance quotes from top Tennessee insurance companies at once. Are you currently insured in Tennessee? Yes No Are you insuring multiple cars? Yes No Are you a homeowner? Yes No 15-20 21-24 25-34 35-44 45-54 55-64 65+ Age ZIP code A Rush Hour and a Fast Food Snack: Auto Car Insurance Compare Quotes What Is It? What Is Its? A: An auto insurance policy that insures your car against liability and malicious acts. Requirements 18-years-old .

Tennessee Health Insurance Exchange Challenges

Tennessee Health Insurance Exchange Challenges to Democrats To Expand Medicaid expansion and Medicare plan expansion—or, at least, the Medicaid expansion plan. “Health care reform does not include a mandate requiring all insurers in Tennessee to comply with the ACA”, said James [sic] McDermott, executive director of HealthCare.gov, a nonprofit health care initiative. Health reform does and will require insurance providers to give consumers the option of price transparency to assess their plans, and premiums, in a wide variety of ways. Health reform also has the support of the largest privately-owned providers in Tennessee: Anthem Blue Cross, Mercury Health, Cigna, and Golden Rule. In fact, some of Anthem’s largest, publicly-traded health insurance providers were already members of the Trump administration. But in today’s climate, many of them won’t be able to do business without the support of hospitals and insurers. The government has already begun enforcing the insurance exchanges, and in June it approved rate regulation that.

A health insurer steps up in Tennessee, averting possible Obamacare crisis

A health insurer steps up in Tennessee, averting possible Obamacare crisis. The Tennessee Association of Health Plans has helped many individuals and small businesses gain access to affordable health insurance plans, and the state also allows these plans to remain ACA compliant. Tennessee has been one of just eight states that don’t allow insurers to consider pre-existing conditions when calculating your premiums. Since 2013, the Affordable Care Act has been the only state in the nation mandating health insurers provide financial support for medically underwritten policies. While this hasn t happened quite as often as expected for Tennessee, it’s still a very good step. The ACA clearly established “pre-existing conditions” as a standard that has been followed successfully by other states. Unfortunately, under the ACA, insurance companies can deny coverage to people with pre-existing conditions (and) charge them more premiums to keep their coverage in force. It’s likely that if you get your insurance through a pre-existing condition care, your provider will be forced to either accept new prices, or refuse to.

2017 Health Insurance Plans Available to Tennesseans

2017 Health Insurance Plans Available to Tennesseans The cost of car insurance and the costs of insurance policies and the costs of insurance policies in the state of Tennessee go up based on where you live. Insurance rates in Tennessee, like all states, are determined according to a variety of factors, such as your age, zip code, driving record, make and model of vehicle, marital status, and your driving history. To estimate your car insurance cost, insurance companies use various factors like your location, credit score, and how many miles you drive each year to calculate your . According to , the average full coverage car insurance quote in the state of Tennessee is $1721.95. This is only on the side of full coverage car insurance, which includes liability insurance, comprehensive coverage, collision coverage, and comprehensive coverage for those with a driving record that will struggle to find adequate coverage. While a full insurance quote for this kind of coverage is common nationwide for the amount.

President Trump signs order to rewrite federal health insurance rules

President Trump signs order to rewrite federal health insurance rules underwriter to make health care cheaper. You would find coverage under the ACA available through most exchanges. The coverage could even be available through a special, more complicated form of insurance. You could also shop for coverage elsewhere for your financial situation. Read our to learn about your options. Although you may only be responsible for medical costs for a fixed period, you might not receive as much money back for care as you would with an individual policy. In this article, we’ll explain all the ways to during the health insurance crisis. One of the most important parts of health insurance is the form of coverage you’ll need to help you save money. Most insurance policies require payment directly from insurance providers. Before you take off and get your new policy, check your insurance contract or plan carefully. You will not be offered the same benefits and coverage as if you were receiving the previous coverage. You have other options as well, but have a.

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clexa--warrior · 4 years ago

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In the earliest days of the Trump crisis, just about a month after the inauguration, I received the horrifying news that my best friend and podcast partner, Chez Pazienza, had died of a drug overdose.

This article was originally published at Salon

It was the evening of Feb. 25, 2017, and the shock still hasn’t quite worn off. In fact, I ask myself nearly every day what Chez might’ve said about the most recent atrocity committed by the chief executive. I’ll never know for sure, but there’s something comforting in that exercise, imagining how he’d frame this dark ride with equal parts Gen-X angst, stinging Bourdain-ish erudition and artistically worded blue streaks that would’ve made George Carlin applaud.

I’m convinced, however, that it wasn’t really an overdose that killed him. Sure, it was the weapon of choice, but it wasn’t the ultimate cause of death. Chez possessed the ability to foresee this Trump crisis stretched out in front of him — maybe not the specifics, but a general concept in his big brain for the horror show that was awaiting us. I believe it was the crushing reality of not only being force-fed a Trump presidency every day but also covering it professionally that forced him to drift back to his old addictions to ease the pain. And I wish more than anything that I could have stopped him.

Nevertheless, Chez could clearly see the incoming abuses, the crimes, the ungainly nonsense, the recklessness, the racism, the petty vindictiveness — all of it.

In 2015, he accurately forecast that Trump, if elected, would spitefully withhold federal funding from regions that refused to support his cruel whimsy. Naturally, we’ve watched this play out with Puerto Rico, California and most recently Pennsylvania, where Trump, this week, threatened to withhold funding for the commonwealth because of Gov. Tom Wolf’s COVID plan. In Trump’s view, responsible leadership is worthy of punishment because it makes him look bad by contrast, while incompetence, mainly his own, is routinely lionized.

Trump’s blinding dumbness in the areas of history, the Constitution, the presidency and democratic institutions has infected him with an ugly, bastardized view of his job description, inflamed by his own biases and whatever he’s picked up from watching cable news. He’s a presidential dilettante, even now, nearly four years into the gig.

His wafer-thin understanding of presidential leadership contributes to his most self-defeating misapprehension: that he’s only the president of the red states. Everyone else is the enemy, even more so than our actual overseas adversaries — surely more than Kim Jong-un and Vladimir Putin, whom Trump praises more often than many of his fellow citizens and colleagues. The rest of us are only useful to him as punching bags and targets for his screechy, obscene, misspelled tweets and, more recently, his fascist police force. The upside of his deformed view of the presidency is that if he loses this election, it’ll partly be because he refused to expand his support beyond his loyalists.

This is one of the reasons why he felt compelled to cheat in the 2020 election by attempting to blackmail the president of Ukraine into smearing Joe Biden — a plot that ended with Trump’s impeachment and trial in the Senate. After all, how could he win re-election with only 40-44 percent popular support without making up the difference … somehow?

His relationship with his disciples is a match made in hell, given that his Red Hat fanboys have an equally stunted view of the presidency. I assure you, they’d never allow Trump-style behavior from their doctors, their kids’ teachers or, hell, their airline pilots. If they hadn’t been so badly brainwashed by the conservative entertainment complex, they never would have gifted the nuclear codes and the immense power of the presidency to such an unstable, erratic, incompetent political tourist who has utterly failed to grow into the job and rise to the occasion — who has failed to accept the intense gravity of his post. As Barack Obama said in August, “It’s because he can’t.”

At no other time has that been more evident than in Trump’s response to the pandemic. For the first two years of his presidency, many of us sat on the edge of our seats wondering when Trump would be seriously challenged either by a military threat, a terrorist attack or a global pandemic. From the moment Hillary Clinton conceded, I suspected this buffoonish greenhorn would be put to the test and fail badly. I never imagined that his reaction, untethered from experts, would be quite this calamitous.

His response to the hurricanes that collided with Puerto Rico represented a harrowing preview of how he’d handle the pandemic. I was convinced at the time that he was at least temporarily unaware that Puerto Rico was even part of the United States. I mean, how could he have been so thoughtless and unsympathetic to actual Americans? Turns out, he probably knew — he just didn’t give a shit. Never before has a modern president behaved so callously toward a devastated population of his own people, hurling paper towels at their heads as if he were firing a T-shirt cannon at a college basketball pep rally. Today, the island territory continues to rebuild despite Trump’s reprehensible indifference.

America is better than this. We’re better than him.

There have to be consequences for his indifference to the destruction in Puerto Rico as well as the 225,000 casualties of COVID-19 (and counting). Neither should have happened here. But this is what it looks like when the president and his people fail to do the paint-by-numbers things in response to a crisis — things that so many other presidents managed to achieve. Had Trump listened to the experts at the CDC and WHO, thousands of Americans would still be alive today and we might have been free and clear of this blight by now. Instead, Trump listened to the entertainers on Fox News, not to mention the shrieking voices in his head, convincing him to abandon the effort at exactly the wrong time — in April, at the initial height of the infection curve.

Before giving up, he applied travel restrictions to China, but it was too little too late. Forty thousand people arrived in the United States from China by flying through Europe and landing in New York, magnifying the catastrophic outbreak there. After that, Trump did nothing else to slow the spread, making George W. Bush’s 2005 response to Hurricane Katrina look masterful by comparison. Now, eight months into this disaster, Trump continues to ignore the rules, ignore safety protocols and ignore the experts, holding maskless, undistanced rally after rally, fueling his own ego, even after being infected himself. And there’s no end in sight.

Win or lose, his bungled, herky-jerky reaction to the pandemic will be remembered as the defining failure of his presidency, and it’s the No. 1 reason why he deserves nothing but ignominy and prison.

Rather than accepting the challenge and rising to meet it, as any other president would have, he’s spent all these months of national stress, uncertainty and illness not comforting or proactively leading the American people, but whining, whining and whining some more about how COVID ruined his presidency. Solving the pandemic could have been his greatest achievement — but Trump always makes things worse for Trump. Undermining himself and then playing the victim when things go sideways is the only thing he’s good at.

He possesses the most brittle ego of any president since Richard Nixon — one of many character flaws that undermine his self-identification as a manly alpha. Indeed, he’s nothing more than an easily-ruffled snowflake who constantly bellyaches about how “unfair” the world treats him — you know, the alleged billionaire president. So unfair.

Donald Trump has redefined what it means to be an empty suit. He talks an enormous game, but in reality his entire record is composed of failures and stolen successes. He claims to understand things he’s never able to explain openly or in any detail. Accordingly, he’s obsessed with repealing the Affordable Care Act, but only because it was Barack Obama’s signature achievement, not because it’s bad policy — and it’s not bad policy, he just says it is and his fanboys believe him.

If challenged, I’d wager a year’s salary he couldn’t name anything in the law beyond the mandate and the coverage for pre-existing conditions. I’m sure he doesn’t know about the myriad consumer protections or the mandatory benefits, or how the low-income subsidies work or the Medicaid expansion or the marketplaces — none of it. Yet he’s seeing to it that the entire thing is obliterated mid-pandemic when Americans need coverage the most. He definitely doesn’t know that coverage for pre-existing conditions is made possible, for example, by placing caps on premiums and co-pays, while banning rescission and lifetime limits on coverage. Worst of all, he doesn’t know that many of his own voters are covered today because of the ACA.

Between the pandemic and the possible repeal of the ACA, America is physically sick. And because of Donald Trump, we’re spiritually sick, too. He doesn’t understand that the president sets the tone for the nation. He’ll never grasp that the way he communicates influences the way we communicate with each other. His constant firehose of crapola encourages others to let their hatred, racism and obnoxious, crazy-eyed antagonism fly freely — playing out in our public spaces and on our social media platforms every damn day.

Trump has debased the presidency, replacing decency and humility with unearned self-praise and horrendous sadism. Our nation’s most cherished values and institutions have been randomly crushed by this 90-foot kaiju monster for too long. His constant antagonism has turned father against son, mother against daughter, family against family. Over what? The damaging misadventures of a political fraud — a garish old brat who bankrupted his businesses, defrauded Americans with his sham foundation and university and is currently bankrupting the U.S. treasury while establishing himself as a Putin-style kleptocrat.

In 1860, our nation nearly crumbled under the weight of slavery and secession. Today, our nation is on the verge of collapse under the weight of a painted-up clown whose performative fascism has led to the extrajudicial murder of American citizens on American soil; the use of Homeland Security as a secret police force tasked with assaulting Americans in advance of awkward photo-ops; the use of the Department of Justice as a personal law firm; taxpayer revenue as a personal slush fund; and, worst of all, the construction of internment camps for Central American migrant children, where some have been raped by American guards. Rivaled only by the pandemic response, the Trump Cages are the most disgusting and unforgivable aspect of this presidential crisis.

The 2020 election is about ending all that, while beginning the process of a second Reconstruction — rebuilding our government in a way that guarantees this will never happen again, while convening a Trump Crimes Commission to hold the perpetrators accountable. Part of that process is about remembering what happened here, in this era. There will be voices who insist we should move on and forget about all this ugliness. We would do well to ignore those voices. The minute we forget the damage he’s inflicted upon us all, the next Trump will be waiting to strike.

Indeed, the only way to move on is to punish the crimes and plug the holes. We have no choice but to use this dark ride — one that took my friend Chez and many thousands of others — as an opportunity to repair the gaping Trump-shaped craters in the system exposed and exploited by this unqualified, disgracefully unpresidential and obviously unglued president. If Joe Biden and Kamala Harris successfully oust Trump, a week from today, the Trump crisis will be on its way to ending, while the hard work of cleaning up the mess will begin. In both the election and the aftermath, we cannot fail. Everything depends on what happens next.

#bob cesca #vote for joe and blue down ballot

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losbella · 4 years ago

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patriotsnet · 3 years ago

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Why Do Republicans Want To Take Away Health Care

New Post has been published on https://www.patriotsnet.com/why-do-republicans-want-to-take-away-health-care/

Why Do Republicans Want To Take Away Health Care

Democrats Republicans And Your Health Insurance

Why some Republicans are skeptical of the new Senate health bill

Shereen Lehman, MS, is a healthcare journalist and fact checker.;She has co-authored two books for the popular Dummies Series .

Healthcare reform has been a contentious political topic in the U.S. for many years, and is shaping up to play a major role in the 2020 presidential and congressional elections. What does each party want? Let’s take a look at how the priorities of the Democratic Party and the Republican Party;could impact your health insurance.

National And State Level Coverage Losses

Table 1

Doubling Down Again On Health Savings Accounts

Bolstering health savings accounts has been a very popular reform idea among Republicans, and that enthusiasm is clear in the RSC plan.

The plan proposes to increase how much an employee can contribute to a health savings account. Currently, an individual can contribute $3,500 and a family can contribute $7,000.

RELATED: Premiums on benchmark HealthCare.gov plans decline 4% for 2020: CMS;

A 2018 bill that passed out of the House but didnt make it through Congress increased the contribution cap to $6,650 for an individual and $13,300 for a family.

Now, the RSC plan wants to increase the figures again, this time to $9,000 per individual and $18,000 for families, in line with a proposal from libertarian think tank Cato Institute.

The RSC plan would also expand health savings accounts so that they could be used for a number of health services and products that currently must be paid for with after-tax dollars, the plan said.

Don’t Miss: Who Is The Speaker Of The House For Republicans

The Health Care Repeal Lawsuit Could Strip Coverage From 23 Million Americans

Tomorrow, the Trump administration and 18 Republican governors and attorneys general will file their opening briefs with the Supreme Court in California v. Texasthe health care repeal lawsuit. The lawsuit, criticized across the political spectrum as a badly flawed case, threatens to upend the Affordable Care Act and strip 23.3 million Americans of their health coverage, according to new CAP analysisabout 3 million more than was forecast before the coronavirus pandemic. The anti-ACA agitators who initiated the health care repeal lawsuit, backed by the Trump administration, continue their attempts to dismantle the ACA, including its coverage expansions and consumer protections, amid the pandemic, during which comprehensive health coverage has never been more important. Millions of Americans who have lost their jobs and job-based insurance due to the current economic crisis are relying on the insurance options made possible by the ACA to keep themselves and their families covered.

Is The Supreme Court Likely To Save Obamacare

The Supreme Court is likely to leave in place the bulk of Obamacare, including key protections for pre-existing health conditions.

Conservative justices John Roberts and Justice Brett Kavanaugh appeared in two hours of arguments to be unwilling to strike down the entire law a long-held Republican goal.

The courts three liberal justices are almost certain to vote to uphold the law in its entirety and presumably would form a majority by joining a decision that cut away only the mandate, which now has no financial penalty attached to it.

Leading a group of Democratic-controlled states, California and the Democratic-controlled House of Representatives are urging the court to leave the law in place.

A decision is expected by late spring.

Recommended Reading: How Many Republicans Voted To Impeach Trump In The House

Republicans Really Hate Health Care

Theyve gone beyond cynicism to pathology.

By Paul Krugman

Opinion Columnist

Of all the political issues that divide us, health care is the one with the greatest impact on ordinary Americans lives. If Democrats hadnt managed to pass the Affordable Care Act, around 20 million fewer Americans would have health insurance than currently do. If Republican-controlled states hadnt refused to expand Medicaid and generally done as little as possible to support the act, national progress might have tracked progress in, say, California so another 7 or 8 million people might have coverage.

You obviously know where I stand on this political divide. But Im starting to believe that I misjudged Republican motives.

You see, I thought their behavior was cynical and strategic: They opposed Obamacare because they thought there was political mileage in scaring people about change, and also in denying Obama any successes. Oh, and their donors really hated the taxes on the rich that pay for the ACAs subsidies. And right up through 2016 they could hope to convince voters that they had a secret plan for something much better than Obamacare.

Indeed, all of these things surely played a role in GOP health care strategy. But at this point theyve clearly lost the political argument. In 2017, Republican attempts to repeal Obamacare made it clear to everyone that their party didnt have any better ideas, and never did; everything they proposed would have devastated the lives of millions.

The Real Reason Republicans Couldnt Kill Obamacare

Democrats did the work, Republicans didntand that says a lot about the two parties.

Adapted from The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage, St. Martins Press 2021.

The Affordable Care Act, the health-care law also known as Obamacare, turns 11 years old this week. Somehow, the program has not merely survived the GOPs decade-long assault. Its actually getting stronger, thanks to some major upgrades tucked in the COVID-19 relief package that President Joe Biden signed into law earlier this month.

The new provisions should enable millions of Americans to get insurance or save money on coverage they already purchase, bolstering the health-care law in precisely the way its architects had always hoped to do. And although the measures are temporary, Biden and his Democratic Party allies have pledged to pass more legislation making the changes permanent.

The expansion measures are a remarkable achievement, all the more so because Obamacares very survival seemed so improbable just a few years ago, when Donald Trump won the presidency. Wiping the law off the books had become the Republicans defining cause, and Trump had pledged to make repeal his first priority. As the reality of his victory set in, almost everybody outside the Obama White House thought the effort would succeed, and almost everybody inside did too.

That was no small thing, as Republicans were about to discover.

Read Also: When Did Republicans Turn Against Nixon

The Healthy Could Buy Less Expensive Policies In Some States

Obamacare requires insurers to provide an array of health care benefits, including maternity, mental health, prescription drugs and substance abuse. This comprehensive coverage, however, jacks up premiums and provides services that some consumers find unnecessary — think, a couple in their late 50s who aren’t having any more kids likely don’t need maternity coverage.

The bill would allow states to waive this federal mandate, which would allow insurers to offer skinnier plans that offer fewer benefits with lower premiums.

Do you have a pre-existing condition? How will the GOP healthcare bill affect you and your family? Share your story: Text/WhatsApp us on +1-347-322-0415

Opinion: Democrats Are Lying On Health Care

Republicans Aren’t Campaigning On Healthcare â They’re Hiding From It (HBO)

In November of every even-numbered year since at least 1970, the biggest lie in American politics has been Democrats claiming that Republicans are going to take away your Social Security. Republicans learned to live in a defensive crouch and to try to avoid mentioning the words Social Security. Now the new lie is about health care, mostly that Republicans are going to take away coverage for;preexisting conditions.

As usual, the truth is very different. The Senate Republican Policy Committee explained in a May 2017 paper that under the Republican-backed alternative to Obamacare, the American Health Care Act, no one will be denied coverage because of a pre-existing condition. Even if you are skeptical of Republican talking points, you dont have to look very far to find objective confirmation. According to FactCheck.org, Sen. Schumer was wrong to say, as he did on the Senate floor April 28, that the bill goes back to the day when insurance companies could deny coverage to those with preexisting conditions.

Democrats cant accept that the hallmark of the Obama years Obamacare has been a flop and is being taken apart piece by piece. And they will do anything to use the health-care issue against Republicans. No lie is too big.

Republicans dont want to take away your health care or leave people with preexisting conditions without coverage. If Democrats will lie to you about this, they will lie to you about other things.

Recommended Reading: Do Republicans Vote In The Democratic Primary

Why Do Republicans Oppose Obamacare

Patrizia Rizzo, SEO Reporter

11:10 ET, Nov 11 2020

Patrizia Rizzo, SEO Reporter

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REPUBLICANS have campaigned against Obamacare ever since it was signed into law in 2010.;

But with a change in presidency ahead, the Supreme Court is likely to leave in place the bulk of Obamacare, including;key protections for pre-existing health conditions.

Why Is The Affordable Care Act So Despised By So Many Conservatives

IT HAS been called the most dangerous piece of legislation ever passed, as destructive to personal and individual liberties as the Fugitive Slave Act and a killer of women, children and old people. According to Republican lawmakers, the sources of each of these quotes, the Affordable Care Act , or Obamacare, is a terrible thing. Since it was passed by a Democratic Congress in 2009, it has been the bête noire of the Republicans. The party has pushed more than 60 unsuccessful Congressional votes to defeat it, while the Supreme Court has been forced to debate it four times in the acts short history. Obamacare was also at the heart of the two-week government shutdown in 2013. Why does the ACA attract such opprobrium from the right?

Read Also: How Many Registered Republicans In Texas

Opinionwe Want To Hear What You Think Please Submit A Letter To The Editor

Despite what they say on television about protecting the most vulnerable, one by one the Republican senators are all getting in line behind Trump’s Supreme Court nominee. We don’t yet know who that is, but we can assume how he or she will vote on Obamacare.

People with pre-existing conditions like me are again terrified of losing our insurance, this time in the midst of a pandemic. We’ve lived through years of scary uncertainty and now months of sheltering in place. Enough is enough. We are all health care voters now. We’ll see whether our wavering senators are health care voters, too.

Laura Packard is a Denver-based health care advocate and cancer survivor. She is the founder of Health Care Voices, a non-profit grassroots organization for adults with serious medical conditions, co-chair of Health Care Voter, and runs the pharma accountability campaign for Hero Action Fund. Follow her on Twitter:

States Allowed To Add Work Requirements To Medicaid

What is it? Medicaid expansion was a key part of the ACA. The federal government helped pay for states to expand Medicaid eligibility beyond families to include all low-income adults, and to raise the income threshold, so that more people would be eligible. So far, 37 states and Washington have opted to expand Medicaid.

What changed? Under Trump, if they get approval from the federal government, states can now require Medicaid beneficiaries to prove with documentation that they either work or go to school.

What does the administration say? “When you consider that, less than five years ago, Medicaid was expanded to nearly 15 million new working-age adults, it’s fair that states want to add community engagement requirements for those with the ability to meet them. It’s easier to give someone a card; it’s much harder to build a ladder to help people climb their way out of poverty. But even though it is harder, it’s the right thing to do.” Seema Verma, administrator of the Centers for Medicare and Medicaid Services, Washington, Sept. 27, 2018

What’s the impact? Even though HealthCare.gov and the state insurance exchanges get a lot of attention, the majority of people who gained health care coverage after the passage of the ACA 12.7 million people actually got their coverage by being newly able to enroll in Medicaid.

Also Check: Why Are Republicans So Scared Of Trump

Republicans Stop Giving A Sh*t About Babies Once They’re Actually Born

Republicans are generallyÂ;pro-life, and mostÂ;conservativesÂ;believe that life beginsÂ;at the moment of conception.

They see aÂ;fetus not as part of a woman’s body, but asÂ;a human beingÂ;who doesn’tÂ;deserve to die throughÂ;abortion.

In last week’sÂ;Republican debate, nominees Â;the viral and controversialÂ;videoÂ;of a Planned Parenthood official allegedlyÂ;discussing the sale of fetal organs.

Republicans used the video asÂ;a springboardÂ;to discussÂ;limiting — and, in some cases, completely prohibitingÂ;– a woman’s access to an abortion.

In fact, Republicans areÂ;so committed to protecting the lives of the unborn that there isÂ;an entire page on the party’sÂ;websitededicated to the importance of upholding its reputation asÂ;the “pro-life party.”Â;It says:

The Republican Party must continue to uphold the principle that every human being, born and unborn, young and old, healthy and disabled, has a fundamental, individual right to life.Â;Like Abraham Lincoln, we rely on the Declaration of Independence for our authority to assert that every individual human being has a Creator-endowed right to life, and that it is the duty of government to protect that right.

Cool.

Besides the obvious “my body, my choice” liberalÂ;perspective on this, which says that what a woman decides to do with what’sÂ;in herÂ;body is up to her,Â;there’s a massiveÂ;problemÂ;with the Republicans’ pro-life platform.

But why don’t they give a single sh*t about that baby once it’s actually born?

Paul Ryan Has Dreamed Of Slashing Medicaid Since His Keg

Paul Ryan

Republican Paul Ryan, like most other members of the U.S. Congress, is a millionaire.

Christa Patton is 68 years old. She is frail and no longer able to leave her home. She lives on a fixed income. Patton told Van Jones on a recent episode of his CNN show “The Messy Truth” that she would not be able to eat without the Meals on Wheels program.

Paul Ryan is the speaker of the U.S. House of Representatives. By his own account, in college he used to hang out with his friends and drink beer while sharing his dreams of cutting Medicaid. When Ryan was 15 years old, his father died from an alcoholism related heart attack. Ryan and his family then received his father’s Social Security survivor’s benefits. Ryan used that money to attend college. This was not the only money that Paul Ryan received from the federal government. His family built its wealth from receiving government contracts.

Like his idol Ayn Rand , Paul Ryan has combined meanness, cruelty and callousness toward the weak and the vulnerable with gross and unapologetic hypocrisy.

Republicans like Ryan along with the millionaires and billionaires who comprise Donald Trump’s Cabinet and inner circle literally want to take food, shelter and health care away from poor people like Christa Patton. Today’s Republicans view these Americans as useless eaters to be disposed of by means both passive and active.

Social psychologists have shown that, in effect,;poor people become;invisible to the rich and upper classes.

Read Also: What Cities Are Run By Republicans

Premium Subsidies And Affordability

The ACA’s premium subsidies were designed to keep health insurance affordable for people who buy their own coverage in the individual market. Premiums for individual market plans increased alarmingly in 2017 and 2018, although they were much more stable in 2019 and 2020, and rate changes for 2021 appear to be mostly modest. But premiums for people who aren’t eligible for premium subsidies can still amount to a substantial portion of their income.

The individual market is a very small segment of the population, however, and rate increases have been much more muted across the full population .

Democrats have proposed various strategies for making coverage and care affordable. Joe Biden’s healthcare proposal includes larger premium subsidies that would be based on the cost of a benchmark gold plan and based on having people pay only 8.5% of their income for that plan . Biden’s proposal would also eliminate the ACA’s income cap for premium subsidy eligibility and provide subsidies to anyone who would otherwise have to pay more than 8.5% of their income for a benchmark gold plan. This would eliminate the “subsidy cliff” that currently exists for some enrollees.

The 2020 Democratic Party platform calls for a “public option” health plan that would compete with private health insurance carriers in an effort to bring down prices, and lowering the eligibility age for Medicare from 65 to 60.

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brittanyjone01 · 5 years ago

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The U.S. Health Care System: An International Perspective

The U.S. health care system is unique among advanced industrialized countries. The U.S. does not have a uniform health system, has no universal health care coverage, and only recently enacted legislation mandating healthcare coverage for almost everyone. Rather than operating a national health service, a single-payer national health insurance system, or a multi-payer universal health insurance fund, the U.S. health care system can best be described as a hybrid system. In 2014, 48 percent of U.S. health care spending came from private funds, with 28 percent coming from households and 20 percent coming from private businesses. The federal government accounted for 28 percent of spending while state and local governments accounted for 17 percent. Most health care, even if publicly financed, is delivered privately.

In 2014, 283.2 million people in the U.S., 89.6 percent of the U.S. population had some type of health insurance, with 66 percent of workers covered by a private health insurance plan. Among the insured, 115.4 million people, 36.5 percent of the population, received coverage through the U.S. government in 2014 through Medicare (50.5 million), Medicaid (61.65 million), and/or Veterans Administration or other military care (14.14 million) (people may be covered by more than one government plan). In 2014, nearly 32.9 million people in the U.S. had no health insurance.

This fact sheet will compare the U.S. health care system to other advanced industrialized nations, with a focus on the problems of high health care costs and disparities in insurance coverage in the U.S. It will then outline some common methods used in other countries to lower health care costs, examine the German health care system as a model for non-centralized universal care, and put the quality of U.S. health care in an international context.

The Organization for Economic Co-operation and Development (OECD) is an international forum committed to global development that brings together 34 member countries to compare and discuss government policy in order to “promote policies that will improve the economic and social well-being of people around the world.” The OECD countries are generally advanced or emerging economies. Of the member states, the U.S. and Mexican governments play the smallest role in overall financing of health care. However, public (i.e. government) spending on health care per capita in the U.S. is greater than all other OECD countries, except Norway and the Netherlands. This seeming anomaly is attributable, in part, to the high cost of health care in the U.S. Indeed, the U.S. spends considerably more on health care than any other OECD country.

Drivers of Health Care Spending in the U.S.

Prohibitively high cost is the primary reason Americans give for problems accessing health care. Americans with below-average incomes are much more likely than their counterparts in other countries to report not: visiting a physician when sick; getting a recommended test, treatment, or follow-up care; filling a prescription; and seeing a dentist. Fifty-nine percent of physicians in the U.S. acknowledge their patients have difficulty paying for care. In 2013, 31 percent of uninsured adults reported not getting or delaying medical care because of cost, compared to five percent of privately insured adults and 27 percent of those on public insurance, including Medicaid/CHIP and Medicare.

While there is no agreement as to the single cause of rising U.S. health care costs, experts have identified three contributing factors. The first is the cost of new technologies and prescription drugs. Some analysts have argued “that the availability of more expensive, state-of-the-art medical technologies and drugs fuels health care spending for development costs and because they generate demand for more intense, costly services even if they are not necessarily cost-effective.” In 2013, the U.S. spent $1,026 per capita on pharmaceuticals and other non-durable medical care, more than double the OECD average of $515.

Another explanation for increased costs is the rise of chronic diseases, including obesity. Nationally, health care costs for chronic diseases contribute huge proportions to health care costs, particularly during end of life care. “Patients with chronic illness in their last two years of life account for about 32% of total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations.” The National Academy of Sciences found that among other high-income nations the U.S. has a higher rate of chronic illness and a lower overall life expectancy. Their findings suggest that this holds true even when controlling for socio-economic disparity. Experts are focusing more on preventative care in an effort to improve health and reduce the financial burdens associated with chronic disease. One provision of the Patient Protection and Affordable Care Act, commonly referred to as simply the Affordable Care Act (ACA), implemented in 2013, provides additional Medicaid funding for states providing low cost access to preventative care.

Finally, high administrative costs are a contributing factor to the inflated costs of U.S. health care. The U.S. leads all other industrialized countries in the share of national health care expenditures devoted to insurance administration. It is difficult to determine the exact differences between public and private administrative costs, in part because the definition of “administrative” varies widely. Further, the government outsources some of its administrative needs to private firms. What is clear is that larger firms spend a smaller percentage of their total expenditures on administration, and nationwide estimates suggest that as much as half of the $361 billion spent annually on administrative costs is wasteful. In January 2013, a national pilot program implemented under the ACA began. The aim is to improve administrative efficiency by allowing doctors and hospitals to bundle billing for an episode of care rather than the current ad hoc method.

Health Insurance in the U.S.: Uneven Coverage

While the majority of U.S. citizens have health insurance, premiums are rising and the quality of the insurance policies is falling. Average annual premiums for family coverage increased 11 percent between 1999 and 2005, but have since leveled off to increase five percent per year between 2005 and 2015. Deductibles are rising even faster. Between 2010 and 2015, single coverage deductibles have risen 67 percent. These figures outpace both inflation and workers’ earnings.

The lack of health insurance coverage has a profound impact on the U.S. economy. The Center for American Progress estimated in 2009 that the lack of health insurance in the U.S. cost society between $124 billion and $248 billion per year. While the low end of the estimate represents just the cost of the shorter lifespans of those without insurance, the high end represents both the cost of shortened lifespans and the loss of productivity due to the reduced health of the uninsured.

Health insurance coverage is uneven and often minorities and the poor are underserved. Forty million workers, nearly two out of every five, do not have access to paid sick leave. Experts suggest that the economic pressure to go to work even when sick can prolong pandemics, reduce productivity, and drive up health care costs.

There were 32 million uninsured Americans in 2014, nine million fewer than the year prior. Experts attribute this sharp decline in the uninsured to the full implementation of the ACA in 2014. Of American adults who had health insurance in 2014, 73 percent had one or more full-time workers in the family and 12 percent had one or more part-time workers in the family. Just 49 percent of American adults reported getting health insurance from an employer in 2014.

Coverage by employer-provided insurance varies considerably by wage level. Firms with higher proportions of low-wage workers are less likely to provide access to health insurance than those with low-proportions of low-wage workers.

In 2014, 11.2 percent of full-time workers were without health insurance. However, the percentage of part-time workers without insurance was 17.7 percent, a significant decrease from 24 percent in 2013, thanks in part to the Affordable Care Act. The uninsured rate among those who had not worked at least one week also decreased from 22.2 percent in 2013 to 17.3 percent in 2014.

Smaller firms are significantly less likely to provide health benefits to full or part-time workers. Among all small firms (3-199 workers) in 2015, only 56 percent offered health coverage, compared to 98 percent of large firms.

After the Affordable Care Act allowed for many young adults (19-25) to remain on their parents’ health plans, there was a statistically significant increase in the percentage of insured young people from 68.3 percent in 2009 to 82.9 percent in 2014. Over the same period, the percentage of young people aged 26-34 with insurance increased from 70.9 percent to 81.8 percent.

Minorities and children are disproportionately uninsured. In 2014, 7.6 percent of non-Hispanic Whites were uninsured, 11.8 percent of Blacks were uninsured, 9.3 percent of Asians, and 19.9 percent of people of Hispanic origin were uninsured. The Kaiser Family Foundation has found that about 80 percent of the uninsured are U.S. citizens. Among children, six percent were uninsured in 2014. These children are 10 times more likely than insured children to have unmet medical needs and are five times as likely as an insured child to go more than two years without seeing a doctor.

Women in the individual market often faced higher premiums than men for the same coverage. Beginning in 2014, the Affordable Care Act banned this practice, as well as denying coverage for pre-existing conditions.

In 2014, 19.3 percent of the population living below 100 percent of the poverty line ($23,550 a year for a family of four) was uninsured. According to the Kaiser Family Foundation, 90 percent of the uninsured have family incomes within 400 percent of the federal poverty level. This makes them eligible for either subsidized coverage through tax credits or expanded Medicaid eligibility under the Affordable Care Act’s state health exchanges.

Rising Healthcare Premiums

Health insurance premiums in the U.S. are rising fast. From 2005 to 2015, average annual health insurance premiums for family coverage increased 61 percent, while worker contributions to those plans increased 83 percent in the same period. This rate of increase outpaces both inflation and increases in workers’ wages.

In 2005, the average annual premiums for employer-sponsored health insurance were $2,713 for single coverage and $8,167 for family coverage. In 2015, premiums more than doubled to $6,251 for employer-sponsored single coverage and $17,545 for employer-sponsored family coverage.

A growing number of workers face a deductible of $1,000 or more for individual plans. In 2015, 46 percent (compared to 38 percent in 2013 and 22 percent in 2009) of workers were enrolled in a plan with an annual deductible of $1,000 or more. Employees at small firms are more likely than those at large firms to have a deductible greater than $1,000.

The Union Difference:

Union workers

are more likely than their nonunion counterparts to be covered by health insurance and paid sick leave. In March 2015, 95 percent of union members in the civilian workforce had access to medical care benefits, compared with only 68 percent of nonunion members. In 2015, 85 percent of union members in the civilian workforce had access to paid sick leave compared to 62 percent of nonunion workers.

At the median, private-sector unionized workers pay 38 percent less for family coverage than private-sector nonunionized workers, according to a 2009 study.

Across states, there are significant disparities in both the availability and the cost of health care coverage.

In 2012, Medicare reimbursements per enrollee varied from $6,724 in Anchorage, Alaska to $13,596 in Miami, Florida. Annual premiums are similarly disparate. In 2015, the average family premium in the South was $16,785 while the same coverage averaged $18,096 in the Northeast.

Firms in the South were less likely to provide coverage for an employee’s domestic partner than other regions. In the South, 41 percent of firms reported providing benefits for same-sex partners (compared to 51 percent in the Northeast) and 20 percent reported offering benefits to opposite-sex domestic partners (compared to 46 percent in the Northeast).

High Costs Drive Americans into Bankruptcy

Universal coverage, in countries like the United Kingdom, Switzerland, Japan, and Germany makes the number of bankruptcies related to medical expenses negligible. Conversely, a 2014 survey of bankruptcies filed between 2005 and 2013 found that medical bills are the single largest cause of consumer bankruptcy, with between 18 percent and 25 percent of cases directly prompted by medical debt. Another survey found that in 2013, 56 million Americans under the age of 65 had trouble paying medical bills. Another 10 million will face medical bills they are unable to pay despite having year-round insurance.

It has been suggested, based on the experience of Massachusetts, where medical-related bankruptcies declined sharply after the state enacted its health reform law in 2006, that the ACA may help reduce such bankruptcies in the future.

The Affordable Care Act: Successes and Remaining Challenges

In March, 2010, President Obama signed the ACA into law that made hundreds of significant changes to the U.S. healthcare system between 2011 and 2014. Provisions included in the ACA are intended to expand access to healthcare coverage, increase consumer protections, emphasizes prevention and wellness, and promote evidence- based treatment and administrative efficiency in an attempt to curb rising healthcare costs.

Beginning in January 2014, almost all Americans are required to have some form of health insurance from either their employer, an individual plan, or through a public program such as Medicaid or Medicare. Since the so-called “individual mandate” took effect, the total number of nonelderly uninsured adults dropped from 41 million in 2013 to 32.3 million in 2014. The largest coverage gains were concentrated among low-income people, people of color, and young adults, all of whom had high uninsured rates prior to 2014.

A major provision of the ACA was the creation of health insurance marketplace exchanges where individuals not already covered by an employer-provided plan or a program such as Medicaid or Medicare can shop for health insurance. Individuals with incomes between 100 percent and 400 percent of the federal poverty line would be eligible for advanceable premium tax credits to subsidize the cost of insurance. States have the option to create and administer their own exchanges or allow the federal government to do so. Currently, only 14 states operate their own exchanges.

Designed to promote competition among providers and deliver choice transparency to consumers, the state-based exchanges appear to be doing just that. A recent analysis by the Commonwealth Fund found that the number of insurers offering health insurance coverage through the marketplaces increased from 2014 to 2015. Additionally, there was generally no reported increase in average premiums for marketplace plans over that period. The analysis found only a modest increase in average premiums for the lowest cost plans from 2015 to 2016.

The ACA also included a major expansion of the Medicaid program, although the Supreme Court ruled in 2012 that this expansion is a state option. As of November 2015, 30 states have chosen to expand Medicaid. As of 2014, adults with incomes at or below 138 percent of the federal poverty line are now eligible for Medicaid in the states that have adopted the expansion.

Despite improvements to the U.S healthcare system under the ACA, a number of challenges remain. In 2014, 10.4 percent of Americans were still uninsured, and those with insurance still face high deductibles and premium costs. Furthermore, in the 20 states that had not expanded Medicaid, an estimated three million poor adults fall into the “coverage gap” where their incomes are above current Medicaid eligibility limits but below the lower limit of premium credits on the healthcare exchanges. The bulk of people in the coverage gap are concentrated in the South, with Texas (766,000 people), Florida (567,000), Georgia (305,000) and North Carolina (244,000) having among the highest number of uninsured.

The ACA included a number of other provisions to improve healthcare access and affordability. The law banned lifetime monetary caps on insurance coverage for all new plans and prohibited plans from excluding children and most adults with preexisting conditions. Insurance plans are also prohibited from cancelling coverage except in the case of fraud, and are required to rebate customers if they spend less than 85 percent (80 percent for individual and small group plans) of premiums on medical services. Additionally, the ACA established the Prevention and Public Health Fund to allocate $7 billion towards preventative care such as disease screenings, immunizations, and pre-natal care for pregnant women and between 2010 and 2015. Furthermore, $11 billion in funding for community health centers and $1.5 billion in additional funding for the National Health Service Corps was included in the law.

A number of cost control provisions were included in the ACA in an attempt to curb rising medical costs. Among them is the Independent Payment Advisory Board, which will provide recommendations to Congress and the President for controlling Medicare costs if the costs exceed a target growth rate. The administrative process for billing, transferring funds, and determining eligibility is being simplified by allowing doctors to bundle billing for an episode of care rather than the current ad hoc method. Additionally, changes were made to the Medicare Advantage program that would provide bonuses to high rated plans, incentivizing these privately-operated plans to improve quality and efficiency. Furthermore, hospitals with high readmission rates will see a reduction in Medicare payments while a new Innovation Center within the Centers for Medicare and Medicaid Services was created to test new program expenditure reduction methods.

Informational Source

#Medicare #Health #Health Insurance #Insurance

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kristinsimmons · 5 years ago

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Improving the Affordable Care Act Markets (Part 1)

By JONATHAN HALVORSON, PhD

With each passing year, the Affordable Care Act becomes further entrenched in the American health care system. There are dreams on both the far left and far right to repeal and replace it with something they see as better, but the reality is that the ACA is a remarkable achievement which will likely outlast the political lifetimes of those opposing it. Future improvements are more likely to tweak the ACA than to start over from scratch.

A critical part of making the ACA work is for it to support healthy, competitive and fair health insurance markets, since it relies on them to provide health care benefits and improve access to care. This is particularly true for insurance purchased by individuals and small employers, where the ACA’s mandates on benefits, premiums and market structure have the most impact. One policy affecting this dynamic that deserves closer attention is risk adjustment, which made real improvements in the fairness of these markets, but has come in for accusations that it has undermined competition.

Risk adjustment in the ACA works by compensating plans with sicker than average members using payments from plans with healthier members. The goal is to remove an insurer’s ability to gain an unfair advantage by simply enrolling healthier people (who cost less). Risk adjustment leads insurers to focus on managing their members’ health and appropriate services, rather than on avoiding the unhealthy. The program has succeeded enormously in bringing insurers to embrace enrolling and retaining those with serious health conditions.

This is something to celebrate, and we should not go back to the old days in which individuals or small groups would be turned down for health insurance or charged much higher prices because they had a history of health issues. However, the program has also had an undesired effect in many states: it further tilted the playing field in favor of market dominant incumbents.

The national competitive picture has gotten worse since the ACA was passed. Today the top three insurers enroll at least 80% of the individual market in 37 states (up from 33 states in 2011) and the top three insurers enroll 80% of the small group market in 41 states (up from 37 states in 2011). In the small group market, the number of insurers enrolling over 1,000 lives declined nationally from 506 in 2012 to 409 in 2016. Even more starkly, 19 of the 23 co-op insurers created with funding from the ACA are now defunct. These co-ops failed for a number of reasons, one of which was the annual risk adjustment payments they had to make to insurers that had enrolled the majority in their local markets for decades, mostly BlueCross/BlueShield plans. Since there are many factors at work here, it is natural to ask how risk adjustment could be implicated.

There are at least three potential problems:

Some plans have advantages in maximizing risk scores, which may not reflect differences in true underlying member population risk or lead to better care;

The risk adjustment model makes no allowance for plan size when one or two insurers dominate a market; and

The risk adjustment model does not account for the fact that plan designs with tighter cost management methods are often avoided by less healthy people, creating a moral hazard.

Regarding the first point, risk scoring has become its own cottage industry, to which plans devote substantial resources out of necessity (if you don’t find and record as many risks as your peers, you in effect pay your competitors for each risk you haven’t found). The effort must be repeated each year, or else the diagnoses cannot be counted towards the risk score. The risk coding must document a care plan, but the reward amount is independent of any additional services delivered. Plans with more sophisticated data mining and outreach operations to confirm diagnoses will receive higher risk scores than plans with less sophisticated operations, even if underlying health conditions are the same. In addition, larger plans with long-tenured membership have an advantage, since they have multiple years of diagnosis and claims data to analyze for eligible conditions and identify likely diagnoses to confirm. Also, when large plans receive new members, the individuals are more likely to already be in their databases from a previous enrollment than is the case for small plans.

Even if a plan can purchase outside services to mine the data and find these health conditions, having every insurer do it independently, over and over each year, does not appear to be the most efficient use of resources and it creates winners and losers based on access to data.

A very large gap in plan size can create still more issues. In Alabama, the local BlueCross/BlueShield plan has long been the dominant insurer. The ACA helped drive its share of the small group market from 90% up to 97%, while the number of competitors dropped from six to three. Responding to its crisis, Alabama requested and received a 50% reduction in the size of risk adjustment transfers.

Part of the problem in situations like this is simple math: risk adjustment transfers are based on each insurer’s deviation from the average statewide risk score. A larger insurer will always be more insulated from random variance in risk, and a very large insurer will necessarily drive the statewide average to be much closer to its risk level than to its competitors. Consider an Alabama-like example in which a large insurer has 90% market share and a 10% higher risk score than the average of its competitors. Because the number of enrollees in each plan matters when calculating the average, the statewide average risk score average will be only 1% below the large insurer’s risk level—but 9% above competitors’. To oversimplify a bit, the small insurers would be forced to pay 9% of their premium to the giant.

Of course, if the small insurers had members with 10% higher risk in this example, they would receive 9% in premium while the dominant insurer would pay 1% of its premium…though this rarely happens. This is for several reasons, such as the tendency of the dominant plan to have longer tenured members as the “blue chip” plan in an area, or as mentioned above the advantage of having a larger data repository of state residents. Both of these make it easier to capture every diagnosis. In addition, these plans often have older and sicker members than small plans, which tend to have smaller networks, engage in more active cost control measures, and be less familiar names, which older and sicker consumers select less often. There is a selection bias of higher risk members towards plan designs which do the least to control total costs—at least, with respect to measures that matter in the selection process. These cost-inflating plans include more of out-of-network benefits and more high-cost providers in their networks, and have lower utilization management.

This point applies regardless of the size of the plan, and occurs even across a single insurer’s products. For example, in Pennsylvania Independence Blue Cross operates under two ACA plan IDs, one of which is for its Keystone HMO (think smaller network, no out-of-network benefit, referrals to see a specialist) and the other for its PPO (think no referrals and extensive out-of-network benefits). The HMO owed $74M, while the PPO received $82M in statewide risk adjustment payments in 2018. Essentially, risk adjustment in its current form undermines important cost reduction strategies. Since rates are generally required to be actuarially justified after rate adjustment is taken into account, this forces the HMO to have higher rates than it otherwise would have, suppresses enrollment in the plan trying to reduce costs, and subsidizes those who enroll in the more inflationary plan.

There are also difficulties faced by smaller plans when competing in an oligopolistic market: established giants have market power, deep relationships with providers, employers and brokers, and high brand recognition and familiarity. Going back to the case of an insurer with 90% of the market and 10% higher risk score, a non-dominant insurer could not be expected to price its products 9% higher to cover the ACA risk transfer cost. These plans generally have to price low to grow, and forcing the premium higher to reflect the statewide average health care cost may cause a plan to lose what little business it has. Despite widespread belief to the contrary, health insurance is a low margin business, with profits typically in the range of 3-5%. A consistent transfer amount anywhere near 9% can wreak havoc, and under the ACA risk adjustment program the transfers are sometimes much higher. Many of these points apply not only to very small insurers, but to larger insurers that have traditionally had a small or no presence in a given market (such as an insurer that has had a presence in Medicare Advantage but seeks to expand in the ACA individual or small group market).

New York State couldn’t be more different than Alabama in many ways, but it is undergoing a similar dynamic. In the small group market, one company, UnitedHealth, has long been by far the largest player, with roughly half of the statewide small group enrollment and over 70% of the greater NYC market. Inspired by the ACA, two new insurers (Health Republic and CareConnect) initially made a splash and were able to grab market share. They enrolled everyone they could…which ended up being disproportionately younger, healthier people willing to switch plans for something new and unfamiliar in order to save some money. Other plans in the market have attempted to grow by curating the network to a select group of providers to reduce premium, and in the process have also been left with a healthier population.

To be clear, risk adjustment is critically important to balance out differences that arise from some consumer preferences. For example, high deductible plans tend to attract healthier enrollees who don’t expect to use their insurance. Without risk adjustment, these plans would become even cheaper than they already are, while more comprehensive plans that attract sicker members would get disproportionately more expensive, setting off a downward spiral that pushes more and more people into plans that have the least benefits. Risk adjustment is a fantastic way to prevent this sort of self-destruction of insurance markets. However, in other cases where risk levels differ due to preferences, such as an aversion among older and sicker people to unfamiliar plans or narrow networks, forcing insurers to pay a penalty that completely compensates for preferences can be harmful to innovation and the public interest. It is still important to allow for some risk adjustment in these cases, but fully compensating for the selection bias can create a perpetual penalty for types of plans that are actually helpful to coordinate care and control costs.

Risk adjustment is by no means the only systemic issue that has caused companies to exit the market in almost every state, but it has compounded other problems and persists year after year. For the smaller plans still competing in Alabama and downstate New York, nearly all are facing large annual risk transfers to the dominant plans. Some insurers are still losing 20% or more of their total premium in 2019, well beyond what they could make up for with premium hikes without losing membership. Meanwhile, United alone received about one billion dollars in risk adjustment transfers in New York from 2014 to 2018. Less extreme versions of these imbalances occur in state after state, from New Mexico to Illinois to Vermont.

The bottom line is that risk adjustment is a crucial tool to direct the focus of health plans and improve fairness and stability, but rewarding insurers that are better at identifying health conditions independent of overall quality and health outcomes, and correcting for all of the differences in risk scores in a state, can misdirect focus and undermine the ability of innovative insurers and progressive products to compete in the marketplace. More on this, and on what a solution could look like, in a following post.

Jonathan Halvorson is a Senior Healthcare Consultant at Sachs Policy Group and has a long-term interest in the transformative potential of technology on the health care system

Improving the Affordable Care Act Markets (Part 1) published first on https://wittooth.tumblr.com/

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lauramalchowblog · 5 years ago

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Improving the Affordable Care Act Markets (Part 1)

By JONATHAN HALVORSON, PhD

There are at least three potential problems:

Some plans have advantages in maximizing risk scores, which may not reflect differences in true underlying member population risk or lead to better care;

The risk adjustment model makes no allowance for plan size when one or two insurers dominate a market; and

The risk adjustment model does not account for the fact that plan designs with tighter cost management methods are often avoided by less healthy people, creating a moral hazard.

Jonathan Halvorson is a Senior Healthcare Consultant at Sachs Policy Group and has a long-term interest in the transformative potential of technology on the health care system

Improving the Affordable Care Act Markets (Part 1) published first on https://venabeahan.tumblr.com

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vox · 8 years ago

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What the Republican Obamacare replacement plan means for the sickest Americans

A couple of weeks ago, I talked to a 28-year-old woman living with stage 4 colon cancer about what she feared most from the looming repeal of the Affordable Care Act.

The ACA made health insurance affordable, Julienne Edwards told me, despite her chronic condition. Her nightmare scenario was that repealing the law could mean she wouldn’t be able to afford the treatments she may need down the road, or that her family would have to turn to crowdfunding to pay for the cost of her care.

Yesterday, the House Republicans finally released their replacement plan for the ACA in the form of two bills (one from the Energy and Commerce Committee and another from the Ways and Means Committee). Edwards and more than 117 million Americans like her who are living with a chronic illness now have a clearer picture of what their lives will look if the Republicans get their way in Congress.

Edwards’s nightmare, at least for now, seems a little more possible — but with some big caveats. The American Health Care Act, as the new Republican plan is called, would continue some of the ACA’s provisions that seemed to be designed to protect chronic disease patients like Edwards. Under the new plan, people still couldn’t be denied coverage, and insurers would be prohibited from having “lifetime limits,” a maximum on how much they’ll spend on one person’s health care.

But the new plan would introduce a “continuous coverage” clause that could uniquely punish sick Americans like Edwards. It would also hurt low-income Americans who relied on Medicaid or subsidies to purchase their health insurance.

The AHCA would continue to protect people with preexisting conditions

When Edwards was diagnosed with cancer, she benefitted from two of the ACA’s most popular provisions. She was able to stay on her parents’ insurance plan until she was 26 under the ACA’s dependent coverage provision, so her surgery and initial treatments were covered.

Then she was able to buy affordable insurance despite the fact that she had a costly illness. This is because of another Obamacare provision called guaranteed issue, which says people with preexisting conditions like cancer or HIV can’t be denied coverage.

The new Republican plan, like the ACA, mandates that insurers offer coverage to everybody, regardless of how sick they are, as Vox’s Sarah Kliff explains. This means that insurance companies can’t deny coverage to people like Edwards who have preexisting conditions. Nor can they charge them more as long as they’ve been insured continuously, although for patients with chronic illnesses, maintaining continuous coverage can be difficult.

The ACA required insurance companies to remove lifetime caps on spending, which means that people like Edwards can get the treatments they need throughout their lives without hitting a cost ceiling. The AHCA would maintain that requirement too, avoiding another of Edwards’s nightmare scenarios — that she’d hit a cap early in her life and not be able to afford some of the treatments she needed.

The new plan also keeps the dependent coverage provision. This is another big win for young people living with chronic diseases, since it means they could be sheltered under family insurance plans before they have jobs and incomes that are stable enough to cover the cost of their medical care.

The trouble with “continuous coverage” and the new tax credits

It has long been a truism of American health care that a small group of patients cost the most money. The top 1 percent of health care spenders account for nearly a quarter of overall health care spending, and the top 20 percent are responsible for 82 percent of the total.

It is this 20 percent that are the most challenging group for any insurance coverage expansion, because they have bills that are well beyond the financial reach of most people — and the government needs to decide how much money it wants to invest in a safety net for them.

The ACA’s answer to this was the individual mandate: Require everybody to buy insurance through the individual mandate, putting the young, old, sick, and healthy into the same risk pool. Those who didn’t purchase insurance risked tax penalties.

The Republican health reform plan strips away the individual mandate, and instead introduces a continuous coverage requirement. Insurance companies wouldn’t be allowed to discriminate against patients based on preexisting conditions — so long as those patients have managed to maintain health insurance continuously, without a lapse of more than 63 days.

In theory, this should encourage everybody to have coverage all the time, ensuring the insurance risk pool is a good mix of healthy and sick people.

The reality is that many people with chronic diseases may not be able to meet that requirement. “People with chronic conditions and disabilities [like HIV] are more likely to have gaps in coverage as a direct result of their conditions,” said Amy Killelea, the health reform director at NASTAD, a leading nonpartisan nonprofit that represents public health officials who administer HIV and hepatitis programs.

The research on cancer patients similarly suggests that up to 85 percent of them stop working while getting treatment, with absences that range from 45 days to six months. (This was true for Edwards: She had to put her law degree on hold, decline a job she had lined up, and stop working during her treatment. Two years after her diagnosis, she only works part-time now.)

These breaks in employment could mean breaks in insurance. If people with a break in insurance purchase health insurance individually, the ACHA would allow insurers to increase their premiums by 30 percent for the first year after their coverage gap. The extra charges would likely fall hardest on people who are already sick, since they need health insurance the most and would have to pay up. Healthy people, meanwhile, could decide to avoid the surcharge by not buying insurance on the individual market at all — rolling the dice until they get a new job that offers insurance.

Sick people who had to drop out of the labor market due to illness would end up paying more for coverage, which is why groups like the American Cancer Society and NASTAD have been lobbying against the continuous coverage. Healthy people could try to skip the surcharge altogether. The result would be more sick people and fewer healthy people in the insurance marketplace.

The AHCA would offer less help for low-income Americans with chronic diseases

Chronic diseases are a big source of lost income — not only because of interruptions in work or job losses during treatments, but also because illness can shorten the number of productive years an individual can work. When people get sick, and don’t earn as much as they used to, Obamacare helped them in other ways: It made them eligible for income-based subsidies to pay for their insurance. People who earned the least got the most help.

The new Republican plan will get rid of the income-based subsidies, and instead replace them with a new system of tax credits based on age. This means people who are older — regardless of income — are covered more generously (though the tax credits phase out for wealthy people).

“It will be harder for people living with HIV to afford plans that will actually cover their care and treatment needs,” NASTAD’s Killelea said, since the change could mean low-income folks get less help to pay for their premiums. (According to the Kaiser Family Foundation, age-based tax credits would be between 31 and 82 percent lower for a 60-year-old who earns $20,000, depending on where that person lives in the country.)

The other way Obamacare helped poorer Americans was through Medicaid expansion. Before the ACA, only low-income children and parents and pregnant or disabled people were eligible for the government health plan for the poor. Through Obamacare, the working poor could also get coverage in states that expanded Medicaid.

This had a huge impact on the chronic disease community. The Kaiser Family Foundationrecently released the first national estimates of changes in insurance coverage among people living with HIV in the US, and found that Medicaid coverage increased for that population from 36 percent in 2012 to 42 percent in 2014, while the uninsured rate in this group dropped from 22 percent to 15 percent. Thousands of HIV patients gained health insurance. And that’s only one disease group.

The proposed plan would only continue Medicaid expansion until 2020 — which is a reversal from previous Republican replacement plans, which proposed cutting the program immediately. But this still leaves people who depend on Medicaid expansion in limbo. And the new plan would also change how Medicaid is funded by the government, from an open-ended commitment to pay all of a Medicaid enrollee’s bills, to a “per capita cap” system, where states would only allot a fixed sum of money to each enrollee.

It’s still not clear how much this will reduce Medicaid spending, but the projections suggest the per capita cap will result in less support for Medicaid, likely forcing states to make cuts to eligibility and benefits. For America’s sickest, this won’t be a good thing.

#health care #health insurance #affordable care act #ACA #Obamacare #American Health Care Act #GOP #policy #politics #health

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