Tag: AHCA

Programs for vulnerable Americans on chopping block
President Trump has released his budget, and it puts programs for vulnerable Americans on the chopping block. Along with food stamps, Medicaid, Supplemental Security Income (SSI) and CHIP (the Children’s Health Insurance Plan), Trump proposes to slash Social Security, expressly violating his campaign pledge not to touch Social Security. All told, Trump’s budget slashes $1.7 trillion from these programs over 10 years.

Trumps plan would cut as much as $62 billion from Social Security Disability Insurance and $9 billion from SSI. It also ends the Community Services Block Grant, which supports the Meals on Wheels programs that provide hot meals to older adults in their homes; it cuts $193 billion in food stamps. And, it ends the low-income Home Energy Assistance Program (HEAP), which helps older adults pay for the cost of their heat. Under the plan, Medicaid cuts would total $610 billion, putting at risk long-term care for vulnerable older adults.

Trump’s budget plan is in line with those of the Republican-controlled House, which is also looking to pay for massive tax cuts by stripping funding from programs for vulnerable Americans, according to Politico. People in need of help paying for food, housing, education assistance are all at risk. Republicans are even considering cuts to veterans’ benefits. The American Health Care Act (AHCA), if passed, would cut $880 billion from Medicaid.

Bottom line, to balance the budget in ten years, President Trump and Republican leaders are willing to slash hundreds of millions of dollars currently supporting programs that protect low-income and working families. At the same time, their goal is to come up with the money needed to enhance funding for the military and cut corporate taxes. Balancing the budget will require about $8 trillion.

Which specific programs serving vulnerable Americans get cut likely won’t be determined until the fall.

Politico further reports that the Republicans in charge of the 2018 fiscal budget are likely also to propose privatizing Medicare, essentially adopting Speaker Ryan’s plan, though that would be symbolic this year.

Republicans hope to get their plan through Congress without a filibuster, using the budget reconciliation process, which only requires a majority vote to pass. But, it’s not clear whether they will be able to get support for slashing low-income programs from moderate Republicans.

Here’s more from Just Care:
May 24, 2017
AHCA and the Medicare Trust Fund
The solvency of the Medicare (Part A Hospital Insurance) Trust Fund turns in large part on Congress. Democratic leaders extended its life when they passed the Affordable Care Act and imposed additional payroll taxes on the wealthiest Americans. Now, according to the Center on Budget and Policy Priorities, Republican leaders in the House have voted to shorten its life by two years in passing the American Health Care Act (AHCA).

Over its decades-long history, the Medicare Part A Trust Fund has seen significant rises and falls in its projected life. In 2005, the Trust Fund was projected to remain solvent for 15 years until 2020, in 2009 for only eight years until 2017, and in 2015, for 15 more years until 2030. The Affordable Care Act extended its life by 11 years when it imposed an additional Medicare tax on wealthy Americans.

The ACA obligates people earning more than $200,000 a year (couples $250,000) to pay an additional Medicare payroll tax of 0.9 percent, essentially raising payroll contributions for this cohort from 2.9 percent to 3.8 percent. AHCA, as passed by the House, eliminates this tax in 2023, reducing contributions to the Part A Trust Fund by $59 billion over 10 years.

Medicare payroll tax contributions support the Medicare Part A Trust Fund, so when the economy is strong and more people are working, the fund grows faster than when the economy is weak and fewer people are working. The size of the Trust Fund also turns on Medicare hospital expenditures, a function of both the number of people with Medicare getting hospital care and the cost of that care.

The Medicare Part A Trust Fund is currently projected to have enough money to pay out Medicare Part A hospital benefits in full until 2028. If AHCA becomes law, it would have enough money to pay out these benefits until 2026. (Medicare Part B medical benefits are paid for through the Part B premium and general revenues.) And, a Congress that wants to keep it solvent can do so, much as Congress can ensure the Pentagon is funded.

If the Republican Congress passes AHCA and does away with the ACA’s additional payroll tax on the wealthiest Americans, it would hand over an additional $13,700 on average to wealthy Americans in 2025 and make it harder for people with low incomes to get Medicare or other affordable coverage. It would also cut payments to hospitals serving underinsured and uninsured people by some $48 billion over ten years.

N.B. Even if Congress did nothing in 2026, the Medicare Trust Fund could pay out 87 percent of Part A benefits and all of its benefits under Part B of the program.

Here’s more from Just Care:
May 17, 2017
House votes to deny millions health insurance
The House of Representatives voted last week to kill many provisions of the ACA and replace them with the Affordable Health Care Act (AHCA), a bill that would deny millions of Americans, including older adults and people with disabilities, good affordable health insurance. The bill passed by a vote of 217-213, without an estimate of its costs or an understanding from the Congressional Budget Office (CBO) of the full range of projected consequences for people with health insurance today, including people with Medicare and Medicaid.

But, as Tim Jost reports in Health Affairs, the AHCA provisions entail substantial cuts in health care spending, deprive low-income Americans of Medicaid coverage and leave tens of millions of Americans–those with employer coverage and those with individual coverage–uninsured or underinsured. Based on earlier projections, because it eliminates the Medicare tax on wealthy Americans, if passed, AHCA would also shorten the life of the Medicare Trust Fund by two years.

In brief, AHCA, the Republicans’ proposed health care law would:
- Hand hundreds of billions of dollars in tax cuts to pharmaceutical companies, medical device companies, along with the wealthiest Americans. In the process, it would weaken Medicare, and it would jeopardize the financial base that supports health care subsidies for people with low incomes in the state health insurance exchanges. Some good news: It keeps the provision in the ACA that closes the Medicare prescription drug donut hole in 2o2o.
- Allow insurers to charge older people five times more than younger people and even more than that if states permit it. Inevitably, this would mean that older people not yet eligible for Medicare and without employer coverage would be hard-pressed to afford health insurance.
- Slashes Medicaid funding by $880 billion over the next 10 years. It also imposes either state block grants that may keep eligible individuals from getting coverage or per person payment caps that could limit Medicaid benefits. The 11 million people with Medicare and Medicaid might no longer be able to rely on Medicaid to help cover their Medicare premiums, coinsurance and deductibles, or their nursing home care.
- Mean 24 million people will lose health insurance coverage. It would not be affordable for them.
- Allow employers and states to offer policies that leave people without essential benefits and underinsured; moreover, if insurers are able to offer policies that do not cover key benefits, people will no longer be protected by the ACA’s cap on out-of-pocket costs for those benefits. They also will no longer be protected by the ACA’s protection against lifetime coverage limits for those benefits.
- Keep tens of millions of people with pre-existing conditions from getting affordable coverage in states that permit insurers to raise rates on these people. And, even if people with pre-existing conditions could afford health coverage, it’s not clear that the coverage available would offer the health care benefits they would need.
- Cut health insurance subsidies based on income for people in the health exchanges beginning in 2020 and replace them with a small tax credit based on age to people with low incomes.
- No longer impose tax penalties on individuals who do not get coverage or employers who do not offer coverage. This would likely mean that younger healthier individuals would not buy coverage, driving up premiums by 15-20 percent for everyone else. And, many employers will stop offering health insurance coverage.
- Lead to 1.8 million people losing their jobs.
Of note, House Republicans, knowing full well the implications of these provisions, ensured that they and their staff continued to get good affordable coverage. The American Health Care Act protects members of Congress and their staff from some of its harshest provisions. Among other things, they are guaranteed coverage of all essential benefits even if their states opt to cut them for everyone else. Similarly, their insurers cannot charge them more if they have pre-existing conditions, even if their states waive this protection for everyone else.

Not surprisingly, hospitals and doctors are expressing concern with this bill. It will likely leave hospitals and doctors holding the bag for the cost of care for millions of Americans, including people who opt not to get coverage and need costly health care and people who are forced to buy inadequate coverage. Given, Medicaid cuts, insurers are likely to lose a big block of Medicaid business. But, if the bill becomes law, they are also likely to be given the freedom to cut benefits and charge exorbitant premiums to people with pre-existing conditions in many states, which will be helpful to their bottom lines.

AHCA is now in the hands of the Republican-controlled Senate. In order to pass, every Senate Republican but two must support it.

Here’s more from Just Care:
May 11, 2017