My First Response to the New Republican Healthcare Bill – The first song on my Sirius radio this morning as I drove to work was Sam Cooke’s “A Change is gonna come”. For the last three months, I have anticipated changes in the Affordable Care Act, from the repeal and replace promise, to a more realistic massaging of the current ACA requirements. The first draft of the American Health Care Act (AHA) is now upon us and there are some significant changes that include the following: Gone is the individual mandate that requires all U.S. citizens to have health insurance or pay a tax. Gone is the employer mandate that required employers who have more than 50 employees to offer a qualified health insurance product or else pay a fine. Gone is the hope of future Medicaid expansion, as the current proposal is actually Medicaid expansion in reverse as monies flow to each state in block grants based upon how many disabled, elderly, and nursing home beneficiaries there are in each class.
There are many current ACA provisions that remain, such as dependents’ ability to stay on your health insurance policy until age 26, the elimination of pre-existing conditions(thank the good Lord), and a renewed interest in the Cadillac tax but delayed until 2025.
Tax credits will change dramatically. Currently, the older beneficiaries get more of the tax credits, since their health insurance premiums are based upon age. Folks who have lower incomes also get more of the tax credits to help make insurance more affordable. There will be no more wage-based advance tax credits. Age will determine how much tax help you get. If your income is greater than $75,000 as an individual or $150,000 if married, you’re not getting any tax credit for health insurance.
The legislation gives a greater incentive to buy a High Deductible Health Plan by increasing the amount of money you can put into a Health Savings Account (HSA). It forces folks to keep their insurance, but if you let your coverage lapse, there may be a 30% increase in premium to re-enter the marketplace. It prohibits anyone who wins more than $80,000 in the lottery from enrolling in Medicaid!
While some will call it Obamacare 2.0, others will call it ACA Light- my nice reference to light beer with fewer calories, neither what the American Health Act nor the Affordable Care Act did – address the continued escalation of healthcare. The ACA and now the new AHA is a health insurance bill, not a health care bill. Nothing lowers the cost of an MRI, an office visit, the cost of insulin for a diabetic, or controls the outrageous pricing of prescription drugs. Until we tackle the underlying problem, we’re just giving change lip service. But I hold out hope, that as Sam Cooke sang this morning, “It’s been a long, a long time coming, But I know a change is gonna come, oh yes it will.”