Updated June 27th, 2017
CBO Analysis – If Americans Are Not Forced To Have Insurance, Many Will Choose To Remain Uninsured
The CBO released its rating of the Better Care Reconciliation Act (BCRA), also known as the Senate’s version of Trumpcare, and the news isn’t much better than when the CBO scored the House’s version of Trumpcare, the AHCA.
In their analysis released today, the CBO predicts that by 2026, 22 million more Americans will be uninsured under the BCRA (Better Care Act) than would be uninsured under Obamacare. This would mean that in total more than 49 million Americans would be uninsured. If you recall, the CBO thought 23 million Americans would be uninsured by 2026 under the AHCA. In contrast according to the CBO, if Obamacare were to remain in place, only 28 million would be uninsured in 2026.
A large portion of this uninsured group would be from those who would have been eligible for Medicaid under Obamacare but are no longer eligible under the Medicaid rollback provisions of the BCRA. The CBO predicts that Medicaid enrollment would go down by 15 million more under the BCRA by 2026 than under Obamacare.
If There’s No Tax Penalty Americans Won’t Be Motivated To Enroll In Coverage
The CBO doesn’t believe that the continuous coverage requirement would be as effective as the individual mandate. According to their analysis, 15 million more Americans will be uninsured at the end of the 2018 because there is no tax penalty for being uninsured. This as well as increased costs in most markets, initially.
Under the BCRA version of Trumpcare, it proposes to remove the individual mandate and instead adopt a continuous coverage requirement model. Under this model, it would impose a premium hike of 30% per month, for a full calendar year.
In addition, for any consumer who went more than 63 days without health insurance coverage and as soon as the consumer reached that gap in coverage, they would be barred from re-enrolling, or enrolling in another plan for six-months.
Just to recap that; if you let your coverage lapse for 63 days, you not only lose your coverage, but you will also not be allowed to re-enroll in a plan again for six months.
When you are able to re-enroll, it will cost you 30% more, for one year.
We Should Point Out:
To some extent a similar measure is already in place with the ACA, (Obamacare). Each year there is what is called an open-enrollment season. It is only during this period of the year that consumers can enroll in a health insurance plan that is compliant with the rules set in place under the Affordable Care Act (ACA/Obamacare). This is typically a window of time 45 to 60 days.
Some Senate GOP members are said to believe that imposing these rules will prevent sick people from “gaming the system” and only getting insurance only when they needed it, and not paying for it when they are healthy. This is said to be another measure that would help stabilize the health insurance marketplace. The CBO believes that this continuous coverage requirement would not increase overall enrollment initially until premium costs came down. Once premium costs continued to move down to a significant point, the continuous coverage requirement would increase enrollment slightly according to the CBO’s calculations.
Similar to the AHCA, the CBO projects that the BCRA will reduce the country’s deficit by $321 billion, which is mostly attributed to the eventual roll back of Medicaid funding and due to the savings from the removal of subsidies. This number would be much greater if the BCRA would keep in place many of the Obamacare taxes or the individual mandate.
The CBO admits that there is room for error in their estimates in large part due to the fact that there are so many provisions in the BCRA that give opportunities to the states and different agencies to affect enrollment numbers and costs.
We will have more detailed analysis soon.
Updated June 26th, 2017
Trumpcare (BCRA) CBO Score Is Out – 22 Million More Will Be Uninsured By 2026
The Senate’s version of Trumpcare, also known as the Better Care Reconciliation Act, is out, and it’s not looking good. According to the CBO’s analysis, this version of Trumpcare would lead to 22 million more Americans being without health insurance by 2026. This is 22 million more without coverage than if Obamacare and the expansion of Medicaid were to remain in place. This is a slight improvement on the House version of Trumpcare released in March. We will be releasing an additional update with more substantial details within a few hours.
Susan Collins of Maine has already expressed that she can not support this version of the BCRA.
Updated June 22nd, 2017
The Senate Releases Their Version of Trumpcare – The “Better Care Act” (BCRA)
After weeks of speculation about how the American Health Care Act (AHCA or Trumpcare) would change once it reached the Senate, Republican lawmakers on Thursday, June 22, released a draft proposal of their bill. Titled the Better Care Reconciliation Act of 2017, the new bill cuts back on several provisions of the current law – the Affordable Care Act, or Obamacare as it’s more commonly called – and changes several features of the House bill that came before it. Here’s a summary of what we might expect under Trumpcare if the Senate bill gets signed into law as-is, albeit an unlikely scenario.
Among the biggest points of contention between Republicans and Democrats alike is the treatment of Medicaid. The House bill (AHCA) made substantial changes to the joint federal and state program for low-income Americans, and the Senate bill appears to go even further. Under the Better Care Reconciliation Act:
- Medicaid expansion will end much sooner than it might have under the AHCA. Over the next four years, the expansion guidelines (allowing those earning up to 138 percent of the federal poverty level) would be phased out. By 2020, no new enrollees in the expanded guidelines would be permitted. Federal funding for expansion shrinks to 90 percent by 2020 and decreases by 5 percent until 2023, at which point expansion funding ends entirely.
- Funding for the Medicaid program shifts to a per-capita system based on the consumer price index for medical care until 2025. At that point, per-capita funding will be based on the consumer price index for all goods, which is a lower mark of growth. Effectively, this would force even larger spending cuts to the program on a nationwide basis.
- States will be given the option to require Medicaid recipients to work, with notable exceptions for students, disabled people and pregnant women. States can also decide what constitutes employment for Medicaid purposes, including how long someone has to work in order to qualify for state assistance.
Cost Assistance Under The BCRA
Under Obamacare, cost assistance exists in the form of tax credits or subsidies designed to reduce the burden of monthly premiums for low- and middle-income Americans. Credits are based on income. The House bill created tax credits based on age, but the Senate reverts to the ACA’s approach of income-based assistance – with limitations:
- Under the Senate bill, people who earn up to 350 percent of the federal poverty level would qualify for tax credits to reduce the cost of premiums. By contrast, current law caps assistance at 400 percent of the FPL.
- Tax credits decrease with age. Older people will spend a greater portion of their income on health insurance premiums than younger people.
- The Senate bill also caps tax credits at a lower overall percentage of the cost of medical care, effectively making them less robust than the subsidies that exist under current law.
- For insurers, the Senate bill continues funding for cost-sharing subsidies through 2019. This is a significant concession as several major insurers have bowed out of the individual marketplace due to uncertainty over cost-sharing subsidies. These subsidies reimburse insurance companies for offering lower cost-sharing amounts to lower-income enrollees. CSR payments have been on hold this year while a case is pending in court.
Other Changes In The BCRA
There are several other important changes that the Senate bill makes to the original AHCA, including state waivers for essential health benefits, a repeal on certain Obamacare taxes, funding for grants to fight the opioid crisis in America, and a lack of funding for any abortion services. In summary:
- States could apply for a waiver of the essential health benefits requirement currently mandated by law, which would allow them to define essential health benefits for their individual marketplaces instead of requiring all health plans to cover a robust set of benefits. This could open up the possibility of cheaper plans with higher out-of-pocket costs.
- Insurers may be able to reduce the overall percentage of medical care that they cover under the Senate bill, going from an average of 75 percent to 58 percent. The Senate plan also might increase average out-of-pocket expenses by 68 percent.
- The Senate bill keeps the House bill’s elimination of Obamacare taxes – such as the 3.8 percent tax on investment income for people earning about $200,000 a year – primarily for the very wealthy, who could see significant tax cuts as a result.
- There’s a one-time total grant of $2 billion available to states that need assistance in developing programs to combat the growing opioid addiction epidemic. This provision may prove popular in states that have been particularly affected by the drug crisis.
- Under the Senate bill, people can’t use any funding from the Better Care Reconciliation Act to pay for abortion or to buy plans that cover abortion. Funds from the BCRA also can’t be given to providers who deal with abortion in any way, which means that this provision of the Senate bill effectively defunds Planned Parenthood.
These changes in no way represent the final bill that will be submitted to President Trump, but Senate Majority Leader Mitch McConnell is hopeful of a vote in the upper chamber as early as next week. Senate moderates have been vocal in their stance against deep Medicaid cuts. The Senate bill does not appear to reflect this vocal opposition, nor does it do anything to strike a balance between the middle and far-right members of the Republican Party, not to mention opponents on the left. The Better Care Reconciliation Act of 2017 will undoubtedly go through a host of changes as it works its way to the president’s desk.
Updated June 21st, 2017
Will Americans Have Enough Time To Understand What’s In The Senate Version Of Trumpcare Before A Vote?
One of the most often used and cliched expressions in history is the one that describes the definition of insanity.
Insanity: “Doing something over and over again and expecting a different outcome.” We’ll come back to insanity in a bit.
There’s growing concern coming from Americans, be it Republicans, Democrats or Independents, that the Senate version of AHCA, which is also know as Trumpcare, will be rushed to the floor for a vote without providing enough time for it to be thoroughly reviewed. According to reports, the Senate version of Trumpcare is expected to be released on Thursday, (June 22nd) with a vote coming sometime the following week. This is supposed to be enough time for the CBO to review the latest version of Trumpcare before a vote.
President Trump Expressed Concerns About The House Version Of Trumpcare
Regarding the President, it has been reported that President Trump personally expressed concerns to Senate Republicans about the forthcoming Senate version of Trumpcare. According to numerous sources, who were in attendance at a Senate luncheon where healthcare reform was being discussed, President Trump referred to the House version of the AHCA as “mean” and encouraged Senators drafting this next version of Trumpcare to “add more money” to the bill. That request is most likely in reference to the risk pool funds that are going to be required if states opt out of preventing insurance carriers from excluding individuals with pre-existing conditions or charging them significantly more for coverage. Any state that does not prevent individuals with pre-existing conditions from being rejected for coverage or being priced out of coverage, will have to opt into doing so. They will then have to place those Americans with pre-existing conditions into a high-risk pool where their higher medical expenses would be covered by a pool of funds provided by the government.
By many accounts, the total amount of money that was projected to be required to cover those individuals under the House version of Trumpcare, was not nearly enough. We should note that insurance carriers won’t have to directly reject anyone from obtaining coverage if they have a serious health condition. Technically speaking, according to the House version of Trumpcare, Americans will still have access to health insurance coverage, it will simply be priced at a cost that is far out of reach for 98% of Americans. In effect, if you are healthy, your health insurance could be far less expensive than, for example, someone who has cancer, diabetes, hepatitis or plans on having a child. It is unknown what the total list of pre-existing conditions that would impact access because of higher costs would be.
CBO analysis of the House version of the AHCA projected that by 2026 the new legislation would result in 23 million more Americans being left without health insurance coverage. This is approximately 80% higher than the current uninsured rate under Obamacare. Additionally, the CBO analysis projected that the House version of Trumpcare would actually increase the total number of Americans without health coverage to 18.2% by 2026.
That is approximately a 10% increase from the uninsured rate in 2013, before the launch of Obamacare. Individuals who are thought to be most at risk immediately under the House version of Trumpcare are those who are getting coverage from Medicaid.
All of this is lining up to be very politically dangerous, particularly for any state that actually expanded Medicaid coverage under Obamacare. This explains why three Republican governors have sent a letter to Congressional leaders expressly rejecting the current version of Trumpcare that rolls back Medicaid expansion. Their states have all expanded medicaid under Obamacare, and many Americans in those states rely on it for health coverage. If that coverage is stripped away from voters in those states, there is a very good chance that come next election, Republican governors in those states that allowed it to happen will be out of a job. Individuals who have healthcare under Medicaid and CHIP (Children’s Health Insurance Program) are the second largest group of insured individuals within the United States of America.
Freedom Caucus Continues To Tout Their Version Of The Bill Without A Real Explanation Why It Is Better
So, if the House version of Trumpcare is so bad, who exactly is in favor of it, or will be in favor of the Senate version of Trumpcare, if it is similar? Well, it is actually quite difficult to find a Republican touting the House version as a great solution, this is of course excluding the Freedom Caucus members who are responsible for it. That said, even Freedom Caucus members are light on substantive details as to why it’s better for Americans.
Rep. Scott DesJarlais of TN, a Freedom Caucus member, as well as a physician, couldn’t make much of an argument for it in an Op-Ed published on June 1st. First he falsely implies that insurance carriers are seeing record profits from Obamacare.
Some insurance carriers are seeing record profits, but it isn’t from Obamacare or Medicaid, it is from Medicare.
He then cites the recent decrease in life expectancy as proof that Obamacare is a failure. Of course he provides no sources for this data, and doesn’t get into the details that explain how the national average went from 78.9 years old to, wait for it, 78.8 years old!
So what is the real reason why there was the first fractional decline in average life expectancy in decades? There are many contributing factors, but the most significant ones can be attributed to diabetes, alcoholism, opioid addiction, depression and poverty. All of the actual reasons for the slight increase, excluding poverty, are conditions that will not be required to be covered by the House version of Trumpcare. So naturally, stripping away access to care to address those actual reasons for the increase is not going to improve people’s outcomes and increase life expectancy. One other point regarding poverty — if someone is sick and unhealthy and living in poverty, how are they expected to lift themselves out of that scenario unless they can get access to healthcare and get healthy?
The Atlantic, an actual fiscally conservative organization, gets into the details and explains the real reasons for the fractional decline, and spoiler alert, it’s not because of Obamacare.
DesJarlais then states that the house version of Trumpcare, which rolls back Medicaid expansion, “modernizes it to ensure that only those who truly need the program can take advantage of it”.
There’s no real explantation what “modernizes it” means. Unless the modern version of medicaid according to the Freedom Caucus, is one that is simply available to a much smaller number of Americans.
Then, in what has to be the best part of his Op-Ed, he writes the following:
“If you can believe it, ObamaCare’s Medicaid expansion favors able-bodied adults over the poor and disabled who rely on the program. That’s unfair.”
“If you can believe it”…
So it’s very clear, we do not believe it.
That statement does sound dreadfully familiar though… Where have we read that baloney before? Oh right, The Heritage Foundation, the lobby that is funded by billionaires, you know who immediately benefit the most from the repeal of Obamacare.
No sir, “what is unfair” is that you are allowed to publish a misleading Op-Ed that cites ZERO sources to an audience of millions, as fact, because you’re a doctor and an elected official. What is unfair is that there are no consequences for misleading the American people by withholding important facts and details.
Why A Rushed Vote Can Only Be A Bad Sign For Things To Come
Behind closed doors and away from the press, it is said that there are a number of Republicans who are extremely concerned about what lies beneath with Trumpcare. They say “what lies beneath” because it is often weeks or months later that unseen details and important fine print, that can easily be missed in hastily passed legislation, finally reaches the surface. Sadly only then are facts finally separated from falsehoods, but at that point it’s too late.
That is precisely what happened with the House version of Trumpcare. It was only really highlighted by The Wall Street Journal that according to the House version of Trumpcare, employer plans could see drastic changes that could harm employees of corporations by allowing lifetime caps on coverage to be put in place. Most employers wouldn’t offer these kind of plans, because it would just lead to employees leaving for jobs that offer better healthcare.That said, the fact that they could do it, that the option is there, that is what is troubling to many people.
If you think that maybe that is just one isolated example of hastily passed legislation coming back around to be a real problem, think again. Because in 2013 Marco Rubio was successful in sneaking into the federal funding bill a rider that stripped away cost sharing payments that are required to be paid out to insurance carriers for their loses on Obamacare. Rubio and his team kept this somewhat under wraps until they felt it was politically timely to take credit for it, and boy did he.
He wasn’t just responsible for it, but campaigned on it during the Presidential election.
— Marco Rubio (@marcorubio) December 2, 2015
Two weeks ago, Anthem announced it was exiting 18 different counties in Ohio, leaving many Americans within the state with no coverage options at all. Anthem, in a move that is indicative of just how frustrated they are with the lack of communication and transparency from the current administration regarding healthcare reform, and the CSR payments, announced the move with a clear indication that the politics and uncertainty are to blame.
Since the election is history and Obamacare is now more popular with Americans than it ever has been, Senator Rubio is keeping quiet about his role in helping tank Obamacare. He’s certainly not tweeting it out like he was on the campaign trail!
Without question Senator Rubio’s actions encouraged other carriers to pull out of the market, decreased competition, increased costs and was ultimately successful in weakening Obamacare and the individual market.
If Blue Cross Blue Shield of Florida, one of the carriers serving the largest number of Americans under Obamacare, ends up doing the same thing as Anthem in Ohio, it is very likely Rubio is not re-elected for office in Florida ever again. Even if he intends on running for President in 2020, he likely won’t win over the majority of Floridians.
If the Senate version of Trumpcare closely follows the House version, the version viewed as mean and underfunded by the President, and as a far more dangerous alternative to Obamacare by the American Medical Association that’s bad enough. If Americans are mislead about what it actually contains, what it potentially could lead to, and if it is not crystal clear just exactly how the legislation will change healthcare within the United States immediately, it will just lead to more chaos.
Chaos is great for politicians who are campaigning, or who are seeking donations for future campaigning. Chaos doesn’t work when it comes to healthcare or health insurance, that has become painfully obvious.
We’re not insane, and we know you’re not either.
It’s time for Republicans and Democrats to be fully transparent with the American people, and with insurance carriers, about what this next iteration of healthcare reform will bring.
Updated June 12th, 2017
How Things Go From Bad To Worse If Trumpcare Passes
One major problem neither side of the aisle is talking about is the lack of insurance carriers willing to stay in the exchanges. Aetna, United Healthcare, Humana and Anthem, have all announced exits from the ACA, either entirely, or almost entirely. Anthem, the latest to announce, is exiting 18 major counties in Ohio. This was an ominous announcement, in part because Anthem was very direct and transparent about their reason for doing so. Their decision centers around how it seems that politics are taking priority over people, and the governments contractual agreements with insurance carriers.
Despite the majority of Americans supporting Obamacare, the ACA, or Trumpcare for that matter, it will in fact fail Americans if insurance carriers aren’t willing to offer coverage under the law. Time is literally running out for insurance carriers to “stay on or get off” this healthcare reform highway, as they have to submit plans for 2018 by late June.
This is compounded by the fact that in March of this year, a regulation brought forward by the previous administration, limits the amount of time a consumer can have a “short term health insurance plan”. Short term health insurance has become an increasingly popular alternative to Obamacare plans, especially within the last 18 months as premium prices have risen dramatically in certain states.
Short term plans are not a fit for all consumers, especially those with serious health issues, or anyone planning to have a child. Short term plans can deny an applicant coverage for pre-existing conditions and the level of coverage benefits is approximately the same as catastrophic coverage. That said, if you’re relatively healthy, short term health insurance can be a great option as plans typically cost about 30% of what an ACA plan does.
Most American’s health plans require them to pay out-of-pocket for doctors visits and urgent care services and other general expenses, just like with short term plans. Short term health plans are in fact widely available, but like with anything else, the devil is in the details, and with short term health plans, you really do need to pay attention to the fine print. Short term coverage, or “term plans” as they are sometimes called, are less regulated than ACA plans. This results in there being a number of plans offered by some less than ethical companies, who often have no issue ignoring laws, regulations and moral guidelines.
According to this new regulation, short term plan coverage is capped at 3 months, which means that at the end of 3 months, that consumers short term plan ends. Brokers and carriers are required to determine if in fact a consumer previously had a short term plan at any point during the previous 12 months. This places larger, well established companies offering “short term health insurance” in a very difficult position. While they abide by the rules and regulations required of them according to HHS, others on the fringes of the industry will not.
What does this mean for Americans? It means that if there are a number of states where there are no plans, or limited plan choices or only cost prohibitive plans, consumers will very likely be forced to purchase a short term health insurance plan. This could result in Americans having to work with brokers who don’t operate in a 100% above-board manner.
Unfortunately, like in almost every other industry, the health insurance space has no shortage of scammers and con artists. Continuing to restrict short term health insurance plans to a 3-month coverage max will only increase the probability that consumers end up having to purchase coverage through one of these “shady” companies. Boiler room call centers, overstated claims on coverage benefits, pushy sales people and a generally horrendous claims process, are just some of the things Americans, who have to rely on short term health coverage, can look forward to if they don’t enroll with an ethical and transparent company.
Updated June 7th, 2017
18 Counties in Ohio without Coverage as Anthem Announces Withdrawl From ACA
Over 10,000 people in Ohio could lose access to an Obamacare health plan in 2018. On Tuesday, June 7, Anthem announced that it would be scaling back its participation in the federal health exchange in the Buckeye State, leaving about 18 counties without any options on the exchange for next year. The major insurer joins other big names in the industry in breaking ties with the Obamacare exchanges, but Anthem’s withdrawal from the Ohio market is somewhat surprising. Earlier in 2017, the company was cited as the most significant marketplace participant. Now, only residents of Pike County in Ohio will have access to a single Anthem plan, available outside of the exchange.
Anthem’s decision to back out of the marketplace in Ohio has come at a critical time for healthcare reform. As Republicans work diligently to push the American Health Care Act (AHCA) through Congress and onto President Trump’s desk, opponents of the current law – the Affordable Care Act (ACA) – point to Anthem’s withdrawal as yet another sign that Obamacare is floundering. Skyrocketing premium rates in 2017 combined with the exit of major insurers from the marketplace lend fuel to the fire for Republican reform.
Worse still, Anthem indicated that it could pull out from more than just Ohio in 2018. If the company did withdraw from the 14 states in which it currently offers plans, that would leave approximately 250,000 marketplace enrollees without any options for coverage on the exchange. Residents of Georgia, Mississippi and Kentucky would take the brunt of the impact. These three states, all of which are considered Republican leaning states, the latter being the home state of Senator Mitch McConnell, would potentially be in in play in the mid-term election in 2018 if healthcare accessibility were to get worse than it is currently.
Anthem cites several reasons for its exit next year, chief among them is the instability created by uncertainty when it comes to healthcare reform. Republican lawmakers have been consistent in their dogma to “repeal and replace,” but until last month, no single plan existed to accomplish their goals. With the AHCA making its way through the Senate this summer, conservatives and President Trump are hoping to put healthcare reform behind them so they can focus on tax reform.
Despite the official stance from Anthem that business considerations and uncertainty are driving their withdrawal from the Ohio exchanges, Democrats point the finger to politics. They claim that the Republican proposal does more harm than good, and debate over healthcare reform is the real reason why insurers are getting skittish for 2018.
In the meantime, Anthem isn’t alone in fearing for the future. Aetna and Humana, giants in the insurance industry, also announced cuts for 2018. More industry leaders could follow as state deadlines for rate filings – already pushed back for the year – come to a close.
Updated May 24th, 2017
CBO’s Analysis Of Trumpcare Doesn’t Help Its Prospects With The Senate
The CBO finally released their report on the House of Representative’s healthcare reform bill that was passed by Republicans on May 4th.
The CBO announced today that the AHCA or Trumpcare as it is also called, would cause 14 million more people to become uninsured in 2018 than if Obamacare remained in place. In 2026, the CBO estimates that a total of 51 million people would be uninsured under the AHCA compared to 23 million under Obamacare. Anyone who took their tax credits (in lieu of Obamacare’s subsidies) and bought a non-major medical plan such as a mini-med plan or some sort of supplemental plan were counted as uninsured by the CBO because their plan would not cover regular medical claims.
This version of Trumpcare would also decrease the federal deficit by $119 billion, which is $32 billion less than the first iteration would have done for the country. While the changes to Medicaid and the removal of Obamacare’s subsidies would save the program money, funding the high-risk pool for people with pre-existing conditions and eliminating a number of taxes imposed on employers and individuals, which previously helped fund the program, would result in less savings overall under the new law. It is also largely viewed as incredibly beneficial for the top 1% of earners within the United States, as they will see a significant tax cut.
One of the big questions for insurers is whether the AHCA would stabilize the market. The CBO concluded that the market would be stable while subsidies were still in place, which is until 2020 and then it would continue to be stabile after the tax credits went into place. But the CBO believes that one-sixth of the population would live in an area of the country where the market would not be stable because their state took waivers to not require insurance carriers to cover the ten essential health benefits and to charge higher premiums for pre-existing conditions. People with pre-existing conditions would likely find their coverage options unaffordable, even with financial help, and would choose to be uninsured.
Another big outstanding question with the AHCA is whether it would bring premium costs down. The CBO believes that premium prices would increase until 2020. However, after that point, premiums would be lower than under Obamacare because insurance carriers could offer plans that didn’t cover the essential health benefits or charge more for people with pre-existing conditions in states that took those waivers. Even though premiums would be lower, out-of-pocket expenses for families that had plans that didn’t cover the essential health benefits would be much greater because they would have to pay out of pocket for services that would have been covered, at least in part, by Obamacare such as maternity and prenatal care, emergency services and preventative care.
The Senate now has the bill and they were very clear that they were going to carefully weigh the CBO’s report when reviewing and modifying the AHCA passed by the House. It remains to be seen whether this report will cause the Senate to change more or less.
Updated May 17th, 2017
Online Enrollment Streamlined by CMS Today
CMS announced today, May 17th, that they are changing the process to enroll online for consumers and agents for the upcoming 2018 open enrollment period. This new process will make enrolling much easier and faster than what was in place last year.
Last open enrollment period, consumers and agents were required to go through the income verification process on Healthcare.gov. That meant that if a consumer called an agent on the phone or if the consumer tried to enroll on their own through an online broker, only part of the application process could be completed before the consumer or the agent on the consumer’s behalf had to deal with a series of questions to verify identity and income on Healthcare.gov. If someone was trying to do this on a particularly busy day or on a day where Healthcare.gov was having technical issues, this part of the process was very slow
The industry called this Healthcare.gov interruption the “Double Redirect” and it was a nuisance to everyone and caused a lot of people to choose to enroll over the phone, which is less efficient because there’s only so many agents who can answer the phone, or to not enroll at all. Thankfully, CMS recognized that this was a hindrance to enrollment and fixed the problem before the next open enrollment period.
The new process allows consumers enrolling through an online broker or on the phone through an agent to go through the whole application process, start – to – finish, on one website, without having to deal with verifying their income on Healthcare.gov. This new enrollment process is only available to consumers with straightforward enrollments that don’t require supporting documentation and to those enrolling during the open enrollment period, which starts on November 1st and ends on December 15th. Anyone looking to enroll in a plan during a Special Enrollment Period will have to use the Double Redirect process.
CMS also announced that they have a more detailed plan for upcoming seasons to improve the enrollment process but that this temporary solution should help streamline things in the meantime.
Updated May 16th, 2017
Answers To Your Questions About What Conditions May Not Be Covered Under Trumpcare
We receive a lot of emails and calls on a daily basis from individuals who have concern about what Pre-existing conditions will or will not be covered when Trumpcare is passed. Without question it is the most significant concern for Americans that engage with our organization on a daily basis. First it is important to note that the facts are, we just do not know that much yet, because the law is still being drafted. We won’t have concrete and definitive answers until the Senate version is completed and then presented for analysis. Even at that point, technically insurance carriers will have some level of discretion to what they provide coverage for. Even if an insurance carrier could legally exclude someone for having, for example, “anxiety”, it doesn’t mean that they will in fact reject everyone who has been diagnosed with that condition. We hear from a lot of people on a daily basis who seem pretty anxious about what Trumpcare has in store for them. We know these uncertain times are unsettling, it is for everyone, even us, so please forgive us if we try to inject some humor into this serious subject matter when possible.
So all that said, you should not necessarily expect the worst outcome to be the likely one. There could be some restrictions imposed by Trumpcare that will not allow insurance carriers to exclude for as many pre-existing conditions as they did before. It remains to be seen if everything will revert back to how things used to work five years ago, before Obamacare. Five years ago, someone with a condition as common as migraines, technically they could be rejected from receiving coverage. We don’t know if Trumpcare will impose limitations on the list of pre-existing conditions to include only the more costly chronic conditions, like cancer or diabetes.
So just to be clear, we are having to speculate at this point about what we think might be likely to happen. We base all of this on real factual information and data that is available today, and we also take into account how the health insurance industry operated prior to the launch of the Affordable Care Act / “Obamacare”. It is our preference to not speculate, but we still receive a massive amount of feedback from concerned Americans on a daily basis. We would prefer to err on the side of “accurately speculating” instead of just sticking our heads in the sand and not answering your questions as best we can. As always we will continue to update this website with the latest on Trumpcare. Feel free to sign up for updates and share our infographics with whomever you like via email or social media. We are a free resource for consumers, and we have no issue with anyone sharing any of our content.
Below is a link to our Trumpcare pre-existing conditions page where we get into the details of how we compiled the data that is highlighted in the infographic below. Again, it is early in this process, so per our constant repetitive reminder, do not panic, just keep staying informed as Trumpcare moves forward.
Updated May 10th, 2017
A Factual Analysis of the Ten Essential Health Benefits and Why They Should Matter To You
We have been receiving a consistent flood of emails and calls from Americans with questions about what the ten essential health benefits are, and what it could mean for their healthcare if insurance carriers are no longer required to cover them as the AHCA is proposing. We need to be clear that according to the”Trumpcare” bill, the power to not require insurance carriers to provide for the ten essential health benefits is left up to each individual state to determine. We will explain this in more detail below. So ultimately it becomes a “states rights” issue should the AHCA or Trumpcare be passed into law as it is written as of today.
It is being reported that the bill that was passed by the house, is universally unpopular and thought to be dead-on-arrival and viewed as a non-starter for nearly everyone within the Senate. There is an entirely new version of the AHCA that is being drafted from scratch, and it will no doubt address the issues that most people, elected officials and their constituents, have expressed opposition to or great concerns about.
That said, it doesn’t mean that you should expect that the Senate version will not be heavily influenced by what was included in the previous version of the AHCA. As the expression goes, the devil is in the details, and we want to give you a very detailed rundown of the ten essential health benefits, and what they provide, so that you can make an informed decision about what you think should included in Trumpcare.
The 10 Not So “Essential” Health Benefits Under The House Version Of Trumpcare
After the House of Representatives passed the American Health Care Act (Trumpcare) on May 4th, people were concerned that states would allow insurance companies to “opt out” of providing coverage for essential benefits that were required under the Affordable Care Act (Obamacare). Under current law, there are 10 essential health benefits that all major medical policies must offer, whether you buy a private plan or get your insurance through work.
In the House version of the ACHA, it allows states to request a waiver from this provision that allows insurance companies to offer plans that don’t cover these benefits if they can demonstrate that offering plans without the 10 EHB’s, would reduce premiums.
Ten Essential Health Benefits Currently Required
These are the 10 essential benefits that your major medical plan has to cover:
- Ambulatory (outpatient) care
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services
- Laboratory services
- Preventive and wellness services, and chronic disease management
- Pediatric services, including oral and vision care
- Prescription drugs
- Rehabilitative and habilitative services and devices
Essential benefits offered under the ACA were designed to help people prevent and treat illnesses but were not designed to cover elective or non-essential treatment. Employer-sponsored plans offer essential health benefits already so the change would primarily affect plans offered through the individual market. However, there is some concern that if states were allowed to define essential benefits, large employers (who base their plans on any state’s definition of essential benefits) could scale back on coverage or at least the financial caps that are currently in place. Right now, most Americans with coverage get health insurance from an employer.
How Things Worked Before Obamacare
Prior to the passage of Obamacare, insurance companies could offer low-rate policies that didn’t offer coverage for some conditions or services. They could also charge higher deductibles or co-pays for some services, like emergency room care or laboratory services. Some fear that too many people in the individual marketplace will opt for less expensive plans that don’t cover maternity care, mental health services or rehabilitative devices. Unfortunately, these are costly services to cover out of pocket. If you buy a less expensive plan with fewer benefits, you may end up paying much more out of your own pocket if you need costlier care.
One of the reasons Republicans wanted to remove the essential benefits requirement is that this provision has been instrumental in making plans more expensive for a lot of people. It has also limited consumer ability to choose a lower-priced insurance plan. Older Americans, for example, felt that they shouldn’t be required to pay for maternity care they won’t ever use while people without children felt that it was unfair to be forced to carry pediatric coverage. Other consumers prefer to pay very low premiums for what used to be known as catastrophic plans. Catastrophic coverage only covers, as you might expect, catastrophic situations, such as a broken back or a sudden and debilitating illness. For example, if you end up in a car accident for example, and have a traumatic head injury, you could end up with total costs of $500,000 or more in claims. A catastrophic plan would prevent you from being on the hook for the entire $500,000. Instead you would be looking at total costs of $12,000. That’s certainly not an insignificant amount of money, but it isn’t the kind of medical debt that ruins the average persons life, much like a $500,000 debt would.
The bill faces an uphill battle in the Senate, especially with the added provision that states could allow insurance companies to opt out of the essential benefits requirement. Senate leaders have been clear that they will not approve any bill that eliminates the provision covering 10 essential benefits.
Republicans in the House were reluctant to include the provision as they feel it could lead to a Democratic filibuster over the budget reconciliation used to repeal Obamacare. Should a filibuster occur, Republicans would be unable to break it and the law could die on the Senate floor.
However, even if the bill does not pass the Senate, the essential benefits provision could be weakened by Health and Human Services Secretary Tom Price, who has said that he plans to change the regulations that govern it. Secretary Price cannot eliminate the law, but he does have the power to determine how it’s implemented. In addition, Seema Veema, who runs the Centers for Medicare and Medicaid Services, has said that she doesn’t support coverage for maternity care in every policy. The legislative branch may not pass Trumpcare, but changes at the Cabinet level could still take place.
Potential Race to the Bottom
Experts in the healthcare industry say that eliminating requirements for essential healthcare coverage entirely could lead to a “race to the bottom.” Insurers would have a strong incentive to drop expensive coverage – like cancer treatment, high-cost prescriptions or mental health treatment – in order to offer plans at extremely low rates. There’s concern that this practice could make it more difficult, if not impossible, for people with pre-existing conditions to find a company that would cover their treatment at an affordable rate.
State Waivers And High Risk Pools
One of the important things to note about the AHCA, more specifically the MacArthur Amendment that allows for waivers to eliminate essential health benefits, is that states must apply to the federal government to obtain a waiver. States that apply for a waiver must create high-risk insurance pools to accommodate people with pre-existing conditions who may be affected by the elimination of essential health benefits. States would also need to prove that eliminating or reducing essential benefits would lower the cost of healthcare or increase the number of people covered by insurance. Waivers would be automatically approved if the federal government failed to respond to a state’s request within 60 days.
If the removal of essential health benefits remains in the bill after it passes the Senate, it could mean that consumers will be able to choose less expensive policies for their healthcare in the marketplace. However, those lower-cost policies could come with a hefty price in the event of unexpected medical bills.
You should give serious thought to which ion the ten essential health benefits under Obamacare, would be essential for you in a plan under Trumpcare.
We encourage you to sign up for updates and notifications from us regarding Trumpcare if you have not done so already.
Updated May 6th, 2017
Trumpcare and the Legislative Process
If you’re afraid that the passage of the American Health Care Act in the House of Representatives means that it is the law of the land and that your health coverage is now different or gone, you’re not alone. We’ve received a lot of emails with questions about how the House of Representative’s passing of the AHCA affects their health insurance coverage. If there are parts of the AHCA, or Trumpcare as it is also called, that you want changed, you may still get your wish because the AHCA has a long road of review, amendments and votes ahead of it.
The Legislative process is confusing, so we’ve laid it out as simply as possible. For reference, the AHCA is only on Step 5 and according to the interviews with different Senators this week, Step 5 is going to take a few months.
- The Representative gets support from others to sponsor the bill and it is sent to committee
- Committee discusses the bill and makes changes before it is sent back to the floor of the House
- Representatives debate the bill and make changes before they vote.
- The House votes on the bill. If a majority of the House votes “Yes”, the bill is passed and moves on to the Senate
- Bill first goes to a Senate committee that discusses the bill and makes changes and amendments.
- The bill is then debated on the Senate floor before it is voted on with a “Yea” or “Nay” vote
- If a majority of the Senators vote “Yea” on the bill, it is passed back to the House for review.
- House and Senate members in a joint committee discuss the differences between the two bills and make any final changes.
- The jointly approved bill goes back to the House and the Senate for final vote. If approved by Congress, it goes to the President
- The President can sign the bill, veto it, or do nothing (will become a law after 10 days if Congress is in session.)
- If vetoed, it goes back to the House and Senate to reconsider. If 2/3 of Congress vote to pass the bill, the veto is overridden
- The bill becomes a law!
Updated May 5th, 2017 at 2:05 PM EST
Individuals Enrolled In Obamacare With Concerns About Losing Your Coverage – Do Not Panic
In the last twenty-four hours this website along with the other healthcare information properties operated by HealthNetwork have received more than one million visits. Many of you have contacted us with concerns about losing your current coverage under Obamacare and or coverage through an employer sponsored plan. Here is the most important thing you need to know right now. As of today, and throughout the rest of 2017, nothing has changed for you and your existing coverage. Insurance carriers are required to honor any 2017 plan regardless of what legislation is ultimately passed. Continue to pay your monthly premiums and you will continue to have full coverage. We encourage you to remain informed of the facts and not make any decision that could result in you losing coverage, as an example, such as for non-payment.
We understand and appreciate your concerns, and that is why we will continue to be working seven days a week to provide you with factual information and answers to your questions each and every day. We encourage you to sign up for updates and notifications from us regarding Trumpcare. You can do so at this link.
The AHCA that was passed in the house on May 4th, 2017 still has many important hurdles it must pass before it becomes law. There is growing sentiment that what was passed in the house will not be what ultimately reaches the Senate for a vote. Republicans and Democrats are going to have little choice but to find a way to work together in a truly collaborative effort in order to draft a bill that meets the needs of the American people and has a real opportunity to become law.
For more information on the differences between Obamacare and Trumpcare updated for the latest version of the AHCA, please use the following link below.
For a more detailed explanation of Pre-existing conditions and what that means under Trumpcare, please use the link below.
More updates regarding Trumpcare to follow soon.
Updated May 4th, 2017 at 8:40 p.m. EST
Republican Senators Comment on AHCA
Several Republican Senators quickly chimed in on the passage of the American Health Care Act, and or Trumpcare, and the forecast isn’t looking good for anyone in the House who was hoping that the Senate would pass the bill as written.
A number of Republican Senators including Lindsay Graham (R-SC), Dean Heller (R-NV), and Lamar Alexander (R-TN) made it clear in interviews with the media that the Senate will be pouring through the AHCA, determining the probable results of the AHCA’s provisions on issues such as essential health benefits, pre-existing conditions, and the Medicaid expansion roll-back on the real costs of healthcare. They will be carefully examining and actually considering reports and commentary from the CBO and determining what kind of compromises are necessary to not only take care of Americans, improve the system, and bring down costs, but to also get it passed when it is taken to vote. Republicans have a slim majority in the Senate and it’s going to be a difficult to get the majority vote – 51 Yea’s – it needs to send the bill back to the House for a final vote, before it can then go to President Trump’s desk.
Another point made pretty clear by Republican Senators after the House passed the AHCA was that it will not rush this issue like it believes the House did. Several Republican Senators commented that the House moved too quickly and did not properly consider all of the ramifications of the bill. They vowed to take however long it takes to get the bill right. This is great news for all Americans who are in favor of affordable healthcare that will provide essential coverage options.
Another point to keep in mind is that whatever is passed by the Senate and then ultimately the House and President Trump will not fully replace Obamacare, but will rather just make changes to certain parts. While it may be frustrating with how this is all playing out, we are encouraging people to not panic and instead just stay informed of the facts. If you would like to sign up for updates and notifications from us regarding Trumpcare, you can do so at this link.
Updated May 4, 2017
AHCA Passes the House
The House GOP voted on and passed the American Health Care Act today by a 217 – 213 vote, and not a single Democrat “Yea”.
Right after the final votes were tallied, you could hear Democrats sing”Na Na Hey Hey Goodbye” in the background. Although you would initially think that it was Republicans singing this tune, saying goodbye to Obamacare, it was actually a bunch of optimistic Democrats who believe that this vote will upset constituents around the country so much that they will vote for Democrats in the midterm elections.
Now it’s on to the Senate where the ACHA may be sliced and diced and amended.
To be continued…
Updated May 4th, 2017
It’s The Final Countdown For The Trumpcare Vote – Part Duex
The House is set to vote later today on President Trump’s AHCA, or what it is also known as, “Trumpcare”. According to reports, the Freedom Caucus has no intention of blocking the proposed bill from passing this time (the AHCA has technically never gone up for a vote, but it has gotten close two other times), despite the fact that it is not exactly what the Freedom Caucus originally pushed for in an Obamacare replacement plan. What they wanted could have been a complete and total disaster for Americans who receive subsidized health insurance or even those with an employer based plan.
After the last failed attempt at getting the AHCA to a vote, Republicans worked on an amendment proposed by Tom MacArthur of NJ that allowed states to seek waivers from some popular pieces of Obamacare, including essential health benefits and no discrimination on pre-existing conditions, which will be discussed in more detail below. It’s unknown how they planned on making that popular with anyone who lives in a state that decided to ask for these waivers, but really why spend time trying to figure that out.
Here’s where things stand right now as of 11:35AM EST.
President Trump’s Administration, as well as the Republicans who have been trying to move Trumpcare forward, have been able to get the latest version of the AHCA to a point where it could be passed by making some major concessions to its detractors.
To quickly summarize and allow you to not have to read about the many different tweaks and modifications that have occurred, the version of the AHCA that’s going up for a vote today, will now give states the ability to opt out of requiring that the ten essential benefits be included in any plan offered to consumers by insurance carriers.
States will also have the option to allow insurance carriers to charge people with pre-existing conditions more money for their plan. Insurance companies are not permitted to deny coverage due to a pre-existing condition, which is similar to Obamacare, but under the AHCA, they may charge more for it since these people are technically more expensive to cover. It should be noted that pre-existing conditions doesn’t just mean people with cancer or a very costly illness. Diabetes is a pre-existing condition that carriers may charge higher premiums for and that is a wildly growing problem in the United States. This is concerning in states where there has been limited Medicaid expansion, specifically “red states” where there is less support for government mandated health coverage. That said, also included in this latest version of the AHCA is a stipulation that says that states that choose to allow insurance carriers to charge more to people with pre-existing conditions will also have access a pool of money to help lower the costs passed on to the consumer. This past week, Republicans who were still undecided or were a hard “No” on the AHCA bill as amended and changed worked with President Trump to increase the amount of money in the risk pool. The total amount of additional funds set aside for this “high risk pool”, for a five-year period from 2018 to 2023, is $8,000,000,000 (Eight Billion Dollars). Time will only tell whether the amount of money now in the high risk pool will be enough to cover everyone living in a state that took the waiver on pre-existing conditions.
Proponents of the bill say that this should be a state’s issue and that by allowing states to better control what kind of plans are offered and what is or is not required to be covered and included, will allow costs to come down significantly and will benefit Americans in that state. Is this possible? Yes, maybe it is, in theory. That said, there is a very high probability that the actual roll-out of a state-focused healthcare initiative will be a very bumpy road that leaves many people even more dissatisfied with their coverage options. Insurance products are just not created and rolled out in a time efficient manner. If Americans are disappointed with how slowly the legislative process works in the United States, they should take a closer look at how long it typically takes an insurance carrier to bring a product to market. Let’s be clear that it is not insurance companies wanting to be difficult or not wanting to provide coverage to as many people as possible, as quickly as possible. It is simply because health insurance and all of its thousands of moving parts are incredibly complicated, and it is impossible to just slap together a health insurance product in a couple weeks.
One of the most important questions that we have that remains unanswered is exactly how the risk pool functions when it comes to consumers with pre-existing conditions. If someone with a pre-existing condition, who was previously covered under Obamacare now has to transition into a new plan that they’re being charged more for because they have a pre-existing condition, how is that difference in price covered? Is it out-of-pocket from the consumer and they are reimbursed, because that’s a non-starter for 98% of consumers. Or will carriers simply offer the same plans to everyone with or without pre-existing conditions, but the risk pool funds will simply be paid out from the government, direct to carriers, for costs they incur from those individuals with costly pre-existing conditions.
How vague the AHCA is and lacking in specific details is not a selling point. Leaving things up to the interpretation of state legislators is often how the federal government finds itself being sued by its own states. We would be more concerned if it were not for the simple fact this is all kind of irrelevant because the AHCA still has the most difficult obstacles ahead of it- passing the Senate and ultimately the President’s desk.
There are many other revisions to come over the coming months and spending too much of your energy focusing on this version on a daily basis just might not be the best use of your time. While many have been reporting that President Trump may not be totally up to date on the day to day of the AHCA and all of its complicated details, or lack-thereof, there is one thing that has been made very clear since he was sworn into office – he will veto anything that he feels will be unpopular with Americans. It is very unlikely that he would not break out his own veto pen if it meant that legislation with his (figuratively speaking) name on it, Trumpcare, was going to cause harm to Americans. Regardless if it meant upsetting Republicans or individuals in his cabinet, right or wrong the man does what he wants to do. He has zero reason to care what the Freedom Caucus or organizations like Americans For Prosperity think of him. They have undermined him at every opportunity. It seems that there’s been, to some extent, a game of political chicken going on. It is almost as if the Freedom Caucus members have been trying to get him to have to resort to working with Democrats, because apparently that will be viewed negatively by American voters in the upcoming midterm elections. We’re not sure that’s a strategy that’s going to work, because at HealthNetwork we engage with and communicate with more than 18 million health insurance shoppers each year and what we have learned is that when it comes to individuals and their family’s healthcare, partisan politics and typical voter’s issues – excuse the pun – is all Trumped by healthcare.
Since President Trump has been sworn into office, Americans have gotten a very good look at how messy and complicated all of this is. Contentious or downright hostile town hall meetings with a much more informed and skeptical Republican electorate has become the new normal. There’s an outcry from voters on both sides for elected officials to stop fighting with one another and work together to get something that is actually better put in place quickly. If voting against the GOP means that Americans get to keep minimum essential health insurance coverage options in place, especially in a midterm election where it is psychologically easier for someone to flip their vote, we are 100% certain that is precisely what the majority of Americans will do. People want to live, so an informed and motivated electorate will vote in favor of living over the alternative.
Updated April 24th , 2017
CMS Releases Updates That Have A Major Impact On Obamacare And Trumpcare
On April 13th, CMS released a final rule that changes the Obamacare law and is designed to stabilize the market, which is something that carriers have been requesting for more than a year. Republican’s efforts to repeal and replace Obamacare are ongoing, but until there’s something else in place, Americans and the healthcare industry are left with Obamacare. CMS is hopeful that these new rules will not only bring down the costs of healthcare for both Americans and the healthcare industry, but will also stabilize the market, which will allow carriers to continue to offer coverage. They are also hopeful that this will encourage insurance carriers who have either exited the exchanges or are planning to, instead to remain on board and ultimately get behind this next iteration of healthcare reform by expanding their coverage. This will create a more competitive and robust marketplace which in turn should result in consumers paying less for their healthcare.
OEP – The open enrollment period is now shortened to just 45-days. The new period will start on November 1st and end on December 15th of every year moving forward. We are not entirely sure why this is beneficial to either insurance carriers or consumers, but it’s going to become the new normal moving forward. We strongly believe that this past OEP was not successful when compared to previous seasons, in large part because CMS limited the ability of other HC.gov partners with unnecessary red tape. Regardless if it was a broker or carrier, for the first time ever they were all forced to hand the consumer off to HC.gov for data verification before they could complete enrollment. This was through something called “the double redirect”. Forcing the consumer to have to engage with HC.gov simply increases the probability that the consumer hits some kind of bottleneck in the enrollment process and doesn’t end up enrolling. It is the equivalent of shopping at the grocery store and then at checkout being forced to go to the DMV to obtain some new kind of identification, simply so that you can now go back to the grocery store and pay for your stuff.
It has been proven that alternative channels for enrollment are more efficient than HC.gov, and when the double-redirect went into effect it brought enrollment rates down for certain partners of HC.gov, by upwards of 80%. Industry wide it is estimated that enrollments rates were cut in half.
We mention this simply because of our concern that shortening the enrollment window to 45 days, and keeping the “double redirect” in place, it could very well ensure that even fewer consumers are able to enroll in a plan which will ultimately cost Americans their healthcare, and potentially their lives.
Application of the binder payment – If you didn’t pay any of your premiums from the last year, your carrier can take the payment you are required to make to enroll in a new plan (the binder payment), and apply it to the missed payment(s). This only applies if you enroll in a plan with the same carrier.
Having an outstanding balance may bite you later – If your coverage was canceled a couple of years ago because you didn’t make all of your payments and you now need to enroll in a plan with that same carrier today, that carrier can make you pay the outstanding balance before giving you coverage.
The new pre-enrollment verification process – In past years, Healthcare.gov’s procedure for approving coverage during the Special Enrollment Period was to have the carrier issue coverage immediately and then request proof of the qualified life event afterwards, if at all. Under the new rule, you are required to provide the proof first and after Healthcare.gov validates your life event, the carrier will get your application for coverage.
Limitations to certain QLE’s – If you get married or give birth, foster, or adopt a child and you need coverage for that additional person, you may only add that person to your current plan. This life event does not permit you to change your carrier or plan. Also, losing coverage due to non-payment of your bills does not create a qualified life event. You will simply not have insurance.
Permitting carriers to get creative with plan coverage options –This rule is a bit complicated, so we’ll keep it simple. Under Obamacare, a bronze plan had to cover an average of 60% of the costs, silver covered 70%, gold covered 80% and platinum covered 90%. Under this new rule, the range of coverage is expanded so that carriers have the ability to offer a gold plan that covers more and may cost a little more or a gold plan that covers a little less and may cost a little less. This should mean more plan options at different prices.
Defer to the States to validate a plan’s network – Most states review the details of a health plan before approving it. Previously, Healthcare.gov would do a similar review, which is ultimately unnecessary. This rule now permits Healthcare.gov to just accept the state’s review of the plan and its network and save the money on the independent review for something else.
Change contract requirements regarding ECPs – Carriers are now required to contract with 20% of the total number of essential community providers available in a service area, which is down from 30%. An essential community provider is a medical provider that serves low-income or medically underserved communities.
For more detailed specifics about these changes, you can visit our page on the Latest CMS Rules Changes Full Details .
Updated March 24th, 2017
Trump Administration And Paul Ryan Are Forced To Pull The Trumpcare Bill
Today, in a somewhat surprising turn of events, the Trump administration was forced to pull their bill for healthcare reform from the House before it was able to be voted on. We say this is surprising simply because President Trump and his Administration, along with Republicans, are now faced with what are really two far worse alternatives. They can now watch as Obamacare continues on its current path, which almost no one really believes is a positive one, or they can begin the process to compromise with Democrats in the House, instead of within the Senate.
If we were callous enough to be placing bets on the most likely outcome, we’re going with the latter. No one is happy with limited choices, high deductibles, limited access to doctors and the host of other complaints that Americans have with their current coverage under the ACA. Let’s not forget that across both sides of the aisle, Democrats and Republicans seem to agree on at least one thing, that Obamacare needs major improvement.
In a news conference President Trump blamed Democrats for the failure of this bill to be passed in the House. It seems ridiculous to think that after making absurd concessions to the House Freedom Caucus, purely for the purpose of appeasing their ridiculous demands, that any Democrat would even consider for a second voting in favor of the bill. Democrats are just as concerned about preserving their image with their base voters as Republicans are. Even if Democrats know that once the Trumpcare bill reaches the Senate it will then be revised, because it has to be revised, no Democrat is actually going to sign off on it now in the House because of the political backlash they would receive. Furthermore, to do that would really reveal in a very public way, just how gross the process is by which legislation works and how absurd politics are. As the saying goes, no one wants to see how the sausage gets made, you just want to eat it.
Where Should The Blame Really Go?
Without question, every American who is tired of paying higher premiums, deductibles of $10,000 or more, tired of having limited choices, and is just generally dissatisfied with their healthcare options, should place the entire blame for Trumpcare not passing the House, on the House Freedom Caucus. Even President Trump eluded to shifting some of the blame towards the House Freedom Caucus in an interview, although his tone was fairly muted.
Now you might be wondering why exactly we’re calling the Freedom Caucus out for derailing healthcare reform. It’s really simple, and we have covered this before, but until this past Wednesday, when the Freedom Caucus was emboldened by a political action group backed with tens of millions of dollars, the majority of the House Freedom Caucus was set to vote the bill through, as were the rest of the Republicans. That’s when Americans For Prosperity announced that they would financially support any Republican who voted against the bill.
This was a devastating blow that did two things. First, it signaled to members of the House Freedom Caucus that they better get in line with the demands being made by Americans for Prosperity or that organization would be looking for new blood to shift their financial support to come the next election cycle in 2018.
The second thing it did was to force the House Freedom Caucus members to come up with a list of ridiculous demands to amend the bill. Demands so hurtful to all Americans, even those who get insurance through their employer, that once given enough time to be fully explained in the news cycle, Americans were so against the proposed bill that it made it impossible for any Democrat to go along with, or any moderate Republican for that matter.
Removing the Ten Essential Health Benefits from Trumpcare meant that pregnant women wouldn’t be guaranteed access to prenatal care or care after childbirth, or that there wouldn’t be support for opioid addiction – you know, that massive problem impacting millions of families in the country. In less than a week the House Freedom Caucus forced the Administration to distort the Trumpcare bill into something unrecognizable and politically cancerous. House Freedom Caucus members apparently care more about ensuring their seats than doing what is right for the American people.
Who Are The Men And Women In The House Freedom Caucus?
It’s a question that’s been trending heavily within the last 48 hours and for good reason. So first off, “gotcha”, there are no women in the House Freedom Caucus. Secondly, not dissimilar to organized crime rings that don’t officially put members’ names on a list for publication, there is no official list of House Freedom Caucus members. Some of them openly identify themselves as members and some don’t. They don’t have a website or some official fan club, and they don’t always openly identify themselves as members to the news media. Oh, but they do have a Facebook, and a Twitter!
All of the members are basically known to Washington insiders and according to reports, the news media can “un-officially” identify them by literally watching them walk into meeting rooms.
Here’s a link to the un-official list of current members. This list is believed to be accurate.
It is pretty ridiculous that a group of elected officials, who feel so empowered to have so much influence over legislation in this country, yet have only been elected by and actually represent such a small percentage of Americans, don’t all have the courage to face the American people and answer for their actions that affect all of us.
Instead, they chose to throw a wrench into the process by which our great country has been founded on.
In closing, don’t give up hope on healthcare reform that improves outcomes for all Americans. If there’s one thing that might quickly unite both Republicans and Democrats, it very well could be taking down the Freedom Caucus members and not allowing them to derail democracy any longer.
Updated March 23rd, 2017
It’s The Final Countdown To The House Vote On Trumpcare
President Trump is reported to have made his stance clear to the House Freedom Caucus on their continually increasing demands on what they believe should be in the “Trumpcare bill”. In effect, according to President Trump, there’s no more room for negotiation. Either vote the bill through or take responsibility for not moving forward an alternative to Obamacare, and subsequently prepare yourself to answer to the Americans who voted you into office for not doing so.
Let’s face facts, there are many people who are not happy with the healthcare options that they have available to them. Premiums in some states are absurdly high, choices are limited, and the actual process to use ones healthcare can be quite difficult. There are however tens of millions of people who, despite the inherent flaws that the current solution has, don’t want to lose the coverage they have. There’s plenty of blame to go around that reaches across the isle, Democrats and Republicans have all played their part in bringing the health insurance industry to this point.
Lets also address the reality that creating a much better healthcare system, one that works for everyone, is not an easy task. If Republicans and Democrats had worked collaboratively from the start, almost ten years ago, instead of simply toeing the line of their respective political parties, we might not be in this situation.
What was once originally the framework for Obamacare, is far different than what ended up being passed. That’s politics in the Unites States and that is the beast that Americans have to remind themselves they have to fight against. As every day Americans who are simply trying to scratch out a better life for themselves and their families, we have to remind politicians that simply focusing on party politics is no longer acceptable. People should always be above party, especially when you’re talking about policy that literally leaves peoples lives in the balance.
The Freedom Caucus has not only forgotten that they serve the American people, but they’ve quite literally asked for revisions to “Trumpcare” that are going to put millions of families at risk immediately. Why did they do this — pure partisan politics. The Freedom Caucus is a small faction within the GOP who are regarded and thought of as the more extreme members of the republican party. They frustrate to no end the majority of the GOP because they often make demands and push for policy that might sound “principled” in theory, but in practice, will often do more harm than good for the majority of Americans, especially those who are not wealthy.
Their latest efforts with respect to healthcare reform under President Trump is the best indicator of that. President Trump, Paul Ryan and Trump’s cabinet allowed the Freedom Caucus to make additional requests, or demands really, of provisions to be included in the AHCA, “trump care”. Their first set of changes were once thought to be sufficient to placate them. As we headed towards a date for a vote, word began to spread that their original demands were not enough. Shortly thereafter, it was announced that if the ten essential requirements for coverage under Trumpcare, as it is in the ACA, were not removed they would vote against the bill. President Trump, true to his word, again negotiated with the Freedom Caucus. Agreeing to remove the ten essential benefits in order to move the bill forward and pass the house.
Then, with less than twenty-four hours before a vote was to take place, Americans For Prosperity, a political action group backed by the Koch brothers, who have a combined net worth estimated to be $100 billion, announced that they would invest millions into supporting any member of the House who would dare to vote against Trumpcare. That is of course unless President Trump made one final concession. Remove the protections that prevent health insurance carriers from denying coverage to individuals with pre-existing conditions.
That’s when things came to a grinding halt and why the vote is now being pushed off until Friday. Here’s the real reason why you should be upset about all of this. All of the grandstanding that the Freedom Caucus members, and or the more extreme members of the GOP have been doing, is just a big ruse. They know that what they’re proposing, removing the ten essential benefits and asking for pre-existing conditions to be removed, which were the most popular parts of Obamacare and now Trumpcare, will never have a chance of passing in the senate. ZERO chance of passing. For the Freedom Caucus and or anyone to deny this, would be a massive whopper of a lie.
Tomorrow, the President is going to find out just how willing some members of the Republican Party are to burning it all to the ground. Democrats and Republicans, who actually want to make progress, need to prepare themselves for the grand bargain that will come in the later stages of this legislative process. If anyone thinks that there won’t be healthcare reform of some sort moving forward during Donald Trump’s presidency, they’re delusional.
It’s time that we all put our best foot forward and stop thinking of ourselves and starting thinking about the country, about the American people, and how collectively all of us — Republicans, Democrats and *miscellaneous — can all work together to improve healthcare for all Americans.
Regarding *miscellaneous, no disrespect to the other political parties not mentioned, it’s a joke. We had to throw some humor in at the end. We’d prefer you stop reading this with a smile on your face.
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Updated March 21st, 2017
Trumpcare (AHCA) Is Revised In An Attempt To Compromise With Conservative Members of GOP
President Trump, Paul Ryan and GOP leadership took a step forward in their effort to appease the more conservative members of the house, which are mostly made up of members of the House Freedom Caucus. There have been a number of complaints from Freedom Caucus members that the current bill does not go far enough in its repeal of Obamacare. In fact, they’ve mockingly referred to the “Trumpcare Plan” that was put forth as Obamacare 2.0.
Their outright rejection of the AHCA as it stands prior to yesterday’s modifications, has lead to some adjustments being made to the bill that will be up for a full vote by the House on Thursday. Those adjustments ironically aren’t going to make much of a positive impact for voters, especially the ones they should be most concerned about.
According to recent CBO estimates, the 50 to 64 demographic will be the group most hurt by the repeal and quick replacement of Obamacare. Some will see their premiums increase from an average cost of $200 month to more than $1,200, in large part because the AHCA doesn’t prevent insurance carriers from pricing plans to reflect the increased risk that older individuals represent, as compared to a younger and more active demographic.
The changes to the AHCA that came out yesterday are going to bring cheers from the wealthy, as one of the modifications moves up the date of the full repeal of the Obamacare taxes from 2018 to 2017.
Another update is that there will now be a work requirement for Medicaid eligibility. There are exceptions to this rule for people under the age of 19, heads of household who are under the age of 20 and are in school or a work training program, any woman who is pregnant, single parents and caregivers of children under the age of 6. States will have the flexibility to add their own exemptions and any state that implements a work requirement for Medicaid eligibility will receive federal funding assistance of 5%.
Another modification to Medicaid regulations are a proposed shift from Medicaid expansion based on a per capita system, to that of a block grant system. This measure is aimed at limiting the amount of coverage that states would be responsible for in all demographics and in theory would free them up to shift funds towards helping those within the 50 to 64 demographic, who are going to see such a significant increase in their premiums. That demographic is viewed as the most at risk to shift their votes should people care that their monthly costs are going to skyrocket under the current AHCA plan.
Again we feel like a broken record over here, but all of this is still very early, and there are still many changes to come. Hurdle number one for the President is to simply get the AHCA through the House. If the Freedom Caucus is allowed to be such a thorn in the side of the moderate GOP members who want to do a full repeal and replacement of Obamacare, and actually succeed in preventing the bill from passing the house, it is going to make the next steps even more unlikely to come to fruition within a reasonable timeline.
It is just not likely that the current legislation is actually what ends up moving forward and ultimately is endorsed by both republicans and democrats. As it stands now the AHCA is very light on details and specifics and is more window dressing being used to appease the irrational members of the GOP who simply want to “repeal Obamacare” regardless of who it would harm.
Early Tuesday morning President Trump met with house republicans and made clear that if the house doesn’t vote in favor of the leadership’s proposed healthcare bill, there will be consequences. According to John Bresnahan of Politico and Phil Mattingly of CNN, he expressly warned that a lot of them will lose their seats in 2018 if they don’t get this done.
While the majority of the polling population has indicated that they are not in favor of Trumpcare as it stands now, that very well might not matter. President Trump has demonstrated that he’s a master of selling things in such a way that the details don’t matter. He’s great at getting the press to cover the polarizing statements that place blame on others, and the facts that ultimately matter, those are often covered in a less sensational way that people find boring. This results in many people buying into his message and not getting into the actual details. That is a very dangerous scenario for Republicans who aren’t on Team Trump and was clearly made known with his warning to the house Freedom Caucus this morning.
What Republican voters will remember in 2018, because President Trump will remind them, and he’s got the tweets to prove it, is that President Trump was bringing forth a better solution to repeal and replace Obamacare. Unfortunately the House Freedom Caucus got in the way of that simply because of self-serving politics. Instead of allowing the mainstream GOP to roll out Trumpcare in a manner that didn’t harm Americans and prevent people from being left behind, and doing so in step with their self-described, three-step process, House Freedom Caucus Chairman, Rep. Mark Meadows and the other members felt it was more important to give tax breaks to the wealthy immediately and kick single mothers off of Medicaid.
We anticipate that the latest version of the AHCA will pass the House, because it is a lose-lose scenario for the holdouts of the more conservative members of the GOP if it does not. If President Trump’s own party doesn’t uniformly fall in line, it sends a very bad message to its base, it will slow down other legislation, and it simply further opens the door for Democrats in 2018 and beyond.
When there’s more to read about we’ll let you know. If you would like to sign up for alerts, you can do so at this link.
Updated March 13th, 2017
CBO Estimates That The “Trumpcare Bill” As It Stands Now Will Result In 24 Million Losing Coverage
Estimates from the CBO, just released today, March 13th, 2017, indicate that by 2026 more than 24 million Americans will lose their health insurance coverage under the new AHCA (American Healthcare Act), also known as “Trumpcare”. This estimate is thought to be considerably higher than what was anticipated and a significant portion of those individuals losing coverage would be Americans currently enrolled in Medicaid. Most of those individuals would see their benefits cut in 2020, a much shorter timeline than the remainder of the individuals and families within that estimate put forth by the CBO.
As always, our focus is to provide you with facts and as little commentary as possible. That said, we do feel that we should again disclose that we do not believe that the bill that has been put forth is actually meant to move forward in the first place. Instead, we feel that it is, just as President Trump hinted at, simply a starting point for negotiations.
Why do we believe this? Well excluding the more extreme members of the Republican party who view medicaid as some kind of entitlement for individuals who are not deserving of health coverage, most republicans, and all democrats, believe that taking Medicaid away from tens of millions of Americans, especially in rural areas, could eventually end up pushing votes in the next midterm election to democrats.
A Serious Cause For Concern – A Lack Of “Inside Baseball” Being Discussed
Inside baseball, for those unaware, is a term used to describe “insider knowledge” or information those within a specific industry have because they work within it on a daily basis.
What concerns us at HealthNetwork, owner of Trumpcare.com, is that we have yet to find one elected official to have discussed the real mechanics of how the health insurance industry works, more specifically how slowly it moves. Health insurance carriers are notoriously slow moving, and this isn’t intentional in the sense that moving slowly allows them to make more money. No, it’s a by-product of how complicated the entire industry is and how many moving parts there are to fix in order to make changes.
We can’t help but to be alarmed at what we often hear and read from everyday people who seem to be under the impression that when President Trump’s healthcare legislation is passed, the positive effects of what is being promised will be available immediately. There generally seems to be some kind of expectation by politicians and more importantly Americans that if any legislation, let alone the one being currently proposed is passed, that it would result in immediate cost savings and improve outcomes and quality of care.
For example if the “Trumpcare plan” being proposed now guaranteed a 40% cut in monthly premium costs, it wouldn’t be possible for health insurance carriers to bring plans to market for approximately 18 months if not longer. Health insurance carriers think about future changes and or introducing new products, expanding their footprint into new states and so on, on timelines that are typically two to three years out.
Any new healthcare reform, once passed, will take a significant amount of time for the health insurance industry to adapt to and then bring products to market reflective of that legislation. That could mean that individuals who are losing coverage could be waiting for a very long time before they see plans offering the same (approximate) level of coverage and or any other beneficial aspects to come to market. Many major health insurance carriers have jumped out of the market because they were not making money from ACA plans. It will be some time before even those who want to get back into the market can do so.
We believe a more realistic timeline for most of the United States to see a major rollout of “Trumpcare plans”, for lack of a better term, is three years.
All that said, we don’t believe that the AHCA in its current form was ever intended to move forward. It’s a really great way for both republicans and democrats to have something to work off of that most agree is very flawed. Both sides will need to save face with their respective electorate, making the AHCA the perfect vehicle to force their hands in collaboration with one another, something they historically do not often do. In their all but inevitable grand compromise with one another, something that needs as much work as the AHCA does is well suited to play that role.
Below are some bullet-point highlights from the CBO analysis.
Here are the highlights from the CBO report and how they rated Trumpcare:
- Within the next decade, 24 million Americans will be uninsured under Trumpcare.
- By 2018, 14 million more Americans would be without insurance than would be uninsured if Obamacare remained in place. CBO believes this is mostly due to the fact that the individual mandate is not part of the Trumpcare plan.
- Trumpcare would reduce the federal deficit by 337 billion dollars over the next decade.
- Most of the budgetary savings and most of the pool of newly uninsured people would come from Trumpcare’s proposal to roll back Medicaid expansions put in place by Obamacare.
- The CBO predicts that the tax credit method of public financial assistance under Trumpcare would be attractive to lower expenditure, health people and those people would enter the market and purchase insurance.
- The CBO estimates that insurance premiums would rise until 2020 and then begin to lower as was also the case under Obamacare and that by 2026, the average premium would be 10% less than it would be if Obamacare were to stay in place.
- Insurance for older people would be more expensive under Trumpcare than Obamacare. Under Trumpcare, insurance carriers are permitted to charge older Americans five-times more per month than a younger person. Under Obamacare they are permitted to charge no more than three-times more.
Updated March 7th, 2017
The Trumpcare Bill Is Out And It Is Clearly Not What Will Ultimately Be Passed And Become Law
Servers across all of our healthcare information sites, including this one, have been absolutely swamped with traffic. In fact, for HealthNetwork as a company, this is one of the largest days with respect to consumers seeking answers about the future of Obamacare, and more importantly, the healthcare reform becoming know as “Trumpcare”.
With respect to why so many people are researching Trumpcare today, it’s simple, GOP leaders within the house released a draft of a bill that outlines the first proposed steps to repeal and replace Obamacare with the GOP and President Trump’s alternative. We could have jumped on the bandwagon and started covering this in full detail immediately, but from the outset, to anyone working within the health insurance industry, it was clear that this wasn’t the final bill. This document is not what is expected to actually get passed by both republicans and democrats.
First of all, with respect to sweeping legislative change and the documents that outline any new laws, regulations and rules, this document is very succinct. It also spends a fair amount of time covering things that are not top of mind for most Americans. For example, rules that prevent individuals who have won large lottery prizes from receiving government sponsored health benefits. Put another way, there’s some “filler” material in this document.
Here are the main points that you should pay attention to in the proposed bill:
- Repeals The Individual Mandate (The Tax Penalty For Not Having Health Insurance Coverage)
- Provides Coverage For Those With Pre-Existing Conditions
- Allows Children To Stay On Parents Plan Until They Are 26
- Medicaid Expansion Is not Impacted Until 2020
- Replaces Subsidies With Refundable Tax Credits
- Removes The 3.8% Tax On Individuals Earning More Than $250,000 A Year
- Places More Focus On Encouraging People To Open Health Savings Accounts
So all that said, it doesn’t really matter at this point. Those bullet-points are nice, but truthfully what’s in the bill doesn’t matter simply because everyone on the inside knows it is simply a starting part. Right now the more conservative part of the GOP is flipping out and calling the plan “Obamacare-Lite” or “Obamacare 2.0”. Democrats are saying it is going to result in 20 million people losing their health insurance coverage. As they say, the devil is in the details, and we don’t actually have all of the details yet because they have yet to be determined.
Over the next couple of weeks or months, President Trump and his cabinet along with republicans, democrats and insurance industry executives will all be forced to begin the painful process of understanding “compromise”. Because that is what is going to be required in order to draft a replacement to Obamacare that will actually get passed.
It has to serve the interests of the American people first and foremost. We’re not going to cover and provide guidance on every little bit of information that gets released in dramatic fashion by politicians. It’s great if you’re in the news business, because drama equals dollars, but for us, we’re in this to help people make good decisions. Decisions that are based around facts and unbiased information, and right now there’s just not too much to share with you at this point.
What was released is nothing more than a working document to build from, even President Trump said so himself today.
Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster – is imploding fast!
— Donald J. Trump (@realDonaldTrump) March 7, 2017
So we suggest you sign up to receive notifications from us, and when there’s something to actually inform you about, we will. Right now everything else is basically just focused on politics, and there’s no shortage of websites that handle that “stuff”.
Updated January 31st, 2017
Today Is The Last Day To Sign Up For Obamacare
If you still need to obtain health insurance coverage for 2017, today is your last chance to do so for 2017. Open enrollment ends on 1/31 at midnight. If you sign up by today, you will be grandfathered into a 2017 plan, and at no point during 2017 can your insurance carrier stop providing you with coverage. If you need to sign up for Obamacare please use the link below.
Updated January 21st, 2017
President Trump Signs Executive Order That Could Result In A Rollback Of The Individual Mandate
After being sworn into office as the 45th President Of The United States of America, the first order of business for President Trump was to sign an executive order that could lead to the collapse of the federal health insurance marketplace (Healthcare.gov) as well as for the state exchange marketplaces. His executive order opened the door for the HHS Secretary to provide “hardship exemptions” to just about anyone who does not want to obtain health insurance coverage that meets the minimum requirements set by the ACA. Or it could be given to anyone who simply doesn’t want to have health insurance and doesn’t want to pay the tax penalty. Why is this damaging to the insurance exchanges? Health insurance carriers have concern that this could lead to only those who are chronically ill to seek coverage and discourage in particular, young healthy individuals who help balance out the risk pool.
Currently there is little else that is known about when President Trump’s healthcare reform policy will take shape, when details about it will be shared, and what options those who want to retain the same benefits that the ACA allows for, will have as an alternative.
As things stand right now, if you need health coverage for 2017, you need to get enrolled right away. We highly advise that you not wait until the enrollment deadline which is 1/31/2017 to try to enroll. Enrollment on that day in particular will be incredibly difficult. We estimate that there will be upwards of three million Americans trying to sign up for coverage from 1/30 through 1/31.
Again we highly advise that anyone who needs coverage to sign up immediately and get grandfathered into a plan for 2017.
How A Republican Led Repeal Of Obamacare Without Having A Replacement Plan Ready Will Harm All Americans
Current support for an outright repeal of the Affordable Care Act, also know as Obamacare, led by the Republican controlled Senate is almost unanimous. Just five Republican members of the Senate, are thought to be objecting to an immediate repeal of Obamacare that does not include a replacement.
– Senator Bob Corker of Tennessee
– Senator Rob Portman of Ohio
– Senator Susan Collins of Maine
– Senator Bill Cassidy of Louisiana
– Senator Lisa Murkowski of Alaska
Presently if an outright repeal were to be brought forth and put into action immediately, it would mean that approximately 20 million Americans would be at risk of losing their health coverage very soon. This would also mean that all Americans, not just those insured through Obamacare, but also through an employer, would lose the rights and protections the law affords them as well. So, in effect, a full repeal impacts anyone who has almost any level or type of healthcare coverage, subsidized or not.
Specifically, the most important parts of the law that are universally popular and thought to be a proposed part of President-elect Trump’s replacement plan are the following.
- Guaranteed Issue (You can not be refused coverage because of a pre-existing condition)
- Expanded Age Limit For Children On Parents Policy (Children can remain on a parents policy until they are the age of 26)
- Expansion Of CHIP (More than 9 million children are now receiving insurance benefits because of an expansion of the Children’s Health Insurance Program
- Medicaid Expansion (Medicaid has been expanded in a number of states because of provisions within the Affordable Care Act)
Timeline For Government And Insurance Carriers To Create A Full Replacement
Current timeline estimates for a functional repeal and replace, one that the government and the health insurance carriers work hand-in-hand to craft and then implement is thought to be minimally two years.
Why is this? Well the main reason is simply this, the health insurance industry moves at a glacial pace. This isn’t out of complacency or disinterest in making swift progress to improve outcomes for Americans. No, it is simply a by-product of a large, unwieldy beast of an industry, one that is a touch point in hundreds of millions of Americans lives. This naturally comes with a lot of responsibility and expectation to get it right. Out of necessity, health insurance carriers are data-driven, number crunching, accountants, hunched over complex spreadsheets for months, calculating risk modeling. Their goal is to determine a hopefully accurate estimate on risk exposure and viability of the plans being offered to consumers.
Combine what’s mentioned above with the logistics required to negotiate all new contracts with hospitals, doctors, PBM’s (prescription drugs) urgent care centers, and every other part of the health insurance food chain. When you take into account all of the different moving parts, it is actually easy to understand why a two year minimum for a realistic timeline is not just reasonable, but maybe even be a little optimistic.
What An Outright Repeal Would Mean Immediately
It would mean that the more than 20 million Americans, who currently have coverage under the Affordable Care Act, would be in jeopardy of coverage disruption or losing access to their current available health plan entirely.
Why is this? Well for one, if a repeal is put into action without a replacement — in effect a safety net for those who might be dropped from their coverage if their insurance carrier decides to no longer offer plans with the same minimum benefits — Americans will be harmed.
Insurance carriers would be able to go back to excluding anyone with a pre-existing condition they determined to be too risky from obtaining coverage. Or, if they are offered coverage, their policy might stipulate that any costs associated with treatment for the pre-existing condition would not be covered by their plan.
What are common health conditions that prevented someone from obtaining coverage before the ACA?
- Cancer (all types)
- Extensive Sports Injuries (ACL,MCL and similar injuries)
- Opioid Addiction
- Heart Disease
- Obesity (significantly over weight)
Will President-elect Trump’s Final Obamacare Replacement Plan Be Harmed By A Quick Repeal?
Another aspect that could be troubling for the future success of President-elect Trump’s replacement plan to Obamacare, is that it could make insurance carriers less willing to participate with Obamacare’s replacement in the future. Again, insurance carriers are not unlike massive Navy aircraft carriers that take a considerable amount of time to simply point in another direction, it takes time to move the ship safely in a new direction. For Republicans to not take into consideration what negative impact a fast repeal with no replacement will have on them will not be forgotten.
Presidential elections are held far more often than the health insurance industry wants to plan and rollout the next iteration of healthcare reform. It might be more difficult for President-elect Trump to get buy-in from a majority of health insurance carriers, which is going to be essential in order to have a highly competitive marketplace where costs get driven down because of lots of competition. Making the transition from Obamacare, to President-elect Trump’s replacement for it significantly more difficult. This not only seems to potentially put much of the Senate at odds with the President-elect, but with the voters who elected him in the first place. Many of whom it goes without saying, but we’re saying it anyway, benefitted from the down-ballot vote, or so the Republican-led sweep would leave a reasonable person to believe.
Is The Republican Senate Simply More Interested In Seeking A Swift “Symbolic Repeal” Or To Best Serve Americans?
You kind of have to wonder exactly who benefits from a full repeal that is not paired with a simultaneous replacement ready to go.
- Americans currently covered by Obamacare? No, it certainly doesn’t benefit them. They may no longer have coverage. Obviously anyone who is now recovering from any significant illness or disease would now be in great peril. Impacting a larger percentage of people will be those who simply lose their coverage.
- Americans who have coverage outside of Obamacare through an employer? No, they have more protections now and essential minimum requirements as a result of the ACA.
- Insurance Carriers? No, quick-sweeping legislative changes that throw a wrench into the gears of the healthcare machine they’ve been trying to keep on the road simply forces a lot of carriers to scramble to prevent a sudden crash and or death spiral of the system that is in place.
- Health Insurance Costs, Will Those Go Down? Nope, pricing under any new model will take that same approximate two-year timeline to formulate and negotiate if we’re talking about major medical coverage. Insurance that includes all of the universally popular parts of Obamacare that Trump has said he wants to keep.
- Wealthy People? Yes, it is entirely true that the top earners in the country are going to see an immediate tax benefit from a full repeal.
So Who The Heck Benefits From This Repeal Without A Replacement Already?
It beats the heck out of us, really. In all seriousness the Senate moving forward with a full repeal without caring about having an actual replacement safety net can only be viewed as pure politics and nothing more than a symbolic gesture on the part of the Republican Senate. For seven years they have been attempting to bring legislation to repeal Obamacare to a vote, most often only to be defeated on the senate floor, and or only to be vetoed by the President. Prior to the actual launch of the ACA they tried to cut it down before it even had a chance to provide healthcare to millions for the first time. For the GOP, which has been complaining about Obamacare for almost a decade, it’s been a lot of frustrating “tough talk” and no real opportunity to “walk the walk” for a very long time. Well now that the moment has unexpectedly arrived and caught everyone off guard, it now seems the ACA is exposed and hard-line Senators such as Mitch McConnell are more concerned about following through on their years of “attempts at a repeal” than the messy aftermath of a quick repeal will actually have.
It seems that any reasonable person would find it hard to argue against a measured response that carefully weighs the consequences, and let’s get to brass tacks, the collateral damage that will be left in its wake.
Are Republicans Setting Themselves Up For A Strained Relationship With The President-elect And Midterm Voters?
Americans have made it clear that they’re only in favor of a repeal and immediate replacement of the ACA. No polling has indicated that anyone is in favor of effectively hanging everyone out to dry, pulling coverage from 20 million, and the probable ensuing market collapse, all so Senate republicans can throw a festival on the ashes of the ACA celebrating their victory.
Additionally a vote to repeal without a replacement could be viewed as a slight against the President-elect and the American people. The repeal would be serving Senate politicians who most Americans in this election cycle seemed to be pretty fed up with, hence Trump’s election. Politicians who are party first and American people second, could find themselves in jeopardy of losing ground in future elections. Considering the enrollment numbers this enrollment season so far, on top of the overwhelming data that indicates Americans aren’t in favor of a repeal without a replacement, and the all but inevitable market collapse that will unfold following a swift repeal, this could be a very dangerous game of political chicken for Republicans.
Which kind of brings us full circle to the question of, are Republican Senators actually listening to the people who elected them to serve in the first place?
If You Have Concerns About A Quick Repeal Without A Replacement – Here’s Your Chance To Make Your Opinion Heard
Below you will find the contact information for all current Republican Senators, who intend to vote for a repeal of Obamacare regardless if there is a replacement plan ready to ensure Americans don’t lose their healthcare coverage or protections provided by parts of the Affordable Care Act. If you have questions about why these Senators would be willing to put not only those currently receiving health insurance benefits under the ACA at risk, but also those who will be covered by President-elect Trump’s plan in the future, you can call or email to let them know directly.
|Jeff Sessions (R-AL)||202-224-4124||Contact|
|Richard Shelby (R-AL)||202-224-5744||Contact|
|Lisa Murkowski (R-AK)||202-224-6665||Contact|
|Dan Sullivan (R-AK)||202-224-3004||Contact|
|Jeff Flake (R-AZ)||202-224-4521||Contact|
|John McCain (R-AZ)||202-224-2235||Contact|
|John Boozman (R-AR)||202-224-4843||Contact|
|Tom Cotton (R-AR)||202-224-2353||Contact|
|Cory Gardner (R-CO)||202-224-5941||Contact|
|Marco Rubio (R-FL)||202-224-3041||Contact|
|Johnny Isakson (R-GA)||202-224-3643||Contact|
|David Perdue (R-GA)||202-224-3521||Contact|
|Mike Crapo (R-ID)||202-224-6142||Contact|
|Jim Risch (R-ID)||202-224-2752||Contact|
|David Purdue (R-GA)||202-224-3521||Contact|
|Todd Young (R-IN)||202-224-5623||Contact|
|Joni Ernst (R-IA)||202-224-3254||Contact|
|Chuck Grassley (R-IA)||202-224-3744||Contact|
|Jerry Moran (R-KS)||202-224-6521||Contact|
|Pat Roberts (R-KS)||202-224-4774||Contact|
|Mitch McConnell (R-KY)||202-224-2541||Contact|
|Rand Paul (R-KY)||202-224-4343||Contact|
|Bill Cassidy (R-LA)||202-224-5824||Contact|
|John Kennedy (R-LA)||202-224-4623||Contact|
|Susan Collins (R-ME)||202-224-2523||Contact|
|Thad Cochran (R-MS)||202-224-5054||Contact|
|Roger Wicker (R-MS)||202-224-6253||Contact|
|Roy Blunt (R-MO)||202-224-5721||Contact|
|Steve Daines (R-MT)||202-224-2651||Contact|
|Deb Fischer (R-NE)||202-224-6551||Contact|
|Ben Sasse (R-NE)||202-224-4224||Contact|
|Dean Heller (R-NV)||202-224-6244||Contact|
|Richard Burr (R-NC)||202-224-3154||Contact|
|Thom Tillis (R-NC)||202-224-6342||Contact|
|John Hoeven (R-ND)||202-224-2551||Contact|
|Rob Portman (R-OH)||202-224-3353||Contact|
|Jim Inhofe (R-OK)||202-224-4721||Contact|
|James Lankford (R-OK)||202-224-5754||Contact|
|Pat Toomey (R-PA)||202-224-4254||Contact|
|Lindsey Graham (R-SC)||202-224-5972||Contact|
|Tim Scott (R-SC)||202-224-6121||Contact|
|Mike Rounds (R-SD)||202-224-5842||Contact|
|John Thune (R-SD)||202-224-2321||Contact|
|Lamar Alexander (R-TN)||202-224-4994||Contact|
|Bob Corker (R-TN)||202-224-3344||Contact|
|John Cornyn (R-TX)||202-224-2934||Contact|
|Ted Cruz (R-TX)||202-224-5922||Contact|
|Orrin Hatch (R-UT)||202-224-5251||Contact|
|Mike Lee (R-UT)||202-224-5444||Contact|
|Shelley Moore Capito
|Ron Johnson (R-WI)||202-224-5323||Contact|
|John Barrasso (R-WY)||202-224-6441||Contact|
|Mike Enzi (R-WY)||202-224-3424||Contact|
Last Updated 12/29/2017
Why Do Some Republicans Seem Intent On Repealing Obamacare, Even Without A Replacement Plan Ready To Go?
When Donald Trump was out on the campaign trail as the GOP presidential nominee, he consistently proclaimed that he would repeal Obamacare on his first day in office. He indicated that he would not simply alter or update Obamacare, he’d completely repeal it. Although after meeting with President Obama, he did in fact say that there are aspects of the ACA that he thinks are worth keeping. This is a positive sign, as it really indicates that President Elect Trump isn’t only going to focus on doing what the GOP advises him is best, for the sake of politics and “optics”. A President should have to make policy decisions that might conflict with even his own administration. That looks to be leadership that’s focused on the people, not political parties and political process, kudos to Trump.
At face value, the Republican Party in general has been against Obamacare since the day it became law in 2010. At every milestone, when new features of the law were preparing to go into effect or problems led to doubt about the process, opponents of the law – largely conservatives – would challenge the Affordable Care Act in court and take their case to the people. Republicans even took parts of Obamacare to the Supreme Court, but challengers lost every battle to replace the ACA.
Why does the Republican party hate Obamacare so much? When you strip away the natural tensions that exist between the two major parties, you’re still left with some pretty interesting reasons why the GOP opposes President Obama’s healthcare reform law. It’s unknown how many of these reasons Donald Trump actually buys into, but he has made it clear that he wants Obamacare gone and replaced with his own version of healthcare reform.
For The GOP That Failed To Repeal It For Years, It’s Personal
The Supreme Court declared Obamacare to be constitutional in 2012, but that did not stop conservative objectors from challenging certain aspects of the law time and again. For instance, Republicans challenged in the Supreme Court in 2016 the provision of the ACA that forced all employers to provide employees with birth control. If companies refused, then the federal government would step in and offer those employees birth control.
The Republican party represents several religious groups that object to the concept of birth control. Contraception clashes with their beliefs, so business leaders challenged a law that seemed in direct opposition to their religious freedoms. The Supreme Court again refused to rule against Obamacare and ordered Congress to find a compromise. There have been a couple of other challenges like this one from the GOP that are solely based on the personal preferences of the Republican Party and its constituents.
Tax Subsidies and Penalties, Unpopular But Necessary
Since Obamacare went into law in 2010, the Republican Party has tried at least 56 times to repeal it without success, often targeting tax penalties and subsidies as reasons why Obamacare needs to be repealed.
According to Republicans, tax penalties are invasive because they force Americans to buy something they may not want to buy. Compelling people to buy coverage goes against conservative ideals of personal liberties. The GOP also feels as though subsidies are wasteful spending that put an unnecessary burden on the American taxpayer. Democrats counter that the subsidies allow millions of Americans to afford insurance who could not afford it before Obamacare. As for the penalties, there are practical reasons for them. No one disputes the idea that forcing people to buy insurance is a hard position to be in, but there are practical reasons for the individual mandate. Without it, young and healthy people might avoid buying insurance, which would drive up costs for everyone else.
A Matter of (Political) Ideology
Obamacare has encouraged the centralization of the health care industry. Under the ACA, the government has taken on a larger role in insurance, both in terms of regulation and administration, so the point that Republicans view Obamacare as a form of “socialized medicine.”
Conservatives believe that the government should stay out of people’s lives and not get involved in any kind of private commerce. Donald Trump’s speeches regarding health insurance have indicated that Trump considers health insurance to be a private enterprise service, and not something that is a “right”. Obamacare interferes with that dynamic. This is just one example of conflicting ideologies. When two groups disagree substantially on a foundational topic, like the government’s role in the private lives of individuals, tensions run high.
Higher Deductibles Are Making Coverage Less Practical
By June 2016, the deductibles for Obamacare health insurance policies reached an average of $7,000 per year. That means that the average consumer has to spend $7,000 out of pocket every year before health insurance kicks in. Needless to say, the GOP has jumped all over this issue and has made it the focal point of its healthcare reform platform.
Rising Premiums Making “Affordable Care” Out Of Reach For Many
Prior to Obamacare, most Americans who had health insurance had employer-sponsored health insurance that may have gone up a little each year to compensate for costs. It’s estimated that premiums on the Obamacare marketplace will go up an average of 25 percent for 2017. That’s a much higher jump than people are used to, and the core of the problem seems to be the way that Obamacare is set up.
Premiums for Obamacare plans are based on participation. The more people buy plans, the lower the premiums can stay. With more companies dropping out of the marketplace and fewer people buying new plans, there just aren’t enough numbers to make prices affordable. Rising premiums coupled with rising deductibles are coming together to create a perfect storm – a storm that Republicans can use to sway public opinion in its favor when they change the law.
There are practical and personal reasons behind Republican bias against Obamacare. Donald Trump won over GOP voters by embracing the repeal-and-replace mantra during his campaign. But when the Republican party only won 52 senate seats instead of the 60 necessary for repeal, it became obvious that Trump could not keep his promise, at least not completely.
Hatred for Obamacare among Republicans is so strong that Congress is expected to approve measures that would gut Obama’s signature health care law and replace it with something else as quickly as possible. What that something else might be is still up in the air. What should be most concerning for Americans is the idea that anyone within government on the left, right, or center, would think first about their political positioning and career before what is actually best for the people they serve. Obamacare is far from perfect, but it has in fact improved the well being of millions who were previously uninsured, and in some cases, that’s saving American lives.
Last Updated 12/12/2016
What is the Republican Plan to Replace Obamacare?
Since the Affordable Care Act became law in 2010, opponents, primarily Republicans, have been trying to repeal it. While Donald Trump was campaigning for the presidency, he took up the mantra of the Republican Party – repeal and replace – which helped him gain traction with conservatives who may not otherwise have voted for him. Trump’s campaign website outlines some of his ideas about healthcare reform, but there has not been anything specific to indicate how he intends to carry out his plans. As we draw nearer to his inauguration in January, Republicans in Congress will need to come to a consensus about how to proceed.
Obamacare is an extensive piece of legislation that reaches into the lives of millions of Americans. It wasn’t until he won the presidential election and started to put his cabinet together that Trump started to release more details about his plan to replace the ACA. It looks like Trump is going to follow the advice of two men who have been leading the charge against Obamacare for years. Dr. Tom Price from Georgia and House Speaker Paul Ryan are at the forefront of the repeal-and-replace movement, and they have a plan that they could drop right into place once Trump takes office.
An Evolving Republican Plan
Tom Price introduced the Empowering Patients First Act in 2009, but his most recent iteration of the bill was released to the 114th Congress in 2015. Each has been intended to be a replacement for Obamacare. Price believes that the ACA puts too much power into the hands of the government, hospitals and doctors in terms of delivery of care. He wants to give patients more and better health care options, and he wants to hold medical care providers accountable for the quality of their care.
It should be noted that Price’s plan is not a complete overhaul of Obamacare. Price agrees with some statutes of Obamacare, and those happen to be the same statutes that Donald Trump supports. Speaker Paul Ryan was one of the Congressional leaders who helped to introduce the Empowering Patients First Act. Ryan is expected to be at the forefront of any changes to Obamacare using the Empowering Patients First Act as a road map.
The Democratic Response
Not unexpectedly, Democrats in Congress were not impressed when Price’s bill was introduced. Democrats contended that Republicans were never serious about the bill because it was never presented as a real bill for the Congress to consider. But now that the GOP runs the show in D.C., Democrats can expect to see real health reform legislation hit the floor that looks a lot like Price’s plan.
What Changes will be Made to Obamacare?
A quick look at the Republican health care reform bill offers better insight into what Trumpcare might become. Highlights include:
- Expanding the availability and limits on Health Savings Accounts
- Helping people move away from employer-sponsored health insurance by offering some form of tax incentives to make the individual purchase of health insurance more affordable
- Setting limits for how much employer-sponsored health care can be offered as tax-free income
- Removing any limitations that may exist in buying and selling health insurance across state lines
- Offering block grants to the states so that they can tailor Medicaid services for their citizens instead of having to follow a growing number of federal rules
- Privatizing Medicare by starting to offer a method for helping seniors to fund their own health plans by 2024
Since the election, the GOP and Ryan specifically have been updating the public on more details regarding changes to Obamacare and Medicare. Donald Trump has been relatively quiet on any of these changes, and Trump has not offered any new information on what he intends to do with Obamacare when he is inaugurated.
From the Democratic Side
While Republicans may be reaching a consensus, it’s not entirely clear what that consensus might be. Several outlets have speculated on how the GOP replacement plan might affect the current American health care system. According to ObamacareFacts.com:
- Costs for healthcare will once again start to skyrocket.
- Pre-existing conditions will again be allowed to affect coverage (Donald Trump has denied this).
- All tax subsidies will be eliminated.
- Eligibility requirements for Medicaid will narrow.
- Tax breaks will favor businesses over individuals.
The truth about what will replace Obamacare is probably somewhere in the middle between what the GOP is saying and what the Democrats are saying. Trump himself has shifted his position several times, and his latest insistence is that he wants to keep key parts of Obamacare in place. Much of the ACA’s future – and with it, the future of 22 million people who have coverage thanks to Obamacare – depends on what happens once Trump takes office in January.
Trumpcare’s Potential Premium Deductions
Health insurance, specifically the Affordable Care Act (ACA), was a prime talking point during the 2016 presidential campaign. Republican nominee Donald Trump promised to repeal the ACA the moment he took office. But since the GOP only has 52 senate seats instead of the 60 needed for a repeal, it is unlikely that Trump will be able to keep his campaign promise.
Despite not having a two-thirds majority in the senate, Trump can still make significant changes to the ACA that would permanently and completely alter the way it looks and works. One of the areas where Trump wants to make changes is by creating premium deductions for individuals. In order to understand what Trump wants to do here, we need to first look at how individuals are currently able to treat health insurance premiums on their taxes.
Taxes and Health Insurance
Health insurance premiums are considered non-taxable income for you and your employer. That’s why your premiums are taken out of your pay in pre-tax dollars. Your employer is also able to deduct the portion of your health insurance premiums that it pays, making sure that health insurance premiums are basically a non-tax event.
The ACA made a few changes to health insurance related taxes that affect everyone. If the medical and dental expenses you pay out of pocket exceed 10 percent of your gross income, then you can use the portion over 10 percent as a deduction. If you pay certain for certain medical expenses out of your own pocket, such as the cost for medical transportation, then you can deduct that from your taxes as well.
While you cannot claim any money that you paid into a Health Savings Account (HSA), the good news is that you can use that money tax-free to cover medical expenses. The ACA also allows you to deduct any out-of-pocket expenses you paid to drive to a medical care facility. This means that your transportation to a hospital, whether it is by car or ambulance, is tax deductible.
Trumpcare Tax Subsidies
Under the ACA, any consumer with an income that is less than 400 percent of the federal poverty line can get some kind of tax subsidy to help with the costs of health insurance. Anyone who makes less than 250 percent of the federal poverty line will have access to cost-sharing reduction subsidies that help to absorb more of the medical costs you paid out of your own pocket for the year. Tax credits are applied up front by most people. The cost-sharing program is applied when you file your taxes, so it works as a reimbursement.
If you do not have a qualifying health insurance plan in place throughout the year and are not exempt from having coverage, then you risk paying a federal income tax penalty. Exemptions exist for certain groups of people, like members of Native American tribes, religious organizations that object to health insurance, and people who are incarcerated.
In 2016, the penalty was $695 for each uninsured adult and $347.50 for each uninsured child in your family, or 2.5 percent of your family’s total taxable income, whichever was higher. The Obama administration uses the penalty as a way of motivating people to buy insurance and help keep overall costs down for everyone. Opponents of the law view the individual mandate as invasive, and Republicans have vowed to eliminate it once Trump takes office.
Taxes under Trumpcare
Donald Trump’s take on health insurance taxes is confusing and vague. For example, he wants to allow everyone to be able to use the tax-free HSA program, but he doesn’t indicate if that includes people without health insurance as well.
The most significant tax change Trump wants to make with his health insurance reforms is to allow everyone who pays insurance premiums to a private insurance company to be able to deduct those premiums. In other words, if you buy your health insurance directly from an insurance company, then Trump wants your premiums to be in pre-tax dollars, just like anyone who has employer-sponsored insurance.
There are two issues with this plan that render it useless. First, the Huffington Post ran the numbers and determined that offering this sort of tax deduction to private insurance buyers is not the same as getting employer-sponsored health insurance. While the deduction helps, consumers are still better off getting their insurance through their employers.
Trump points to how much his premium deductions will help small businesses and self-employed workers, but both groups can already write off health insurance premiums from their taxes. In essence, Trump’s