Source: L.A. Times
The Affordable Care Act repeal bill unveiled last week by Senate Republicans has aptly drawn universal scorn from healthcare experts, hospital and physician groups and advocates for patients and the needy. Yet some of the measure’s most egregious, harshest provisions are well-disguised in its maze of legislative verbiage”
Protection for people with preexisting conditions is destroyed. The ACA’s so-called Section 1332 waivers were designed to allow states to try innovative approaches to healthcare, especially through their Medicaid programs. But under the ACA, states can only seek waivers under certain conditions — the changes can’t lead to fewer people insured, or subject them to higher out-of-pocket expenses. The Senate bill repeals those limitations — and removes the flexibility of the Secretary of Health and Human Services to approve them.
States would be authorized to waive rules requiring that almost all customers be charged the same premium. That’s an invitation to preferential pricing that would effectively remove protections for people with preexisting conditions — they could be priced out of the individual market in a return to the dysfunctional system that denied them insurance in the pre-ACA era.
Older Americans would get socked with much higher premiums and costs. The bill expands the permissible range of premiums for older buyers compared to younger from a ratio of 3 to 1 in the ACA to 5 to 1. The ACA’s subsidies are based entirely on income, and are provided to households with income up to 400% of the federal poverty line. The measure also pegs subsidies partially to age, with older buyers entitled to smaller subsidies.
The fight against opioid addiction is crippled. As much as 40% of the cost of treatment of addicts has been paid by Medicaid. The harsh cuts in that program imposed by the Senate bill would force more of that expense onto states that simply can’t afford it. Meanwhile, the projected loss of medical coverage by as many as 23 million Americans under repeal will keep many victims of the epidemic from finding treatment. The Senate measure substitutes a frayed Band-Aid to cover that loss.
The bill is a poorly-disguised massive tax cut for the wealthy — including health insurance chief executives. The tax cuts would be paid for by cutting Medicaid — which serves the middle class and the poor — to the bone. Meanwhile, The Affordable Care Act cut the limit on the deductibility for health insurers from one million to $500,000 in pay per executive and eliminated to for “performance-based” compensation, such as stock options or restricted stock grants. The Senate would repeal that provisions, allowing salaries for health insurance chief executives to go through the roof.
Some of these provisions match those in the House Republicans’ repeal bill passed May 4, and some are even harsher — more “mean,” to use a term President Trump himself applied to the House bill. The Senate bill wouldn’t do much better, and might do worse.