Nel's New Day

May 3, 2017

Trumpcare, A ‘Moral Monstrosity’

Filed under: Health Care — trp2011 @ 11:18 PM
Tags: , , ,

Sarah Palin’s warnings about “death panels” in government health care are coming to fruition with the GOP version, supposedly up for a vote in the House tomorrow right before congressional members disappear for another two-week vacation. The difference from what she said a few years ago, however, is that her own party, not the Democrats, is creating the death panels. In House Speaker Paul Ryan’s (R-WI) desperation to pass the “repeal and replace” of the Affordable Care Act, he has blatantly lied about what’s in the Trumpcare bill.

Unlike Ryan’s claims, these are the facts:

  • The GOP plan would raise out-of-pocket costs.
  • The GOP plan will hurt people between the ages of 40 and 65.
  • The GOP plan will remove the ACA benefits to Medicare.
  • The GOP plan will strip coverage from some of the 24 million who got it under the ACA.
  • The GOP plan allows states to strip pre-existing conditions from health insurance.

In every congressional district, at least tens of thousands will lose coverage while the rest of the people will face premium hikes of 15 to 20 percent and deductible increases of 60 percent.

GOP North Carolina Rep. Robert Pittenger told people who live in states that deny pre-existing conditions through waivers that they should move to another state.  Last year he said that protests in Charlotte were caused by people who “hate white people” after the police fatally shot a black man.

Rep. Mo Brooks (R-AL) said that “good people” don’t have serious or life-threatening pre-existing conditions. These people “lead good lives”—they’ve “done things the right way.” These people are also half the population, those who can be denied health care because of any medical condition existing before enrolling in health insurance—like asthma or pregnancy.  Some of his constituents wrote him about being some of these “bad people“—such as being born with cerebral palsy or being in an automobile accident.

Rep. Fred Upton (MI) opposed the bill until he sold out for $1.6 billion a year in a high-risk pool, at least 90 percent less than necessary to make it viable. High-risk pools, recommended for the sickest five percent of people insured in small-group and individual markets, have a history of failure. States limited people from enrolling in them or using the coverage. People in these pools also face much higher premiums—up to twice as much—as people in the individual market and very high deductibles. High-risk pools can allow annual or lifetime limits on coverage, something not permitted in the ACA and have coverage exclusions for up to 12 months, meaning that people have no insurance for that time. California’s plan had only a three-month waiting period for coverage for pre-existing conditions but had a $75,000 annual limit and a $750,000 lifetime limit. Florida’s high-risk pool was such a disaster that it froze new enrollment in 1991, a situation that lasted for almost two decades. Before the full implementation of the ACA in 2011, these pools in 35 states covered only 226,600 people with net losses of $1.2 billion. Of nonelderly adults, 52 million people in the nation have pre-existing conditions which would make them uninsurable. And these pools don’t help the other 90 percent of the people forced to pay hundreds of thousands of dollars in premium “surcharges.”

People on Medicare may also be affected by Trumpcare.  The ACA provided free preventative screenings such as mammograms and colonoscopies as well as an annual free wellness visit. Another provision closed the “doughnut” hole, the coverage gap in prescription drugs that beings when insurer’ and beneficiaries’ combined costs for drugs reached $3,700 and ends at $4,950 for catastrophic coverage. By this year, people have to pay 40 percent for brand-name drugs and 51 percent for generics in that hole which was scheduled to close by 2020 when beneficiaries would be responsible for 25 percent of the cost after the deductible. A repeal without replacement could eliminate this help for people on Medicare.

The ACA helped Medicare become more solvent because of its cost-cutting provisions, including a reduction of federal payments to Medicare Advantage plans. Keeping ACA would keep Medicare would be in the black for 11 years longer than before ACA’s enactment, but its repeal would add $80 billion a year to Medicare spending. The government may make up the losses with higher Medicare premiums, deductibles, and cost sharing for beneficiaries.

The GOP bill still exempts congressional members and their staffs from losing popular aspects of the Affordable Care Act. Rep. Tom MacArthur (R-NJ) claimed that there would be a later vote about the exemption.The fast-track consideration came without posting the bill text and without a Congressional Budget Office analysis about the bill’s effects.

House Minority Chair Nancy Pelosi (R-CA) said today before the vote:

“Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan to push Americans with pre-existing conditions into the cold. But tomorrow, House Republicans are going to tattoo this moral monstrosity to their foreheads, and the American people will hold them accountable.”

With its provision to eliminate ACA taxes on the wealthy, Trumpcare is the first move to drastically cut taxes for the few percent.

Trumpcare would also

  • Tie subsidies to age instead of income and geographic location.
  • Charge higher premiums to people in the 50s and early 60s, as compared to younger consumers—at least five times but more if states get waivers for a higher ratio.
  • Cut $800 billion from Medicaid support.
  • Permit states to require able-bodied adults to work for Medicaid.
  • Give waivers to states to exempt people with pre-existing conditions and allow insurers to provide insurance without the 10 essential health benefits—most of the parts of health insurance.
  • Allow caps on some of the health benefits.
  • Repeal tax credits in 2020 that help some people pay deductibles and make co-payments.
  • Stop the requirement for larger companies to provide affordable insurance to their employees.
  • Permit high-risk pools (see above).

An unwritten part of the GOP platform is that poor people are to blame for their poverty, and the rest of the population, which shrinks daily, can thrive without them. Uninsured people actually cost the system more than when they are covered. Even worse, however, the GOP belief is totally unethical. The current president promised all these people that he would take care of them. These people voted for him because they believed his promises. Now he’s thrown them away while continuing his lies that he will “mandate” coverage for pre-existing conditions and provide subsidies.

The GOP members of the House who are getting out of Washington immediately after the vote might want to avoid their constituents in their home districts. Although the House can avoid a CBO analysis of the Trumpcare effects, Senate budgetary rules require a score before they vote. At that time, people will find out the estimated impact of the measure.

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