Trumpcare is out: Who wins and loses in Florida?

A long-awaited House Republican plan to repeal and replace the Affordable Care Act is out, with President Trump calling it a “wonderful” package “for review and negotiation” and critics blasting it as “Obamacare 0.5” that raises costs or puts coverage out of reach for millions.

Winners stand to include taxpayers, people who don’t want the government to make them buy insurance and some of  the people buying Obamacare marketplace plans who get no financial  assistance now because they make too much money. About one out of 10 Floridians buying policies on ACA exchanges get no payment help.

Prospective losers include the bulk of the more than 1 million Floridians who get government assistance to pay for ACA plans, people who lose jobs because fewer folks have insurance coverage to pay for services, and people with pre-existing conditions who will pay more if they cannot afford to maintain continuous insurance coverage or get a less affordable deal under a state-run program.

Some of the more precise effects won’t be known without further analysis inside and outside Washington, but it’s  clear Florida  has a lot at stake. Its Obamacare customers have the most to lose nationwide in subsidies  — $5.2 billion — that are designed to make insurance premiums cheaper, according to one study.

The plan eliminates any penalty for the government mandate  that forces individuals to buy health insurance, ends Medicaid expansion in three years  and gives grants and more control to the states. Those principles have been popular among conservatives, but the political challenge will be to find enough  GOP votes to approve a plan that retains some Obamacare  elements but covers perhaps 20 million fewer Americans, many of them in states President Trump carried.

There are already signs of trouble. Four Republican senators from states that expanded Medicaid have already signaled concerns about what happens to that program.

“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell hours before the bill came out  Monday.

President Trump tweeted Tuesday, “Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster – is imploding fast!”

One political problem for Trump: If Obamacare is imploding, then this bill would likely hasten that process, analysts say. If younger and healthier people are no longer required to buy insurance, that leaves older and sicker people probably forced to pay more in a shrinking pool — the “death spiral” in state exchanges. Politically, there are diminishing returns for saying it’s Obama fault if voters come to expect Trump and Congress to govern and do something to make it better.

Trump said this was just the start, though: “Don’t worry, getting rid of state lines, which will promote competition, will be in phase 2 & 3 of healthcare rollout.”

He mentioned a drug plan without specifics: “I am working on a new system where there will be competition in the Drug Industry. Pricing for the American people will come way down!”

Trump has said drug makers are “getting away with murder” on pricing but has not made clear exactly what he would do about it.

The House bill keeps two popular Obamacare features: Young adults can stay on their parents’ health plans until age 26 and  insurers are forbidden to deny coverage or charge more to people with pre-existing medical conditions. It does allow insurers to charge more to such people if they have had a gap in coverage, however. That’s designed to discourage people from dropping in and out of coverage and paying premiums only when they need care, though advocates for patients say it’s very difficult for people of modest incomes battling serious illness not to go through periods when they cannot afford premiums.

The plan released late Monday offers its own version of subsidies, in the form of tax credits, to make insurance more affordable. It expands help to more people with higher incomes than the Affordable Care Act does  — individual incomes below $75,000 and $150,000 for couples. But the help tends to be smaller for many people compared to the original ACA  and varies by age, starting at $2,000 a year for individuals under age 30  and rising to $4,000 by age 60.

“Today is just the first step in helping families across this country obtain truly affordable health care, and we’re eager to get this rescue mission started,” said House Energy and Commerce Committee Chairman Greg Walden, R-Ore., in a statement.

Columnist and GOP critic Paul Krugman tweeted, “It’s not Obamacare 2.0. It’s Obamacare 0.5 – a half-assed attempt to preserve ACA successes without spending nearly enough money.”

But it doesn’t please the small-government folks on the right either, like Americans for Limited Government, which concluded, “Partial Obamacare repeal falls short in key areas.”

Here’s more on what Walden said the legislation does:

  • Creates a Patient and State Stability Fund – This new and innovative fund give states broad flexibility to design programs that best serve their unique populations. They can also use funds to increase access to preventative services.
  • Responsibly unwinds Obamacare’s Medicaid expansion – By freezing new enrollment after 2 years and grandfathering in current enrollees, we protect patients and offer a stable transition.
  • Strengthens Medicaid – Using a per capita allotment, our legislation ensures a fair funding formula for states while creating a viable financial future for the program.

 

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  1. […] change in the premium subsidy calculation for purchasing insurance is especially troubling in Florida, which leads the county in the amount of assistance provided to consumers.  The Kaiser Family […]

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