Senate Majority Leader Mitch McConnell tweeted Thursday that “Americans deserve better” than Obamacare, but Consumers Union called the revised bill “just as harmful as before.”
The tweaked Better Care Reconciliation Act contributes $420 billion to budget savings, more than some previous versions, largely by capping spending on Medicaid while keeping some Affordable Care Act taxes in place, CBO found.
About 15 million people will lose or choose not to buy insurance in 2018 compared to leaving current law intact, analysts projected. By 2026, 82 percent of all U.S. residents under age 65 would be insured, compared with 90 percent under current law, they said.
CBO said fewer people will have coverage for reasons including a rollback of Medicaid expansion, reductions in subsidies to make insurance cheaper for lower-income consumers and the loss of penalties for not having health insurance.
The revised Senate bill would keep some ACA taxes in place to give more money to the states to lower consumer premiums and fight opioid addiction.
The CBO scored a version that does not include the so-called Cruz Amendment to allow insurers to offer cheaper “skinny” plans if they offer at least one compliant with the Affordable Care Act. Critics say the problem there is it could segregate sick people into what amount to high-risk pools in ACA plans.
The parade of revisions and different versions can get confusing, but Senate leaders have said they still plan to push for a vote next week. Still, prospects appear cloudy at best as several GOP senators have publicly balked at this plan or reviving an older proposal to repeal Obamacare in two years and work on a replacement in the meantime.
As support for a Senate health bill collapsed, President Donald Trump tweeted Tuesday he wants to let the Affordable Care Act fail, an act consumer groups warned would trigger a financial, medical and public health crisis for millions in Florida and other states.
“As I have always said, let ObamaCare fail and then come together and do a great healthcare plan,” Trump tweeted. “Stay tuned!”
Talk in the Senate has turned back to simply repealing Obamacare to take effect in two years, buying time to reach agreement on what to put in its place. That’s similar to legislation that passed in 2015 and was vetoed by then-President Barack Obama.
It appeared doubtful by Tuesday afternoon even the repeal plan can get enough votes to pass either. This isn’t 2015 with a sure veto waiting. It’s the majority party’s decision with 2018 elections over the horizon. The Congressional Budget Office forecast the consequences of repeal with no clear replacement could include the collapse of the individual market, premiums rising and up to 18 million people losing or choosing to drop coverage in one year.
Trump has threatened threatened to withhold billions of dollars that lower consumer costs by calling these as insurer “bailouts,” though they have been part of the ACA marketplace from the start.
“President Trump, from all indications, is ready and willing to allow the continued sabotage of the existing law in order to make his self-fulfilling hope of Obamacare failure a reality,” advocacy group Florida CHAIN (Community Health Action Information Network) said in a statement.
“This path to repeal is just as dangerous as the Senate’s replacement plan,” said Betsy Imholz, special projects director for Consumers Union. “The uncertainty created by Congress has scared off insurers, hurting the marketplace and consumers in real time. A full repeal of the Affordable Care Act without any replacement plan would trigger a financial, medical, and public health crisis.”
She continued, “By simply repealing the ACA and abdicating their responsibility to consumers, Senators would be causing the same problems they had with their replacement plan — millions uninsured, skyrocketing premiums, market instability and no protections for those with preexisting conditions are only the beginning of these disastrous consequences.”
Florida has plenty at stake. It leads all states using the federal health marketplace with about 1.5 million customers, and has 4 million served by Medicaid. Millions more Floridians in employer plans could also be potentially affected by repealing ACA rules, such as banning insurers from imposing annual and lifetime caps on benefits, requiring essential benefits like emergency, drug and maternity coverage, and other provisions.
Trump said in another tweet, “We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!”
Florida Gov. Rick Scott said he is heading to Washington this week to stick up for taxpayers at risk of getting overlooked in the obsessive focus on millions who could lose health care or get charged more.
That’s good news for taxpayers making more than $200,000 a year, who risk being denied major tax cuts if the GOP House and Senate fail to agree on an Obamacare overhaul.
“There seems to be a lot of people advocating for more government and higher costs in Washington and not a lot of people advocating on behalf of taxpayers,” Scott said in statement ahead of his trip. “I look forward to traveling to Washington to fight for Florida families and ensure there is a health care proposal that dismantles the terrible, expensive mess of Obamacare. Let’s remember, costs have skyrocketed under Obamacare and we need a new health care policy that allows patients to have access to quality healthcare at an affordable price.”
The House and Senate GOP plans differ on a few points, but agree on the basics of one thing: a $1 trillion tax cut for corporations and high earners, including individuals making more than $200,000 a year, or $250,000 a year for couples. Those taxes were imposed to pay for the Affordable Care Act.
Scott’s office said it did not have figures handy for how many Floridians would benefit.
Scott, a former hospital company executive, does not take his $130,273 annual state salary. He said he wants to create jobs and cut taxes for everybody, citing 55 tax cuts for $6.5 billion in his tenure by April.
Immediate tax cuts retroactive to the start of 2017 would affect those making $200,000 or more a year. More broadly, the long-term direction of Medicaid, a critical focus of Obamacare replacement efforts, affects a deeper base of taxpayers who support the program through state and U.S. taxes. Medicaid covers 4 million Floridians, including about half the childbirths, 70 percent of seniors in nursing homes and 41 percent of Palm Beach County’s children.
As U.S. Rep. Brian Mast, R-Palm City, has pointed out in town hall meetings, removing Obamacare’s tax penalty of $695 or more for not having health insurance would also represent a tax cut. That would provide a measure of relief for those who do not want coverage, hope they won’t need it or cannot afford it anyway. The decision by Florida’s GOP-led legislature not to expand Medicaid, to protect state taxpayers from having to pay a portion of those costs in later years, left about 800,000 residents unable to qualify for that program’s coverage. At the same, many don’t qualify for government help on the ACA marketplace because the subsidy plan tied to income levels assumed states would expand Medicaid.
The Congressional Budget Office projected 23 million fewer people would have health coverage in 2026 under the House bill compared to leaving current law intact. Younger, healthier and higher-income people could see their health costs fall over time, partly through tax credits, but older, sicker and lower-income people stand to pay more as they lose subsidies or insurers are allowed to charge them more, CBO found. People with pre-existing conditions could face “extremely high costs” in states allowed to waive Obamacare rules and put them in, for example, high-risk pools, the report said.
The Senate plan provides more subsidies to low-income people compared to the House bill, but at a reduced level compared to Obamacare, and makes deeper long-term cuts to Medicaid. Supporters say it protects people with pre-existing conditions, though advocacy group Consumers Union warned it could let insurers put annual and lifetime caps on benefits, posing a threat to people with illnesses that are costly to treat.
CBO expects to post its analysis of the Senate bill early this week on its website.
Though several GOP senators have said they can’t support it without changes, Senate leaders have said they hope to see the plan come to a vote as early as this week.
Obamacare’s subsidies tied to income mean that about nine out of 10 of the roughly 1.5 million Floridians buying ACA marketplace plans pay an average premium of about $84 month. Because the subsidies rise with rate increases, that cost is not likely to change very much for them even though six insurers filed for a rate increase averaging about 17 percent for ACA market plans in Florida in 2018. Customers without subsidies feel the full impact.
Scott said he is going to Washington this week on a schedule whose details will be announced later.
“I would like to thank Sen. Mitch McConnell and the Senate Republicans for working to eliminate the high taxes, fees and unreasonable mandates of Obamacare,” Scott said. “I also want to thank President Trump for his commitment to repeal and replace Obamacare. I have been carefully reviewing the bill and next week, I will be traveling to Washington to meet with Congressional leaders to provide input on how we can make the bill better for Floridians.”
He highlighted some points he plans to make.
“First, all states must be treated equitably,” Scott said. “Florida taxpayers deserve the same treatment as every other state under the Medicaid program. Second, every American, including those with pre-existing conditions, should have the ability to buy any kind of insurance they want. This will drive down costs and give people the flexibility and power to determine what they want to buy.”
Instead, President Donald Trump has worked on getting a bill passed that would push 23 million people out of health insurance, according to the Congressional Budget Office. The AMA opposes the bill.
“There’s never been in my recollection a time when we talked about taking away insurance,” Gurman said. “We’re the richest country in the world. This is the place where we have the availability of tremendous medical care. We’ve just got to make it work for everybody, including the sickest and most vulnerable among us.”
Trump has said drug makers are “getting away with murder” but has not followed that up with major policy moves.
The Trump administration and House on Monday asked for another 90-day delay in a House lawsuit to block billions of dollars in Obamacare cost-sharing subsidies, but insurers repeated calls for greater certainty to stabilize 2018 health markets.
The court filing removed the possibility the administration would seek an immediate end to government funding that keeps costs down for lower-income consumers. The loss of such subsidies could cause insurers to bail out of Affordable Care Act markets in 2018 or raise premiums by double digits, and up to 25 percent in Florida, the Kaiser Family Foundation calculated.
But continued uncertainty about 2018 could achieve much the same effect. Insurers say they still need to know what rates to file for 2018 by June 21, and the cost-sharing money is a critical part of the equation.
“We need swift action and long-term certainty on this critical program,” said Cathryn Donaldson, director of communications for America’s Health Insurance Plans. “It is the single most destabilizing factor in the individual market, and millions of Americans could soon feel the impact of fewer choices, higher costs, and reduced access to care.”
The delay in the court case buys another 90 days until the next filing is required. Meanwhile, the Senate is considering its own version of a massive overhaul of Obamacare that the House passed, the American Health Care Act.
As a bargaining chip with Democrats, President Trump has threatened to end the subsidies that reduce co-pays and deductibles for lower-income consumers. The subsidies are expected to total about $10 billion in 2018.
Among people 18 to 64, the state’s uninsured rate climbed to 20 percent, up from 18.7 percent in 2015.
Florida rejected Medicaid expansion under the Affordable Care Act, shunning an option that lowered uninsured rates in many other states. State Republican leaders called it too expensive.
A big part of the political calculus heading toward 2018 elections: Whether voters blame Democrat-designed Obamacare or GOP stewardship for any perceived problems. Town hall meetings certainly show how prickly the issue can get.
President Trump backed legislation the House passed that rolls back close to $1 trillion in taxes. Congressional Budget Office analysts say the bill could lower costs for healthier, younger and higher-income people, but it is projected to raise costs for older, sicker and lower-income folks and push more Americans out of coverage — up to 24 million. Revised CBO projections could arrive next week, but it’s in the Senate’s hands now.
Florida’s Republican Gov. Rick Scott, urged by President Trump to run against Democrat Bill Nelson for a 2018 U.S. Senate seat, responded through a spokeswoman to a request for comment from The Palm Beach Post.
“As someone who grew up without access to healthcare, Gov. Scott knows firsthand how important improving access is to people across the state,” press secretary Lauren Schenone said. “The Governor has not gone line by line on the current bill but he believes Congress cannot give up on getting rid of Obamacare and is encouraged that something is being done.”
Scott supported increased flexibility in the House bill to let states have greater control over how they spend federal health dollars. In addition, Florida successfully lobbied the Trump administration for almost $1 billion in increased “Low Income Pool” money to help cover vulnerable people.
But supporters of the 2010 Affordable Care Act said the latest numbers highlight the stark choices facing the country now. They show 20 million more Americans gained coverage since the ACA passed. Florida led the nation in people using the federal marketplace to buy policies, more than 1.5 million.
“That means, when Donald Trump was elected, more Americans had health insurance than ever before,” said Ben Wakana, former health spokesman in the Obama administration. “There’s no reason for us to go backward — but unfortunately there’s a big risk that we will, due to Republicans’ relentless repeal drive and Trump’s sabotage of the health care system. Your move, Mr. Trump.”
As of Tuesday night, Trump, occupied by other things, had not tweeted about health since May 7, when he urged the Senate to take up the bill the House passed: “Republican Senators will not let the American people down! ObamaCare premiums and deductibles are way up – it was a lie and it is dead!”
Even before the Senate has acted, the Trump administration’s Centers for Medicare and Medicaid Services released new information Tuesday that it said would help states seek waivers from requirements in the Affordable Care Act. The ACA already allows some waivers, and more changes could come under proposed legislation.
“CMS is helping to provide guidance to states who want to pursue solutions to help lower costs and increase coverage choices for Americans struggling with unaffordable premiums and reduced competition in the insurance market, brought on by the ACA,” the release said.
Opponents say Trump’s own threats to withhold key Obamacare funding, such as billions in “cost sharing” dollars to lower what consumers pay, are helping bring about reduced competition, bolting insurers and rising premiums. The top Democrat in the Senate, Chuck Schumer, called such tactics a “gambit to hold hostage health care for millions of Americans.”
Florida’s numbers reflect its “coverage gap,” said Joseph F. Pennisi, executive director of the Florida Policy Institute, which calls itself a “common-sense” nonprofit think tank promoting general prosperity based in Lake Mary.
“There are more than 500,000 Floridians in this category, because they make too much money to qualify under Florida’s extremely restrictive Medicaid income standards (for a family of four, the adults must have an annual income of less than $7,000 to be eligible) but too little to qualify for subsidies in the federal marketplace,” Pennisi said by email. “There is a dramatic difference in uninsured rates between states that expanded Medicaid and non-expansion states. Florida could see a major reduction in its uninsured rate if it expands coverage.”
He continued, “Florida made some gains in terms of the percentage of insured residents thanks to the ACA. However, that’s being threatened now by the American Health Care Act, which would result in millions of people across the U.S. losing coverage.”
Speaker Paul Ryan on Monday promoted “choice and competition” he said will be fostered by the GOP House overhaul of Obamacare, but a West Palm Beach congresswoman warned of deadly consequences for people needing help from opioid addiction, mental illness and pre-existing health conditions.
“The problem is the states are not going to have enough money to fund a better system,” said U.S. Rep. Lois Frankel, D-West Palm Beach. “This bill is going to kill a lot of people.”
Just last week Florida Gov. Rick Scott recognized a statewide emergency with the opioid epidemic, she noted.
U.S. Health and Human Services Secretary Tom Price said the American Health Care Act does not permit health insurers to deny coverage to people with pre-existing conditions, though it can charge them 30 percent more if they do not maintain continuous coverage.
On NBC’s “Meet The Press” Sunday, Price responded to critics: “What I believe they are not recognizing is this is a different and we believe better way” to cover individuals with pre-existing conditions or injuries.
The bill provides about $138 billion over 10 years to help states if they choose to set up “high risk pools” to cover people with pre-existing conditions, but many analysts said that likely will not be nearly enough.
The issue is not just being able to get a policy, but at what cost, said Brent Schillinger, a medical consultant on the board of Florida CHAIN (Community Health Action Information Network).
It does little good “if the premium, or the co-pays and deductibles, are so high you cannot afford it,” Schillinger said.
The bill, which awaits consideration by the Senate, is really designed to fund a roughly $1 trillion tax cut for companies and wealthy people, Democrats in Congress say. The original March version of the bill would push 24 million people out of insurance coverage, the Congressional Budget Office found. A score on the revised bill is expected as early as this week.
Local representatives from groups including the National Alliance on Mental Illness, The American Heart Association and the Leukemia & Lymphoma Society attended Monday’s gathering near St. Mary’s Medical Center in West Palm Beach.
Younger, healthier and higher-income people could save money under the House bill, which eliminates Obamacare taxes and subsidies, replaces them with tax credits from $2,000 to $4,000 available to a broader range of income levels, and allows states to let insurers offer less comprehensive plans.
“Obamacare is collapsing,” Ryan tweeted Monday. “This bill brings back choice and competition in our health care system.”
Update 2:17 p.m.: House gets to 216 votes to pass American Health Care Act, for a final tally of 217-213. Now it goes to the Senate.
Update 1:50 p.m.: House Speaker Paul Ryan said the House cannot fail to act with insurers pulling out of states including Iowa and Virginia.
“We will not falter,” Ryan said. “We will replace. Today is the day we’re going to do this.”
Original post: Freedom Caucus Chairman Mark Meadows predicted Thursday morning the GOP plan to overhaul Obamacare will pass later in the day “by a very narrow margin,” while opposing groups including AARP said it will make coverage unaffordable for millions.
The revised American Health Care Act has not been scored by the Congressional Budget Office, but Rep. Meadows, R-N.C., told CNN it will “drive premiums down” for many people. The original plan would have pushed 24 million out of coverage, CBO projected, but Meadows said numbers in the revised bill could look “more attractive,” though the House is not waiting for them before voting.
Senior advocacy organization AARP warned before the vote that people with pre-existing conditions, including 3.1 million in Florida, could face additional costs of up to $25,000 or more a year in high-risk pools, based on past experience.
In addition, people 50 to 64 on lower incomes could pay up to $13,000 more each year in premiums and deductibles in what AARP officials call an age tax.
“These are unaffordable amounts,” AARP legislative policy director David Certner said in a conference call Thursday.
About 454,000 Floridians ages 50 to 64 enrolled and receiving tax credits in the Affordable Care Act marketplace stand to see higher health-coverage premiums than they pay under current law, AARP officials have said. That’s more than any other state.
The bill would let states allow insurers to charge older and sicker people more and offer less comprehensive plans, potentially bringing down costs for healthier, younger and higher-income people.
Under the ACA, Florida receives the most money of any state, $5.2 billion, in federal subsidies to make premiums more affordable for lower-income consumers, the Kaiser Family Foundation calculated.
AARP officials said Thursday an additional $8 billion over five years for high-risk pools included in the latest version falls well short of a filling a need they say studies put at more than $100 billion.
On the floor, House Democrats blasted the original plan in March as a $1 trillion tax cut for corporations and the wealthy dressed up like a health care bill.
Democratic leader Nancy Pelosi, speaking on the House floor Thursday, said, “Forcing the vote without a CBO score shows the Republicans are afraid of the facts.”
Late-night comedian Jimmy Kimmel tearfully spoke of his son’s heart surgery and asked Congress not to raise costs on sick people, rousing Obamacare supporters and irking backers of a proposed GOP health overhaul — with one calling it “cheap.”
On Wednesday, American Medical Association president Andrew W. Gurman said that Florida’s 3.1 million people with pre-existing conditions could find themselves priced out of coverage under the latest proposal.
Proposals such as letting states allow insurers to charge sick people more in “high-risk pools” darken the picture for millions in Florida who have heart problems, diabetes and other conditions, he said.
“These people, our family members neighbors and friends, would take a huge step backwards,” Gurman said.
Kimmel recounted on the air how heart surgery saved his young son’s life, and he urged legislators not to take away protections that make covering costly illness more affordable for families who don’t have the resources he does.
“If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make,” he said. “I think that’s something that whether you’re a Republican or a Democrat or something else, we all agree on that, right?”
“I thought it was cheap,” Lewis began. “As a father, I can understand, I can try to understand. President Obama said being a dad and having a child is like having your heart living outside your body. So I completely understand where Jimmy Kimmel is coming from, the passion I think is sincere. I don’t think that this is the right move for him to do to politicize this. This is a guy who is incredibly rich, of course, he’s not going to have a problem.”
Discussions about boosting proposed federal support by an extra $8 billion to help states with high-risk pools still don’t resolve fundamental issues with the House GOP’s American Health Care Act, Gurman said. The Congressional Budget Office projected it would push 24 million people out of health insurance. In addition, many people, such as those 50 to 64 with lower incomes, could pay thousands more each year in premiums and co-pays under the plan.
“These changes could make coverage completely unaffordable for people with pre-existing conditions,” Gurman said.
Proponents say it would lower premiums for many healthy people.
The latest plan has “much lower premiums & deductibles while at the same time taking care of pre-existing conditions!” President Trump tweeted Sunday.
The latest version of a proposed GOP Obamacare overhaul is winning praise from low-tax, small-government advocates for its potential to lower costs for healthy people, but older consumers and those with pre-existing conditions in places like Florida fear it is a nightmare in the making.
A South Florida breast cancer survivor said Wednesday she would find it “devastating” to be forced out of coverage she now considers affordable and into a potentially much more costly option, such as a high-risk pool, under the revised GOP House plan.
“I can’t imagine being put in a high-risk pool because I can’t afford it basically,” said Stella Mariani-Gonzalez, 62, of Miami.
She described herself on a conference call organized by senior advocacy organization AARP as a self-employed cancer survivor who currently receives coverage through a policy on the Affordable Care Act exchange.
Back in 2001, long before the ACA passed, she said her scaled-back insurance plan paid for only a handful of chemo treatments. She was forced to pay out of pocket and go hundreds of thousands of dollars in debt until she reached the point where she was indigent and could be covered by Medicaid, she said.
“My insurance was pretty much useless,” she said.
States could opt out of certain Obamacare requirements under an amendment to the GOP House replacement plan, the American Health Care Act, by U.S. Reps. Tom MacArthur, R-N.J., and Mark Meadows, R-N.C.
Under the plan, states could let insurers offer skinnier plans that don’t necessarily include things like preventive care, maternity or drug benefits. People with pre-existing conditions could be charged more if the state sets up a separate arrangement for them, such as a high-risk pool.
Whether and when that will win consensus House GOP support — let alone buy-in from Democrats or Senate approval — remains to be seen. A House plan with 17 percent support in polls collapsed in March.
But supporters of the revised proposal including the small-government advocacy group FreedomWorks say it brings the prospect of lower costs for healthy people. President Adam Brandon said the latest version provides “states with much-needed flexibility to stabilize the market, enroll more people in health plans, and bring down the cost of premiums.”
Yet it means many older and lower-income people and those at higher risk for illness could be effectively priced out of affordable coverage, AARP officials said.
A state could let insurers sell health coverage that “charged different prices and offered different benefits for people who had pre-existing conditions, such as cancer survivors, people who have survived heart attacks or strokes, people with diabetes and other health conditions,” an AARP statement said.
About 43 percent of Americans ages 50 to 64 who don’t have insurance through an employer or Medicaid have such a pre-existing condition, the group figures.
High-risk pools in most U.S. states have “functioned poorly in the past, providing inadequate coverage at exceptionally high prices,” AARP said. As of 2011, Florida’s own high-risk pool covered only two hundredths of one percent of Floridians in the non-group insurance market , the lowest percentage of any of the 35 states that offered high-risk pools then, officials said.
Because of changes to government subsidies that bring down consumer costs, many older residents were already facing staggering cost increases under the original replacement plan, AARP warned.
For example, a 64-year-old in Palm Beach County with income of $15,000 would have to pay $11,195 more per year by 2026 in insurance premiums, the AARP Public Policy Institute calculated.