My colleague Avik Roy has suggested that passing a full Obamacare replacement (as opposed to a partial replacement passed via reconciliation) might be possible even though it would require Democratic votes to obtain the 60-vote threshold in the Senate, and that a pre-condition to achieving that would require the Congressional Budget Office (CBO) score the replacement as covering at least as many people as the Obamacare does.
As if to give a warning shot across the Republican bow, the officially non-partisan CBO warned that it “would not count those people with limited health benefits as having coverage” when evaluating changes to the health care law, and that changes to the “essential health benefits” required under the ACA could result in people receiving tax credits to help pay for health insurance under a new law, but being counted as not having health insurance according to the CBO, if the coverage they have doesn’t meet the CBO’s requirements. At issue, basically, is “What is health insurance?”
. . .
As Congress readies legislation to repeal and replace the Affordable Care Act (ACA), Congressional Budget Office (CBO) estimates will play an important and respected role as they did in the passage of the law in 2010. We now know that many of CBO’s projections of important aspects of the ACA have significantly differed from actual outcomes. In this piece, I highlight CBO’s key past errors in projecting effects of the ACA. They can largely be grouped into two categories. First, CBO projected that the exchanges would be stable by now with more than twice as many enrollees as they currently have, rather than suffering from severe adverse selection in most states as they now are. Second, CBO projected that the ACA Medicaid expansion would be much smaller and less expensive than it has turned out to be.
. . .
AEI’s Improving Health And Health Care Plan, developed by a group of scholars affiliated with the American Enterprise Institute and released on December 9, 2015, only partially repeals Obamacare. The replacement consists of three broad components:
1. Private Health Insurance Reform. This would consist of 4 parts:
- Age-Adjusted Tax Credits. Obamacare’s income-related subsidies are replaced with less expensive advanceable and refundable tax credits that vary only by age (0-17, 18 to 34, 35 to 49, and 50 and over).
- Automatic Enrollment. Any household that does not take the tax credit they receive and purchase insurance of their choice will automatically be enrolled in a catastrophic plan equal to the value of the credit for which that household is eligible. States have the option to decline to implement default enrollment.
- Capped Tax Exclusion. The long-standing tax exclusion for employer-provided health insurance coverage is retained, but the ACA’s Cadillac tax is replaced by a functionally-equivalent cap on the amount of the exclusion ($8,000 for single and $20,000 for family coverage).
- Expanded Use of Health Savings Accounts. All households become eligible to open an HSA account regardless of enrolled health plan. Those that open an HSA can make tax preferred contributions of up to $2,000 for individuals and $4,000 for families. Beneficiaries enrolled in HDHPs would be allowed to make contributions up to the allowable amounts under current law in addition to the $2,000/$4,000 contributions allowed for all. As well, a one-time HSA credit for up to $1,000 for those that are enrolled in an HSA-compatible plan in 2017.
Read more . . .
The Alternative to Obamacare, originally developed by Jeffrey Anderson and released by the 2017 Project as A Winning Alternative to Obamacare, first released on February 10, 2014, starts by fully repealing Obamacare. The replacement consists of three major components:
- Obamacare’s income-related subsidies are replaced with less expensive tax credits that vary only by age (0-17, 18-34, 35-49 and 50-64).
- The long-standing tax exclusion for employer-provided health insurance coverage is retained, but the ACA’s Cadillac tax is replaced by a functionally-equivalent cap on the amount of the exclusion (set at the 75th percentile of annual employer sponsored insurance premiums); workers in firms with fewer than 50 full-time-equivalent workers would be allowed to purchase non-group coverage with tax credits.
- Annual contribution limits for health savings accounts are increased to $6,250 for individuals and $12,500 for families. As well, enrollees in health savings accounts are eligible to receive a one-time, refundable tax credit of $1,000 to be deposited directly into the account.
The Patient CARE Act, introduced on February 4, 2015 and sponsored by Senators Burr (R-NC) and Hatch (R-UT) and Rep. Fred Upton (R-MI), starts by fully repealing Obamacare “except for the changes to Medicare”. The replacement consists of three major components:
- Medicaid is reformed by imposing a capped per-beneficiary allotment adjusted for inflation (a less stringent form of block-granting Medicaid insofar as it automatically adjusts for changes in the number of Medicaid eligibles);
- Obamacare’s income-related subsidies are replaced with less expensive tax credits that vary by age, family status and income (disappearing above 300 percent of federal poverty level).
- The long-standing tax exclusion for employer-provided health insurance coverage is retained, but the ACA’s Cadillac tax is replaced by a functionally-equivalent cap on the amount of the exclusion ($12,000 for single and $30,000 for family coverage); workers in firms with fewer than 100+ workers would be allowed to purchase non-group coverage with tax credits.
Congress often waits for a new president to take office before it gets down to business. This year, Republicans will drop that custom in their dash to scrap the Affordable Care Act.
Within hours of the new Congress convening on Tuesday, the House plans to adopt a package of rules to clear the way for repealing the health care law and replacing it with as-yet-unspecified measures meant to help people obtain insurance coverage.
Then, in the week of Jan. 9, according to a likely timetable sketched out by Representative Greg Walden, Republican of Oregon, the House will vote on a budget blueprint, which is expected to call for the repeal of the Affordable Care Act.
. . .
Democrats are warning that once ObamaCare is repealed, people with serious illnesses won’t be able to get health insurance. President Obama says repeal will mean going “back to discriminating against Americans with pre-existing conditions.”
That’s fake news.
The truth is, all Republican proposals to repeal and replace the Affordable Care Act protect people with pre-existing conditions.
Likewise, they all eliminate ObamaCare’s invidious discrimination against healthy people. ObamaCare forces the healthy to pay the same premiums as the chronically ill, whose medical costs run 10 times as high. That’s because a mere 5 percent of the population consumes half the nation’s health care.
. . .
President Barack Obama will head to Capitol Hill Wednesday to meet with congressional Democrats about how to shield Obamacare from Republican efforts to dismantle it, a Capitol Hill source told POLITICO.
The meeting is at 9 a.m. in the Congressional Visitors Center auditorium and is for both House and Senate Democrats, according to a notice sent to members Friday morning.
With Republican vowing to begin repealing Obamacare almost immediately when the 115th Congress convenes next week, Democratic lawmakers are immersed in strategy sessions on how to protect the nearly seven-year-old health care law.
Republican leaders in Congress and the incoming Trump administration have said that they plan to move quickly to repeal the Affordable Care Act (ACA) in the early weeks of 2017, with a delay in the date of when key aspects of the repeal would become effective until perhaps 2019 or 2020. This is the so-called “repeal and delay” option. They have also pledged to replace the law in separate legislation, or a series of bills, that would come later, although it is not clear what the replacement would look like or when it would pass.
We do not support this approach to repealing and replacing the ACA because it carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services, and because it is unlikely to produce a coherent reform of health care in the United States. The most likely end result of “repeal and delay” would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services.
. . .
Medicaid has grown in size in recent years, with ObamaCare extending coverage to millions of low-income people who hadn’t qualified before. But Republicans warn of the program’s growing costs and have pushed to provide that money to states in the form of block grants — an idea President-elect Donald Trump endorsed during the campaign.
Vice President-elect Mike Pence signaled in an interview with ABC this month that the incoming administration planned to keep Medicare as it is, while looking at ways to change Medicaid.
“I think President-elect Trump made it very clear in the course of the campaign that, as president, we’re going to keep our promises in Social Security and Medicare,” Pence told ABC. “With regard to Medicaid, though, I will tell you, there’s a real opportunity, there’s a real opportunity as we repeal and replace ObamaCare to do exactly what the president-elect also said on the campaign, and that is block granting Medicaid back to the states.”
. . .