What are your main concerns with the House Republican healthcare plan?

[Blue3]

Just reading summaries of it so far, the biggest things that stand out to me are

1. Phasing-out federal support for Medicaid expansion by 2020
(this should be moving in the opposite direction)

2. Phasing-out ALL Medicaid also seems to be the plan, by creating a per-capita limit, not adjusted for inflation. That's brand-new. This definitely has Paul Ryan's fingerprints all over it.

3. Tax-credits (from $2000-$4000) are distributed according to age... not according to income, or higher insurance costs due to pre-existing conditions, which seems rather stupid. So "technically" they can't deny you insurance if you have a pre-existing condition but they can make sure you don't have enough money to pay for the treatments you need.



There's also some things I've heard about how repealing some protections might mean people are technically "insured" but their insurance won't cover much or mean much.

Also, how there's a new premium increase if you're uninsured for more than 2 months (the new "individual mandate" in all but name), but with no exceptions, so you'd be penalized if you lose your job-based insurance and don't get another job within 2 months.

But I need to read more to be sure of those... or can someone here explain this?

[Hindsight was 2020]

That its horriblely thought out..........mainly because it's horriblely thought out

[Cashew]

My main concern is that it passes.

[Virginiá]

My main concern is they are going to really screw everything up even while knowing beforehand that they will screw everything up because they can't do a full repeal. The only lawmakers seemingly standing in the way (for now) of this bumbling mess is a small group of Republican Senators, some, maybe even most, probably only care because they fear a backlash come time for reelection.

[pbrower2a]

I may do without medical treatment until I am eligible for Medicare.

Bad as life can get under President Trump, death might solve all my problems. I have a condition that ensures that I cannot hold a well-paying job, one adequate for buying private for-profit medical insurance. Anxiety and depression have been norms of my existence.

[(Still) muted by Kalwejt until March 31]

That its horriblely thought out..........mainly because it's horriblely thought out

-Same. Obvious things aren't in there, stuff that should be removed is.

[Badger]

My main concern is that it passes.

[SteveRogers]

My main concern is that they've replaced each component of Obamacare with something they can sell to their base as "more conservative" without giving any thought at all to how these things will work together as a coherent scheme.

[Dr. Arch]

That its horriblely thought out..........mainly because it's horriblely thought out

-Same. Obvious things aren't in there, stuff that should be removed is.

[Trapsy]

costs and coverage.

[KingSweden]

I believe there is a health policy out there that is cost effective, portable and provides coverage to millions while adhering to free market ideas while avoiding Obamacare's pitfalls.

I do not believe that the GOP of 2017 is capable of crafting such a policy at this time.

Ideally, we'd do something like Germany, which has a private insurance rather than socialized system, but since crafting strong insurance rules is Nazism, or so I've been told for eight years, we obviously can't do that

[Deblano]

I believe there is a health policy out there that is cost effective, portable and provides coverage to millions while adhering to free market ideas while avoiding Obamacare's pitfalls.

I do not believe that the GOP of 2017 is capable of crafting such a policy at this time.

Ideally, we'd do something like Germany, which has a private insurance rather than socialized system, but since crafting strong insurance rules is Nazism, or so I've been told for eight years, we obviously can't do that

[Deblano]

It's pretty much a last-minute plan to back their words up with actions since all the GOP has been doing for 8 years is grandstanding over Obamacare.

[Torie]

ust reading summaries of it so far, the biggest things that stand out to me are

1. Phasing-out federal support for Medicaid expansion by 2020
(this should be moving in the opposite direction)

Yes, this is a problem. Caps not tied to need is itself a fiscal ticking time bomb, unless one is prepared to see over time the poor not have adequate health care, or return to the emergency rooms, after getting really sick.

2. Phasing-out ALL Medicaid also seems to be the plan, by creating a per-capita limit, not adjusted for inflation. That's brand-new. This definitely has Paul Ryan's fingerprints all over it.

See above.

3. Tax-credits (from $2000-$4000) are distributed according to age... not according to income, or higher insurance costs due to pre-existing conditions, which seems rather stupid. So "technically" they can't deny you insurance if you have a pre-existing condition but they can make sure you don't have enough money to pay for the treatments you need.

As you get older, insurance gets more expensive is the rationale, and makes sense. Also the tax credits are means tested, i.e. phased out as you income increases. So this aspect might work OK.

There's also some things I've heard about how repealing some protections might mean people are technically "insured" but their insurance won't cover much or mean much.

That is a detail that needs to be carefully examined. Is the tax credit enough to pay for adequate insurance for the impecunious, along with medicaid assistance? And do poor states get more medicaid assistance?

Also, how there's a new premium increase if you're uninsured for more than 2 months (the new "individual mandate" in all but name), but with no exceptions, so you'd be penalized if you lose your job-based insurance and don't get another job within 2 months.

The theory presumably is one would be able to buy individual insurance until one gets another job, with the financial assistance available. The devil is in the details of course.

I hope Muon2 joins this conversation. What do Mainstreet caucus type Pubs think of this, who think there needs to be an adequate social safety net?

[Torie]

Good questions/comments below, to which I respond in red.

ust reading summaries of it so far, the biggest things that stand out to me are

1. Phasing-out federal support for Medicaid expansion by 2020
(this should be moving in the opposite direction)

Yes, this is a problem. Caps not tied to need is itself a fiscal ticking time bomb, unless one is prepared to see over time the poor not have adequate health care, or return to the emergency rooms, after getting really sick.

2. Phasing-out ALL Medicaid also seems to be the plan, by creating a per-capita limit, not adjusted for inflation. That's brand-new. This definitely has Paul Ryan's fingerprints all over it.

See above.

3. Tax-credits (from $2000-$4000) are distributed according to age... not according to income, or higher insurance costs due to pre-existing conditions, which seems rather stupid. So "technically" they can't deny you insurance if you have a pre-existing condition but they can make sure you don't have enough money to pay for the treatments you need.

As you get older, insurance gets more expensive is the rationale, and makes sense. Also the tax credits are means tested, i.e. phased out as you income increases. So this aspect might work OK.

There's also some things I've heard about how repealing some protections might mean people are technically "insured" but their insurance won't cover much or mean much.

That is a detail that needs to be carefully examined. Is the tax credit enough to pay for adequate insurance for the impecunious, along with medicaid assistance? And do poor states get more medicaid assistance?

Also, how there's a new premium increase if you're uninsured for more than 2 months (the new "individual mandate" in all but name), but with no exceptions, so you'd be penalized if you lose your job-based insurance and don't get another job within 2 months.

The theory presumably is one would be able to buy individual insurance until one gets another job, with the financial assistance available. The devil is in the details of course.

I hope Muon2 joins this conversation. What do Mainstreet caucus type Pubs think of this, who think there needs to be an adequate social safety net?

[Chancellor Tanterterg]

The whole way this thing has been handled reminds me of Boris Johnson after Brexit.  I get the distinct sense the Republicans never actually expected to be in a position to repeal the ACA and are now hastily cobbling together some mess of a bill just b/c they've been promising to repeal Obamacare for so long rather than b/c anyone actually thinks doing so is a good idea.  I'm pretty disgusted that they're trying to take away health insurance from millions of people and are willing to cause so many needless deaths just for the sake of a pathetic attempt to save face that no one's even buying (remember kids, taking away poor people's healthcare b/c the dog finally caught the garbage truck is pro-life ).  My biggest concern is that there is no way a purely political bill hastily crafted under such absurd circumstances can be anything other than a disaster.  People are going to die easily avoidable deaths if this passes simply because the Republicans made a ridiculous promise in bad-faith and I have a serious problem with that on multiple levels.

[KingSweden]

The whole way this thing has been handled reminds me of Boris Johnson after Brexit.  I get the distinct sense the Republicans never actually expected to be in a position to repeal the ACA and are now hastily cobbling together some mess of a bill just b/c they've been promising to repeal Obamacare for so long rather than b/c anyone actually thinks doing so is a good idea.  I'm pretty disgusted that they're trying to take away health insurance from millions of people and are willing to cause so many needless deaths just for the sake of a pathetic attempt to save face that no one's even buying (remember kids, taking away poor people's healthcare b/c the dog finally caught the garbage truck is pro-life ).  My biggest concern is that there is no way a purely political bill hastily crafted under such absurd circumstances can be anything other than a disaster.  People are going to die easily avoidable deaths if this passes simply because the Republicans made a ridiculous promise in bad-faith and I have a serious problem with that on multiple levels.

Heh. I like this analogy. The dog that caught the car

[Absentee Voting Ghost of Ruin]

At this point, I'm worried by wanna-be dictator Pussygrabber's ravings about "getting rid of state lines" and "Pricing for the American people will come way down". I know what they should mean, but given that he's gone off the deep end, who knows what ill intent lurks behind his malignant tangerine countenance?

Is he going to sell us out, cheap, once he's destroyed state government? Normally I'd say that's ridiculous, and clearly not what he meant, but we are talking about a paranoid madman who thinks there's a Chinese plot to pretend to make the planet warmer, that his predecessor plotted against him (hint: if Obama had, Clinton would be president) and has trouble with basic math, science and economics.

[Averroës Nix]

The legislation doesn’t really deserve to be called a repeal and replace plan. It’s a large tax cut paired with substantial changes to Medicaid and a few alterations to the structure of the Affordable Care Act - chiefly to remove the mandate and revenue provisions - but the major elements of Obama’s reforms remain in place. For as long as the system holds up, at least.

There are good reasons to be worried about how this legislation will affect Medicaid programs, insurance coverage, and state and federal budgets. But those on the right who complain that this is merely “more of the same” are mostly correct.

The bill doesn’t change most of what of the ACA does, including its most popular and expensive provisions, including coverage for pre-existing conditions, guaranteed issue, capped out-of-pocket expenditures, coverage for adult children, the ban on health status underwriting. It also leaves intact all of the law's “health system” reforms that patients never experience firsthand - initiatives focused on value-based payments, electronic medical records, quality improvement, and so on.

Briefly, my worries are:

1. The removal of the ACA’s tax provisions, amounting to somewhere around $100b in lost revenue per year, will worsen the federal budget. We’ll see how the projections look and, much more importantly, what actually happens if it passes, but the spending cuts are definitely not sufficient to cover the loss of revenue.

2. The changes to Medicaid are very likely to cause severe budget problems for states and hospitals when they take effect. In the long run states will respond with large cuts to Medicaid that will inevitably increase the number of uninsured. This bill is extremely bad news for poorer/low revenue states that receive more federal dollars.

3. The changes to the structure of the ACA will probably damage the individual marketplaces and cause more insurers to pull out as average costs per enrollee continue to increase. In particular, replacing the mandate with a penalty for failing to maintain continuous coverage amounts to a lesser penalty for most people who go uncovered. This will discourage healthier people with lower costs from purchasing increasingly expensive coverage (i.e. adverse selection will cause a death spiral).

(Some defenders of the ACA insist that the insurance exchanges are fine as of now, but there are already substantial concerns among experts - see for example Uwe Reinhardt's comments in recent months. If you believe these experts, this will require a legislative fix within the next five years one way or the other.)

I recommend Aaron Caroll’s take here at the Incidental Economist blog for  more comprehensive outline that remains pretty accessible.

[Attorney General, LGC Speaker, and Former PPT Dwarven Dragon]

Removal of Medicaid Expansion
Requirement to maintain continuous coverage to avoid being discriminated against because of pre-existing conditions
May actually increase uninsured rate in the long term

I'm open to a replacement for ObamaCare, large scale modification of it, or even addition of the public option, as long as it:

1) affect Medicaid expansion
2) Is not likely to increase the uninsured rate in the short or long term
3) keeps private sector insurance intact

The GOP plan does not meet all of that criteria, so I will not support it.

[progressive85]

I have no concerns.  It's a great plan - for the Opposition.  There's about 25 Republicans in the House who should vote for it (:

[Blue3]

So, what parts of this are most likely to go, if it's to pass?

I think they need to really scale back how much they touch Medicaid, if at all. That's probably where most of the CBO's "24 million will lose insurance" comes from (I haven't read the report, so anyone who has, feel free to confirm or deny this part).

Also should get rid of the penalty where you're charged if you lose your job and don't get a new one within 2 months.


(they should include more than just age as a factor when it comes to the tax credits (such as income level, and healthcare costs due to preexisting conditions)... but I doubt that will happen)

[Middle-aged Europe]

That people could die.

[Classic Conservative]

Ending the Medicaid expansion.