Health Act Repeal Threatens to Strike Economy’s Engine

Health Act Repeal Threatens to Strike Economy’s Engine

Three are hospitals.
The outsize economic role of the American health care industry heightens the risks posed by the Republicans’ effort in Washington to repeal the Affordable Care Act, enacted in 2010 under President Barack Obama, and it comes at a delicate moment for the broader economy.
“Reversing Obamacare is negative for the economy in the next year or two.” The cost of providing coverage to millions more Americans has its own economic consequences.
Health care now accounts for nearly a one-fifth of overall consumer spending.
Oscar Onteveros, 37, began working as a nursing assistant at the Los Angeles County-University of Southern California Medical Center three years ago, after working for years in factories and in temporary jobs.
The overall industry has benefited from the strong economy and the coverage expansions under Medicaid, he said.
About 20 million people gained coverage under the federal health care law.
Like other executives, Dr. Boutrous argues that health system groups need to find ways of reducing the overall cost of care.
“What’s been missing is what makes health care so expensive in this country,” he said.
But Mr. Gragnolati also worried about the health bill’s potential effects on patients, some of whom have gained access to care for the first time.

Pre-Existing Condition? Your Insurance Could Cost Up to $140,000 More Under the AHCA

Pre-Existing Condition? Your Insurance Could Cost Up to $140,000 More Under the AHCA

Pre-Existing Condition?
Your Insurance Could Cost Up to $140,000 More Under the AHCA.
Insurance premiums for people with pre-existing conditions could increase by hundreds of thousands of dollars if the American Health Care Act, which passed the House Thursday, becomes law in its current form.
The AHCA allows insurers in states that offer a high-risk pool option to charge people with pre-existing conditions more for insurance if the patients do not maintain continuous coverage.
But if the Senate keeps the waiver provision of the AHCA, cancer patients could see premium surcharges as high as $142,650, according to a report from the liberal Center for American Progress.
The CAP report estimates premium surcharges for conditions for a 40-year old with various ailments compared to a healthy 40-year-old, based on data from the Centers for Medicare and Medicaid Services.
The study finds that “individuals with even relatively mild pre-existing conditions would pay thousands of dollars above standard rates to obtain coverage.”
For those with serious medical conditions, the costs are exorbitantly higher.
Here are some of the other surcharges, based on CAP’s report: Condition Surcharge as a share of standard premium Surcharge in dollars Metastatic cancer 3,500% $142,650 Lung, brain, and other severe cancers 1,790% $72,980 Colorectal, breast, kidney, and other cancers 703% $28,660 Diabetes without complication 137% $5,600 Rheumatoid arthritis and specified autoimmune disorders 652% $26,580 Major depressive and bipolar disorders 208% $8,490 Drug dependence 502% $20,450 Autistic Disorder 135% $5,510 Seizure disorders and convulsions 179% $7,300 Congestive heart failure 459% $18,720 Asthma 106% $4,340 Stage 4 chronic kidney disease 286% $11,650 Completed pregnancy with no or minor complications 425% $17,320 It’s important to note that the AHCA still bans basing premiums on gender and occupation, so pregnancy may not be considered a pre-existing condition, though that is unclear.
But the underlying message remains: If the ACA’s protections for people with pre-existing conditions are scrapped in the GOP’s health bill, sick people in the individual market will pay much, much more for health insurance.

5 Things to Know About AHCA, the New House Republican Health Care Bill That Just Passed

5 Things to Know About AHCA, the New House Republican Health Care Bill That Just Passed

Essential Health Benefits Could Disappear Obamacare created a list of 10 essential health benefits that health plans must offer, including maternity care and mental health care, which were routinely excluded from pre-Obamacare policies on the individual market.
The amended American Health Care Act would allow states to apply for a waiver to define their own essential health benefits starting in 2020.
Another concern is that, without essential health benefits, coverage for pre-existing conditions becomes meaningless.
Medicaid Would be Cut The American Health Care Act would radically change Medicaid, by phasing out the Obamacare Medicaid expansion that extended health coverage to more than 10 million lower-income Americans.
The American Health Care Act would slash federal Medicaid spending by about $840 billion over 10 years, according to CBO projections.
Obamacare levied certain taxes on the wealthy to help fund the premium subsidies that help make insurance more affordable for the 85% of the people on the individual marketplace who receive them.
These high-risk pools are intended to help bring down costs for sick people, but a recent report from the AARP found that premiums could exceed $25,000 per year for people in these pools, pricing many people out.
This is the age breakdown for subsidies: 30 and Under: $2,000 per year 30 to 40: $2,500 per year 40 to 50: $3,000 per year 50 to 60: $3,500 per year 60 and Over: $4,000 per year Compared to the ACA’s credits, this structure benefits young healthy people, while hurting older people as well as sick young people.
Meanwhile, the difference in subsidies would mean that the consumer pays just $1,700 out-of-pocket for premiums under Obamacare, versus $14,600 under the American Health Care Act.
The waivers for pre-existing conditions and essential health benefits would also disproportionately affect women: things like maternity and newborn care could be on the chopping block, as well as birth control coverage.

No One Knows Exactly How Trumpcare Would Work

No One Knows Exactly How Trumpcare Would Work

The first amendment, negotiated by Republicans Tom MacArthur of New Jersey and Mark Meadows of North Carolina, on behalf of the conservative Freedom Caucus, would allow states to opt-out of a Obamacare provision requiring insurers to charge everyone the same amount for health insurance.
So that means that if your kid has leukemia, you’ll still be able to get insurance, but it could cost you, say, hundreds of thousands of dollars per year.
That same MacArthur-Meadows amendment also allows states to opt-out of another, different Obamacare provision.
That one requires insurers to offer health plans covering ten basic “essential health benefits.”
As a Wall Street Journal story pointed out, if any state opts-out of covering essential health benefits, hundreds of millions of Americans could see their benefits shrink.
Back in 2011, the Obama Administration announced that employers should interpret an obscure sentence in the Affordable Care Act to mean that they can offer employees the required benefits from any state where they operate.
If any state—even just one!—opts out of Obamacare’s 10 essential benefits requirement, then large employers anywhere can use that state as their benchmark.
That leads us to the second major amendment in this version of the House Republicans’ “repeal and replace” bill, which was negotiated by Michigan Republican Fred Upton.
The logic bgoes like this: if people with pre-existing conditions are priced-out of private health plans, they can petition to be accepted to special, state-run insurance pools—those are the “high risk pools”—for the sickest of the sick.
But most conservative estimates say high risk pools will cost about $25 to $35 billion dollars a year.

The House Will Vote on the Republican Obamacare Repeal Bill on Thursday

The House Will Vote on the Republican Obamacare Repeal Bill on Thursday

The House Will Vote on the Republican Obamacare Repeal Bill on Thursday.
(WASHINGTON) — In a startling turnabout, Republicans say they are ready to push their prized health care bill through the House and claim a victory for President Donald Trump, six weeks after nearly leaving it for dead and days after support from GOP moderates seemed to crumble anew.
In a final tweak, leaders were adding a modest pool of money to help people with pre-existing medical conditions afford coverage, a concern that caused a near-fatal rebellion among Republicans in recent days.
The House passed that legislation Wednesday 309-118, and Senate passage seemed certain as early as Thursday.
Just Tuesday, The Associated Press had counted 21 Republicans saying they would oppose the bill — one short of the 22 defections that would kill it if all Democrats voted no.
House approval would edge Republicans closer to repealing much of President Barack Obama’s health care law, which would represent at least partial redemption of campaign pledges by GOP candidates — including Trump — since its enactment in 2010.
But states could get federal waivers freeing insurers from other Obama coverage requirements.
Obama’s overhaul has extended health insurance to around 20 million Americans.
That office also said the bill’s subsidies would be less generous for many, especially lower-earning and older people not yet 65 and qualifying for Medicare.
House Speaker Paul Ryan, R-Wis., pulled the plug on a March 24 vote as conservatives opposed the bill for not fully repealing Obama’s law and GOP moderates considered its cuts too severe.

Fewer are hungry; but for those who are, the struggle is worse

Fewer are hungry; but for those who are, the struggle is worse

The gap between how much these folks earn and what they need to survive — the so-called “food budget shortfall” — is growing, the Chicago-based non-profit Feeding America said.
It suggests that though fewer people are facing hunger, those who are struggle more these days to make ends meet.
Ironically, the group says in a report out Thursday, many of these families actually now earn too much to qualify for federal nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP), known widely as food stamps, and free and reduced-priced school lunch programs.
About one in four people surveyed said they’ve tried but can’t qualify for food stamps for their family or free and reduced-price school meals for their kids.
Currently, a family of four must earn about $24,000 a year or less to qualify for food stamps.
In its annual report, Feeding America said that in nearly every county in the U.S., children are at a higher risk of “food insecurity” than others: about one in five children are food-insecure, compared with 14% across all age groups.
In 14 counties, more than 100,000 children don’t always know where their next meal is coming from.
In every county and congressional district, far too many Americans are having a difficult time trying to feed themselves and their families.” The U.S. Department of Agriculture (USDA) defines food insecurity as any instance in which someone reports having to eat poor-quality food or, in worse situations, reports “multiple indications of disrupted eating patterns” and eating less than necessary.
Aviv said the findings underscore the need for federal nutrition programs, particularly SNAP, and for charitable food assistance such as food banks.
Follow Greg Toppo on Twitter: @gtoppo

How the Republican Health Care Bill Changed Since They Last Tried to Pass It

How the Republican Health Care Bill Changed Since They Last Tried to Pass It

Most people who rely on Obamacare subsidies would have seen their subsidies dramatically reduced.
Conservatives Republicans said it didn’t do enough to lower premiums and repeal regulations, and moderate Republicans said it would hurt too many people who had benefited from Medicaid and the Obamacare premiums.
The MacArthur Amendment It seemed at the start of April that Republicans had defeated their own effort to repeal Obamacare.
The so-called MacArthur Amendment said that insurance companies would still be required to cover people with pre-existing conditions; only now, they could charge them higher premiums.
In order to protect those with pre-existing conditions in states that opt-out of the Obamacare rule, there would be a “high-risk pool” to help cover individuals, backed up by federal funds.
Nonetheless, in the last week of April, the MacArthur Amendment helped swing most of the near-40-member House Freedom Caucus to support the bill.
The Upton Amendment Still, however, there were numerous moderate Republicans who opposed the bill.
Still, the $8 billion will likely not be enough to cover shortfalls in the high-risk pools.
“It’s still the underlying policy,” said Rep. Ryan Costello, a moderate Republican who opposes the bill.
Now there is talk about a vote this week, before the bill can get a score from the Congressional Budget Office, as is customary.

2 Republican Holdouts Say They’ll Support the GOP’s Health Care Bill

2 Republican Holdouts Say They’ll Support the GOP’s Health Care Bill

2 Republican Holdouts Say They’ll Support the GOP’s Health Care Bill.
(WASHINGTON) — A pair of moderate Republicans who’d been holdouts against the GOP health care bill said Wednesday they were now backing the high-profile legislation after winning President Donald Trump’s support for their proposal aimed at reviving the languishing measure.
Upton said he believed the long-stalled measure was likely to pass, though it was unclear initially exactly how many votes the new revision would win over.
For weeks, House leaders have lacked the votes for their drive to repeal much of President Barack Obama’s health care law, especially among moderate Republicans.
Like many moderates, Upton and Long had expressed concerns that the GOP bill weakened protections under Obama’s law that prevent insurers from charging people with pre-existing conditions higher premiums.
Before the White House meeting, House Speaker Paul Ryan praised the proposal and said the GOP was getting “extremely close” to finally being able to pass the stalled legislation.
The existing health care measure would let states get federal waivers allowing insurers to charge higher premiums to people with pre-existing illnesses who’d let their coverage lapse.
To get the waiver, the state must have a high-risk pool or another mechanism to help such people afford a policy.
The money in Upton’s plan would help people with pre-existing illnesses pay premiums in states where insurers can charge them more.
There’s already around $130 billion in the legislation states could use to help people afford insurance, but critics have said that’s just a fraction of what would be needed for adequate coverage.

Income Certifications: Personal Retirement Accounts from Top to Bottom

Income Certifications: Personal Retirement Accounts from Top to Bottom

Tenant B has a personal retirement account with a cash value of $15,000 and receives $2,400 once a year from this account.
Tenant B would then have an asset of $15,000, because once a year is not frequent enough to be considered regular and periodic (as demonstrated in the example under Exhibit 5-2(5) in the HUD Handbook 4350.3) and no amounts should be listed under the gross annual income portion of the Tenant Income Certification.
Household has $5,000 or Less in Assets If the household’s total assets are $5,000 or less, then no third-party verification is required and include the cash value of the retirement account (definition of cash value discussed later) on the Under $5,000 Asset Certification on the appropriate line, list the expected income from the account in the current year, and add that asset and income to the income from assets section on the first page of the Tenant Income Certification.
Whether or not the household’s total assets are more or less than $5,000, on the first page of the Tenant Income Certification, the personal retirement account should be listed at its cash value.
If the tenant does not have access to any part of the personal retirement account until retirement or until some vestment period is over, then the account and any related income does not need to be listed on the Income Certification.
Next, determine the anticipated income from the personal retirement account for the next 12 months, either by inquiring of the tenant for instances where the household’s assets are less than $5,000, or by calculation performed based on the asset verification, estimating future earnings or annualizing past earnings if future earnings are not available.
The income you include as income from this asset is the total amount of income the asset is expected to generate, even on portions that are not available for withdrawal and not included in the cash value in the asset.
On the Tenant Income Certification, the Income from Assets section would include a $15,000 personal retirement account asset and $2,500 ($25,000 x 10 percent) in income from this asset.
On the Tenant Income Certification, the Income from Assets section would include a $15,000 personal retirement account asset and $9 ($15,000 x .06 percent) in income from this asset.
On the Tenant Income Certification, the Income from Assets section would include a $2,000 personal retirement account asset and $650 ($6,500 x 10 percent) in income from this asset.

Paul Ryan Reassures Republicans That They Won on Spending Deal

Paul Ryan Reassures Republicans That They Won on Spending Deal

(WASHINGTON) — House Speaker Paul Ryan sought to assure conservatives on Wednesday that a massive government-wide spending bill is a win for President Donald Trump and Republicans, citing “a really good down payment” on rebuilding the military and “the biggest increase in border security in a decade.”
It is a product of weeks of Capitol Hill negotiations in which top Democrats like House Minority Leader Nancy Pelosi successfully blocked Trump’s most controversial proposals, including a down payment on the oft-promised Trump Mexico border wall, cuts to popular domestic programs, and new punishments for so-called sanctuary cities. “What we really wanted to do is break the parity requirement that we endured under Obama, where if you wanted to put a dollar into the military for a ship, for a plane, for bullets, for gas, you had to give the domestic spending of federal government another dollar,” Ryan said.
The White House boasted of $15 billion in emergency funding to jumpstart Trump’s promise to rebuild the military and an extra $1.5 billion for border security. “This is what winning looks like.”
The pending bill buys five months of funding while Trump and his allies battle with congressional Democrats over spending cuts and funding for Trump’s oft-promised wall along the U.S.-Mexico border.
Ryan said “I am not even going to venture to guess” whether such battles might generate a shutdown, though Republicans were surprised by Trump’s tweets and view the prospect of a shutdown as a political loser for them.
At issue is a mammoth, 1,665-page measure to fund the government through September that largely continues a long-established tradition of bipartisan spending deals that boost funding for medical research, aid for schools, and law enforcement accounts, while defending foreign aid, grants to state and local governments, and the Environmental Protection Agency from cuts sought by tea party Republicans.
Democratic votes will be needed to pass the measure even though Republicans control both the White House and Congress, which made Pelosi and Schumer active and powerful participants in the talks, leading to bipartisan outcomes like a $2 billion disaster aid fund, $407 million to combat Western wildfires, and additional grants for transit projects, $100 million in emergency funding to fight the nation’s opioid crisis, and a $2 billion increase for medical research at the National Institutes of Health.
Negotiators on the bill say it looks pretty much like the measure would have looked like if it had been ironed out last year under Obama — save for Trump’s add-ons for the Pentagon and the border.