They have saved the worst for last or next to last or maybe a never-ending nightmare of repeal efforts (Groundhog Day). The salient points of Graham Cassidy are: a shift and reduction of the ACA’s financial resources from the federal government to the states as a time limited block grant; a shift of federal resources from the leader states to the most resistant Southern states that have done little or nothing beyond obstruction; waivers to allow states to disenfranchise and/or insurers to charge higher premiums to those with pre-existing conditions and a per capita cap on the federal match for the Medicaid program. For California, these proposals could not be more damaging. A recent report from the CDC (Centers for Disease Control) found that the uninsured rate in California had fallen from 17% to 7% due to the state’s successful implementation of the ACA. This bill will erase all that progress and do far more extensive damage to states' budget and health care system. Over 30 million Americans would lose their coverage.
I lived in Charlottesville twice. The first time was shortly after my birth; my father was attending University of Virginia Law School and rehabbing from his war injuries incurred after his jeep went over a German land mine in France. Hard to believe, but I have lifetime friends from both my first stay and my second stay in Charlottesville.
We dodged a bullet in the Senate; there is now a moment and opportunity for constructive bipartisan problem solving, so let’s start improving the Affordable Care Act. Here are a few ideas worth considering on how to dramatically improve affordability of coverage and accessibility of care in the Exchanges under the Affordable Care Act (ACA).
This is not about statues, but about the frightening resurrection of white supremacy movements that many had thought were obsolete and yesterday’s news. So let’s first discuss the issues, then let’s discuss the symbols.
President Trump is considering ending federal ACA funding for cost sharing reductions. This ACA funding allows individuals with incomes up to 250% of the federal poverty level to reduce their copays and deductibles in the individual market. It costs about $7 billion annually and helps about 5.7 million Americans. He believes that if the funding was ended, the Health Insurance Exchanges would collapse and Democrats would agree to repeal and replace the Affordable Care Act.
Within this bi-partisan House caucus, there are several points of burgeoning agreement on the future of the Affordable Care Act (ACA): 1) Extend cost sharing reductions. 2) Fund states to reduce individual market premiums through reinsurance or high-risk pools. 3) Eliminate the medical devices tax. 4) Roll back the employer mandate to employers of 500 or more employees. 5) Value and outcome based Medicare reimbursements. 6) Cross state sale of insurance.
The House and Senate need to convene the problem solvers as opposed to the Freedom Caucus bomb throwers and work out the following issues: 1) cost sharing reductions, 2) reinsurance and risk adjustments, 3) care and coverage in rural regions, 4) incentives for cost effective care and 5) the uninsured in the non-expansion states.
Straight repeal has failed; repeal and replace has failed. Senate Republicans now will try to pass skinny repeal. Skinny repeal would at a minimum repeal the individual responsibility, the employer responsibility and the medical devices tax.
The latest CBO analysis concludes that the most recent proposed Senate Amendments will reduce coverage by 22 million Americans, will increase deductibles very dramatically in the individual market and the Exchanges, and will reduce the federal deficit by $420 billion over the next ten years. The key difference from earlier versions is jettisoning the cuts in taxes for high income Americans.