ACA Repeal Replace
Aaron Reyes
David Becerra
Overview of ACA Gains
Increasing and improving coverage
•
The rate of uninsured has fallen 37% since the
beginning of 2014
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In the first quarter of 2016, the uninsured rate fell
to 8.6% - the lowest rate in our nation’s history
•
20 million Americans have gained coverage under
the ACA
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129 million Americans with pre-existing conditions don’t have to worry about
losing coverage; 105 million Americans no longer have lifetime or annual limits
•
Nearly 3 million Americans remain uninsured in the “Medicaid gap”
Source:
Wendell Primus, Senior Health Policy Advisor to House Minority Leader Nancy Pelosi. Presentation given
12/8/2016, Washington D.C.
Overview of ACA Gains
Restraining Health Care Costs
•
Since the ACA passed, health costs have grown at their
slowest rate in 50 years
•
Premiums for employer-sponsored coverage grew just
4.2% in 2015, compared to an average of 7.9% from
2000-2010
Improving Health Care Quality
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565,000 fewer hospital readmissions in Medicare
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17% reduction in hospital-acquired conditions
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Promising results for early innovation models
Source:
Wendell Primus, Senior Health Policy Advisor to House Minority Leader Nancy Pelosi. Presentation given
12/8/2016, Washington D.C.
Trump Administration
Plan To Replace Affordable Care Act
Step 1: Pass Legislation i.e. American Health Care Act
Step 2: Director of Health & Human Services will use power to deregulate
insurance marketplace to in increase choice and competition
Step 3: Rebuild Healthcare System: Regulate
medical liability, increase provider
reimbursement, become more cost effective
with government sponsored/ health related
spending, allow health insurance policies to be
sold across state lines and provide tax credits
to help alleviate the cost of health insurance.
Identify The Players:
The 115th Congress
House
Senate
Speaker of the House: Paul Ryan
Vice President: Mike Pence
237 Republicans
52 Republicans
193 Democrats
46 Democrats
Freedom Caucus
2 Independents
Moderates
Budget Reconciliation
Provisions under threat:
1.
Medicaid (Medi-Cal) expansion (MAGI Medi-Cal)
2.
Market place financial assistance (APTC, CSR)
3.
Individual and employer mandates*
Provisions Not Under Threat
1.
Guaranteed issue
2.
Modified community ratings
3.
Essential health benefits
4.
Actuarial value standards (Metal Tiers)
American Health Care Act
What would the new plan to replace the ACA include?
Officially introduced on March 20, 2017.
Government will no longer penalize Americans for not having health insurance
However, the government would encourage people to maintain coverage by
allowing insures to impose a surge of 30% for those who have a gap between
health plans.
The Legislation would preserve two of the most popular features of the 2010
health-care law:
Young adults can stay on their parent’s health plan until age 26
Health insurers cannot deny coverage or charge more to people with
preexisting medical problems.
Changes to Medicaid
•
Medicaid would be converted from its current form of entitlement to anyone
eligible
into a per capita cap on funding to states, depending on how many people they had
enrolled
•
In states that expanded Medicaid under the ACA, the government for now
would
continue paying for virtually the entire cost of the expansion.
- Increase State Taxes
- Cut to Benefits
- Decrease in eligible medicaid recipients
•
For the other 19 states that did not expand Medicaid, the legislation would
provide
$10,billion spread over five years.
CBO Projections on Repeal
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•
•
•
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The number of uninsured would increase by 18
million in the first new plan year following repeal.
After the elimination of the Medicaid
expansion, the number of uninsured would
increase to 27 MM in the first year and to 32
MM by 2026
Premiums in the non group market would increase by 20-25% relative to
current projections
Premium increases would reach 50% in the year following repeal
Premiums would almost double by 2026
Source:
CBO Report: How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and
Premiums. January 17, 2017
CBO’s Highlights for Medicaid
•
$880 billion drop in federal Medicaid spending over the decade
•
14 million fewer Medicaid enrollees by 2026
•
•
95 percent of people who are getting Medicaid through the health
law’s expansion would lose that enhanced federal funding
15 percent of Planned Parenthood clinic patients would “lose access to care.”
Impact on California
Health Insurance at Risk
•
4.9 MM Californians are at risk of losing coverage through ACA
repeal
•
1.2 MM will lose subsidies through Covered CA
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The uninsured rate in California is projected to spike 146% through
2019
California Economy
•
California stands to lose $160 BN in federal funding for Medicaid,
CHIP
and premium assistance
•
20.5 BN annual federal funding for the Medicaid expansion
Sources
Implications of Partial Repeal of the ACA through Reconciliation (Washington, DC: Urban Institute, December2016),
Impact on Orange County
Health Insurance at Risk
•
260,086 OC residents are at risk of losing
coverage (Medicaid expansion). This constitutes
8.3% of the counties population
•
117,170 OC residents will lose federal subsidies
for purchasing insurance
Economic Loses
•
15,000 health sector jobs are at risk of being lost
due to ACA repeal
•
$1.4 BN in GDP would be eliminated from the
county economy
Sources
Dietz M, Lucia L, Kominski GF, and Jacobs K, ACA Repeal in California: Who Stands to Lose?, UC Berkeley Center for Labor Research and Education
and UCLA Center for Health Policy Research, December 2016.
Lucia L and Jacobs K, California’s Projected Economic Losses Under ACA Repeal, UC Berkeley Center for Labor Research and Education, December
2016.
Healthcare Reform Comes to a Halt
On March 24th, Speaker Paul Ryan announced the bill has been pulled and would
not be put up for a floor vote.
President Trump continually vows to push through healthcare reform in the near
future.
Freedom Caucus remains firm in their stance. The proposed plan is not
conservative enough.
President Trump extends an Olive branch to Democrats. Speaker Ryan condemns
this action.
The Compounding Variables:
Why Did It Fail?
Dagger: Congressional Budget Projections
Republican Governors: Medicaid Funding
Political Party Ideological Disparities: Freedom Caucus vs. Moderates
Health Plans Needed To Release New Rates
Individual State Exchanges Lobbying: Covered CA
State, Regional & County Associations Lobbying
Advocation Center of Education (ACE)
Things that can be done administratively
•
U.S. House of Representatives v. Price (Burwell)
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CMS regulatory change/interpretations
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Enforcement of tax code
Republican Plan for Tax credits
•
Tax credits may range from $2,000 per year for those under 30
to $4,000 per year for those over 60
•
The full credit would be available for individuals earning up to $75,000 and up to
$150,000 for married couples filing jointly
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Tax Credits will phase out for individuals earning more
•
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Ex. For each $1,000 in additional income, a person would be entitled to $100 less in credit
Meaning a 61- year old could make up to $115,000 and still receive some credit.