It won’t just be Medicaid recipients ripped to shreds by the American Health Care Act. To no one’s surprise — even Paul Ryan’s — the CBO estimate states that the AHCA would cause 24 million Americans to lose their health insurance — 14 million in the first year. Meanwhile, it would raise average premiums on the rest by up to 20% in the midterm election year, 2018, and in the following year.
That means that in 10 years the number of uninsured Americans would actually be higher than it was before the Affordable Care Act took effect.
There are a few nuggets to gladden the hearts of the heartless in the CBO estimate. The GOP is trumping the finding that, by the end of the decade, the average insurance plan would cost 10% less than under Obamacare.
Sounds great! you may be thinking. Think again if you happen to be in an older age bracket. The plan does this by making it far harder for older Americans to afford insurance, leading to them to drop out of the market.
Calling the AARP…again.
According to the Upshot’s analysis:
On premiums alone, prices would rise by more than 20 percent for the oldest group of customers. By 2026, the budget office projected, “premiums in the nongroup market would be 20 percent to 25 percent lower for a 21-year-old and 8 percent to 10 percent lower for a 40-year-old — but 20 percent to 25 percent higher for a 64-year-old.”
But the change in tax credits matters more. The combined difference in how much extra the older customer would have to pay for health insurance is enormous. The C.B.O. estimates that the price an average 64-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan.
That leaves a younger, healthier (and thus less expensive) population in the health insurance market. Presto chango, you have cheaper premiums because the people who need healthcare the most are doing without.
They won’t be dying in the streets…they’ll be dying in their homes for want of care.
CBO Estimate: Blocked by Block Grants
In the press — or the enemy of the people, as President Trump would brand them — Medicaid block grants have received far less attention than other issues related to the AHCA. That’s starting to change. Yet, the imminent danger of Medicaid block grants has certainly not been lost on the 64.1 million people who receive Medicaid…including, of course, me.
We are among the most vulnerable the AHCA throws under the overcrowded undercarriage of the bus. Fortunately, there are forces coming to our rescue.
I’ve written that the napping giant of the AARP is beginning to awaken to the threat to its members. In preparation for the coming onslaught, the administration has launched a preemptive strike to delegitimize this powerful senior lobby, which was not only responsible for the failure of a Reagan administration Medicare initiative, but more recently killed President Bush’s Social Security privatization scheme (oy, I forgot that example for my last post!).
“When AARP has been left outside the gate, a reform push has typically failed,” as the Washington Post put it (emphasis theirs).
Still, the single biggest challenge to Trumpcare/Ryancare, is from their own party. The beauty of a democratic system is that our elected representatives periodically have to face the approval of their constituents. Thus far, four moderate Republicans from Medicaid expansion states have announced their opposition. According to the Washington Post:
“We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states,” Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska) wrote in a letter to Senate Majority Leader Mitch McConnell (R-Ky.).
Sixteen Republican-controlled states decided that helping their citizens was more important than scoring points against the Affordable Care Act and then-President Obama. In total, 31 states plus the District of Columbia expanded their Medicaid rolls to people who earn up to 138% of the poverty level.
These states — including my state of California — will be among the biggest losers if, as seems increasingly unlikely, the AHCA is passed. The bill doesn’t mean that those who qualified for Medicaid thanks to Obamacare will instantly be thrown off the rolls. In 2020 enrollment to the Medicaid expansion will be frozen. States that want to continue enrolling new members under the expansion — say, due to a recession — will have to foot the bills themselves.
Under Medicaid block grants, states will have to rob some Peter to pay Paul. If they can even do that.
As it stands, though, the AHCA might not even make it through the House, delivering Paul Ryan a devastating defeat.
I’ll give you a minute to wipe away your tears.
The AHCA’s Medicaid expansion drop-dead date had been 2020, but to make the plan palatable to red-meat conservatives, Trump and Ryan are thinking of accelerating the deadline to 2018.
While that might well ensure that the Dems take back the House and perhaps even the Senate — despite a highly unfavorable election map — Republicans from expansion states see red (as in, their own blood on the floor). And, yes, it’s even conceivable that they care about the impact on their constituents.
The Speaker of the House has expressed concern that the Republicans might be punished by their base if they fail to repeal Obamacare now that the so-called “Grand Old Party” has seized the reins of power. But they might be in even bigger danger if they succeed. President Trump’s working class base is among the hardest hit by the AHCA.
The GOP does have one stat to lend them cheer, however. Mostly due to cuts to Medicaid, the CBO estimate projects that the AHCA will save $337 million over 10 years, despite generous tax cuts to insurance companies and the wealthy contained in the act. And let’s not forget the savings from cuts to middle class tax credits, which currently make insurance affordable for them.
Furthermore, since the CBO estimate has pronounced that the AHCA wouldn’t add to the federal deficit, the GOP can now pass the AHCA with a simple majority — instead of requiring a filibuster-busting supermajority — in the Senate. Of course, that assumes that the leadership can win over the senators in both wings of the party who have already vowed they would never vote for the bill.
And if Ryan/Trump cave to the wingnut conservatives and toss the Medicaid expansion into the shredder in 2018, they will likely lose more of their rank than current the four moderate senators. In case you forgot, the GOP only has a two-seat majority in the Senate.
Some observers think that’s exactly what they want. That way, they can go to their base and say, “Well, we tried,” without paying the political consequences of implementing their draconian and hastily drafted “plan.”
CBO Estimate: Sticking It to the Most Vulnerable
So far, I’ve mostly talked about process and politics. Yet, it won’t be just insurance coverage endangered, but real live human beings. As The Atlantic put it,
The numbers are in, and they aren’t great for some of the sickest people in the country.
In other words, people like me.
In my next post, I will try to give a sense of the plight of those who will find no safe passage in the GOP’s healthcare schemes.
Or should I say scams?
For as little as $1 a month, you can help feed a starving writer. Please consider supporting my work on Patreon.