Revised Health Care Bill Sent to Senate
In an effort to win over GOP holdouts Senate Republican leaders released a revised health-care plan Thursday providing an added $70B to stabilize insurance exchanges over a decade. This is in addition to $112B provided for the same purpose in an earlier measure.
The new measure discards plans to repeal three ACA taxes on the wealthy; effectively freeing up $230B in cash to bolster health expenditures.
Also included is a provision that allows people for the first time to use health savings accounts to pay insurance premiums.
Senators Lindsey Graham and Bill Cassidy today released their own alternative health plan that would shift much of current federal funding for ACA insurance and future funding directly to states.
The GOP must have a margin of 52-48 majority to repeal the current ACA plan. One way or the other, they can’t ignore the ACA.
There is opposition to the idea of creating bare-bones plans that siphon off healthy, young people and therefore cause premiums to rise in the exchanges. However, this plan funnels billions of subsidies into those exchange plans for poorer, older, and sicker people. Overall, the bill moves far less money into Medicaid and health subsidies than the ACA.
The new draft retains the earlier bill’s language allowing people earning up to 350 percent of the poverty level to receive subsidies, while keeping a skimpier benchmark for subsidies than the ACA silver plan, resulting in higher out-of-pocket expenses.
Also, people could purchase a high-deductible catastrophic plan with federal tax credits, and include a provision prohibiting abortion coverage (except in cases of rape or incest) or to save the life of the mother in plans eligible for tax credits.
Covering the Sick
The revised bill includes a federal fund that would pay health insurers to cover costs of sicker people seeking individual coverage on the insurance exchanges. To qualify, insurers must meet minimum coverage standards in the exchange, and offer coverage off the exchange that meets state requirements. Those buying state-governed plans wouldn’t be allowed to use federal tax credits to buy their coverage but could tap tax-advantaged health savings accounts to cover the costs.
In high cost states (i.e. Alaska), 1% of expanded state innovation/stability grants would be reserved only to subsidize insurance where premiums are at least 75% higher than the national average. Starting in 2022, states must share in the costs of these funds, with states having to shoulder 35% of the burden in 2026.
Also changing: Determining Medicaid payment calculations to hospitals (uncompensated care expected to allot the funds based on a state’s uninsured population instead of Medicaid enrollment…as the ACA does.
The debate is ongoing for Republican leaders, but the resolve to cross the finish line in early August is intensive. There’s a lot of different viewpoints and different feelings about it; all have to be taken into consideration to put together enough votes to pass the bill.
The President is ‘encouraging consensus’ to pass the bill.