Trumpcare - is it better or worse than what we have now?
The American Health Care Act of 2017 has passed the House by a very narrow margin. Before commenting on its contents I want to share some names with you.
Ken Calvert
Paul Cook
Jeff Denham
Duncan Hunter
Darrell Issa
Steve Knight
Doug LaMalfa
Kevin McCarthy
Tom McClintock
Devin Nunes
Dana Rohrabacher
Ed Royce
David Valadao
Mimi Walters
Meet the 14 members of the House from California who voted in favor of the aforementioned bill. All members of the Republican Party. All of whom need to be defeated in the mid-term elections in November of 2018.
Let's clear up one misunderstanding right now. Congress will not be exempt from the provisions of this law (if passed in the Senate and then signed by the Cheeto-in-Chief). The law did contain that carve-out for lawmakers and their staffs, but another piece of legislation introduced by a Republican legislator from Arizona fixes that by making lawmakers and their staffs subject to the AHCA.
Why did they exempt themselves? A procedural move, designed to try and prevent the Senate from having a chance to filibuster the AHCA. You can read about this here.
You can also read about what's wrong with the AHCA in a L.A. Times piece written by Michael Hiltzik (who I find highly accurate and informative). In that piece is a link to a Blue Shield internal document from 2011 listing a myriad of pre-existing conditions they would use to decline coverage.
* * *
One of the biggest problems involving health insurance, before and after the passage of Obamacare is the concept of adverse selection. The problem with the healthcare mandate provisions of Obamacare was that the mandate could be avoided by paying a monetary penalty. If everyone in the country had to be part of the risk pool, then premium costs for all could be lowered while still providing coverage for the sickest part of that risk pool.
Allowing people to avoid being part of that risk pool doesn't work unless the monetary penalty they paid for doing so would provide an amount equal to the premiums not being paid by these people. That was not the case under Obamacare. The amount provided by penalty payments is not nearly enough to cover that amount.
So how do we fix this, without going to a single-payer system? Simple. We offer the people a choice. It can be viewed by some as a Hobson's choice, but it is still a choice.
All individuals under the age of 26 can be covered under the health insurance coverage provided through their parents. Everyone else can choose to enroll in a healthcare plan that meets a minimum level of coverage, or choose to decline coverage until they become covered by Medicare or through a group healthcare plan, subject to the same 3/3/12 pre-existing condition limitation that existed in the past. In choosing to decline coverage, these people accept the following:
1. If they ever file bankruptcy, any and all debts owed for their healthcare are exempt from being discharged. Medical debt will not be factored into the bankruptcy law calculations that determine insolvency.
2. Their ability to deduct medical expenses as an itemized deduction on their income tax returns will be subject to a 20% Adjusted Gross Income (AGI) limitation, rather than the 10% AGI limitation currently in effect for all taxpayers under the age of 65. In simpler terms, in order to deduct any of their medical expenses, they cannot do that until those expenses exceed 20% of their annual income.
Sounds harsh. It is. That is because under Obamacare the penalties for failing to comply with the mandate allowed healthy people to accept the penalty and then if they got sick, they could just go out and buy a policy. As long as that alternative exists, unless the penalties for failure to comply with the mandate reach the level of the cost of coverage, it is easier and there is no risk by refusing to purchase coverage.
Obamacare is imperfect but better than what we had before. Millions more are covered now than were prior to its passage. The AHCA is not an improvement over what we have. If it becomes law, those who voted for it need to be sent packing.
Ken Calvert
Paul Cook
Jeff Denham
Duncan Hunter
Darrell Issa
Steve Knight
Doug LaMalfa
Kevin McCarthy
Tom McClintock
Devin Nunes
Dana Rohrabacher
Ed Royce
David Valadao
Mimi Walters
Meet the 14 members of the House from California who voted in favor of the aforementioned bill. All members of the Republican Party. All of whom need to be defeated in the mid-term elections in November of 2018.
Let's clear up one misunderstanding right now. Congress will not be exempt from the provisions of this law (if passed in the Senate and then signed by the Cheeto-in-Chief). The law did contain that carve-out for lawmakers and their staffs, but another piece of legislation introduced by a Republican legislator from Arizona fixes that by making lawmakers and their staffs subject to the AHCA.
Why did they exempt themselves? A procedural move, designed to try and prevent the Senate from having a chance to filibuster the AHCA. You can read about this here.
You can also read about what's wrong with the AHCA in a L.A. Times piece written by Michael Hiltzik (who I find highly accurate and informative). In that piece is a link to a Blue Shield internal document from 2011 listing a myriad of pre-existing conditions they would use to decline coverage.
* * *
One of the biggest problems involving health insurance, before and after the passage of Obamacare is the concept of adverse selection. The problem with the healthcare mandate provisions of Obamacare was that the mandate could be avoided by paying a monetary penalty. If everyone in the country had to be part of the risk pool, then premium costs for all could be lowered while still providing coverage for the sickest part of that risk pool.
Allowing people to avoid being part of that risk pool doesn't work unless the monetary penalty they paid for doing so would provide an amount equal to the premiums not being paid by these people. That was not the case under Obamacare. The amount provided by penalty payments is not nearly enough to cover that amount.
So how do we fix this, without going to a single-payer system? Simple. We offer the people a choice. It can be viewed by some as a Hobson's choice, but it is still a choice.
All individuals under the age of 26 can be covered under the health insurance coverage provided through their parents. Everyone else can choose to enroll in a healthcare plan that meets a minimum level of coverage, or choose to decline coverage until they become covered by Medicare or through a group healthcare plan, subject to the same 3/3/12 pre-existing condition limitation that existed in the past. In choosing to decline coverage, these people accept the following:
1. If they ever file bankruptcy, any and all debts owed for their healthcare are exempt from being discharged. Medical debt will not be factored into the bankruptcy law calculations that determine insolvency.
2. Their ability to deduct medical expenses as an itemized deduction on their income tax returns will be subject to a 20% Adjusted Gross Income (AGI) limitation, rather than the 10% AGI limitation currently in effect for all taxpayers under the age of 65. In simpler terms, in order to deduct any of their medical expenses, they cannot do that until those expenses exceed 20% of their annual income.
Sounds harsh. It is. That is because under Obamacare the penalties for failing to comply with the mandate allowed healthy people to accept the penalty and then if they got sick, they could just go out and buy a policy. As long as that alternative exists, unless the penalties for failure to comply with the mandate reach the level of the cost of coverage, it is easier and there is no risk by refusing to purchase coverage.
Obamacare is imperfect but better than what we had before. Millions more are covered now than were prior to its passage. The AHCA is not an improvement over what we have. If it becomes law, those who voted for it need to be sent packing.
posted by me at 11:12 AM
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