Thursday, June 22, 2017

Senate GOP Unveils PPACA Repeal Bill Today - Initial Thoughts on Armstrong and Getty

Senate Republican leaders unveiled their PPACA repeal bill this morning giving a first look at the bill designed to repeal Obamacare. We are still analyzing the bill, but upon initial review it appears to shrink the Obamacare Medicaid expansion more slowly than the House bill would have and proposes eliminating nearly all PPACA taxes. The bill also creates a new system of federal tax credits to help people purchase health insurance that is more generous than the House bill; extending up to 350% of the federal poverty level (as opposed to PPACA's 400%).

It is important to remember that this bill is not in finalized form, and there will likely be changes. We will continue to update you on pertinent developments and will advise if and when action must be taken.

I was on the Armstrong and Getty show this morning in a brief segment with my initial thoughts.  I'll be on for a more full explanation tomorrow.

Here is what some media outlets are saying about the proposed law (the best one is the last one from Megan McArdle at Bloomberg):

Senate Leaders Unveil Bill to Repeal the Affordable Care Act
June 22, 2017 –New York Times
Excerpt: “The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.”

Senate health-care draft repeals Obamacare taxes, provides bigger subsidies for low-income Americans than House bill

June 22, 2017 – Washington Post
Excerpt: “The bill eliminates the employer and employee mandates; replaces the ACA’s income-based subsidies with tiered tax credits, gradually increasing for older Americans; allows states to apply for waivers to define their own essential health benefit requirements; expands the limits for Health Savings Accounts; discontinues Medicaid expansion in 2020; and repeals most of the ACA’s taxes. The legislation would delay implementation of the Cadillac Tax by five years, from 2020 to 2025, and it importantly preserves the tax exclusion for employer sponsored insurance.”

Senate finally unveils secret health care bill
June 22, 2017 – CNN
Excerpts: “The bill is very similar to the version of the House bill that passed last month but with some key changes. The text released Thursday showed the Senate legislation would still make major changes to the nation's health care system, repealing Obamacare's individual mandate, drastically cutting back federal support of Medicaid, eliminating Obamacare's taxes on the wealthy, insurers and others. The Senate plan however would keep Obamacare's subsidies to help people pay for individual coverage.”

"Four conservative Republican senators -- Rand Paul, Ted Cruz, Ron Johnson and Mike Lee -- said they opposed the current version. And key votes such as Sens. Dean Heller and Susan Collins have also withheld support."
Senate GOP brings Obamacare repeal bill out of the shadows
June 22, 2017 – Politico
Excerpt: “The Senate bill — blandly dubbed the Better Care Reconciliation Act of 2017 — eliminates Obamacare’s mandates and hundreds of millions of dollars in taxes on the wealthy and the health industry. Notably, it doesn’t impose any new requirement that people purchase or maintain coverage — a major element that Republican leaders said they’re still working on.

The bill also would phase out Obamacare's Medicaid expansion over three years beginning in 2021 and would make deep cuts to the long-term Medicaid program. It keeps the structure of Obamacare's insurance subsidies to help low-income people buy insurance, but tweaks them to cover only those making up to 350 percent of the federal poverty line — down from the 400 percent covered under Obamacare.”

And the the single best analysis I've seen yet, once again, comes from Megan McArdle.

Republicans' Health-Care Bills Boil Down to ... More Obamacare
June 22, 2017 - Megan McArdle writing at Bloomberg
Excerpt: "You know, if you tilt your head to one side and squint a little, you can sort of see … Obamacare.  I called the House health care bill “Obamacare Lite,” but compared to the Senate bill, the House was offering a radical new taste sensation. The Senate bill touches very little of the underlying architecture of Obamacare; all it does is eliminate the insurance mandates, cut spending and give states somewhat more autonomy in how those dollars are spent. Repeal Obamacare, you say? They’re barely even worrying it.

Probably this was necessary to negotiate the tricky Senate math; supporters need almost every Republican to vote for it. Keeping the moderates and the conservatives on board means no radical shifts, or angry hospital lobbyists calling Republican senators whose states participated in the Medicaid expansion.

But while there are a few things to like in this bill, overall, it’s a mess."