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If we’ve learned one thing over the past few months, it’s to stop making predictions about what Congress will do next. Like the killer in a horror movie, every time we thought Obamacare repeal bill was dead– when Paul Ryan gave up on a House vote back in March; when at least three Senators announced their opposition to every public version of the bill– it always somehow managed to come crawling back. And when it looked like a version might actually pass last month, John McCain swooped in at the last minute to put the final stake in its heart.

Or so we thought. We’ve been hearing rumblings that some Republican senators are pushing for another repeal vote. However, others– even more shockingly– are pushing for bipartisan bill to help fix the ACA. Let’s take a closer (but prediction free) look at the two options. [click to continue…]


By now we’re sure you’ve heard that Senate Republicans failed to pass a health bill in July, with the deciding vote cast by John McCain in a dramatic, late-night session. (In a healthcare bloggers’ nightmare, Senate Republicans managed to schedule the vote while I was on a camping trip, and when I got back we had to switch web servers and couldn’t upload anything.) Now that the smoke has cleared somewhat, we thought it would be helpful to take a look back at what exactly happened– not to mention how completely insane the process was– and what it means for healthcare moving forward.  [click to continue…]


Man, it’s been a crazy week for the Senate health bill. Last Thursday, GOP leaders released a new version, which included an amendment from Senator Cruz that was supposed to make the bill more acceptable to conservatives. By Monday, enough conservative Senators were opposed that the bill was dead, and the backup plan of repealing Obamacare without a replacement collapsed the next day. Shortly after that, McConnell announced that he was scheduling a vote on healthcare for next week.

Confused? You’re not alone. Even Republican senators still don’t know which Obamacare repeal and/or replacement bills they’ll be voting on. To try and make at least some sense of how we got here, here’s a day-by-day recap of the week’s biggest news. [click to continue…]


Our last post looked at how the Senate health bill would be particularly bad for older Americans, but that’s definitely not the only group the bill would disproportionately harm. The bill (which was written by 13 men) also manages to reduce access to every type of reproductive healthcare for women: not only does it make it harder for women to access birth control or terminate a pregnancy, it also makes it much harder for women who are pregnant to get maternity care.   [click to continue…]


One of the Dave’s I know is an older American who could see his premiums skyrocket thanks to the GOP health plan.

The Congressional Budget Office released its score of the Senate health bill yesterday, and as I read it, I kept thinking back to a comment we received earlier this year, from a reader named Dave.

In March of 2016, Dave lost his job and with it his health coverage; he later found another much lower paying job without benefits (“hey I’m 63, glad to be working at all,” he writes); he bought coverage through the marketplace, where he says that Obamacare’s advanced tax credits “reduced my monthly premiums substantially.”So at first this sounded like was an “Obamacare is working great” story. However, when he did his 2016 taxes, it looked like an end-of-year bonus would push his total income above the cutoff to qualify for the ACA’s tax credits and he’d have to pay them all back. Understandably, he wasn’t happy:

This arbitrary number seems crazy, you go 1 dollar over it and owe thousands back to the IRS. Instead of some kind of sliding scale where if you go above certain limits you start losing the advanced credits but not owe a huge chunk for exceeding by a few dollars. The idiots that wrote and approved this plan, our representatives, OBVIOUSLY didn’t consider the poor schlub middle-class guy with a family of 4 paying 2 college tuition bills, food, mortgage and every other everyday bill, somehow cannot afford a 1700 health insurance bill while earning a certain amount, but go over that amount by a dollar and now he can afford it???, Frigging’ insanity, can’t wait for Trump and the Republican congress to replace this disastrous govt run nightmare.

Now, for most people, the Affordable Care Act does mean affordable premiums. The law’s tax credits lower premiums for people making less than 400% of the poverty line; and if you’re a younger person (i.e. under 40) making more than that, your premiums will still be affordable, because insurance companies charge young people less. But if you’re an older person and your income is too high to qualify for tax credits? You could end up paying more than 25% of your income for health insurance.

This is one of the Affordable Care Act’s biggest flaws, and Dave is right that Congress should fix it. But here’s the thing: the health plan that Trump and the Republican Congress are trying to pass would make things much, much worse.   [click to continue…]


After reading the health bill that the Senate released yesterday, we were wondering how exactly Republicans would argue for this bill. It has massive cuts to Medicaid, increased costs for the sick and older Americans, higher deductibles, waivers letting states opt out of the ACA’s insurance protections… in fact, we didn’t see anything that the majority of Americans would support aside from maybe the repeal of the individual mandate.

Then we saw Pennsylvania Senator Pat Toomey’s op-ed in the Philadelphia Inquirer: apparently the strategy is to mislead constituents about what the Senate bill actually does. So much of the Senator’s op-ed was wrong or misleading that we decided to address it point-by-point.   [click to continue…]


Senate Republicans just released their healthcare bill, and it actually looks a lot like the House version: big cuts to Medicaid, big deductibles, big premium increases for older Americans, and big tax cuts for the wealthy. However, there are some important differences in how it does those things, so let’s get right to it.   [click to continue…]


You on the phone with your Senator, asking about the AHCA.

Senate majority leader Mitch McConnell is reportedly planning a vote on the Republican healthcare bill sometime next week. It’s hard to overstate how crazy that is– a draft of the bill still hasn’t been released, and the vast majority of Senators (Democratic or Republican) still haven’t seen it. When the Affordable Care Act was passed, senators had months to read the bill (and that was after months of bipartisan negotiations). The ACA had 25 consecutive days of floor time for senators to debate and amend the bill; McConnell wouldn’t commit to more than 10 hours for this one. Meanwhile, Republican senators can’t answer simple yet critical questions about the bill, like “what problems is it trying to solve” or “what would the bill accomplish?”

It’s pretty clear that Republicans believe that if Americans knew what’s in the bill, they’d hate it— so the strategy seems to be to pass it before most people find out. There will be just a week between the release of the Senate’s bill and the actual vote, and just a few days between the CBO score and the vote.

But here’s the thing– based on what we do know, we can already tell that the Senate bill will be worse than the ACA. We know this because of well, math.   [click to continue…]


For some reason, House Republicans wrote a healthcare plan, where the guys above get cheaper coverage…

…while these people will pay much, much more.

We have to admit, we’ve been putting off writing about the American Health Care Act (AHCA) for as long as we could, because, well, we’ve been burned before. Every other Republican Obamacare replacement plan we’ve covered was quickly dropped as soon as we wrote about it, sometimes even before we could get the post up. Remember the Patient CARE Act or Scott Walker’s health plan? No? Consider yourself lucky.

For a while it looked like the AHCA was heading down the same path. House Republicans’ first attempt at passage failed miserably— conservatives in the Freedom Caucus refused to support the bill because it didn’t eliminate enough of Obamacare, while moderate Republicans were anxious about leaving 24 million more Americans without coverage. Afterward, the prospect of reconciling the two groups seemed so unlikely that pundits were calling it “Zombie Trumpcare.” To bring the Freedom Caucus on board, House leaders amended the bill to weaken Obamacare’s protections for people with pre-existing conditions (more on that in a bit), which spooked GOP moderates; moderates were then promised an extra $8 billion over 5 years to prop up high risk pool (more on that shortly too). Somehow this worked, and the AHCA passed the House by just one vote.

Still, by all accounts there was no way it could pass in the Senate– instead, Senate Republicans said they planned to start from scratch on their own bill. That seemed like a good idea since the original AHCA was opposed by pretty much everyone who’s not a Republican Congressperson. However, now we’re hearing rumors that the Senate bill might look a lot like the AHCA after all, and some “moderates” in the Senate have started expressing support for eliminating the ACA’s Medicaid expansion (and yes, more on that too in a sec), which had been a key point of contention.

So, since both House and Senate Republicans seem serious about this thing, we figured it’s about time to look at what’s in the AHCA and how it will affect the rest of us.   [click to continue…]


In our last post, we talked about the Trump administration’s threat to stop paying the Affordable Care Act’s cost sharing reduction (CSR) subsidies. For those who missed it, here’s a quick recap:

Under the ACA, people making less than 250% of the federal poverty line are eligible for CSR subsidies that help make their deductibles and other out-of-pocket costs much more affordable. In 2014, House Republicans sued the Obama administration to block the payment of these subsidies, (which go directly to insurers). After Trump was elected president, he and the Republicans asked the courts to postpone hearing the lawsuit, so that he and the Republicans could figure out what they wanted to do about the case. However, the Trump administration could, at any time, decide to stop paying these CSR subsidies.

The law says that insurers have to offer cost-sharing reductions to people who are eligible regardless of whether or not Trump ends the CSR payments (which currently amount to $7 billion). So if Trump does decide to end them, insurers have two options: (1) leave the Affordable Care Act marketplaces altogether or (2) jack up their premiums to make up for that lost money. In our post on Tuesday, we pointed out that insurers have to submit their proposed premiums for 2018 in the next few weeks– so even if Trump doesn’t make good on his threat to ditch the CSR’s, the uncertainty alone will cause insurers to jack up their premiums for next year.

Yesterday we got an early example of exactly that, as Blue Cross Blue Shield released its proposed rates for 2018:

As Duke University’s David Anderson explains on his Balloon Juice blog, another 3% of the increase comes from the reintroduction of a federal tax on insurance companies (they didn’t have to pay it in 2017), which is a one-time increase. As Anderson writes:

“5% trend is a healthy trend. That is a the trend of a market that is fairly stable and reasonably priced.”

Instead, thanks to Trump and the Republicans threatening to blow up the CSR’s, Blue Cross Blue Shield customers in North Carolina are looking at a double-digit increase. There’s still time to fix it though– as Blue Cross Blue Shield wrote in its filing:

“We are prepared to refile a lower rate increase should the Federal government provide firm commitment to fully fund CSR payments in 2018 in a timely matter.”

This is a pattern we’ll see repeated across the country– insurers either raising premiums or exiting the marketplaces altogether– unless Trump and the Republicans stop threatening to blow up these subsidies. And ironically its Trump voters who would likely suffer the most. The way the ACA is structured, people with incomes below 400% of the poverty line are mostly protected from big premium increases– it’s people above that 400% cutoff, who are more likely to vote Republican, that would be paying more.

Let’s hope they remember who’s responsible come 2018.

Update 5/27/17: Greg Sargent of the Washington Post talked to Brad Wilson, CEO of Blue Cross Blue Shield North Carolina, who told him flat out:

“The failure of the administration and the House to bring certainty and clarity by funding CSRs has caused our company to file a 22.9 percent premium increase, rather than one that is materially lower. That will impact hundreds of thousands of North Carolinians[…]

“The effect will be the same across the country. Rates will be materially higher if CSRs aren’t funded.”