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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.”


Trump’s health policy team

We’re back! Sorry, it’s been a minute– we’ve been busy with some other projects– but luckily there hasn’t been any big healthcare news over the past couple months, right?


Ok, so later this week we’ll take a look at the Obamacare replacement bill that House Republicans passed earlier this month (spoiler: it’s not great), but first we wanted to check in on where things stand with the Affordable Care Act itself. Because while the news is full of dumb things Trump has done lately, it’s what his administration hasn’t done that’s the most immediate threat to the ACA.   [click to continue…]


The secret location where Republican House leaders wrote the AHCA?

As we saw back in 2009 with the Affordable Care Act, putting together a health reform bill that enough stakeholders support to pass through Congress is really, really difficult. Equally difficult however is putting together a heath reform bill that no one likes. Yet somehow in drafting the American Health Care Act, House Republican leaders have managed to write a bill that, as The Onion accurately put it, “has drawn criticism from the AARP, the American Medical Association, the American Cancer Society, Planned Parenthood, Breitbart News, the AFL-CIO, the House Freedom Caucus, the National Council of La Raza, the American Academy of Pediatrics, the Club for Growth, the National Disability Rights Network, MoveOn.org, The New York Times, Tea Party Patriots, the CATO Institute, the Heritage Foundation, and thousands of hospitals.”

It’s a bill that, according to the Congressional Budget Office, would add 24 million Americans to the ranks of the uninsured, raise premiums for the poor and elderly, raise deductibles and out-of-pocket costs for everyone else, and– thanks to its defunding of Planned Parenthood– would cause thousands of unintended pregnancies.

We’ll have more on what’s in the bill and what the CBO said about it later this week, but with so much health care news happening so quickly, it’s worth taking a step back to look at how Republicans managed to write a bill that– much like Nickelback— everyone seems to hate.   [click to continue…]

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We wanted to share three pieces of related information that might be of interest to anyone who is concerned about possible repeal the Affordable Care Act.

1. A breakdown of who could lose coverage, by Congressional district

Ever since the Affordable Care Act first took effect, Charles Gaba has been tracking how many people have enrolled in health coverage as a result of the law. His website, ACASignups.net, has been cited by everyone from The Washington Post and The New York Times to Fox News and Breitbart as the most accurate source of estimates about the ACA’s coverage expansion

Lately Gaba has been working on a new project: estimating how many people would lose coverage in every Congressional district if Obamacare was repealed without a replacement. To give a sense of what that looks like, here are the figures for Pennsylvania:

2. Congress will be on recess next week

The recess means that most members of Congress will be back home in their districts, meeting with constituents and holding townhall events. There are a bunch of different ways to find out what your representative will be up to. You can call their office and ask (if you type in your address at the website Call to Action, it will give you the number of their district office). Or you can check out the Townhall Project Google doc, where volunteers have been compiling a list of every Congressional townhall they can find throughout the country.

There’s also the website Resistance Recess, where if you type in your zip code, it will show you not only if your representative is holding a townhall, but, if they’re not, whether constituents have organized their own townhall and invited your rep to attend.

3. Townhall events are a great opportunity to share how you feel about Obamacare

For example, at a townhall held by Rep. Diane Black (R-TN), a 35 year-old French teacher who lives in Cookeville, Tennessee gave one of the best defenses of the ACA we’ve ever seen, saying:

“My name is Jessi Bohon and I’m in your district. It’s from my understanding the ACA mandate requires everybody to have insurance because the healthy people pull up the sick people, right? And as a Christian, my whole philosophy on life is pull up the unfortunate. So the individual mandate, that’s what it does. The healthy people pull up the sick. If we take those people and put them in high-risk insurance pools, they’re costlier and there’s less coverage for them. That’s the way it’s been in the past, and that’s the way it will be again. So we are effectively punishing our sickest people. And I want to know why not, instead of fix what’s wrong with Obamacare, make companies like Aetna that pulled out and lied to their consumers about why they pulled out, and said they pulled out because Obamacare was too expensive, but they really pulled out because of a merger. Why don’t we expand Medicaid and have everybody have insurance?”

At a townhall held by Rep. Gus Bilirakis (R-FL), residents of Pascoe County got to demonstrate how they felt being lied to about death panels in the ACA:

But the best part of townhalls is that it’s a chance for those whose lives have been saved by the ACA to share their stories with the people who are trying to repeal it:

Hopefully this info helps when you’re making your own plans for the coming week.


No, Republicans haven’t repealed Obamacare… yet

Late last week, our Facebook feed started blowing up with posts about how Republicans in Congress just voted to repeal Obamacare. I think it started with an article by Charles Pierce at Esquire with the headline, “30 million people lost their healthcare in the dead of night”. There’s a link to what it calls “an easily readable rundown of the details of the crime” at ProPublica. That page is really just the vote tally for Senate Vote 26, which for some reason ProPublica gave the headline “Adopts Budget Resolution To Repeal Obamacare.

All of that sounds scary, but it’s super misleading. Here’s why.   [click to continue…]


It’s open enrollment time for the Affordable Care Act, which means that now through January 31 anyone who needs coverage can buy a plan. And in most states, TODAY (Dec. 15) is the last day to buy a plan that starts on January 1.

Also, there’s been a lot of confusion about what the recent election means for people who get coverage through the ACA, but keep in mind two things:

  1. If you a buy a plan now, you’ll be covered for all of 2017, regardless of what happens in Washington; and
  2. Not only do Republicans not have a plan for replacing Obamacare, they don’t have a set plan for how to repeal it either. The latest option they’ve floated is voting for a repeal that takes effect in three years, but they can’t do that without Democrats, who’ve said it’s a non-starter.

In other words, ACA coverage is safe for a while at least. On the other hand, the election means that the flaws with the ACA aren’t getting fixed any time soon either, and buying coverage can still be confusing– especially if it’s your first time. To help make the process a little easier, here’s our guide to getting covered under Obamacare, updated for 2017!   [click to continue…]


Trump’s 100 day “plan” for healthcare


So… this happened.

As you might have noticed, we haven’t posted in a while. Partly that’s because we’ve been busy with other projects, but it’s also partly because there hadn’t been much happening in the world of health policy. There were a couple snags with the ACA– premiums increased by more than they had in a couple years and a couple big insurers left the exchanges– but for the most part it was running like it always has, covering more than 20 million Americans who would have been uninsured otherwise. The stalemate between Congress and the White House plus an election year meant that no new health laws were being passed. Both Trump and Clinton posted healthcare proposals on their websites during the primaries (we looked at Trump’s here, and Clinton’s here and here), and Trump like every other Republican promised to repeal Obamacare, but otherwise, healthcare got little attention during the campaign.

And then the election happened.

One of the more troubling things about Trump being elected is that we have little idea of what he’ll actually do when he’s in office. He’s promised to replace Obamacare with “something terrific,” but the proposals on his website are, for lack of a better word, a mess. Even Obamacare critics have worried about Trump’s (lack of) plan. Michael Cannon, health policy director of the libertarian Cato Institute, a man who’s been described as “Obamacare’s single most relentless antagonist,” put it this way:

“This isn’t a health reform plan. It’s a campaign operative copying and pasting a bunch of stuff from the around the web, without knowing what it means or even realizing that he’s describing current law. It shows Trump is as unserious about reforming health care as ever. He doesn’t have a plan. He has paroxysms.”

So we thought that maybe Trump’s hundred days plan would give us some more insight into how he actually plans to tackle healthcare. It did not inspire confidence.   [click to continue…]


zika flier

We haven’t written much about Zika yet, mostly because there are already a ton of great resources explaining pretty much everything you need to know about the virus. In particular we’d recommend:

Also, Zika hasn’t sparked the same kind of public alarm that past outbreaks have, which in some ways is good, since there’s less misinformation floating around. It seems like there’s a general awareness that it’s spread primarily by mosquitos, but can also be transmitted sexually; and that the main risk is for pregnant women, because the virus can cause severe birth defects like microcephaly (although we should point out the World Health Organization estimates that only 1% of women with Zika will have a baby with birth defects). The vast majority (80%) of people who contract the Zika virus won’t show any symptoms; a minority (about 20%) will show minor symptoms like fevers, aches, headaches, and rashes; and in a very small number of cases (1 in 4,000) it can cause Guillain-Barré, a neurological condition that can sometimes lead to temporary paralysis.

However, perhaps because there hasn’t been a major public outcry, Congress has been slow to respond– even though that 1% risk to fetuses was enough for the WHO to declare a public health emergency back in January. Lawmakers on both sides of the aisle say that securing more Zika funding is critical, yet somehow Congress left for summer break without authorizing new funding. Meanwhile, the disease has arrived in the U.S.– it’s now being transmitted by mosquitos in Florida, and a baby born with a Zika-related birth defect died in Texas this week.

And so this week, we’ve seen editorials from Paul Ryan and other prominent Republicans blaming President Obama and other Democrats for blocking Zika funding. That seemed odd given that Republicans are usually the party opposed to new government spending. Turns out that in reality the GOP (1) demanded that the Obama administration use funding meant to prevent another Ebola epidemic, (2) sabotaged a Zika funding bill by adding provisions they knew Democrats wouldn’t agree to, and (3) refused to call Congress back to vote on a clean bill.  [click to continue…]


billy madison

This has probably happened to everyone at least once in school: the deadline for a big paper or presentation was coming up and you hadn’t actually read the book or done the research. At that point, you basically had two options: (1) ask for an extension; or (2) use as many words as you could to present what little information you did have, hoping that the length would obscure the fact that you weren’t really saying anything. There’s a great example of this at the end of Billy Madison:

For six years, Republicans in Congress went the first route, asking for extension after extension on their long-awaited plan to replace Obamacare, always claiming they were going to release one “soon.” That only works for so long though, and with a presidential election coming up, they were starting to face awkward questions from voters and the media about the fate of the 20 million people who would lose coverage if the ACA were repealed.

And so, House Republicans have moved on to the Billy Madison approach. Last week, speaker Paul Ryan released what he called “a first-time-in-six-years consensus by the Republicans in the House on what we replace Obamacare with.” At 37 pages, it’s long enough that on first glance it looks like it could be an actual alternative to the ACA; but just like Billy’s “rambling, incoherent response” was missing “anything that could be considered a rational thought,” the GOP’s rambling, incoherent health reform plan is missing, well, a plan. [click to continue…]