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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.   [continue reading…]


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.   [continue reading…]


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.   [continue reading…]


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.   [continue reading…]


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.   [continue reading…]


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.   [continue reading…]


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.   [continue reading…]

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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.   [continue reading…]