The American Health Care Act (AHCA) would establish per capita Medicaid allocation levels, beginning in 2020, as part of changes to give states more flexibility and incentives to improve care delivery and costeffectiveness in their Medicaid programs that now cover an estimated 72 million Americans. Although some have suggested that the allocation levels would produce large reductions in federal Medicaid spending, a comparison of projected per capita Medicaid spending under AHCA with baseline projections prepared by the Centers for Medicare and Medicaid Services (CMS) suggests that these limits would achieve virtually no federal Medicaid savings.
ObamaCare Watch | Dire Predictions About the Effects of AHCA’s Per Capita Allocations Find No Support in the CMS Data – ObamaCare WatchJune 16, 2017
No matter what happens to the Republicans’ troubled health bill in Congress, Trumpcare is here to stay.The Trump administration has already begun to transform the health insurance market, wielding executive power to rewrite coverage rules, slash Obamacare’s marketing budget and signal an all-out assault on his predecessor’s health care law. And Republicans have high expectations the administration will take additional measures to unwind Obamacare, such as targeting its contraception coverage requirement at the center of two recent religious liberty cases at the Supreme Court.
For better or for worse, it is nearly impossible for the ACA’s insurance exchanges to implode to the extent that its detractors have long predicted. To understand why, it is important to understand how the subsidies and regulations in the ACA work. The ACA employs “price-linked subsidies.” That is, the premium subsidy consumers receive is based on the actual prices for insurance on the exchanges. In addition, the ACA’s regulatory framework caps the out-of-pocket expenses faced by consumers.
All in all, there’s reason to believe that the real decrement in coverage of the AHCA relative to the ACA is closer to 5 million, not 24 million. Furthermore, that 5 million decrement can be fixed with a few technical changes to the bill. I detail all of this in a new piece over at Forbes.
The basic issue is the movement in Obamacare from hypersensitivity to the immense geographic variation in the price of healthcare and health insurance in the United States to the complete insensitivity of the current Republican plan, the American Health Care Act (AHCA). Neither extreme is a good idea. Instead, the federal government, to the extent it is subsidizing health insurance, ought to be sharing the burden created by a failure or inability to control healthcare costs and health insurance premiums with the states and those who elected its representatives.
President Trump urged lawmakers Tuesday to swiftly approve a plan to repeal and replace Obamacare so he can move on to the biggest tax cut since Ronald Reagan’s presidency.“There’s going to be no slowing down, no waiting, no more excuses by anybody,” Mr. Trump told top House Republican lawmakers at a White House meeting on the new health care legislation. “We’re going to get it done.”After Congress tackles the health care law that was introduced in the House Monday, Mr. Trump said eagerly, “we work on the tax cut.”
Forced to navigate House Republican politics, the lobbying pressure from the insurance industry, and the obscure rules of the budgeting process, Ryan has produced a bill that nobody would ever propose as a sane solution to the problems with Obamacare. Its only chance is speed. If Ryan can rush and muscle it through the House and Mitch McConnell can do the same in the Senate, it might end up on Trump’s desk. But the more scrutiny this House bill is subjected to, the more likely it is to share the fate of most efforts at health-care reform and die somewhere on its journey to the Senate, and perhaps long before then. If his health-care-reform effort fails, Ryan himself may not survive as the House leader. Meadows and his colleagues catapulted Ryan to the Speakership, and they still have the power to bring him down.