Posted: 03/01/17 20:21, Edited: 03/01/17 20:27
by Dave Mindeman
During his speech on Tuesday, Trump outlined five keys to replacing Obamacare. Let's take a look.
First of all, these five guidelines exactly match the leaked information from the House leadership. Which proves that Donald Trump never had any plan to repeal and replace. Nothing. All that bullpuckey about having a plan that everyone will like and will be the "best plan ever", never existed. He never even tried.
But he, in effect, gave Speaker Ryan the go ahead to make his plan the priority in the process.
Here is what Trump outlined:
1. Ensuring people with pre-existing health conditions are guaranteed "access" to health insurance, "and that we have a stable transition for Americans currently enrolled in the health-care exchanges.
2. Giving people who buy their own health coverage tax credits and expanded health savings accounts to help pay for their coverage, as well as flexibility about the design of their plans.
3. Give states "the resources and flexibility" in their Medicaid programs "to make sure no one is left out." Medicaid covers primarily poor people.
4. Legal reforms to protect doctors and patients "from unnecessary costs" that drive up insurance costs, and to bring down the price of high-cost drugs.
5. Creating a national insurance marketplace that allows insurers to sell health plans across state lines.
So, let's look at these one by one...and remember, none of these are anything new and a plan that encompasses these as the main points will not come close to health insurance coverages under the ACA.
#1 - Notice the word access. The guarantee of coverage even with pre-existing conditions seems to be under review. (The children staying on up to 26 also seems to be under review) That means the insurance companies are looking for loopholes to get sicker people off their roles. That will NOT be a stable transition.
#2 - The Republican House is divided on tax credits. If allowed credits, people who do not pay enough income tax to equal the allowable credit would get a refund for the difference. The more conservative members only want a tax "deduction" - which would be bad news for lower income filers....and probably cause people to give up trying to get insurance. And by the way, Health Savings Accounts are really just one big tax shelter for the wealthy. You can probably save as much as you want in an HSA - tax free. But then if you can't even fund your 401K with "extra money", how are you going to find more for an HSA? Don't get sucked in on that one.
#3 - Medicaid is probably going back to block grants...which once again, will hurt lower income people in each state. And when block grants are used, the states have to make up any differences for people to be covered and that generally means their will be state coverage differences again.
#4 - There is a simple answer to high cost drugs. Allow Medicare and Medicaid to negotiate prices directly. But there is little evidence of that, so no one knows if any meaningful savings will happen. As for legal reforms, well how that will benefit the consumers is a mystery. Generally, legal reforms means tougher allowances for malpractice.
#5 - Selling insurance across state lines has been a Republican panacea for a long time. There are two possibilities. One, the insurance carriers will compete to get the cheapest premiums with the worst possible coverage into the marketplace. Or 2, the Obamacare mandates on preventative care and basic coverages are going to be thrown out the window. Either idea might make a small dent in premiums, but it will also take us back to the days of sparse coverage or catastrophic coverage only.
There is going to be no comparable plan here. This is another GOP scam that is smoke and mirrors.
Remember the Republican attack ads on the supposed lie about "you can keep your plan if you like it?" Well, the Republican plan is to never even offer you anything close to what you had before...and then tell you they saved you all this money.
It's a joke.