How does a “skinny re­peal” of Oba­macare af­fect Colorado?

The Denver Post - - NEWS - By John In­gold Ques­tion:

U.S. Se­nate Repub­li­cans, look­ing for a health care bill that can win ma­jor­ity sup­port in their cham­ber, sug­gested a new, more mod­est plan Tues­day: A “skinny re­peal” of the Af­ford­able Care Act.

What is it and how would it im­pact Colorado? Read on for an­swers. What is a “skinny re­peal”?

An­swer: In a way, it is the bare min­i­mum that you can roll back the Af­ford­able Care Act, the health care law that’s also called Oba­macare, and still claim you have re­pealed it. The ex­act de­tails of the pro­posal are un­clear, since sen­a­tors haven’t of­fi­cially in­tro­duced any­thing.

But re­port­ing by The Hill, Politico, Vox and other out­lets all agree on two points: The pro­posal would re­peal the in­di­vid­ual and em­ployer man­dates in the ACA — those are the re­quire­ments that ev­ery­body have health in­sur­ance. It would also do away with a tax on med­i­cal de­vices.

Ev­ery­thing else that’s up for de­bate in an ACA re­peal — the sub­si­dies for peo­ple who buy their own in­sur­ance, fund­ing for Med­i­caid, the Med­i­caid ex­pan­sion — would ap­par­ently re­main as it is un­der cur­rent law.

Q: Af­ter so much talk about re­peal­ing Oba­macare, what’s the logic be­hind such a mod­est pro­posal?

A: Re­ports out of Wash­ing­ton, D.C., are that a skinny re­peal would be sort of a place­holder while law­mak­ers from both the House and the Se­nate work on a big­ger idea. The Se­nate is ex­pected to vote on more am­bi­tious plans to roll back the ACA first. If those don’t pass, Repub­li­cans would then put forth the skinny re­peal.

The House has al­ready passed its own plan for re­peal­ing Oba­macare, a pro­posal called the Amer­i­can Health Care Act. For the pres­i­dent to sign a bill into law, the House and the Se­nate must pass the same ver­sion of the bill, though, and the AHCA looks like it’s a non­starter in the Se­nate. So, for the ef­forts to re­peal the ACA to con­tinue, the Se­nate has to pass some­thing. That’s where the skinny re­peal comes in.

As U.S. Sen. John Thune, a Repub­li­can from South Dakota, told Politico, the strat­egy is, “What­ever gets to 50.”

Once both cham­bers have passed their own ver­sion of a re­peal, the House could just adopt the Se­nate’s ver­sion and send the bill onto the pres­i­dent. But it’s more likely the two cham­bers would hash out the dif­fer­ences in what is called a “conference com­mit­tee.” The com­mit­tee would es­sen­tially write a com­bined bill that both cham­bers would then vote on. That makes it un­likely, if it passes the Se­nate, that the skinny re­peal would make it to Pres­i­dent Don­ald Trump’s desk.

Q: But, if it does, how would a skinny re­peal im­pact in­sur­ance mar­kets?

A: For such a scaled-back plan, a skinny re­peal could have sig­nif­i­cant im­pli­ca­tions. The main im­pact comes from drop­ping the man­dates and the rip­ples that fol­low.

With no re­quire­ment to buy in­sur­ance, the Con­gres­sional Bud­get Of­fice has es­ti­mated that a re­peal of the in­di­vid­ual man­date would mean 15 mil­lion more peo­ple with­out health in­sur­ance na­tion­wide by 2026 com­pared to cur­rent law. Some of those would be peo­ple who don’t want to have to buy in­sur­ance. But oth­ers would likely be peo­ple who want in­sur­ance but feel they can’t af­ford it, ac­cord­ing to the CBO.

The rip­ples start, though, when you look at who those peo­ple are.

The CBO projects that those drop­ping out of the mar­ket would likely be younger and health­ier, on av­er­age, leav­ing the re­main­ing in­sur­ance pool rel­a­tively older and sicker. That trend would prob­a­bly freak out in­sur­ers, who would re­spond to a more ex­pen­sive pool by rais­ing pre­mi­ums for ev­ery­one. (The CBO es­ti­mates that pre­mi­ums in 2026 would be 20 per­cent higher na­tion­wide with­out a man­date than they would be if the man­date re­mains in place.)

The fed­eral gov­ern­ment would then spend more pro­vid­ing sub­si­dies to peo­ple who buy their health in­sur­ance on their own — though it would also save money by not pro­vid­ing sub­si­dies to those who bailed. In to­tal, the CBO es­ti­mates that elim­i­nat­ing the in­di­vid­ual and em­ployer man­dates would save the fed­eral gov­ern­ment $381 bil­lion in the first decade.

Mean­while, re­peal­ing the med­i­cal de­vice tax would re­duce fed­eral rev­enue by $19.6 bil­lion in that time.

Q: How would a skinny re­peal im­pact Colorado?

A: There aren’t a lot of Colorado-spe­cific num­bers yet on the im­pacts of a re­peal of the in­di­vid­ual man­date, but there are two ar­eas of con­cern in ad­di­tion to ris­ing costs.

First, with more peo­ple unin­sured, hospitals could be on the hook for pro­vid­ing more care that they don’t get paid for. That could threaten some hospitals’ abil­ity to re­main open.

Sec­ond, if in­sur­ers are spooked by fed­eral pol­icy changes, they could bolt from the state as early as this year, leav­ing peo­ple shop­ping on their own for health in­sur­ance with fewer — or no — choices.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.