Issa's new plan would allow buy-in to Federal employees plans, but without subsidies

[pnwmom]

and without the Medicaid expansion.

http://www.sandiegouniontribune.com/news/health/sd-me-issa-obamacare-20170221-story.html

His 10-page bill calls for repeal of the Affordable Care Act after a two-year adjustment period and does not maintain the subsidies that currently defray health insurance premiums by significant amounts for millions of Americans. It also does not explicitly continue the flow of federal cash that has allowed expansion of Medicaid programs in many states, including California.

Several other Republican lawmakers’ proposals would explicitly maintain premium subsidies and money for Medicaid expansion in one form or another, though most of those measures would not give as much funding as Obamacare.

While granting access to the same plans that federal employees enjoy would surely be a positive development, doing so without subsidies would leave many current Obamacare enrollees unable to afford their premiums, said Timothy Jost, a health policy expert and an emeritus professor at the Washington and Lee University School of Law.

The text of Issa’s draft bill does specifically allow enrollees to deduct the total cost of their yearly health insurance premiums against their personal income taxes. But Richard Kronick, a health policy professor at UC San Diego who has worked with the U.S. Department of Health and Human Services, said deductions are most useful to people who make enough money to land in high tax brackets. Most Americans who currently get Obamacare subsidies are many rungs further down on the economic ladder, he noted.

[Doreen]

1. Republican health care remindes me of health insurance for pets.

You pay for the entire bill right there at the visit and then turn it into the insurance company and then they decide what they will give you back and then take forever to give it back. I could never afford health insurance for my pets and I will never be able to afford Republican health care.

[TheFrenchRazor]

2. so only the well-off will be able to afford health ins; who would have guessed... nt

[Motown_Johnny]

3. Although this clearly has some serious problems, it is a public option.

Pressure needs to be put on the 19 states that have not expanded Medicaid to do so. Now that the evil demon Obama is out of office, maybe the (R)s in those states can bring themselves to do it. It should be a way for (D)s to put pressure on them to cover more people. We should always be pushing that button.

If the tax deductions are being left in place, but the monthly subsidies removed (which I oppose) then maybe lower income people can offset some of this by claiming they are exempt from federal income tax. If no federal income tax is withheld from paychecks, the net pay will go up. This money could be used to help pay the increased monthly health insurance bill and then the numbers can be balanced out when taxes are filed at the end of the year.

This is not an actual solution to the problem, just a possible tactic to try and deal with the change. I admit that it will help some more than others but at least it may be an option for some.

Lets face it. As long as we have Trump or Pence in the White House we are going to need to take any win we can get. Establishing a public option would be a win. Assuming we win back the Presidency in 2020, we can then move to replace the subsidies and again push to continue expanding Medicaid.

I don't like the details in this plan either, but as a starting point in negotiations with someone as crazy as Issa it isn't the worst possible scenario.

[pnwmom]

4. Medicaid-eligible people are already exempt from Federal income tax.

So I don't see how that would help.

[Motown_Johnny]

6. Medicaid is a seperate issue

The OP says

It also does not explicitly continue the flow of federal cash that has allowed expansion of Medicaid programs in many states,


So this may or may not change Medicaid. There is nothing explicit in the proposal so it is reasonable to assume that current law would still be in place.

This is about people buying insurance on the exchanges who are getting subsidies to lower their monthly bill.

[pnwmom]

10. No, it isn't reasonable to assume that the current Medicaid law would still be in place,

because Obamacare changed the Medicaid law, with the expansion to all children and adults with qualifying incomes.

And many people just above the Medicaid level pay little or nothing in Federal income tax.

[Motown_Johnny]

16. From the information in the OP it is reasonable to assume that.

The OP states that there is nothing explicit in the proposal that changes Medicaid (paraphrased).

That law is now in place. It will take another law to change it. Why do you think that this will change it when there is nothing in the proposal about it?


You seem to be confused.


This proposal is about people buying insurance on the exchanges, not people on Medicaid.

[pnwmom]

18. Since Issa's plan repeals Obamacare, and Obamacare greatly expanded Medicaid,

then it is logical to assume that the repeal will return Medicaid to its state pre-Obamacare, when it covered many fewer people.

By not explicitly addressing Medicaid, but repealing Obamacare, Issa is leaving all those newly eligible Medicaid recipients with nothing.

[Motown_Johnny]

20. That is an assumption based on whatever "Repealing Obamacare" means.

It is a 10 page proposal and we have very limited information to work with here.

I wouldn't jump to a lot of conclusions. The (R)s may just be looking for a way to say they repealed Obamacare without actually screwing over tens of millions of people.

[pnwmom]

22. You are assuming it doesn't mean repealing the law in full.

You are being awfully optimistic.

They are planning to screw people if they don't retain the Medicaid expansion and subsidies.

http://www.modernhealthcare.com/article/20160311/NEWS/160319974

Nearly 83%, or 10.5 million of the 12.7 million exchange members, received the law's premium subsidies, according to HHS.

[Motown_Johnny]

25. Yes I am being optimistic.

I admit that.


I just am surprised to see a whack job like Issa forward something that isn't burning sick poor people at the steak and calling it health care.

[pnwmom]

27. The reason you are surprised is because you're not being realistic.

Issa the whack job is not suggesting that there will be subsidies for the people who need them, or retention of the Medicaid expansion.

Your hope is getting the better of you.

[Motown_Johnny]

29. Time will tell n/t

[SickOfTheOnePct]

5. This is in no way a public option n/t

[Motown_Johnny]

7. Sure it is.

It would guarantee availability to insurance for everyone. Right now we have a problem with private insurance companies pulling out of markets and limiting (potentially eliminating) choices.

The ability to buy into the same health care insurance that federal employees have is unquestionably a public option. I agree that buying into Medicare or Medicaid would be better options but this would be a step in the right direction.




https://www.opm.gov/healthcare-insurance/healthcare/

^snip^

The Federal Employees Health Benefits (FEHB) Program

The FEHB Program can help you and your family meet your health care needs. Federal employees, retirees and their survivors enjoy the widest selection of health plans in the country. You can choose from among Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if you live (or sometimes if you work) within the area serviced by the plan.

Use this site to compare the costs, benefits, and features of different plans. We chose the different benefit categories based on enrollee requests, differences among plans, and simplicity. However, we urge you to consider the total benefit package, in addition to service and cost, and provider availability when choosing a health plan.

[pnwmom]

11. A public option is next to worthless without subsidies for people who need them --

which is most people

[Motown_Johnny]

14. People had insurance before the ACA was passed....

and the subsidies were created by the ACA.

So long as the tax benefits are still in place the numbers will balance out every April 15th anyways.

Yes, the subsidies make it easier for people to pay their monthly insurance bill. I use it myself. I even take the maximum subsidy so that my bill is the lowest it can possibly be. This means I owe taxes every year, instead of getting a small refund, but it is worth it to me. I consider it an interest free loan.

The idea that "most people" need the subsidies is just wrong. Most people get their insurance from their employers.

As I said, I don't like that part of the plan either but as a starting point with someone as crazy as Issa it isn't the worst possible scenario.

[pnwmom]

19. I was obviously talking about most people on the exchanges,

and most of them DO need the subsidies in order to afford their insurance.

Issa's plan will really only help the people who are wealthy enough that they wouldn't need to buy their insurance on an exchange, because they can afford policies without any subsidies.

http://www.modernhealthcare.com/article/20160311/NEWS/160319974

Nearly 83%, or 10.5 million of the 12.7 million exchange members, received the law's premium subsidies, according to HHS.

[Motown_Johnny]

24. That would depend on the cost of the programs we would have access to.

As I understand it (and I could easily be wrong) Federal employees get pretty good benefits, including insurance.

If the tax benefits were left in place and access to low cost insurance available, this could be a possibility.

Of course I am in favor of the subsidies staying in place. Keep in mind that this is just the first draft of a bill. There is an entire legislative process to go through. If they want to try and get past a filibuster in the Senate then it is going to have to be something that (D)s can support. Maybe the subsidies, or at least some portion of them, can be left in place.

[pnwmom]

26. But the Fed insurance is not really low cost -- except to the employees

because the government is subsidizing them -- as employees. (As other employers do.)

There is nothing in Issa's plan to suggest there would be a subsidy like that for other people allowed to buy-in.

[Motown_Johnny]

28. It will need to get past a filibuster in the Senate.

To do that it will need some reasonable option for people to buy insurance.


It is way too early to know WTF is going on with this. I am simply not dismissing it out of hand.

[pnwmom]

31. They can pass much of it in a budget resolution with only a majority vote.

They already changed the rules so as long as a provision AFFECTS a budget -- even if it will increase a deficit -- they can pass it with a majority vote.

And they're already threatening to get rid of the filibuster.

[DeminPennswoods]

12. FEHB plans are at least standard in what they offer

Most people don't know that the ACA exchanges are actually based on the way FEHB works. I honestly never understood why the uninsured/underinsured weren't allowed to buy into FEHB from the beginning. I actually think the cost of FEHB plans might stabilize if there was a larger pool of potential enrollees.

[Motown_Johnny]

15. It does seem like an idea worth exploring.

Of course if higher risk persons were buying in then it might actually cause the costs to rise, at least in the short term.


This isn't as good as buying into Medicare but since it was forwarded by a nutcase like Issa I am somewhat encouraged.

[DeminPennswoods]

17. The irony is

that under the current ACA, states are allowed to join together to create exchanges. The states don't even have to be near each other. If they wanted, NY and CA could form a regional healthcare exchange or the old confederate states could form one or all 50 states could decide to form one big US exchange, that, in effect, would be the same as FEHB.

[Motown_Johnny]

21. Would the plans offered be the same?

I may be way off base here but it is my assumption that Federal employees get pretty good benefits, including health insurance.

The ability to have those same options seems promising. Even more promising than some make shift alliances between states with different state laws governing their insurance companies/programs.

[DeminPennswoods]

34. FEHB plans

Each year OMB goes out with a what's known as a "call letter" to all insurers describing the things a plan must offer and cover. Then the insurers decide if they want to participate and if so, submit their plan(s) and pricing. There are a lot of plans from which to choose.

The plans range from the high deductible/HSA plans to fee-for-service blue cross/blue shield to postal worker plans and everything in between. There are also national plans and state-specific plans. It's pretty good, but it's not like some employer plans where the employees contribution is nothing to very small. Based on what I pay, it looks like the split is 25% enrollee and 75% gov't.

[SickOfTheOnePct]

30. No, it's not

"Public option" refers to a government-run plan, like Medicare, as opposed to private insurance plans, like Aetna, BC/BS.

[Sherman A1]

8. Agreed

I will say however that it is a plan. Up until now I haven't heard anything that even resembled something that could be called a plan, so this is progress. I would add that it is a VERY BAD plan in my opinion, but it is a plan.

[wishstar]

9. Not realistic substitute for ACA, since without subsidies, only wealthier could afford buy-in

Merely providing tax deduction doesn't work except for high earners.

Also, those buying in would likely skew older, needing expensive health care so the insurance companies in the Fed plan would demand higher premiums and it could destabilize the Fed plan.

I don't trust Issa and Repubs-

[DeminPennswoods]

13. Federal retirees are part of FEHB

Without checking, I'd guess FEHB users might already skew a little older.

[pnwmom]

23. But their premiums are being paid for by their employer.

They're not having to pay the costs of their age-based insurance premiums out of their pockets.

[wishstar]

32. Fed employees and retirees pay 25% to 35% of premium cost, govt. pays the rest

Feds do pay substantial premiums, it isn't free.

For instance a Blue Cross basic plan for a couple (no kids) costs $1387, the Fed worker or retiree pays $356 per month, govt subsidizes the rest.

[pnwmom]

33. That still means they're getting subsidies of 65-75%, versus

the non-existent subsidies that Issa promises to people who buy into the program.