Senate unveils Healthcare bill

[GTFan]

https://www.nytimes.com/2017/06/22/...l-bill-to-repeal-the-affordable-care-act.html

Bill contents:
https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf

Looks like a more moderate version of the House's AHCA, with the major change being income-based credits instead of age-based. Guess we'll see what the impact is going to be from the CBO's estimate, to be released on Monday.

 

[nvestysly]

Thanks for the links but I'm hoping to find more of a detailed summary of the proposed Senate bill. Has anyone found something that puts all the strike this, substitute that, eliminate this, change that verbiage into an actual summary of changes? Unless a person is a PPACA expert it's difficult to understand the proposed list of changes to specific paragraphs in the existing law.

 

[MichaelB]

Thanks for the links but I'm hoping to find more of a detailed summary of the proposed Senate bill. Has anyone found something that puts all the strike this, substitute that, eliminate this, change that verbiage into an actual summary of changes? Unless a person is a PPACA expert it's difficult to understand the proposed list of changes to specific paragraphs in the existing law.

The only one I've seen so far is this article at Business Insider. Senate healthcare bill, or Trumpcare, AHCA details - Business Insider

In a couple of hours we should have more info available.

 

[FIRE'd@51]

One thing of interest to me is whether repealing Obamacare would return the Schedule A medical deduction threshold to 7.5% of AGI from 10%.

 

[ShokWaveRider]

Unfortunately, I do not think the Tax Credits will work for most people who need them. Basically you have to pay it all up front then claim back on your taxes. My health insurance without Subsidies is `$1,500pm that is $18,000pa. Now tell me, out of those folk in the 50 - 64 group, how may do you think can afford that? I may be able to afford it, but it will be very hard. For those who cannot, I can see them going to the emergency rooms.

Currently the ACA Pays the subsidy directly to the insurance companies. In my Case ~$1,100pm.

 

[easysurfer]

I'm just glad closer to the moment of truth wherever the decisions land and reminding myself to go on "wait until dust settles" mode.

 

[explanade]

Detailed outline here:

https://www.vox.com/policy-and-poli...28/senate-plan-better-care-reconciliation-act

Cuts Medicaid funding about as much as the AHCA.

One thing of note, no individual mandate nor a continuous coverage requirement like the AHCA.

 

[Sue J]

Unfortunately, I do not think the Tax Credits will work for most people. Basically you have to pay it all up front then claim back on your taxes. My health insurance without Subsidies is `$1,500pm that is $18,000pa. Now tell me, out of those folk in the 50 - 64 group, how may do you think can afford that? I may be able to afford it, but it will be very hard. For those who cannot, I can see them going to the emergency rooms.

Currently the ACA Pays the subsidy directly to the insurance companies. In my Case ~$1,100pm.

Yes, that's the first thing I noticed. Not only for the 50-64 crowd but all the families who are getting a substantial subsidy that they would have to cover up front.

Imagine that this would lead to a third party "service" that would "loan" you your subsidy throughout the year. Every month you would be advanced a chunk of money that would serve as your subsidy. Then at tax time your healthcare subsidy is returned to you as a tax credit. And then you are expected to pay off your loan.

Would this loan service be provided by your insurance company? Or a govt agency? Or would there be a new business model for a medical subsidy loan company?

Keep in mind this is just where my thinking meanders. I'm certainly not saying this is anywhere in anyone's bill.

But how do they expect normal folks to be able to cover their lost subsidy on a monthly basis?

On a personal level, after election day I came up with Plan A, Plan B and Plan C, including color coded spreadsheets, to manage how we would cope with drastic changes to our health care premium costs. We both start Medicare in 2020 so we just have to deal with this for 2 years and a couple of months.

We will be fine, but it may get ugly

 

[Alan]

Am I correct in reading this that the individual mandate will be removed?

SEC. 104. INDIVIDUAL MANDATE.
7 (a) IN GENERAL.—Section 5000A(c) of the Internal
8 Revenue Code of 1986 is amended—
9 (1) in paragraph (2)(B)(iii), by striking ‘‘2.5
10 percent’’ and inserting ‘‘Zero percent’’, and
11 (2) in paragraph (3)—
12 (A) by striking ‘‘$695’’ in subparagraph
13 (A) and inserting ‘‘$0’’, and
14 (B) by striking subparagraph (D).
15 (b) EFFECTIVE DATE.—The amendments made by
16 this section shall apply to months beginning after Decem-
17 ber 31, 2015

That will make my IRS return next year a little shorter as US citizens living abroad have an extra form to file to avoid the penalty for not having a PPACA compliant plan.

 

[RunningBum]

The only one I've seen so far is this article at Business Insider. Senate healthcare bill, or Trumpcare, AHCA details - Business Insider

In a couple of hours we should have more info available.

That source says the subsidy cliff will be at 350% of FPL, down from 400%. 400% was already pretty tight to me, not sure I can make 350.

 

[MichaelB]

A summary from The Hill What’s in the Senate healthcare bill | TheHill

- A longer phase out of the Medicaid expansion
- Deeper cuts to Medicaid
- Defunding of Planned Parenthood for one year
- An additional $2 billion in fiscal 2018 for states to address the opioid crisis
- Cuts to ObamaCare tax credits
- The elimination of the individual and employer mandates for having and providing insurance
- Funding to continue cost-sharing reduction payments through 2019
- More flexibility on insurance regulations
- No tax credits for plans that cover abortion.
- Repeals all of ObamaCare’s taxes

This bill is different from the one passed in the House, so if it passes, it still needs to a conference committee for reconciliation.

 

[AllDone]

No changes to pre-existing conditions, however no mandates or continuous coverage requirements either. That's been tried in New York state and Washington state and led to a "death spiral" and destruction of the individual insurance market as people waited to get sick before buying insurance. The third time might be the charm, I guess.

 

[MichaelB]

From the Vox article linked by explanade, the Senate bill also allows states to opt out of essential health benefits requirements.

 

[truenorth418]

Senate version appears to keep the subsidies but now only for those making up to 350% of the federal poverty level not 400% like the current ACA scheme. The House version eliminates the prepaid income based subsidies completely and replaced them with age-based tax credits, reconciled via tax filing after the fact. That's a major difference between the 2 bills.

Many of these changes would be phased in to take effect after 2020. By that time my passive income will likely exceed the 400% level let alone this proposed 350% level. Thus I am hoping for something like the House version.

Oh well whatever happens I will have to adapt and adjust, like always.

 

[MBSC]

One thing of interest to me is whether repealing Obamacare would return the Schedule A medical deduction threshold to 7.5% of AGI from 10%.

The current version of the Senate Bill does this.

"Sec. 116 - Repeal of Chronic Care Tax

(a) In General - ...striking 10 percent and inserting 7.5 percent.

(b) Effective Date -...taxable years beginning after December 31, 2016."

Unfortunately, I do not think the Tax Credits will work for most people who need them. Basically you have to pay it all up front then claim back on your taxes.

Currently, if a person receives too much APTC, they must pay back the excess. However, there are limitations on the repayment amount based on FPL. Title I, Section 101 of the Senate Bill only removes the caps on the repayment amounts. The person would have to repay the entire excess. The APTC process remains in place.

Section 102(b) (Modification of Limitation on Premium Amount) changes the premium subsidy formula from using the SLCSP to the median cost of available 58 percent (Bronze) plans.

 

[RetireAge50]

Oh well whatever happens I will have to adapt and adjust, like always.

+1

 

[Blue Collar Guy]

Senate version appears to keep the subsidies but now only for those making up to 350% of the federal poverty level not 400% like the current ACA scheme. The House version eliminates the prepaid income based subsidies completely and replaced them with age-based tax credits, reconciled via tax filing after the fact. That's a major difference between the 2 bills.

Many of these changes would be phased in to take effect after 2020. By that time my passive income will likely exceed the 400% level let alone this proposed 350% level. Thus I am hoping for something like the House version.

Oh well whatever happens I will have to adapt and adjust, like always.

+2

 

[Ian S]

No changes to pre-existing conditions, however no mandates or continuous coverage requirements either. That's been tried in New York state and Washington state and led to a "death spiral" and destruction of the individual insurance market as people waited to get sick before buying insurance. The third time might be the charm, I guess.

I can't see how that would ever fly with insurance companies. No mandate and no penalty for going without insurance invites healthy people waiting until they get sick to get insurance. This alone could wreck the individual insurance markets for everyone. The reason the Senate could not get such requirements into the bill is that such requirements are not allowable under reconciliation but instead would be subject to the filibuster.

The cuts to Medicaid are pretty severe. Guess all those middle class folks who were hoping granny's nursing home costs would be picked up by Medicaid when her money ran out will have to start getting the guest room ready!

I'm calling my Senators' offices right now.

 

[LARS]

Notwithstanding changes to existing law will impact me, I have decided it is a waste of time focusing at this point on any proposed legislation. First, the Senate has to pass it and if that is accomplished, it will have to go through Committee reconciliation to get a Bill for the House and Senate to pass again to become law.

I figure sitting here today the odds of that happening are 5:1 against ever happening. So why worry, be happy as the song goes.

Regardless, I will only really begin to pay attention if the Senate gets this passed.

 

[REWahoo]

Regardless, I will only really begin to pay attention if the Senate gets this passed.

Party pooper. You take all the fun out of ranting and raving about it.

 

[Cobra9777]

Any mention of HSA increased contribution limits? I've seen none in what I've read so far.

 

[truenorth418]

If one of the goals is to increase competition, one thing that seems to work pretty well in every other industry is competition.

Any indication that this bill will allow for purchase of health insurance across state lines?

 

[Fermion]

If one of the goals is to increase competition, one thing that seems to work pretty well in every other industry is competition.

Any indication that this bill will allow for purchase of health insurance across state lines?

One thing I never understood with that is how the state insurance commissioner thing would work then.

 

[6miths]

Competition can work sometimes but perhaps not so much in an area in which there is such an incredible effort made to hide true costs. Economies of scale seem to work often too which goes against competition I guess.

 

[Golden sunsets]

One thing I never understood with that is how the state insurance commissioner thing would work then.

Also with respect to state lines, are the insurance companies that sell in other states going to run around and sign up/negotiate rates with an entire network of health care providers in each state? That might make sense in contiguous states, maybe... if enough new people apply, but what about states that are not near each other. I have never understood how that could work.