June 30, 2017

Repeal First, Replace Later?

Rand Paul and Donald Trump are suggesting that the GOP repeal the Affordable Care Act now, to keep their promise to America and then work on the hard part of coming up with a health care plan at some other point down the road

First, Trump's tweet, followed by Paul's (wrapped in some context):


As I've said a million times, I'm no expert on how to build a health care bill, but I can pretend to repeal one, so here goes. Note that my assumptions are that 'repeal' means all provisions of the bill will be immediately removed, not continued until such time as a completely new healthcare plan is passed, which is what "repeal now and replace later' means to me. (I'm not sure what other interpretation there could be?)

  1. Immediately shut down Healthcare.gov and the 28 federally facilitated marketplaces and the five state-based marketplaces using the federal platform. 
  2. Cancel the coverage for individuals and families who were covered under the now-defunct marketplaces.
  3. Return any unused premium to them.
  4. Immediately repeal the voluminous taxes required under the Affordable Care Act, whether charged to a business, a health insurer, any medical facilities, and so on. This will of course require an immediate rewriting of the tax code just to get us back to where we were before the Affordable Care Act went into effect.
  5. Immediately repeal the individual mandate.
  6. Immediately kick over-aged dependents off their parents' policies in any location such coverage is not mandated under any other jurisdiction.
  7. Immediately remove the Medical Loss Ration (MLR) requirements, which dictate the percentage of health care premium dollars insurers must pay for benefits (base around 80%) and requires insurers to rebate premiums to insureds when they don't meet the MLR percentage.
  8. Immediately eliminate the full coverage for pre-existing conditions at no additional premium - let the games begin.
  9. Remove no-cost-sharing coverage for preventative care, including things like lead screening, mammograms and paps, prostate screenings, annual physicals, a whole host of lab tests, and countless other benefits - those can all go back to whatever pricing structure was in place before.
  10. Remove all subsidies which currently help people pay for coverage - all of them.  
  11. Similarly, remove all supports that are paid to insurance companies to help cover the costs of  insuring the people who got coverage under the ACA. 
  12. Eliminate requirements for 'essential benefits' including outpatient services; emergency services; hospitalization; pregnancy, maternity and newborn care; mental health and substance abuse, prescription drugs, and more.
  13. Immediately end all funding for Medicaid expansion.
  14. Immediately reintroduce annual and lifetime limits on benefits.
  15. Immediately increase the population of uninsured by the number of people covered under a marketplace (~10 million or so as of February 2017) and the number covered under Medicaid expansion, ~14 million).
I'm sure there's more, but that's what comes to mind right off the bat. 

Seems like lots of benefits would be lost, lots of tax revenue would be lost, lots more people would immediately be uninsured. And lots of people would be unemployed, I'm sure, if there was no need to support the Affordable Care Act's infrastructure. 

On the plus side for Republicans? Taxes would go down, Medicaid expansion would disappear, and lots of people would be uninsured.