Let's look at the Senate plan as diagnosed by the Congressional Budget Office (CBO), which is nonprofit and government-sponsored. It's the group that determines the effects of bills for the Congress. All of these observations are taken directly or paraphrased from the 49-page CBO report:
• 15 million more people would be uninsured next year because there's no penalty for not being insured. That's the headline. But there's a side effect. If healthy people leave the market because they don't think they need it, that means the pool of people with insurance is now sicker by comparison. That means there's more risk in the pool, which means premiums rise for those who are insured.
• 22 million uninsured by 2026 because the lower subsidies and lower spending on Medicaid will push people out of the market.
• The bill saves $321 billion over 10 years (roughly $32 billion/year) for the government. Two things to unpack here. First, while the spending is up for Medicaid from what it is now, it's down by about 3/4 of a trillion dollars compared to its current budgeted amount for the future. Second, there's about $400 billion in subsidy reductions. There are only two ways, per the CBO, that this bill saves money for the government: Less than expected spending (cuts) in Medicaid and less than expected spending (cuts) in subsidies/tax credits.
• Insurance premiums on marketplace plans would rise until 2020 then decrease after that, the CBO projects. The why is important here: Healthy young folk would buy less comprehensive plans that cost less. (Insurance covers 58 percent of costs rather than roughly 70 percent of costs, for example.) These less comprehensive plans cost less because the insurance company covers less of the tab -- therefore incurred expenses fall on the patient's shoulders. It's a shift in the cost from the premium to the co-pay/co-insurance/deductible amount.
• Obamacare created a list of essential health benefits (EHBs) that every health care plan has to meet. One of the provisions of the BRCA is that states can add or subtract things from this list with a waiver. People who use those services covered by an EHB that is later waived by a state would have "substantial increases" in premiums or out-of-pocket spending. It also means there's no annual or lifetime limits once something's off the EHB list. Real-world example: Let's say you live in South Dakota, and South Dakota decides maternity health is no longer an EHB. In that case, your maternity coverage just got a lot more expensive and there wouldn't be an annual or lifetime limit on how much you'd have to spend out-of-pocket.
• There'd be a six-month waiting period before coverage can start for people in the health insurance marketplaces. This is to prevent healthy folks from jumping on board when they got sick and jumping off after health insurance has picked up a portion of the tab.
• Obamacare said that older people (50s/60s) can be charged premiums up to 3 times higher than young people (20s/30s). That number would jump to 5 times in the BRCA. This has the effect of lowering premiums for young people while increasing premiums for older people (p. 25). If you're eligible for subsidies, great -- the CBO thinks you won't see much change in cost. But if you're ineligible for subsidies, older people will get a "much higher" cost.
• It took me a minute to decipher this one, but there's an Obamacare rule that caps the percentage of premiums that go toward profits/administrative costs for insurers. This bill would repeal that requirement and leave it to the states. The CBO thinks half the states would repeal it or go with a higher cap percentage. In states with little competition in the marketplace, this means premiums would go up. Subsidies would cover most of that, but... that's kind of the case with premiums under Obamacare, too. The GOP has made a big stink over the premium increases under Obamacare, even though most of those are covered by subsidies.
• For most lower-income people, you'd pay a similar premium for worse coverage -- higher deductibles and less percentage covered by health insurance.
• For those under the federal poverty line and ineligible for Medicaid, you could get tax credits in a way you can't under Obamacare. That's good. But the deductible would be 1/3-1/2 of their ANNUAL income. That's bad. The CBO believes most would skip health insurance because it's not a practical expense. This goes for a lot of others, too: If people are paying the same for worse coverage, they'll drop the coverage.
• There are a couple deductions in this one, but using a few of the points above (5:1 ratio instead of 3:1 for older patients and worse coverage = dropping the coverage), it's clear this bill will hurt older people who are ineligible for Medicaid the most. They'll either have to pay way more in deductibles and share of costs or they'll simply drop coverage -- which causes a decline in health outcomes.
• States would have a per-capita cap on Medicaid spending. This would mean tough choices for states in who is available for Medicaid or what services are available. In short, Medicaid would be cut, but the decision on what to cut would be left to the states. This is Congress' method of passing the buck — we're not the bad guys, it's the states who decided to do cut/eliminate X. Disabled children are exempt from this cap, however.
• Many states would likely use work requirements for non-disabled, non-elderly, non-pregnant people to make sure someone is eligible for Medicaid. This is currently banned for Medicaid.
• Under Obamacare, more states are expected to expand Medicaid for those up to 138 percent of the federal poverty line. Under this law, no additional states will expand Medicaid. Why? Under this law, the federal government won't match costs by as much -- it's a disincentive for the expansion of Medicaid if this is passed.
• There's $2 billion for the opioid crisis nationwide.
• It would repeal a $1-2 billion/year fund that awards grants for prevention, wellness and public health activities.
• An individual makes $56,800. If they're 21 years old, their premiums go down roughly $1,000/month. If they're 40 years old, premiums don't change much or go down slightly. But if you're 64 years old, premiums go from $4,400/month to $16,000/month under the bronze plan (read: worse benefits) plan and from $6,800/month to $20,500/month under the silver plan!
• Same scenario, but they make $26,500. At 21, their premiums would rise by about $500/month. At 40, premiums would rise by roughly or more than $1,000/month. At 64, premiums would rise by $2,000-$4,000/month. This is because of less-generous subsidies.
• UPDATE: I had seen from other observers that the bill was mostly a tax bill wrapped in a health care package. I don't see exactly the same numbers they did, but I did find this: Revenues in the form of taxes on corporations and the wealthy would drop by $700 billion. That's twice as much as it "saves" the government.
Chronicles of the Low Road
These days, there are two important times for news to break. The first is 4:30 p.m. Central (as I discussed here about when the Washington Post breaks news) and the other is 7 a.m. Central. That's when the President of the United States wakes up and gets on Twitter. Often he says something stupid that takes up the oxygen in the news cycle for the day. Today, that was picking a fight with the MSNBC "Morning Joe" co-hosts, Joe Scarborough and Mika Brzezinski. He used personal attacks on each, calling Joe a "Psycho" and Mika "Low I.Q. Crazy". He also attacked Mika for her looks, because... ?
This clearly crossed the line of civility or dignity one might expect from a national leader. As you would expect, Democrats came out upset about it. But there was plenty of opposition from the right, too. It wasn't just moderates and Trump opponents like Ben Sasse or Susan Collins or Lindsey Graham, though they were outspoken about it. Instead, some of it came from staunch conservatives like Rep. Lynn Jenkins (R-Kan.), Speaker of the House Paul Ryan and Orrin Hatch. That's a good sign — that there are calls for civility and respectfulness from members of his own party. I appreciate these comments, because they re-draw the line in the sand of what is acceptable and what is not in politics. I'm glad they're taking a stance on how politics should be handled. They may not matter much, but it helps create distance between them and Trump — though I don't expect this will cause any permanent split.
But the problem comes from people like Sarah Huckabee-Sanders and Melania Trump spokesperson Stephanie Grisham, both of whom painted Trump as a victim who was fighting back. In their words, Trump had been under attack, and it was necessary to "[fight] fire with fire" and "hit back 10 times harder." They don't seem to recognize that Trump himself had elevated the matter. (Quick sidebar: Melania Trump has said one of the main focuses she'll have as First Lady is against cyberbullying. Yet here is an example of her husband engaging in cyberbullying, and her spokesperson not only calls it OK, but seems to encourage it. Guess stopping cyberbullying starts in your house, but not hers.)
I found myself agreeing with Sen. James Lankford, R-Okla., who made the connection to the shooting of Rep. Steve Scalise last week. Following that tragedy, there were calls from legislators on both sides for civility and respectfulness from political opponents. Lankford said: "National and local leaders, including our President, should model civility, honor and respect in our political rhetoric. The President's tweets today don't help our political or national discourse and it does not provide a positive role model for our national dialogue." Amen, Senator.
Summary Judgments
I could go into the laborious details, but Seattle was one of the first cities to adopt $15 an hour minimum wage. A new study finds that workers were helped by the first minimum wage hike, from $9.47 to $11, but were harmed by the hike from $11/hour to $13. I'm all for an increased minimum wage, but it should be reasonable and productive for the results desired. This study indicates $15/hour is a bridge too far, but a more reasonable middle ground ($10? $11-12 in major metro areas?) might have some success. • • • If you only read one thing today, read this. It's by my friend Kendall Brown (we went to OU together and worked at the Daily together). It's heartbreaking and honest and important to read stories like this — actual faces to the 22 million who could lose coverage under a Republican health care plan. • • • I've had some terrible runs lately. I haven't had a good 4-mile run in a week or two. My plan for this week got a little shaken by storms during my run window. So now I've got to fit in a run tomorrow and Sunday before I run the 4-mile race on July 4. I'm apprehensive, just because I don't feel ready like I was, say, a month ago. • • • Evie has been letting me do her hair more. Poor girl... she doesn't know how bad I am at it. She asked Alyson for "two ponytails" the other day. It was adorable, and my eyes just turned into cartoon hearts. But I can't tell her -- she gets shy about it.
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