Health Insurance Reform Debate Heats Up With Latest Senate Bill and CBO Report

The Congressional Budget Office (CBO) reported on June 26 that the Senate bill to repeal Obamacare would increase the number of uninsured Americans by 22 million by 2026. According to the CBO, 15 million more people will be uninsured next year than under current law. Furthermore, subsidies would be “substantially smaller,” and premiums and deductibles would become so onerous that “few low-income people would purchase any plan” beginning in 2020. Premiums for older people would also be much higher than under current law, and the health-care insurance reform bill would reduce projected Medicaid spending by $772 billion over the next decade and the number of people covered by Medicaid by 15 million in 2026 compared to current law. Meanwhile, the bill would reduce federal deficits by $321 billion over ten years. Although Senate Majority Leader Mitch McConnell (R-Ky.) had hoped for the bill to be approved before the July 4 recess, observers say that is looking increasingly unlikely as four Senators — Susan Collins (R-Maine), Rand Paul (R-Ky.), Dean Heller (R-Nev.), and Ron Johnson (R-Wis.) — have refused to support it.

The Better Care Reconciliation Act, proposed by the United States Senate to repeal and replace the Affordable Care Act, could reduce the number of plans available in Tennessee’s individual market, limit networks, and raise deductibles and premiums. The bill would allow premiums for younger people to fall in the first few years while increasing costs for older people. According to the Kaiser Family Foundation, a 27-year-old earning $30,000 per year in Davidson County could see a $2,480 premium drop by $20 per year. According to recent analyses, people would also see tax credits shrink and be able to obtain less coverage for their money. Tennessee Insurance Commissioner Julie Mix McPeak has stated that she would like to define what benefits are provided in order to better reflect the needs of Tennesseans. If the bill is passed as written, the state may work with insurers to develop a new set of benefits that will go into effect as early as January 2018. However, more than 30% of adults in Tennessee have outstanding medical debt, and that figure could rise if the Senate plan is implemented.

If congressional Republicans pass a comprehensive health-care bill, high-risk health insurance pools could make a comeback. These high-risk pools are government-run health plans that provide coverage to people with expensive medical conditions, such as HIV and cancer, who are unable to obtain coverage elsewhere. The Washington State Health Insurance Pool, the state’s high-risk pool, was established in 1987. Prior to the Affordable Care Act (ACA), approximately 3,000 residents were enrolled in the high-risk pool, and state legislators enacted legislation prohibiting new enrollees after the law’s individual insurance market was established. The pool’s fate is unknown if the Republican health-care plan passes, but Office of the Insurance Commissioner spokesperson Stephanie Marquis said the state would not consider waivers of the ACA’s regulations, such as those that allow insurers to charge people with preexisting conditions more or deny them coverage. She stated that the office is considering long-term plans for its high-risk pool, which could include stabilizing the individual insurance market by paying for the sickest people’s premiums, driving down risk for insurance companies, and, in theory, lowering premiums.

Medicare and Medicaid would be cut in the proposed Senate bill to repeal and replace the Affordable Care Act (ACA), and Medicaid covers approximately 750,000 Mississippi residents, including approximately 75 percent of those in nursing homes. The proposed legislation would shift Medicaid funding to a per capita basis, with annual growth limited. Mississippi currently receives nearly $3 in federal funds for every $1 spent by the state on the Medicaid program. State Insurance Commissioner Mike Chaney stated that the Senate health bill would benefit the state in the short term. “We’re OK in Mississippi until the end of 2020,” he said. People who earn too little to qualify for tax credits can now access policies on the exchanges for about $16 per month for those earning less than 138 percent of the federal poverty level, according to Chaney. If the bill fails to pass, the Trump administration intends to phase out the cost-sharing reductions at the end of June. “That’s scary,” Chaney said, because the Centers for Medicare & Medicaid Services has ruled that insurers cannot re-evaluate rates if cost-sharing is eliminated. He is still worried that Mississippi and other states will face an unfunded Medicaid mandate. “They still have done nothing to address the cost of healthcare,” said Chaney.

The U.S. Senate’s Better Care Reconciliation Act to repeal and replace the Affordable Care Act could reduce the number of plans available in Tennessee’s individual market, increasingly limit networks, and boost deductibles and premiums. In the first few years, the bill would allow premiums for younger people to fall while increasing costs for older people. In Davidson County, a 27-year-old making $30,000 a year could see a premium of $2,480 drop by $20 a year, according to the Kaiser Family Foundation. People also would see tax credits shrink and be able to obtain less coverage for their money, according to recent analyses. Tennessee Insurance Commissioner Julie Mix McPeak has said she would like to define what benefits are covered to better reflect what Tennesseans need. If passed as written, the state could work with insurers on a new set of benefits to come into effect as early as January 2018. However, more than 30 percent of adults in Tennessee have outstanding medical debt, and that figure could rise under the Senate plan.

High-risk health insurance pools could make a comeback if congressional Republicans pass a sweeping healthcare bill. These high-risk pools are government-run health plans that provide coverage to people with costly medical conditions, like HIV and cancer, who cannot obtain insurance elsewhere. Washington state’s high-risk pool, the Washington State Health Insurance Pool, was created in 1987. Prior to the Affordable Care Act (ACA), about 3,000 residents were enrolled in the high-risk pool, and state lawmakers passed a measure preventing new enrollees after the law’s individual insurance market was established. It remains uncertain what will happen to the pool if the Republican health plan passes, but Office of the Insurance Commissioner spokesperson Stephanie Marquis said the state would not consider waivers of the ACA’s regulations, such as those allowing insurers to charge people with preexisting conditions more or deny them coverage. She said the office is looking at long-term plans for its high-risk pool, which could include stabilizing the individual insurance market by paying for the premiums of the sickest people, driving down risk for insurance companies, which would, in theory, reduce premiums.

The proposed Senate bill to repeal and replace the Affordable Care Act (ACA) would make cuts to Medicare and Medicaid, and Medicaid covers about 750,000 Mississippi residents, including about 75 percent of those in nursing homes. The proposed legislation would move Medicaid to a per capita funding with limited growth allowed annually. Currently, Mississippi gets nearly $3 in federal funds for every $1 of state money spent on Medicaid program. State Insurance Commissioner Mike Chaney said that over the short term, the Senate health-care bill would benefit the state. “We’re OK in Mississippi until the end of 2020,” he said. People who make too little to qualify for tax credits currently could access policies on the exchanges at about $16 a month for people who are under 138 percent of the federal poverty level, said Chaney. If the bill does not pass, the Trump administration plans to end the cost-sharing reductions at the end of June. “That’s scary” because the Centers for Medicare & Medicaid have ruled that insurers cannot re-evaluate rates if the cost-sharing is eliminated, said Chaney. He remains concerned that Mississippi and other states will end up with an unfunded Medicaid mandate. “They still have done nothing to address the cost of health-care,” said Chaney.

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