Thursday, March 23, 2017

The ACA versus the AHCA highlights...the stuff the news media isn't sharing...

This morning I was listening to C-Span's Washington Journal on Sirius XM.  This is something I do fairly regularly in the morning.  I was expecting something on the London attack, but what?  On an American news source?  No, they were all talking about the new healthcare bill.  Fox News was on their usual reign of far right, right is right and might rhetoric.  MSNBC on the opposite kick, the left is absolutely right and spending most of their time talking down the new healthcare bill although with little substance to back their opinions.  Business as usual has become news channels passing off their opinions as fact.  No wonder the American public, at least the far right and far left, are so ingratiated in their own opinions the facts are no longer relevant.  C-Span usually has a fairly neutral version, so I switched.  Washington Journal has commentators and speakers, but it also has people calling in identifying themselves as independent, left or right by the numbers they call in on.  Not everyone follows directions really well, so some idiots, yes I'll go that far, will call in on the left number when they are blatantly right and vice versa.  For some reason, they think they can fake it when their words give them away.  But so they are taking the phone calls and C-Span, if you don't ever listen, actually rotates the call in numbers--indy, left, right, indy, left, right.  It's usually fairly interesting and mostly enlightening.  Today, a right wing caller calls in and starts ranting about how much cheaper the new bill will be for the elderly.  Then a left wing caller calls in and rants the exact opposite.  Neither of these idiots had a clue what they were talking about.  The fact that neither of them had a clue hit me like a ton of bricks.  In fact, none of the callers actually had any facts for the next 45 minutes to an hour.   I haven't blogged in a while and I thought about what a friend told me last fall.  He said that whether he agreed or disagreed with me my blogs made him think and that was important.  Okay, so the new healthcare bill.  Obviously, the general news sources are not providing the real information.  They are focused on the rhetoric and telling us how many are for or not for or just sugar coating it to what they want it to be.  The facts are important, but when I went looking for the facts about the bill, even when I could find them, they were somewhat slanted.  So I'm going to take the slant out (as much as I can) and here ya go.  Make up your own mind.  I've done the research for you.  

First, what is staying the same--well, at least the ones that I know every average working American is going to worry about.  Kids up to 26 years old can still be covered on their parents' plans.  The protection for those with pre-existing conditions is going to remain intact.  Finally, one that most people didn't even know was part of the ACA, aka. Obamacare, lifetime limits of what you or I will come out of pocket will be maintained.  Don't get excited.  Like I stated most of you didn't know or care about this one and the limit is like $1M or something.  It's sky high.  Higher than most of us can possibly ever pay off.  So, yea, that one isn't great for a left or right working class family. 

Next, what most Americans--except the far left--were concerned about goes away.  The penalty for not having insurance goes away.  I don't know many people that agreed with this, regardless of whether left or right.  It simply punished those that couldn't afford it for not being able to afford it.  This rarely came up in arguments about this bill which kind of pisses me off.  Instead of focusing on what we agree on to build common ground--particularly something that we all know wasn't good for the lower income working people--we always focus on what we want to disagree on.  This should never have made it into the ACA in the first place, but that's how it works anymore.  We argue over things that we are divided on and let them force things that almost all of us agree should never happen.  Keep that in mind next time you are "arguing" with someone that you perceive as disagreeing with you.  We are not part of the solution if we can't find common ground and prevent things that most agree should never happen.  This punishment on the poor was ridiculous.  

Don't think that's wonderful though.  The GOP bill, the AHCA, makes a 30% penalty premium on anyone that allows their healthcare insurance to lapse.  That's right.  Instead of the government getting the punishment money for not carrying insurance, the insurance companies will be collecting it.  I'm not sure I feel about this.  Think about it.  One, the poorer working class can't afford the crap in the first place.  If they are healthy and ineligible for Medicaid, they will have to pay an extra premium to an insurance company when they are covered again.  There's nothing as far as any research I could find about special situations either like when we become unemployed and cannot afford COBRA.  There's nothing about going from one job and not having coverage during the probationary periods that most companies have for hourly and usually in some cases for salary.  This almost traps hourly people if they change jobs and have to wait.  If you find a better hourly job but you're going to lose your healthcare coverage, it's unclear how this 30% penalty the insurance companies can wage on you is going to work or not work.  

Of course, everyday Americans worry about what will happen with the premiums with the elderly.  Like I stated in the opening paragraph, one right caller called in saying how much the new bill would save the elderly.  The next caller, left, said the exact opposite.  Neither cited anything factual to back up their opinions because neither had the facts.  So it's kind of a mixed bag for the elderly.  Obamacare did limit premium costs for older Americans.  The new bill will allow insurance companies to charge older Americans as much as 3 times what the younger generation is paying.  It also reduces federal tax credits for people in their 50s and 60s purchasing health insurance through the open market.  This effectively increases their out of pocket costs for the insurance.  So, technically this is a double whammy on the 50+ retired, semi-retired crowd.  However, for lower incomes, the tax credits for buying insurance through the marketplace will be increased, so it's unclear whether this would in application balance out the difference.  Most likely, it wouldn't offset the entire difference, so likely it will actually increase out of pocket and premiums on the 50 and up for all incomes.  

Of course, it lowers the threshold for deducting medical expenses from our taxes.  Obamacare increased the threshold to 10% of our AGI (adjusted gross income, that number after you have taken your standard or itemized deductions).  The new bill will lower the threshold to 5.8%.  This is actually lower than pre-Obamacare which was 7.5%.  If we have a lot of medical or even a single major medical occurrence in a year, this is going to help most.  For the average elderly couple, this would actually really help them, but it would also help the average family that has a week long stay in the hospital.  It's a big plus to the new bill for pretty much any American family.  

Now, here's one that we all debate about.  I don't use the HSA at all.  Healthy Americans have no reason to use a HSA account.  Yes, it's all pre-tax, so it can lower your AGI.  And the accumulated amounts can be used in future years if you opt for that type of HSA--although the law is unclear how this works if you never need to use it.  So it's not really your money anymore until this is cleared up completely.  However, Obamacare eliminated the ability to buy OTC drugs--Nyquil, aspirin, motrin, vitamins, etc--with the HSA.  The new bill will restore this.  For someone like me who pretty much has no reason to have the HSA because the only stuff I buy right now is OTC stuff, well, this makes it more logical for me to use.  If you already have to buy a lot of prescriptions, this just adds to your likelihood to use the HSA more.  I don't see a downside to this.  Maybe you do.  I'm having a hard time finding one with the OTC ability restored except that nasty business of what happens to the account if I never use it.  I don't want it going to the Federal government and right now it's mainly a use it or lose it prospect.  Even though there are some rules allowing certain cases of it being part of our estate when we die, Congress could change this with the drop of a hat.  So I wouldn't recommend putting in more than you need unless you know your family history has some serious health issues that will bother you after you retire.  

Many people know that Obamacare was going to expand Medicaid--which seems ridiculous when you consider what most people think.  Most people think that it was making people buy insurance.  It was, well, is.  But, for those that were the poorest, regardless of their ability to work, it made it so that many would be better off not working.  By simply quitting their jobs, they then became eligible for Medicaid and thus this is why Obamacare was going to expand Medicaid.  Yes, that's right.  That's a fact.  No debate.  In implementation, Medicaid was going to expand, and the average working American was going to pay extra Medicaid taxes to cover it.  The new bill ends that.  It caps the Federal government's payouts to the states also.  The bill sets a per person limit dollar amount to the states.  It also provides that states can opt out of the per person dollar limit payout for a lump sum payment from the Medicaid funding.  I'm not sure which of these would be better.  It would probably depend upon the state.  Lower population states would probably benefit by taking the lump sum because it would likely be more than the per person enrolled in Medicaid.  Higher population states would obviously more likely benefit from the per person payout.  While Obamacare sought to increase Medicaid funding gradually to 2020, the new bill looks to eliminate that increase and reduce Federal payouts.  Sounds good to those of us that look at our paystubs and freak out at how much Medicaid is costing us--particularly if we have never used it and don't know anyone that has needed to.  However, we cannot know what will happen in the future, and most of us realize that.  If you happen to be one of those people that was unemployed long enough to exhaust your unemployment benefits, you know that Medicaid was the only option if you had something happen.  You paid into it for years and you may or may not have had to use it, but in that situation, it probably gave you comfort to know you wouldn't be totally abandoned.  

The Medicaid issue though gets weird.  For example, there's a provision in the bill specifically geared towards NYC and NY state.  Why the hell this is in the bill is ridiculous, but our current POTUS being a New Yorker probably plays into that a lot.  The brokered deal is as far as I can tell to prevent NY state from using Medicaid money from NYC for the rest of the counties in the state and vice versa.  This is stupid as hell since it doesn't apply to other major cities versus their states, and I frankly question the legality since Medicaid is dispersed to the states and the states actually administer the Medicaid programs in their states how they see fit.   

Of course, when Obamacare sought to expand the Medicaid program it was also because it eliminated all Federal aid to hospitals that served those with no insurance.  Oh yes, the great healthcare bill of the left made it so that anyone that was uninsured should be turned away from hospitals that would normally help them.  In fact, this actually increased the people turned away from hospitals that were run as commercial entities in the business of making money.  Of course, again, thus the need to expand Medicaid, because the hospitals that helped the uninsured were then tasked to get these type of patients covered under Medicaid.  If it sounds like a merry go round, it probably should.  Now, the new bill removes this ban on Federal aid to hospitals serving the uninsured.  (Note this ban wasn't noticeable or even referenced most of the time because it was a year to year lowering until completely eliminated in 2020.  Gotta love the sneaky way they slip this stuff in that would make even the average leftish American cringe.)  

 Now, the meat and potatoes.  The stuff we have debated--more argued and argued and argued with each other about depending upon whether we view ourselves as left, right or middle.  The average working American got screwed by the Cadillac tax.  Our companies have to pay an increasing tax on the high tiers of healthcare plans.  Many of us discovered that the Cadillac plans were being offered to lower incomes or non working incomes for free while those of us that worked lost our fancier plans.  There's no argument there.  Those that are working all know our plans started to suck.  The Cadillac tax is not, that's right NOT eliminated.  However, the Obamacare healthcare insurance tiers are.  So again, it's unclear whether the Cadillac tax is eliminated or shifted somehow.  The Cadillac tax was calculated by the tier that a company chose to offer its employees, but the tiers won't exist.  Yet the tax itself is not addressed in the new bill....It's hard to say YAY or call bullshit.  It's become a wait and see how it will work implemented.  I didn't like this wait and see with Obamacare and I'm not really thrilled with wait and see with this.  Maybe I'm the odd duck, but I've had enough of trusting them to work out the details after the bill has passed because damn it that didn't work out well the last time.  

Now, here's where it cuts taxes.  Oh yes, you knew it cut taxes somewhere.  I'm going to give you the most grievous first.  Why wait?  The Medicaid tax that we pay?  If you make over $200K (individual) or $250K (married) is going to be cut.  That's right.  A tax cut just for the rich.  So that Medicaid savings is going to be passed on to the wealthy Americans.  It's an end run around so that they can say they didn't cut taxes on the rich, but this is a rich person tax cut.  Period.  It's unclear if this is AGI or gross income.  The IRS always decides those nuances.  I think that those people, no offense if any of my readers are in these income brackets, but you should be paying for those that can't pay more than I should.  The Medicaid tax should either be equal % for all or lower for those that make less.   The truth is this is a tax cut for 1.1% of Americans and it's typical far right bullshit.  Sorry, but true.  Medicaid funding will lose quite a bit and it will only benefit approximately 3.7M people out of 323M.  We call this bullshit pork bellies because it really doesn't help the average American at all--it really helps those assholes we elected and their buddies though.   

The new bill also eliminates the Obamacare taxes on health insurance companies, medical device companies, and drug companies.  Big whoopie.  It was never really clear how these taxes were going to work anyway.  It eliminates the 10% tax on indoor tanning businesses--mostly small business owners.  Obamacare simply was attempting to put these types of businesses out of business.  I'm not a big fan of indoor tanning, but I've usually gone once a month in the summer since I work a job where I don't get outside much and I don't want to look like I just flew in from Antarctica during the summer.  It eliminates $1B to the CDC for grants they provide states and local municipalities to address diabetes, health care awareness, dental programs for kids that schools provide,  and other similar things.  I'm not sure how I feel about that, but i don't like that they create a new fund for the $1B that has no earmarking at all.  My interpretation is that they are stealing from one pocket to put it into a new pocket and they aren't telling what the new pocket's money is supposed to be used for.  Excuse my concern, but I don't trust those people in Washington for the most part and why would you take money from something that appears to be a benefit unless you are cutting my taxes?  This is just a shuffling act and I think it's crap unless they tell me exactly where the shuffled money is going.   

This doesn't even cover all the stuff I learned about the bill--just the stuff I thought the average American would want to know and make up their own mind.  But I've saved the most outrageous thing for last.  The reason I say it is outrageous is because it's got NOTHING to do with healthcare.  Oh yes, you read that right.  This last item has nothing to do with healthcare but is in the new healthcare, AHCA, bill.  The new bill eliminates the 3.8% tax on investment income.  This doesn't affect most of us.  It does affect that 1.1% but even them it probably only benefits half of them to the tune of millions, probably billions of tax dollars.  Now don't get me wrong.  I don't think we should punish the wealthy for being wealthy.  It gives no one incentive to work hard to become wealthy when we punish them with over taxing.  However, why in the hell are they sneaking it into this bill?  No one is even talking about this!!  WTF.  If they want to give this tax break or eliminate this tax, why not do it in the open in a damn tax bill???  Why hide it in this bill?  We all know the most likely reason.  If they were forced to openly debate this, the average, the majority of the American public would be screaming at them, WHY???  But this way, they make us debate Obamacare versus the new bill and slip this little item right passed the sheep and even those of us that pride ourselves that we pay attention.  

For the most part, the new bill is probably what the average Americans, middle Americans, want.  But like every bill in Washington anymore, it is also a shining example of what is still wrong with our system.  The NY crap and the investment income taxes?  Give me a break.  This is what we hate about DC and the people we elect.  We hate that they keep trying to sneak shit passed us and seem to be business as usual even though they know we are sick of it.  And some of the stuff we think this will eliminate isn't really guaranteed to be eliminated...same as the ACA bill.  This bill is like a halfway fix.  But most of us wanted to only go halfway back, so I guess it's okay.  You can decide now--at least on more facts than the tv news media outlets seem to be sharing.  

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