Posted in Health, news, Politics

CBO Score on American Health Care Act is in

The CBO, Congressional Budget Office, gave their analysis of the recently House-passed bill aiming to repeal and replace Obamacare, the American Health Care Act (AHCA).

The most recent report found that the AHCA would

  • reduce the deficit by $119 million
  • cost 23 million Americans to lose their coverage by 2026
  • lowers premiums from current Obamacare/ACA prices

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The bill needs to be approved by the Senate.  In order for it to pass it needs to  comply with the following:

– Not increase the federal deficit beyond a 10 year window

– Save at least $2 billion dollars as overseen by the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions Committee.  If so, this allows Republicans to use budget reconciliation, a budgetary rule that enables them to avoid a Senate Democratic filibuster and pass their bill with only 51 votes rather than a 60 vote majority.

– not cause “millions” of Americans to “lose” their healthcare.

The last CBO analysis of the AHCA found it to potentially cause 24 million Americans to lose coverage, a point debated as Medicaid expansion and federal funds were to slowly regress as the economy improved.

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The CBO also estimated that insurance premiums would RISE 750% with the previous GOP version to repeal and replace Obamacare. This plan appears to LOWER insurance premiums.

Before amendments needed to be made to ensure passage, the original AHCA wanted to implement the following :

  1. Eliminate the tax penalties, “individual mandate” and “employer mandate” imposed on those who don’t purchase health insurance for themselves or employees.
  2. Tax credits will be based on age rather than income ranging from $2000/year for those younger than 30 to $4,000 a year to those who are older than 60. A family would receive up to $14,000 in tax credits a year. These tax credits would start phasing out when income becomes  $75K individually or $150K as a family. For every $1,000 in earnings above those thresholds, the value of the credit phases down by $100.
  3. Allow insurance companies to charge a 30% surcharge to those who have gaps in insurance longer than 63 days.
  4. Maintain coverage, preventing denial, to those with pre-existing conditions
  5. Maintain coverage for children under age 26 who wish to stay on their parent’s plans.
  6. Maintaing the bans on caps on annual or lifetime coverage
  7. By 2020, ACA promised federal funds for Medicaid expansion will stop.  Funds will continue for current Medicaid recipients
  8. Create a Patient and State Stability Fund, which provides states $100 billion to use as they wish for their underserved populations, hospitals, providers or programs that would provide direct care.
  9. States will receive money for Medicaid in a lump sum per person rather than an open-ended promise of funds.
  10. Taxes on medical device industry will expire as will those on pharmaceutical companies and indoor tanning services.
  11. Planned Parenthood is “defunded” as AHCA funds cannot be used to pay for services at their clinics.
  12. HRA increase – starting in 2018 individuals could contribute pretax dollars to their Health Savings Account up to $6550 individually and families up to $13,100.

For more on the CBO analysis, read here:  https://www.cbo.gov/publication/52752

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Entertainment, Health, news, Politics

Fox News Founder, Roger Alies, dies at age 77

Three days after his 77th birthday, Roger Alies died Thursday morning. The cause of death is unknown.

The former chairman of Fox News allegedly suffered a fall 8 days prior at his Florida home. On Wednesday TMZ reported his condition was worsening as he became unconscious and comatose Wednesday night.

His wife released the following statement, “I am profoundly sad and heartbroken to report that my husband, Roger Ailes, passed away this morning.”  “Roger was a loving husband to me, to his son Zachary, and a loyal friend to many. He was also a patriot, profoundly grateful to live in a country that gave him so much opportunity to work hard, to rise—and to give back. During a career that stretched over more than five decades, his work in entertainment, in politics, and in news affected the lives of many millions. And so even as we mourn his death, we celebrate his life.”

The founding CEO of Fox News Channel resigned last summer in the wake of numerous sexual allegations.

Prior to launching Fox News in 1996, he was an adviser to Presidents Richard Nixon, Ronald Reagan and George H. W. Bush and helped launch and head CNBC.

This is a developing story.

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, news, Politics

Aetna Plans to Pull Out of All ACA Marketplaces by 2018

Obamacare gets dealt another blow as Aetna, one of the five largest health insurance companies in the US, has announced they will pull out of all 2018 healthcare exchanges.

This year they remained in only 4 of the 15 marketplaces once held and concerns have grown surrounding their commitment to offering ACA subsidized policies when it was declared they lost $700 million between 2014 and 2016. Since the start of this year, Aetna reports a loss of over $200 million.

The 255,000 current Aetna enrollees will need to find new policies when the exchange opens this fall.

Unfortunately, states such as Delaware and Nebraska are left with only one insurer offering exchange policies now that Aetna is exiting.  Highmark Blue Cross Blue Shield remains in Delaware and Medica remains in Nebraska.

Aetna joins Humana, whose exodus highlighted the plight of insurance companies who failed to attract “healthy” consumers in the current ACA market.  Insurance companies report huge losses as less healthy individuals benefiting from the popular preexisting condition protections awarded under the ACA utilize more funds than what they put in.  Individuals without medical issues weigh the option of waiting to purchase a policy until they “need to” vs. paying for a high priced policy today.  Neither choice is providing the financial relief needed to support the costs of sicker policyholders.

The House of Representatives approved an amended American Health Care Act, a first step to the “repeal and replacement” of Obamacare.  The bill now goes to the Senate where changes are expected one the Congressional Budget Office submits their analysis and Senators debate Obamacare’s future.

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

Posted in Health, news, Politics

House Approves Bill to Repeal and Replace Obamacare

The House of Representatives approved the American Health Care Act (AHCA) in the first step to repeal and replace Obamacare.

On Thursday, by a slim margin, the vote of 217-213 was one over the 216 votes needed to pass the bill.

The AHCA includes an amendment that includes $8 billion in spending over 5 years to subsidize high risk pools that could be affected by the “waivers” offered to states who wished to opt out of requirements that insurance companies cover preexisting conditions.

Freedom Caucus members who opposed the first draft of the bill, supported this new bill, crucial to allowing President Trump to make good on his promise to “repeal and replace” Obamacare.  Representatives Fred Upton and Billy Long switched their vote from “no” to “yes” bolstering GOP support for the bill that could not lose more than 22 votes.

The American Health Care Act has had to appeal, not to Democrats, but to GOP members who were split on whether the AHCA repealed too many popular components of Obamacare.

The original AHCA including the following:

  1. Eliminate the tax penalties, “individual mandate” and “employer mandate” imposed on those who don’t purchase health insurance for themselves or employees.
  2. Tax credits will be based on age rather than income ranging from $2000/year for those younger than 30 to $4,000 a year to those who are older than 60. A family would receive up to $14,000 in tax credits a year. These tax credits would start phasing out when income becomes  $75K individually or $150K as a family. For every $1,000 in earnings above those thresholds, the value of the credit phases down by $100.
  3. Allow insurance companies to charge a 30% surcharge to those who have gaps in insurance longer than 63 days.
  4. Maintain coverage, preventing denial, to those with pre-existing conditions
  5. Maintain coverage for children under age 26 who wish to stay on their parent’s plans.
  6. Maintaing the bans on caps on annual or lifetime coverage
  7. By 2020, ACA promised federal funds for Medicaid expansion will stop.  Funds will continue for current Medicaid recipients
  8. Create a Patient and State Stability Fund, which provides states $100 billion to use as they wish for their underserved populations, hospitals, providers or programs that would provide direct care.
  9. States will receive money for Medicaid in a lump sum per person rather than an open-ended promise of funds.
  10. Taxes on medical device industry will expire as will those on pharmaceutical companies and indoor tanning services.
  11. Planned Parenthood is “defunded” as AHCA funds cannot be used to pay for services at their clinics.
  12. HRA increase – starting in 2018 individuals could contribute pretax dollars to their Health Savings Account up to $6550 individually and families up to $13,100.

The bill is being analyzed by the Congressional Budget Office (CBO) and will need to be approved by the Senate to move forward.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, news, Politics

GOP to bring Obamacare repeal to a vote Thursday

Republican leaders announced that on Thursday the House of Representatives will vote on the new plan to repeal and replace Obamacare.

Majority Leader Kevin McCarthy (R-California) claimed the GOP had enough votes stating, “We will be voting on the health care (bill) tomorrow. Because we have enough votes. It’ll pass. It’s a good bill.”

The bill includes an amendment that includes $8 billion in spending over 5 years to subsidize high risk pools that could be affected by the “waivers” offered to states who wished to opt out of requirements that insurance companies cover preexisting conditions.

Freedom Caucus members appear to be in support of this new bill and are crucial to allowing President Trump to make good on his promise to “repeal and replace” Obamacare.  Representatives Fred Upton and Billy Long have switched their vote from “no” to “yes” bolstering GOP support for the bill that cannot lose more than 22 votes.

The American Health Care Act has had to appeal, not to Democrats, but to GOP members who were split on whether the AHCA repealed too many popular components of Obamacare.

The original AHCA including the following:

  1. Eliminate the tax penalties, “individual mandate” and “employer mandate” imposed on those who don’t purchase health insurance for themselves or employees.
  2. Tax credits will be based on age rather than income ranging from $2000/year for those younger than 30 to $4,000 a year to those who are older than 60. A family would receive up to $14,000 in tax credits a year. These tax credits would start phasing out when income becomes  $75K individually or $150K as a family. For every $1,000 in earnings above those thresholds, the value of the credit phases down by $100.
  3. Allow insurance companies to charge a 30% surcharge to those who have gaps in insurance longer than 63 days.
  4. Maintain coverage, preventing denial, to those with pre-existing conditions
  5. Maintain coverage for children under age 26 who wish to stay on their parent’s plans.
  6. Maintaing the bans on caps on annual or lifetime coverage
  7. By 2020, ACA promised federal funds for Medicaid expansion will stop.  Funds will continue for current Medicaid recipients
  8. Create a Patient and State Stability Fund, which provides states $100 billion to use as they wish for their underserved populations, hospitals, providers or programs that would provide direct care.
  9. States will receive money for Medicaid in a lump sum per person rather than an open-ended promise of funds.
  10. Taxes on medical device industry will expire as will those on pharmaceutical companies and indoor tanning services.
  11. Planned Parenthood is “defunded” as AHCA funds cannot be used to pay for services at their clinics.
  12. HRA increase – starting in 2018 individuals could contribute pretax dollars to their Health Savings Account up to $6550 individually and families up to $13,100.

The Congressional Budget Office (CBO) will not have their analysis submitted by the time the legislation reaches a vote.  Lawmakers begin their week long recess Friday.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, news, Politics

American Health Care Act fails to move forward. Does the US win or lose?

Half the country is rejoicing at the GOP defeat, while the other half is shaking their head in disbelief.  Obamacare is still the law of the land.

The American Health Act was controversial from the start.  Democrats disliked it because it repealed key elements of Obamacare, defunded Planned Parenthood, and started to scale back Medicaid spending and coverage.  Conservatives disliked it because it maintained many Affordable Care Act provisions and did not convince many that it would lower insurance premiums, ensure young individuals to put money into the market and fix our healthcare system.

On Friday, March 24th, House Speaker Paul Ryan pulled the bill before the final vote, and conceded saying, “We’re going to be living with Obamacare for the foreseeable future.”

President Donald Trump stated, “We had no Democratic support,” and added “I’ve been saying for the last year and a half that the best thing we could do, politically speaking, is let Obamacare explode. It’s exploding right now.”

So while Democratic and Republican opponents of the bill celebrate, Americans are wondering what’s next?  Let’s walk through this.

  1.  The Affordable Care Act is still the law of the land.

    The penalties, individual and employer mandates, or “taxes” are still in play.  Although Donald Trump issued an executive order instructing agencies to provide relief from the health care law, and the IRS eased up on rejecting tax filings if line 61 was not completed (attesting one purchased health coverage)  this part of the law has not been officially repealed.

  2. Federally funded Medicaid expansion stays put.

    Those still on Medicaid, for the time being, will still receive coverage.

  3. Insurance premiums are rising even faster than before.

    According to the Kaiser Family Foundation: Health insurance premiums on the Affordable Care Act’s marketplaces (also called exchanges) are expected to increase faster in 2017 than in previous years.

  4. Less insurance companies will be on the exchanges for the upcoming enrollment period.

    With large insurance companies such as Aetna and United HealthCare scaling back, less consumer choices add to the skyrocketing costs.  According to the Kaiser Family Foundation:  Marketplace insurer participation in states using Healthcare.gov in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin.

  5. Obamacare’s “death spiral” may not come as quickly as anticipated. 

    If the Affordable Health Care Act continues to receive federal funding and sputters long enough to hit the midterm elections, House majority could switch to the Democrats, allowing them to pass new provisions to maintain its life support.

Unfortunately, we as Americans are in limbo.  President Trump with a Republican held House and Senate was expected to successfully repeal and replace Obamacare.  However, the American Health Care Act didn’t do that.  It provided a life boat for a sinking ship, and many felt it couldn’t provide longevity or attain popularity needed to make it successful.

The Affordable Care Act was designed such that anyone tries to repeal it, the healthcare system implodes.  For the GOP to approach this as one would attempt to diffuse a bomb, may be an impossible feat.

However, there may be hope.  As both Democrats and some Republicans opposed the replacement for Obamacare, many on both sides dislike the current state of affairs.  Our healthcare system is broken and bipartisanly there is much we can agree on.    President Trump believes it will take Obamacare exploding before the Democrats come to the negotiating table. Let’s hope this happens before then.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, news, Politics

The GOP Plan for Obamacare Replacement: The American Health Care Act

House Republicans have unveiled their plan to repeal most of the ACA and replace it with new legislation:  The American Health Care Act (AHCA).

Two separate House committees, the Energy and Commerce Committee and Ways and Means Committee, attempted to reshape our healthcare system by presenting the following:

  1. Eliminate the tax penalties, “individual mandate” and “employer mandate” imposed on those who don’t purchase health insurance for themselves or employees.
  2. Tax credits will be based on age rather than income ranging from $2000/year for those younger than 30 to $4,000 a year to those who are older than 60. A family would receive up to $14,000 in tax credits a year. These tax credits would start phasing out when income becomes  $75K individually or $150K as a family. For every $1,000 in earnings above those thresholds, the value of the credit phases down by $100.
  3. Allow insurance companies to charge a 30% surcharge to those who have gaps in insurance longer than 63 days.
  4. Maintain coverage, preventing denial, to those with pre-existing conditions
  5. Maintain coverage for children under age 26 who wish to stay on their parent’s plans.
  6. Maintaing the bans on caps on annual or lifetime coverage
  7. By 2020, ACA promised federal funds for Medicaid expansion will stop.  Funds will continue for current Medicaid recipients
  8. Create a Patient and State Stability Fund, which provides states $100 billion to use as they wish for their underserved populations, hospitals, providers or programs that would provide direct care.
  9. States will receive money for Medicaid in a lump sum per person rather than an open-ended promise of funds.
  10. Taxes on medical device industry will expire as will those on pharmaceutical companies and indoor tanning services.
  11. Planned Parenthood is “defunded” as AHCA funds cannot be used to pay for services at their clinics.
  12. HRA increase – starting in 2018 individuals could contribute pretax dollars to their Health Savings Account up to $6550 individually and families up to $13,100.

Now the committees need to “mark up” the bill where they review, debate and amend the legislation before presenting it to the  Budget Committee and then the floor of the House of Representatives.

Critics on both sides have aired their concerns.  According to Fox News, Senate Minority Leader Charles Schumer, D-N.Y., said the proposal “would cut and cap Medicaid, defund Planned Parenthood, and force Americans, particularly older Americans, to pay more out of pocket for their medical care all so insurance companies can pad their bottom line.”

Senator Rand Paul told Fox News he would not vote for “Obamacare Lite”.  He stated, “Some Republicans want to keep parts of Obamacare, and I’m not going to vote for that.”

The problem I see is the premium hikes and high deductibles would still take years to revert back to their pre-Obamacare days, assuming the damage hasn’t been permanent.  The GOP is trying to delicately pull the tablecloth out from under a fragile healthcare system and will still cause some glasses to fall and break.  Should they reset another table that eveyone can move to?  Should they just rip the tablecloth off and rebuild?  Should they clear the plates and reset it with their own china?

I’ve urged the GOP to get rid of the mandates and incentive purchasing coverage so I’m a fan of those inclusions in this bill.  The Patient and State Stability Fund gives states more power to choose how to help their citizens, so I find this another promising piece.  Whether its the best suggestion for a “repeal and replace” has yet to be determined because the GOP is swimming upstream on this one.  Let’s hope the current calms down enough to allow some reform to take place.

A copy of the legislation is provided here:  https://www.dropbox.com/s/4f82iy7d92u0c3a/AmericanHealthCareAct.pdf?dl=0

 

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                                                                                                         Medical Spanish made easy

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician