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CD146: Repeal & Replace

Mar 13, 2017

“Repeal & Replace” is on the move! The American Health Care Act is the Republican plan to partially repeal the Affordable Care Act and it is quickly moving through Congress. In this episode, discover exactly what the bill would do if it were to become law. Also, Jen gives status updates on bills listeners are concerned about.

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Bill Outline

Read The Bill: The "Repeal & Replace" of The Affordable Care Act Part 1 Summary: House Energy & Commerce Summary Part 2 Summary: House Ways & Means Committee Summary

The "Repeal & Replace" of The Affordable Care Act: First Draft

Title I - Energy & Commerce

Subtitle A - Patient Access to Public Health Programs

  • Sec. 101: Defunds the Prevention and Public Heath Fund at the end of 2018
  • Sec. 103: Prohibits any Federal funding for any non-profit that performs abortions for a year

Subtitle B - Medicaid Program Enhancement

  • Sec. 111: Reduces Medicaid funding
  • Sec. 112: Repeals the Medicaid expansion
    • Sec. 112 (c): Repeals the requirement that Medicaid cover "essential health benefits" as of January 1, 2020.
  • Sec. 114: Prevents Medicaid for lottery winners
  • Sec. 115: Gives $10 billion extra to the "non-expansion States"
  • Sec. 116: Forces States to verify Medicaid eligibility every six months, gives them more enforcement money, and allows $20,000 fines for ineligible people who get Medicaid benefits.

Subtitle C - Per Capita Allotment for Medical Assistance

  • Sec. 121: Caps Medicaid funding on a per capita basis. States that spend too much one year will have their Medicaid cut more the following year.

Subtitle D - Patient Relief and Health Insurance Market Stability

  • Sec. 131: Repeals the lower out-of-pocket limits for low-income people effective in 2020
  • Sec 132: Creates a $15 billion a year fund (which is reduced to $10 billion a year starting in 2020) for propping up the health insurance market by paying for "high risk" sick people
  • Sec. 133: Starting in 2019, people who purchase insurance after a coverage gap of 63 days will be charged a 30% penalty for a year. The insurance companies get to keep all the extra money.
  • Sec. 134: The requirements that bronze, silver, gold, platinum level plans exist and must cover certain percentages of expenses and "essential health benefits" are repealed effective January 1, 2020.
  • Sec. 135: Allows insurance companies to charge older people five times more than younger people (they're currently allowed to charge three times more)

Part 2: Tax Provisions Prepared by the Ways and Means Committee (page 67)

Page 67: Remuneration from Certain Insurers

Page 68: Repeal of Tanning Tax

  • Starting in 2018, the 10% tax on indoor tanning is repealed.

Page 69: Repeal of Tax on Prescription Medications

  • Starting in 2018, a fee paid by pharmaceutical manufacturers & distributors will be repealed
    • This will save the industry $2.8 billion per year

Page 69: Repeal of Health Insurance Tax

  • Starting in 2018, a fee on large health insurance companies, which is tied to and increases with premium growth rates, would be repealed.
    • This will save the industry approximately $14 billion per year

Page 70: Repeal of Net Investment Income Tax

  • Starting in 2018, a 3.8% tax on net income from stock market investments over $200,000 will be repealed

Page 71 (Section 1): Recapture Excess Advance Payments of Premium Tax Credits

  • Starting in 2018, the limits on the amount of advanced-paid tax credits that can be taken back from low income people will be repealed.

Page 71 (Section 2): Additional Modifications to Premium Tax Credit

  • Allows tax credits to be used on "catastrophic-only" health insurance plans that are not listed on the exchanges and prohibits tax credits for any plan that covers abortions.

Page 80 (Section 3): Premium Tax Credit

  • Repeals tax credits for premiums starting in 2020.

Page 81 (Section 4): Small Business Tax Credit

  • Repeals the tax credit for employers with fewer than 25 employees who want to provide health benefits to their employees starting in 2020 and prohibits tax credits for any health plan that covers abortion.

Page 84 (Section 5): Individual Mandate

  • Reduces the tax penalties for failing to purchase insurance to $0 and back dates it to be effective in 2016.

Page 84 (Section 6): Employer Mandate

  • Reduces the tax penalties for employers who fail to provide health benefits to their employees to $0 and back dates it to be effective in 2016.

Page 85 (Section 7): Repeal of the Tax on Employee Health Insurance Premiums and Health Plan Benefits

  • Delays the start of a tax on insurance companies which charges a 40% excise tax on "Cadillac plans", which charge premiums more than $10,200/year ($850/month) for individuals until 2025. The 40% is only on the extra premiums charges above the cap.
    • Currently aren't scheduled to take effect until 2020.

Page 85 (Section 8): Repeal of Tax on Over-The-Counter Medications

Page 86 (Section 10): Repeal of Limitations on Contributions to Flexible Savings Accounts

  • Starting in 2018, the $2,500 limit on the amount that can be taken out of an employee's paycheck for employer health plans that use "flexible savings accounts" is repealed starting in 2018.

Page 87 (Section 11): Repeal the Medical Device Tax

  • Starting in 2018, repeals a 2.3% tax, paid by manufacturers or importer, on sales of medical devices that are not generally purchased by the general public at retail stores.

Part 89 (Section 14): Repeal of Medicare Tax Increase

  • Summary says that this section should change the tax for Medicare Hospital Insurance, but the text to be inserted is identical to current law

Repeal Bill Repeal bill Current Law current law Page 90 (Section 15): Refundable Tax Credit for Health Insurance

  • Creates a new tax credit structure tied to age instead of income for people making under $75,000 per year (the credits gradually reduce the more you make over $75,000)
    • Under age 30: $2,000/yr
    • Ages 30-40: $2,500/yr
    • Ages 40-49: $3,000/yr
    • Ages 50-59: $3,500/yr
    • Over age 60: $4,000/yr
  • The credits are capped at $14,000 per family for the five oldest individuals

Page 120 (Section 16): Maximum Contribution Limit to Health Savings Account Increased to Amount of Deductible and Out-of-Pocket Limitation

  • Starting in 2018, increases the amount than can be put in Health Savings Accounts
    • Individual contribution limit raised from $2,250 to $5,000 per year.
    • Family contribution limit raised from $4,500 to $10,000.

Bills Discussed in this Episode

H.J. Res 58: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Department of Education relating to teacher preparation issues

  • Kills a rule that assesses the quality of teacher preparation programs

H.J. Res 69: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the final rule of the Department of the Interior relating to “Non-Subsistence Take of Wildlife, and Public Participation and Closure Procedures, on National Wildlife Refuges in Alaska”

H.R. 720: Lawsuit Abuse Reduction Act of 2017

  • Forces courts to sanction lawyers for filing lawsuits deemed improper.

H.R. 725: Innocent Party Protection Act

  • Changes the procedures for state lawsuits being heard in Federal court.

H.R. 985: Fairness in Class Action Litigation Act of 2017

  • Class action lawsuits could only go forward if each person suffered the same type and scope of injury.

H.R. 38: Concealed Carry Reciprocity Act of 2017

  • Allows people to carry concealed handguns in other states that issue concealed carry permits, in school zones, and on federally owned public land.

H.R. 83: Mobilizing Against Sanctuary Cities Act

  • Cuts off federal funds to cities that refuse to give the feds information about undocumented immigrants.

H.R. 147: Prenatal Nondiscrimination Act (PRENDA) of 2017

  • Applies fines and up to five years in prison to any doctor that tries to perform an abortion or helps a woman get an abortion if they know it’s because of the sex or race of the child.

H.R. 354: Defund Planned Parenthood Act of 2017

  • Prohibits funding for Planned Parenthood for a year unless they promise to not perform abortions. Gives money to community health centers instead.

H.R. 610: To distribute Federal funds for elementary and secondary education in the form of vouchers for eligible students and to repeal a certain rule relating to nutrition standards in schools

  • Repeals the Elementary & Secondary Education Act of 1965, which was enacted as a part of Pres. Lyndon Johnson’s ‘War on Poverty’, which is a commitment to equal access to quality education by giving money to low-income districts.
  • Creates a voucher program that will give parents tax money to send their kids to private schools or home school
  • Repeals nutrition standards for foods served in the school lunch and breakfast programs.

H.R. 756: Postal Service Reform Act of 2017

  • Changes the postal service health benefits program and pension funding
  • Changes post office operations: Stops door delivery to new addresses and changes how rates are determined in a way that doesn’t create an unfair competitive advantage for the post office

H.R. 785: National Right-to-Work Act

  • Prevents labor unions from forcing workers to pay dues (bankrupts unions by forcing them to provide services to non-paying workers)

H.R. 861: To terminate the Environmental Protection Agency.

  • Ends the EPA in 2019

H.R. 881: AMP Act

  • Amends copyright law to provide royalties to music producers, mixers, or sound engineers

H.R. 899: To terminate the Department of Education S. 376/H.R. 1273: 21st Century Endangered Species Transparency Act

  • To amend the Endangered Species Act of 1973 to require publication of the basis for determinations that species are endangered species or threatened species.

Additional Reading

References

Sound Clip Sources

Press Conference: Speaker Paul Ryan's Presentation on the American Health Care Act, YouTube, March 9, 2017.
Hearing: Ways and Means Committee Markup of Affordable Care Act Replacement Bill, March 8, 2017.

Watch on CSPAN: Part 1 - Part 2 - Part 3 - Part 4

Hearing: Energy and Commerce Committee Markup of Affordable Care Act Replacement Bill, March 8, 2017.

CSPAN Timestamps & Transcripts

  • 13:24 Rep. Kathy Castor: This bill was released less than 48 hours ago without a bipartisan Congressional Budget Office score, so we don’t know how much it’s going to cost. Experts say it’s going to add to the deficit. We don’t know how many people are going to lose their insurance and how high the uninsured rate will go up in America because of this bill, because they didn’t take the time to wait, to see what that CBO score said.
  • 3:05:25 Rep. Steve Scalise: We’ve asked CBO, by the way, for a score. Anybody who thinks we’re going to just wait and let some unelected bureaucrats in Washington stop us from following through on our promise to the American people that we’re going to repeal this failed law and finally rescue them from the double-digit increases in premiums and from the $10,000 and more in deductibles and all the other things that have destroyed good healthcare for them, we’re going to keep moving forward and fulfill that promise because the American people expect us to do it, they want us to do it, and CBO’s eventually going to come up with a score before it goes to budget committee, before it goes to the House floor. But in the meantime, if they can’t get the score out there, we’re still going to move forward and follow through on that promise.
  • 3:15:10 Rep. Joe Barton: We’re all God’s children; we all want a CBO score. It’s not our fault that the CBO’s sitting on their bottom and not helping us.
  • 8:35:34 Rep. Gus Bilirakis:We should be making it easier for small businesses to grow and succeed, not harder.
  • 9:10:35 Rep. Frank Pallone: The problem that I see, though, is that—so, you and the others continue to talk about how bad the ACA is, and my point earlier when I mentioned you by name was because I’d like to see how you feel that your bill is going to improve any of these things. Now you mentioned deductibles. The way I read this bill—I’m not going to ask counsel because I read it, and I think it’s clear—the restrictions that we put on—or that have made it more difficult to increase deductibles with a private-insurance market, a lot of those are relaxed now. So I would venture to argue that if you have someone who’s complaining about deductibles, those deductibles are going to go up even more. Rep. John Shimkus: Yeah, but if I reclaim my time because, as you know, we’ve got two bills moving through the write at the same process that the benefit of what’s going on now is you talk to our friends in Ways and Means is the strong development of health savings accounts, which fills that gap, right? You buy insurance for a higher cost. If you live healthy lifestyles, you’ll be able to roll that over, the catastrophic number gets better, your payments get less if you believe in markets and competition.
  • 10:16:45 Rep. Mike Doyle: I’m not sure what the gentleman is talking about when he talks about mandates. What mandate in the Obamacare bill does he take issue with? Certainly not with preexisting conditions or caps on benefits or letting your child stay on the policy to 26. So I’m curious, what is it we’re mandating— Rep. John Shimkus: Will the gentlemen yield? Doyle: Yeah, sure. Shimkus: What about men having to purchase prenatal care? Doyle: That—what— Shimkus: I’m just— Doyle: Every—that’s very— Shimkus: Is that not correct? Doyle: I—reclaiming my time. Shimkus: And should they? Doyle: Reclaiming my time. Chairman Greg Walden: Whoa, whoa, whoa— Doyle: There’s no such thing— Walden: —whoa, whoa, whoa. Doyle: —as à la carte— Walden: Regular order. Doyle: There’s no such thing as à la carte insurance, John. You know, you don’t get the— Shimkus: That's the point! Doyle: —list and say, give me that. Shimkus: That’s the point! We want the consumer to be able to go to the insurance market and be able to negotiate— Doyle: You tell— Shimkus:—on a plan— Doyle: Reclaiming my time. Walden: Whoa, whoa. Doyle: You tell me what insurance company will do that. There isn’t a single insurance— Walden: Gentleman’s time— Doyle: —in the world that does that. Walden: The gentleman’s time—the gentle— Doyle: You're talking about something that doesn't exist.

Cover Art

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