Wednesday, December 28, 2016

$1,000,000,000: The AZ cost of Obamacare repeal

You have seen some of these numbers before, but the Arizona Capitol Times (subscription required) has gathered them all. The reporter asks Do you have $1 billion to spare? He answers: what Obamacare repeal would look like for Arizona.

Repeal would raze Arizona

The financial fallout from repealing Obamacare without replacing it will make everything else Arizona’s policymakers have so far worried about look like small potatoes.

Officials from the Arizona Health Care Cost Containment System [AHCCCS], the state’s Medicaid program, have mapped out several scenarios if the federal law is abolished outright, and the options aren’t pretty. Under the worst scenarios, a straight repeal would devastate Arizona’s health care infrastructure, undermine the state’s much-touted managed care system, and leave a gaping hole in the state budget.

It’s unclear what a replacement would look like, but officials say Arizona will face a steeper challenge under a block grant, under which the states would have more flexibility in running Medicaid but face more financial exposure since they would get a set amount, instead of a guarantee that the federal government will shoulder the burden of insuring anyone who is eligible. Additionally, Arizona is under a voter mandate to insure all low-income residents, and the courts are unlikely to accept in perpetuity policymakers’ argument that the state can’t afford to adhere to the people’s will.

Congressional inaction amid so much talk of repealing Obamacare would also sow chaos on the insurance market place, as insurers get increasingly unsure about how many will enroll, and enrollees face uncertainty about their ability to keep their health plans.

Here are a few numbers to think about. (All are quoted from the Capitol Times report, lightly edited.)

$3.2 billion would be sucked out of Arizona’s economy …

If 425,000 residents lose Medicaid coverage, lawmakers would have to find $328 million …

1.9 million Arizonans are insured through AHCCCS.

50% of the AHCCCS population is between 19 and 64 years old. 44 percent are between the ages of 0 and 18.

$1 billion more: That’s how much the general fund would have to shoulder if Medicaid expansion was rolled back … For context, $1 billion is about 10 percent of the state’s annual budget and roughly pays for the spending of all smaller state agencies, not counting money for education, health care, corrections, the universities, welfare, and child safety.

$24 million is available to spend in the next fiscal year, if the governor and lawmakers want to maintain a structurally-balanced budget. That’s not counting $460 million in the state’s rainy day fund account.

74 percent: That’s the share of federal spending for Arizona’s Medicaid program. Currently, the feds assume the bigger risk of providing health care coverage, as the entitlement program guarantees coverage of anybody who is eligible and the federal commitment to help the states in paying for the program is open-ended.

Paul Ryan’s replacement has an Ayn-Randian smell

How much of this would be changed with a “replace” tacked onto “repeal” depends on how the “replace” would be structured. As noted from the report above, Arizona, along with the rest of the nation, would still take a hit under a block grant program.

After years fruitless votes against Obamacare while dodging the replacement issue, Paul Ryan this last summer came out with some details of what a replacement plan would look like.

You can find the details, such as they are, in this NPR report: If Republicans Repeal Obamacare, Ryan Has Replacement Blueprint.

Soon after the release of the policy paper, TalkingPointsMemo named five key points of Ryan’s plan.

Republican leaders are patting themselves on the back for the rollout of what they’re portraying as their Obamacare replacement plan. The policy paper, which consists of a broad set of aspirations without any dollar amounts or legislative mechanics, promises to slow the growth of health care costs through caps on government programs and on the tax breaks currently offered on employer-provided health plans. It does not, however, make any guarantees of universal coverage, nor does it provide enough details to assess its impact on the federal deficit or how Republicans plan to pay for what they’re promising. Many of the proposals have been trotted out before and have their own downsides when looked at in a standalone fashion.

Here’s what you need to know about the “new” approach:

(1) The policy paper comes after six years of GOP promises to present their own Obamacare alternative.
(2) Republicans would nix Obamacare’s mandates, subsidies and exchanges in favor of a tax credit.
(3) Ryan wants to change Medicare and Medicaid as you know them, akin to his “Blueprint For America” budgets.
(4) Ryan also loosens Obamacare regulations that have helped it achieve its more popular goals.
(5) While this policy paper is more extensive than past promises, Ryan is mum on legislative specifics.

On this last point, the devil is in the details that have yet to be specified. TPM continues.

At 37 pages, Wednesday’s policy paper is more extensive than the usual statement of principles put out by Republicans, but it is still lacking key details when it comes to legislative specifics. The GOP aide on the press call Tuesday for instance said it would be up to legislative committees to “litigate” the size of plan’s caps as well as its tax credits – which the paper promises will be “large enough to purchase the typical pre-Obamacare health insurance plan” – and how they’ll be doled out. He also said they didn’t “have any analysis” on the approach’s effect on premiums or job growth, but that “we believe that it would be double-digit” percentage drops in premiums. He also said there is no deadline planned for crafting the legislative.

As for the more essential question of what the GOP approach would mean for coverage rates and for the 20 million people have received insurance because of Obamacare, the aide also punted:

“You’re getting to the dynamic effect of the plan and we can’t answer that until the committees start to legislate,” he said.

So for Arizonans, we don’t know how much the Ryan replacement plan will cost the state let alone what effect it will have on the nation.

Repeal without replacement?

But for some in the GOP, replacement is a dirty word. Forbes reports on the GOP hardliners who want repeal without replacement.

Opposition is mounting from conservatives against Republican efforts to delay any full repeal of the Affordable Care Act from within the ranks of those who have opposed the law for more than six years.

U.S. House Speaker Paul Ryan earlier this month told 60 Minutes that Congress would “work on an orderly transition to replace” Obamacare for 20 million Americans who gained coverage under the law. And President-elect Donald Trump has said people will maintain coverage after the law is repealed and replaced. Meanwhile, other Republicans have floated ideas that the ACA would be repealed first and replaced over a period of years .

But any delay of a repeal or even a repeal linked to a replacement implemented two to four years down the road won’t work for some of the law’s longtime opponents. They want a repeal. Period.

“From our perspective, delay is not a repeal,” Twila Brase, president of Citizens’ Council for Health Freedom, said in an interview. “You can’t wait for the replacement or you will never get the repeal. My concern is we will never have a repeal.”

Snap. Just like that the conservatives are willing to cut loose 20 million people from their health insurance.

From Scriber’s perspective, the Ayn-Randian stench is real. The Ryan plan places the burden of universal health care on individual decision-making. Obamacare, through its individual mandate, treats health insurance much as we as a nation treat automobile insurance or mortgage insurance or unemployment insurance or social security or Medicare. The Ryan/GOP plan would single out health insurance from our mix of insurance mandates.

What Ryan and the rest of the GOP are saying is that if you have the money, and the foresight to use it, you can buy health insurance. If not, sickness is your own damn fault.

No comments:

Post a Comment