Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending

Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending

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In CBO’s assessment, Medicaid spending under the Better Care Reconciliation Act of 2017 would be 26 percent lower in 2026 than it would be under the agency’s extended baseline, and the gap would widen to about 35 percent in 2036 (see figure below). Under CBO’s extended baseline, overall Medicaid spending would grow 5.1 percent per year during the next two decades, in part because prices for medical services would increase. Under this legislation, such spending would increase at a rate of 1.9 percent per year through 2026 and about 3.5 percent per year in the decade after that.

CBO and the staff of the Joint Committee on Taxation do not have an insurance coverage baseline beyond the coming decade and therefore are not able to quantify the legislation’s effect on insurance coverage over the longer term. However, the agencies expect that after 2026, enrollment in Medicaid would continue to fall relative to what would happen under the extended baseline.

On the basis of consultation with the budget committees, CBO’s just-released cost estimate for the bill measured the costs and savings relative to CBO’s March 2016 baseline projections, with adjustments for legislation that was enacted after that baseline was produced. For consistency, this longer-term analysis uses CBO’s extended baseline published in July 2016. CBO analyzed these longer-term effects at the request of the Ranking Members of the Senate Budget Committee and the Senate Finance Committee.

Related CBO Publications:

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AMA Physicians Reject House ACA Replacement Bill

Andrew W. Gurman, MD Andrew W. Gurman, MD
President
American Medical Association
@AndyGurmanMD

The American Health Care Act (AHCA), released by Congress this week, is intended to repeal and replace the Affordable Care Act (ACA). But as introduced, it does not align with the health reform objectives that the AMA set forth in January to protect patients. While the ACA is imperfect, the current version of the AHCA is not legislation we can support.

The replacement bill, as written, would reverse the coverage gains achieved under the ACA, causing many Americans to lose the health care coverage they have come to depend upon.

In a letter sent today to leaders of the House committees that will mark up the AHCA, AMA CEO and Executive Vice President James L. Madara, MD, wrote that the proposed changes to Medicaid would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes. Dr. Madara also noted that the proposed changes in tax credits and subsidies to help patients purchase private health insurance coverage are expected to result in fewer Americans with insurance coverage.

It is unclear the exact impact this bill will have on the number of insured Americans, and review by the nonpartisan Congressional Budget Office is still pending. The ratings and analytics firm S&P Global Ratings has already estimated that as many as 10 million Americans could lose coverage if this bill becomes law, saying that between 2 million and 4 million people could lose the insurance they purchased in the individual health exchanges under the ACA, and between 4 million and 6 million could lose their coverage under Medicaid.

That just won’t do.

We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.

We physicians often see patients at their most vulnerable, from the first time they set eyes on a newborn child to the last time they squeeze a dying loved one’s hand. We don’t want to see any of our patients, now insured, exposed to the financial and medical uncertainties that would come with losing that coverage.

That is, above all, why physicians must be involved in this debate.

Editor’s note: In the coming weeks, a series of AMA Wire® articles will explore policies that form the basis of the AMA’s advocacy on health reform. Read parts one (“Protecting insurance gains is priority No. 1”) and two (“No going back on key market protections”).

Reprinted with permission and as Published by the American Medical Association on AMA Wire at: https://wire.ama-assn.org/ama-news/physicians-reject-house-aca-replacement-bill

Letter re: the AHCA being driven through the US House

New Speaker, Same Old Policies

— by CAP Action War Room

Paul Ryan’s Record Indicates We’re In For The Same Broken GOP Policies

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Speaker of the House — Paul Ryan (R-WI)

After much chaos and dysfunction, the House of Representatives elected Representative Paul Ryan from Wisconsin to be Speaker of the House. The Republicans have lauded their new Speaker as their “thought leader” who creates the “blueprints” for policies: he was Mitt Romney’s running mate in 2012 and chairman of the Ways and Means Committee. Much of the GOP rhetoric around Ryan’s run for speaker has suggested that he will usher in a new era of moderate, pragmatic, and effective leadership that will be both good for the economy and the American people. Though we hope Ryan can bring sanity to this House of GOP crazies and stop them from holding the government hostage time and again, we’re not holding our breath for a “new day in the House of Representatives.”

Despite GOP rhetoric, the reality of Paul Ryan’s record, including his signature 2014 budget, suggests that his Speakership will be full of the same old, out of touch, extreme Republican policies that undermine working families to help the rich get richer—policies that voters already rejected in the 2012 election. Here are a few reminders of Ryan’s record:

  • Bad for low-income families. Ryan tried to paint himself as an anti-poverty crusader, by embarking on poverty tour in 2014 and releasing a report documenting his concerns about poverty. But in reality, Ryan creates policies that cut programs that are vital for working families and blames poverty on personal failures, claiming that it is the result of a “culture problem.” The bulk of the Ryan Budget’s spending cuts—69 percent—come from gutting programs that serve low-income people. And after his 2014 poverty tour, he proposed slashing $125 billion from the
    (SNAP), also known a food stamps, over the next 10 years, and converting it to a flat-funded block grant. He also proposed cuts to Medicaid, a critical program that provides health care to 70 million Americans, including low-income children, seniors, and people with disabilities. And of course, Ryan wants to repeal the Affordable Care Act, which has provided health insurance for 17.6 million people.
  • Bad for seniors. In his 2014 budget, Ryan abandoned the pledge Republicans made to protect anyone age 55 or older from Medicare cuts and instead advocated for forcing seniors to pay more by radically altering Medicare. He also supports turning Medicare into a voucher system, which would increase premiums for traditional Medicare by 50 percent, according to the CBO. Ryan has also attacked one of the other pillars of economic security for seniors: Social Security. Despite the fact that Social Security survivor benefits made it possible for him to pay for his college tuition, Ryan’s 2010 budget cut benefits and privatized a substantial portion of the program, instead of lifting the Social Security payroll tax cap so that the rich pay their fair share of payroll taxes.
  • Bad for women. Ryan’s dismal record on women’s issues has earned him a 0 percent score from Planned Parenthood on women’s issues. He has voted numerous times to defund Planned Parenthood and is a leading advocate for personhood bills. And though Paul Ryan used his power to guarantee time with his family despite his Speaker duties, he refuses to support legislation, such as guaranteed paid sick and paid family leave, to help others have this right. Unlike Paul Ryan, no one else has federally guaranteed paid time off for illness, holidays, vacation, or the arrival of a new child. Women usually still most feel the burden of this lack of paid leave. More than 40 percent of mothers have cut back on work to care for family. And as new research shows that boosting women’s earnings helps slow the growth of inequality, it is apparent that Paul Ryan’s extremism hurts not only women, but also the economy.
  • Bad for the economy. Ryan’s budgets and rhetoric tout the same failed trickle-down economic theories that have only helped the rich get even richer but leave middle class and working families behind. His budget proposed giving millionaires a tax cut of at least $200,000. And analyses indicate, there is no way to implement Ryan’s tax cuts for millionaires in a deficit-neutral way without raising taxes on the middle class. Ryan also advocates for austerity measures that have never worked and would hurt the economy. And yet, his budget advocates for enormous cuts to investments in education, science, and other programs that benefit the middle class.

BOTTOM LINE: Though we’d like to hope that Paul Ryan’s new title will cause him to reevaluate his policies and support legislation that will actually help working families, his record of damaging polices creates huge warning signs. If Paul Ryan’s reign as speaker is anything like his record, we’re in for another period of GOP extremism that hurts families, seniors, women, and the economy. But now that the chaos has cleared, Republicans in the House of Representatives should take this opportunity under new leadership to pass policies that support working families, rather than the wealthy few.


This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe.  ‘Like’ CAP Action on Facebook and ‘follow’ us on Twitter

Cooking The Books

Two Seemingly Tiny Rule Changes By House GOP Will Rig The Game For The Rich

The new Republican Congress is wasting no time on high-profile political maneuvers to prove their right-wing agenda. Yesterday, the House GOP, bucking some of its own, took its 54th vote to dismantle the Affordable Care Act by voting to redefine full-time as a 40-hour work week (the move would leave up to 500,000 without insurance and increase deficits by $53 billion over ten years). Today, it passed legislation to approve the Keystone XL pipeline instead of working to create clean energy jobs and protect public health. And next week, it is expected to use the need to fund the Department of Homeland Security as a chance to please their far-right anti-immigrant base by defunding the president’s recent common-sense executive actions on immigration.

House Republicans, however, did something else this week that may be getting less attention, but is no less important: They passed the new rules package for the 114th Congress. And two of these little-known but significant rules speak volumes about the broader Republican agenda to favor the wealthy and corporations at the expense of everyone else.

A budgeting method that means a return to failed trickle-down economics

An important part of the lawmaking process is the evaluation of the potential law’s fiscal impact — how much it is projected to change federal spending and revenues. In the first rule change, the House GOP now directs Congress’s nonpartisan scorekeepers to use a new system called “dynamic scoring” when evaluating some proposed legislation: a move that will make it easier to cut taxes.

While the details are quite technical, what Republicans are attempting to do amounts to fuzzy math. Take this example: Republicans propose a tax cut. Scorekeepers have to evaluate how much it will cost. The new rule requires them to predict how the tax cut will affect the overall economy in the future–something that requires a lot of speculation, and could give the impression of reducing how much a tax cut would cost. Now say Democrats propose an investment in education or infrastructure. The rule does not allow scorekeepers to apply the same potentially beneficial predictive speculation to appropriations bills, where these investments are generally made.

This is in effect cooking the books in favor of tax cuts and trickle-down economics. We’ve seen very well how that went under President George W. Bush, whose massive tax cuts in 2001-2003 irresponsibly skewed the tax system in favor of the wealthy and subsequently forced dramatic cuts in important safety net programs. And more recently, Kansas has made the point again. With the promise of a “shot of adrenaline” for the state economy, the state passed massive tax cuts favoring the wealthy; instead, it has gotten a gaping hole in the budget and an under-performing state economy.

A move to hold Social Security hostage

With the second rule change, the House GOP have added a restriction to Social Security that could jeopardize the trust fund and help Republicans in their efforts to cut benefits.

There’s a routine transfer that happens between the Social Security retirement trust fund, which is financially secure, and the Social Security disability program, which has been under more strain in recent years due to demographic shifts such as aging baby boomers. It’s happened 11 times. The new rule passed by House Republicans prevents this transfer, unless it also includes new revenues or benefit cuts. The disability program is expected to run short of money in 2016, which means that beneficiaries will face up to 20 percent cuts in their payments without a transfer between the trust funds. In effect, the rule holds Social Security hostage so that conservatives can extract more concessions in a potential entitlement reform.

BOTTOM LINE: While this week has had a number of high-profile legislative pushes, little-known rule changes have had big effects in revealing the backward priorities of the new GOP Congress. Dynamic scoring for tax cuts will make trickle-down policies that favor the wealthy easier than before. And a restriction on a routine Social Security transfer could mean more benefits cuts for working families.

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This material [the article above] was created by the Center for American Progress Action Fund. It was created for the Progress Report, the daily e-mail publication of the Center for American Progress Action Fund. Click here to subscribe.

Affordable Care Act at 3: Increased Savings for Seniors

— by Kathleen Sebelius, Secretary of Health and Human Services,  March 21, 2013

In the three years since the Affordable Care Act became law, the slower growth of health care costs is saving money in Medicare and the private insurance market, helping to curb previously skyrocketing premiums and making Medicare stronger.

The nonpartisan Congressional Budget Office recently estimated that Medicare and Medicaid spending would be 15 percent less — or about $200 billion— in 2020 than was previously projected, thanks to this slower growth. Medicare spending per beneficiary rose by just 0.4% in 2012, while Medicaid spending per beneficiary actually dropped by 1.9% last year. We are making Medicare stronger, too, by spending smarter, promoting coordinated care, and fighting fraud. Not only does this ensure that taxpayer dollars are spent wisely.  It means that those who count on Medicare — our grandparents, parents, our friends, and neighbors – will have it for years to come.

Today, we are announcing that thanks to the Affordable Care Act, more than 6.3 million seniors and people with disabilities on Medicare have saved more than $6.1 billion on prescription drugs since the health care law was enacted three years ago. This is the result of the law’s closing of the prescription coverage gap known as “the donut hole.”

Nearly 3.5 million people with Medicare saved an average of more than $706 each on their prescriptions in 2012.

In the case of Helen Rayon of Pennsylvania, the savings on her medications is enough to help her contribute to the education of her grandson. She says: “I take seven different medications. Getting the donut hole closed … gives me a little more money in my pocket.”

David Lutz, a community pharmacist from Hummelstown, PA, described his elderly customers, “splitting pills, taking doses every other day, missing doses, stretching their medications.”  But he says this has begun to change with the savings resulting from the Affordable Care Act, and that’s good for their health as well as their budgets.

After the law was passed, the Affordable Care Act provided a one-time $250 check for people with Medicare who reached the Part D prescription drug coverage gap in 2010. Since then, individuals in the donut hole have continued to receive savings on prescription drugs. In 2013 individuals in the donut hole are saving over 50% off of the cost of branded drugs. The savings on both brand name and generic drugs will continue to increase until the coverage gap is closed in 2020.

Along with savings on their medications, American seniors have also benefited from access to vital preventive services — such as mammograms, cholesterol checks, cancer screenings, and annual wellness visits — with no Part B coinsurance or deductibles. In 2012, more than 34 million seniors and people with disabilities with Medicare received at least one free preventive service. Having easier access to preventive services without worrying about the cost helps seniors stay healthier and identify health conditions before they become more serious and costly.

Helen works as a health-and-wellness coordinator at a senior center, arranging for health and fitness activities for seniors older than herself.  She knows they struggle with the costs of staying healthy. “If it weren’t for the health care reform, many of our seniors would not get to a doctor,” to get a check up, Helen says. “It is expensive for us to keep good health.”

Affordable Care Act initiatives are also ensuring that if Medicare beneficiaries do end up in the hospital that their care is coordinated and they stay out of the hospital once they’re discharged. This also gives Medicare beneficiaries – and other taxpayers – more value for their health care dollars. In fact, hospital readmissions in Medicare have fallen for the first time on record, resulting in 70,000 fewer readmissions in the last half of 2012.

The Affordable Care Act is helping us keep our moral commitment to ensure that our grandparents and other seniors get the high-quality, affordable health care and security they need and deserve.

To learn more about how the Affordable Care Act is saving seniors on prescription drug costs by closing the donut hole coverage gap, visit www.hhs.gov/news/press/2013pres/03/20130321a.html


NOTE:  Today, in the U.S. House of Representatives, GOP members of that House, on a purely partisan vote, passed the Ryan Budget which, if it were to become law, would repeal the Affordable Care Act, and all of it’s provisions which help not just those folks on Medicare, but those of us who might have what the insurance industry has termed a “pre-existing condition” that they can then use to deny coverage.  It would also allow insurance companies to once again impose both annual and lifetime limits on coverage.  Those of you with children under 26 would no longer be able to continue to carry them on your existing health insurance policy once they reach age 18. And that’s just a few of the provisions that make a difference in ordinary Americans’ lives.  Please take the time to review exactly “what” is covered under Obamacare  and then help us bury Senator Heller in emails, tweets, and letters letting him know you will not forget any vote he takes to repeal this needed and necessary law by voting for Ryan’s Path to Poverty budget.