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Call Your Rep: Republican Health Care Plan

18 February 2017

This is the second post in the "Call Your Rep" series... If you're reading this, and you have a US Senator or House Representative who is not voting the way you want them to vote, it's time to act: Call your representative!

This post contains background, facts and talking points, and a call to action for your phone call. For more details on how to make this call, read the introductory post here, which includes information about why I started this series, how to find your representative's phone number, how to call your representative to have the most impact, a sample call script, and how to be notified of new posts.

Background (why I chose this topic for today's Call Your Rep)

In Call Your Rep #1, the topic was also health care. Yesterday, Paul Ryan released the outline of a plan to repeal and replace the Affordable Care Act. Congress is actively working on this repeal-and-replace plan, and we need to keep after them so that they don't leave many Americans unable to pay for the health care they need.

Legislation called the "Pre-Existing Conditions Protection Act of 2017" has also been introduced in the House, which would provide protection against one of the provisions of Paul Ryan's plan. This bill calls for premiums and eligibility to not depend on health status, disability, and similar factors, for both group insurance and the individual market.

Topic ("I want to speak to someone about...")

The Republican plan to repeal and replace the Affordable Care Act

Talking Points and Facts ("Here are some thoughts...")

On February 17, 2017, Representative Paul Ryan released a plan for the repeal and reform of the Affordable Care Act. Here are some thoughts regarding this plan:

  • There is an emphasis on Health Savings Accounts, which provide a tax deduction for putting money into a health-dedicated savings account. These are useful for middle-class and richer people [you might mention if you have one], but they are not useful for poor people, who have no extra money to put into such an account. We need to make sure that poor people are able to afford the health care they need, before increasing tax deductions for better-off people.
  • There is an emphasis on "flexibility" and getting rid of "one-size fits all coverage", which really means dropping the standards for what constitutes a health insurance plan. The existing standards in the Affordable Care Act are fairly minimal and very common-sense. If standards are eliminated, employers will be able to provide sub-standard coverage instead of decent coverage for their employees, and some people in the individual insurance market will end up with sub-standard coverage. This will mean that some people who think they have health insurance will not be covered for their actual health care needs.
  • Eliminating standards also makes it very difficult to compare two health insurance plans, because they will not have the same coverage. With standards, the coverage is the same, and all you need to compare is the co-pays, monthly cost, and provider network.
  • Under Paul Ryan's plan, insurance companies will be allowed to deny coverage to some people, based on their health, or exclude coverage of pre-existing conditions. This was the case before the Affordable Care Act, and many people could not get or afford decent insurance, in most states. The plan to go back to "high-risk insurance pools" or flexible grants to states to help people with pre-existing conditions is not likely to actually get coverage to these people -- it didn't work well prior to the Affordable Care Act.
  • Paul Ryan's plan calls for replacing income-graduated subsidies with a fixed-amount tax credit. The credit would be available to anyone not covered by an employer or government plan, and would increase as you got older. This, at first, sounds like a reasonable idea, and it would be simpler to figure out than the subsidies. However, in order to ensure that the poorest people could still afford to buy health insurance, this credit would need to equal the full cost of purchasing a decent health insurance plan. However, since it would be provided to everyone, and it would not be graduated by income, the cost of this system would be much greater than an income-graduated plan if it provided sufficient amounts, and it would leave some people unable to afford health insurance if it provided a lower amount. Neither option is good.
  • Paul Ryan's plan calls for reducing who is covered by Medicaid back to pre-Affordable Care Act levels. This will leave some people without the ability to afford health care, as is currently the case in some states, such as Idaho, that never accepted the optional Medicaid expansion of the Affordable Care Act.
  • Paul Ryan apparently realized that many people, under this plan, would need to go back to receiving their health care in hospital emergency rooms, because it increases reimbursement to states for this type of health care. Health care provided in this manner is much more expensive, and has much worse outcomes, than health care provided through regular doctor visits.
  • The plan language talks about choice and flexibility, yet it clearly states that the tax credit cannot be used for any plan that covers abortions. This is hypocritical, and is clearly an idealogical ploy.

Call To Action ("I am asking _____ to ______")

Ensure that the Affordable Care Act repeal and replace plan includes the following provisions:

  • Pass the "Pre-Existing Conditions Protection Act of 2017", to guarantee that the replacement for the Affordable Care Act does not allow health insurance eligibility, coverage, and premiums to be based on people's health or disability status.
  • Continue to define the minimum standards for what must be covered in a health insurance plan. Dropping standards will mean that some people have sub-standard coverage, and make it impossible to compare health plans.
  • Ensure that there is not a gap between people receiving free coverage through Medicaid, and people who can actually afford to buy health insurance. This means that if there is a fixed-amount tax credit rather than income-graduated subsidies, the credit must be enough to completely cover the cost of a reasonable health plan.
  • Maintain the mandate that everyone obtain health insurance, with tax penalties if they don't. Making sure that healthy people are part of insurance plans is the only way to keep premiums from rising even more.
  • Do not include provisions that receipt of credits or subsidies only apply to insurance plans that do not cover abortion, or specifically mention any other particular health care that cannot be covered.

References (where I got this information)