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Politics New GOP health care bill will determine winners, losers

11:20  15 july  2017
11:20  15 july  2017 Source:   ap.org

President Trump says health-care reform 'more difficult' than peace between Israel and Palestinians

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Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups. The GOP bill would start by phasing out enhanced federal financing for Obama's Medicaid expansion, adopted by 31 states.

The American Health Care Act, which narrowly won passage in the House on Thursday, could transform the nation’s health insurance system and create a new slate of winners and losers . While the Senate will probably demand changes, this bill , if it becomes law in its current form

FILE - In this July 13, 2017 file photo, Senate Majority Leader Mitch McConnell of Ky. walks to his office on Capitol Hill in Washington. Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups. (AP Photo/Pablo Martinez Monsivais, File)© The Associated Press FILE - In this July 13, 2017 file photo, Senate Majority Leader Mitch McConnell of Ky. walks to his office on Capitol Hill in Washington. Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups. (AP Photo/Pablo Martinez Monsivais, File)

WASHINGTON — Republicans' latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups.

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It would give consumers more responsibility for their insurance choices, a goal long held by conservatives who argue that's key to a true health care market. Younger adults and healthy people in the solid middle class may find more agreeable options. But low-income people may not be able to afford coverage, along with older and sicker adults.

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House passes GOP health bill , a step toward Obamacare repeal. The Senate will also have to wait on a CBO score so that its parliamentarian can determine whether the chamber is even allowed to vote on the bill Here’s what we know, as of Thursday, about the winners and losers from the House vote

Let's go over some winners and losers . And GOP leaders apparently got their members to shrug off a brutal CBO report of the old version of their health - care bill to vote for this one.

And there are potential unintended consequences for people with employer-provided insurance, currently about 170 million Americans. Allowing individuals to pay premiums from tax-sheltered accounts may create incentives for employers to stop offering coverage, say some independent analysts.

The legislation would put limits on federal spending for Medicaid, a partnership program with states to cover low-income people, the disabled and nursing home residents. The drawback is that state officials could eventually face no-win choices, such as having to pick between paying for coverage for low-wage working mothers and support services for elderly people trying to stay out of nursing homes.

As Senate Majority Leader Mitch McConnell, R-Ky., steers toward debate and votes next week, here is a look at some of the latest changes and major issues:

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The Senate’s Obamacare repeal bill , which touches all parts of the health care system and beyond, creates new sets of winners and losers .

The Congressional Budget Office estimates twenty-two million fewer people would be insured by 2026 under the GOP 's proposed health care plan. USA TODAY.

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CRUZ'S PLAN

The new Senate bill incorporates the core of a proposal from Sen. Ted Cruz, R-Texas, that would reorganize the market for policies purchased by individuals. As many as 20 million Americans get coverage this way, about half through subsidized markets like HealthCare.gov, created under former President Barack Obama.

Cruz would change basic requirements that Obama's law imposed on individual plans, including standard benefits such as pregnancy, maternity and newborn care; wellness visits and mental health treatment. The law also requires the same premium rates for sick and healthy people.

Under the Cruz approach, an insurer can offer plans that don't comply with such requirements, provided they also offer coverage that does. The problem, say critics, is that the healthy would flock to low-premium, skimpy plans, leaving the sick to face escalating prices for comprehensive coverage.

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Americans divided over GOP health care bill , Kaiser poll finds. (CNN) A new poll finds that many Americans are not optimistic about what the GOP health care bill will do to their coverage.

WASHINGTON (AP) — Republicans' latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups. McConnell's new bill made a major change to tax-sheltered health savings accounts, which was also advocated by Cruz.

"Healthy people would have opportunities to buy lower-premium, skinnier plans, while people with pre-existing conditions not eligible for premium subsidies could find themselves priced out of insurance," said Larry Levitt of the nonpartisan Kaiser Family Foundation.

The latest bill includes another $70 billion to help states keep health insurance affordable for older, sicker customers. But it's not clear how those backstops would work, and the federal funding eventually would end.

Some insurers are worried because of a technical change with huge practical implications: Health plans that enroll healthier customers would no longer have to cross-subsidize those with sicker patients, as is currently required.

"We think it is unworkable," said Justine Handelman, top Washington lobbyist for the BlueCross BlueShield Association. She predicted skyrocketing costs for taxpayers also, stuck with the bill for sicker patients.

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EMPLOYER ESCAPE HATCH?

McConnell's new bill made a major change to tax-sheltered health savings accounts, which was also advocated by Cruz.

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Story highlights The GOP health care bill would repeal Obamacare's individual mandate 14 million more people would be uninsured next year under this bill than under Obamacare

House Republicans have passed a bill to replace the Affordable Care Act. If it is signed into law, the American Health Care Act will affect access to health care for millions of people in the U.S. The AHCA would shrink Medicaid coverage

Under the bill, health savings accounts could be used to pay premiums with pre-tax money. Under current law, they can only be used to cover out-of-pocket costs, such as deductibles and copayments.

The change is meant to level the playing field for people buying individual plans, as compared to people getting employer coverage. The value of workplace insurance is tax-free for employees and tax-deductible for employers.

But some analysts say McConnell risks undermining workplace coverage.

The upside is that the change might encourage more self-employed people to buy individual health insurance policies. The downside is that some employers may see it as an invitation to drop health benefits, particularly since the GOP also would repeal Obama's requirement that larger companies provide health care or face fines.

"Allowing individuals to purchase insurance with pre-tax dollars eliminates one of the advantages to employer-provided insurance," said Elizabeth Carpenter of the Avalere Health consulting firm. "That may lead some employers to consider whether or not they want to continue to offer health insurance."

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THE POOR AND THE SICK

McConnell kept some of the Obama-era tax increases used by Democrats to finance expanded coverage. But the money will be going to shore up private insurance, not the Medicaid program. Medicaid accounts for half or more of the 20 million Americans gaining coverage as a result of the Affordable Care Act.

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The legislation appropriates .176 trillion from 2020 to 2026 for this new Market-based Health Care Grant Program. There were so-called winners and losers in the individual market under the ACA. How would that change under this bill ?

New winners and losers could complicate prospects for latest GOP health care bill . Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups.

Medicaid covers low-income people, from many pregnant women and newborns, to disabled people and many elderly nursing home residents. The GOP bill would start by phasing out enhanced federal financing for Obama's Medicaid expansion, adopted by 31 states. Perhaps more significantly, it would limit future federal funding for the overall program. As a result, it's estimated Medicaid would cover 15 million fewer people by 2026.

The bill would add $45 billion to help states confronting the opioid epidemic pay for treatment and recovery. But that hasn't swayed the American Medical Association, which points out that people in recovery also need comprehensive health insurance.

Republican governors don't like the Medicaid cuts, and some have been vocal. About half the states that expanded Medicaid now have GOP chief executives.

Nevada Gov. Brian Sandoval, a Republican who oversaw a Medicaid expansion, said more than 200,000 people gained coverage in his state.

"You think about 210,000 men, women and children, senior citizens, the drug addicted, the chronically ill," Sandoval said. "These are people that used to get their treatment in emergency rooms, if they got any treatment at all. I keep going back to the fact that they are living a better quality of life."

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Associated Press writer Jennifer McDermott in Providence, Rhode Island, contributed to this report.

CBO scores modified version of Senate GOP's repeal and replace plan .
This score differs from a cost estimate CBO released Wednesday, which analyzed plan to repeal 2010 health care law now and replace it later . Here's what the CBO said about earlier versions of the Senate bill:Repeal only (CBO estimate: July 19): That estimate projected that 32 million more people would become uninsured over the next decade. It also said that 17 million more people would become uninsured next year, compared to current law.Version 1 of BRCA (CBO estimate, June 26): The original version of BCRA would have left 22 million more people uninsured over the next 10 years.

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