American Health Care Act

Report: House GOP health care bill would spark job losses, economic downturns across the country

kkrisberg — Fri, 16 Jun 2017 15:49:22 +0000

Report: House GOP health care bill would spark job losses, economic downturns across the country

Despite glowing reviews from the House GOP about their health care bill, the people that actually crunch the numbers say it’ll likely mean millions more uninsured and higher premiums for people in poorer health. Now comes more bad news: it’ll also result in more than 900,000 lost jobs and billions in lost state revenue.

A new report from researchers at the Commonwealth Fund and George Washington University Milken Institute School of Public Health calculated the impact of the American Health Care Act (AHCA), which House Republicans passed in May, on employment and economic activity in every state. They found that if the AHCA becomes law, it could mean a loss of 924,000 jobs by 2026, with a majority of those losses felt in the health care sector. Also by 2026, gross state products would face a loss of $93 billion and business output would have declined by $148 billion. States that expanded Medicaid eligibility — which initially came with 100 percent funding from the feds — would be especially hard hit if the AHCA successfully repealed and replaced the Affordable Care Act (ACA).

“If this passed, there will be more people uninsured, more people unemployed, state budgets will suffer and there will be less public revenue for states to invest,” Leighton Ku, lead author of the new report and director of George Washington University’s Center for Health Policy Research, told me. “The end game is essentially less revenue for states, but an increased demand for their services.”

Those job losses, however, won’t hit immediately. Before the deep cuts to health care funding are felt on the ground, Ku and colleagues estimate the AHCA would lead to 864,000 more jobs by 2018. That short-term benefit, the report says, is because the House GOP bill initially raises the federal deficit by repealing a number of ACA taxes — like taxes on investment income, high-income earnings and medical device makers — that went toward supporting the ACA’s expansion efforts. Ku said from a monetary perspective, the AHCA’s tax repeals are a “big deal — it’s billions of dollars” in lost tax revenue. In the short term, he said, the feds go into deficit to pay for the tax repeals, leaving more money in people’s pockets to fuel the kind of consumer consumption that can stimulate economic growth.

But it won’t last, according to the report. As the AHCA’s deep cuts to Medicaid and marketplace subsidies come to full fruition, states start losing revenue and jobs. That initial jobs bump comes because the House GOP bill’s tax cuts go into effect before the cuts to Medicaid and insurance subsidies do. As Ku said, the bill “front loads the tax cuts and back loads the cuts to health care.” The irony, he said, is that cutting taxes on the wealthy, which the AHCA does, typically doesn’t stimulate the economy as well as providing relief for low- and moderate-income families. Ku and co-authors Erika Steinmetz, Erin Brantley, Nikhil Holla and Brian Bruen write:

Both government spending increases and tax reductions can stimulate job creation and economic growth. The relative effects depend on how the funds are used. Government spending or transfers, like health insurance subsidies, typically have stronger multiplier effects in stimulating consumption and economic growth than do tax cuts. Tax cuts usually aid people with high incomes who shift much of their gains into savings, stimulating less economic activity. A recent analysis found that 90 percent of the AHCA’s tax cuts go to the top one-fifth of the population by income.

At a more local level, consequences of the AHCA vary from state to state, but the outcomes overall aren’t promising, the report found. The 10 states with the largest job losses by 2026 will be New York with 86,000 lost jobs; Pennsylvania at 85,000; Florida at 83,000; Michigan at 51,000; Illinois at 46,000; New Jersey at 42,000; Ohio at 42,000; North Carolina at 41,000; California at 32,000 and Tennessee at 28,000. States that expanded their Medicaid programs will experience faster and deeper job and economic losses, though states that didn’t expand will face losses as well. Laws in seven states — Arkansas, Illinois, Indiana, Michigan, New Hampshire, New Mexico and Washington — automatically reverse the Medicaid expansion if the agreed-upon federal Medicaid funding changes, which it most certainly does under the House GOP bill.

The report also estimated that if only the AHCA’s coverage losses were implemented — and not its tax cuts — it could lead to job losses of 1.9 million by 2026, with such losses beginning to climb in 2019. If only the bill’s tax cuts were realized, jobs would be expected to grow through 2026. However, if both tax cuts and coverage cuts are put into place, the initial job bump would eventually morph into job loss. About two-fifths of the jobs lost due to the AHCA’s coverage changes would be felt in the health care sector. Researchers also noted that Trump’s fiscal year 2018 budget proposal, which came out in May, appears to call for an additional $610 billion cut to Medicaid. If that happened in addition to enactment of the AHCA, the employment and economic losses would be even greater.

Ku said if the health care sector does lose jobs at that rate, it will surely affect the sector’s capacity to serve all those in need. And while that impact would differ by community, it’s areas that don’t have enough health providers in the first place — like rural communities — that could suffer most.

This most recent jobs report follows a different report, by the same researchers and released in January, that studied the economic and job impact of simply repealing the ACA without replacing it. That report also found job and economic losses in every state. Ku said when the Senate releases its version of a repeal-and-replace bill, he and his colleagues plan to calculate its economic impact as well.

For a copy of the new report, the “American Health Care Act: Economic and Employment Consequences for States,” visit the Commonwealth Fund.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Fri, 06/16/2017 - 11:49

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“House GOP health care bill would spark job losses, economic downturns across the country”

So would curing cancer and developing a pill to prevent/cure all illnesses.

So many doctors and nurses would be out of work, and hospitals nearly vacant.

See Noevo -

Actually the opposite. Cheap health interventions - sanitation, vaccines, and antibiotics - mean that people lived to get more chronic and expensive conditions like cancer. Cure those and they'll live even longer, to get the really expensive conditions like Dementia and general old age infirmity. Every time you raise life expectancy through medicine, you make room for more, and more expensive diseases.

If people end up living to 150, that means they will spend perhaps half of their entire life needing medical interventions of one kind or another.

The rural area's that voted for this POS will be hurt the most. How fitting.

The ACA is safe for now, but it’s still very much in danger

kkrisberg — Sat, 25 Mar 2017 18:10:32 +0000

The ACA is safe for now, but it’s still very much in danger

Yesterday, House Republicans failed to find enough votes to pass their Affordable Care Act replacement. It was a very good day for the millions of Americans projected to lose their coverage under the GOP plan. But let’s be clear: Obamacare is not safe.

In a last-ditch effort to round up more votes, House Speaker Paul Ryan, R-Wis., proposed an amendment that would have, beginning in 2018, allowed states to determine the kinds of essential health benefits required in insurance plans purchased with tax credits. Under Obama’s health care law, insurance plans sold via the federal health care marketplace had to cover 10 essential health benefits, as did coverage via the Medicaid expansion. Those 10 benefits are: outpatient care; emergency room care; in-hospital care; pregnancy, maternity and newborn care; mental health and substance abuse; prescription drugs; rehabilitative and habilitative services; lab tests; preventive services; and pediatric services. This is basic health care coverage that provides actual value for your dollars. Fortunately, for those of us who’d prefer real value in their insurance plans and who realize there’s no such thing as a functional a la carte health insurance market, the Republican plan failed.

However, it’s not only Congress that can impact the essential health benefits. In fact, federal officials can do all kinds of things through the regulatory system to impact the ACA, including doing nothing at all. The ACA isn’t perfect — few pieces of legislation are — and without federal support to enforce its provisions, address problems and make adjustments as indicators evolve, things could begin to fray. And public support is vital to the ACA’s survival.

One core component of the ACA that’s vulnerable is the essential health benefits — a provision that set a basic bar to ensure that if you’re mandated to buy something, it should provide you with something of value. Health and Human Services Secretary Tom Price has the power to impact the essential benefits through the regulatory process. And because he tried just that as a member of the House — his ACA replacement, the “Empowering Patients First Act,” eliminated essential benefit requirements — there’s reason to believe he’d be open to attempting the same thing as HHS secretary.

In addition, Trump signed an executive order in January directing federal agencies to ease the fiscal burden that the ACA might have on people and states (that’s code for pulling back enforcement). As a result, the IRS announced that it would continue processing tax returns that don’t disclose health insurance status, which could present an easy way for people to skirt the ACA’s individual mandate. If you think of the ACA as a bicycle tire, the individual mandate is the hub. Let it quietly crumble and the spokes go too.

That’s all to say that the ACA isn’t out of the woods just yet. So, let’s briefly look at just some of the consequences of dropping or weakening the ACA’s essential health benefits and easing coverage mandates.

Hospital care and emergency care: According to a 2015 federal report, hospital uncompensated care costs were $7.4 billion lower in 2014 than they would have been if insurance coverage had remained at 2013 levels. That’s a whopping 21 percent reduction in uncompensated care spending. Five billion dollars of that reduction came from states that expanded Medicaid eligibility. This 2015 study found each additional uninsured person costs local hospitals $900 each year in uncompensated care. This one found that Medicaid expansion states experienced a decrease in uncompensated hospital costs of 3.1 to 4.1 percentage points of operating costs. (Adding this last one in there because so many states haven’t expanded Medicaid.)

Pregnancy, maternity and newborn care: According to a 2011 federal report, less than a year after the ACA was signed into law, of the then-currently marketed plans submitted by health insurance companies to Healthcare.gov, 62 percent of enrollees did not have maternity coverage. Not having maternity coverage is expensive: This study found that from 2004 to 2010, the price insurers paid for childbirth rose between 41 and 49 percent depending on the type of birth. The average price for pregnancy and newborn care was $30,000 for vaginal delivery and $50,000 for a C-section. Before the ACA — the days when the free market reigned in much of the individual market — just 6 percent of health plans available to 30-year-old women in states where maternity care wasn’t required on the individual market actually offered the benefit.

Mental health and substance abuse: That 2011 federal report of the then-currently marketed plans submitted to Healthcare.gov found that 34 percent of enrollees didn’t have substance abuse coverage and 18 percent lacked mental health coverage. This federal report found that behavioral health problems are the second-most common pre-existing health condition, affecting 45 million Americans. Thankfully, between 2010 and 2014, the number of Americans with a pre-existing condition who went uninsured for a full year dropped by 22 percent. The recent Republican plan didn’t target the ACA’s pre-existing condition protections. But a weakening of the essential health benefits could mean that even if people with behavioral health problems weren’t barred from the insurance market, the services they need might not be available.

Pediatric services: As of June 2013, more than 28 million children enrolled in Medicaid and another 5.7 million in the Children’s Health Insurance Program depended on the programs for timely access to doctors when they’re sick. This 2016 study found that 2.8 million children gained coverage under the ACA, a more than 41 percent reduction in the children’s uninsured rate. In states like Alabama, Mississippi and South Carolina, the number of uninsured children fell by more than half. In 2014, the rate of U.S. children without health coverage fell to a historic low of 6 percent. Researchers estimate that if the ACA is repealed, nearly 4 million children would lose their coverage by 2019.

This is what Trump told ABC News in January: “Just so you understand people talk about Obamacare. And I told the Republicans this, the best thing we could do is nothing for two years, let it explode. And then we'll go in and we'll do a new plan and -- and the Democrats will vote for it. Believe me.”

Let’s take him seriously.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Me and my family depend on the ACA for access to quality health care.

kkrisberg Sat, 03/25/2017 - 14:10

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Beyond the numbers: What’s it like to have an unplanned pregnancy?

kkrisberg — Fri, 17 Mar 2017 17:02:14 +0000

Beyond the numbers: What’s it like to have an unplanned pregnancy?

There’s a lot at stake for women’s health in the Republican plan to replace the Affordable Care Act, which eliminated out-of-pocket costs for birth control and has been highly successful in breaking down barriers to affordable family planning. The cost-sharing changes alone are saving individual women hundreds of dollars each year on their choice of contraception.

So far, the Republican replacement proposal, known as the American Health Care Act, doesn’t impact the Obama-era contraception coverage provisions, nor does it touch other women’s health benefits, such as designating maternity care an essential health benefit. But it does attempt to cut off funding to Planned Parenthood, which serves millions of women and men every year; restrict insurance coverage of abortion; and roll back Medicaid funding, which experts predict will disproportionately impact low-income women. (It is important to note, however, that on the issue of contraceptive coverage and other essential health benefits important to women, Health and Human Services Secretary Tom Price does have the power to change the rules governing those benefits through the agency’s rulemaking process. In turn, it’s probably too early to say the ACA’s contraceptive benefits are safe.)

All these potential policy changes come with very real impacts to women’s health and economic security. The Urban Institute released a new health policy brief this month that illuminates those impacts and helps us gain a deeper understanding of the role of family planning in women’s lives. Part of a multiyear project known as “Beyond Birth Control: Family Planning and Women’s Lives,” the new brief focuses on prevalence and perceptions of unplanned births. It’s based on data from the Urban Institute’s Survey of Family Planning and Women’s Lives, a nationally representative survey of nearly 2,000 women of reproductive age. Among the brief’s key findings, significant numbers of U.S. women experience an unplanned birth in their lifetimes, and such experiences have serious impacts on their lives and opportunities.

Researchers found that more than one-third of women surveyed in 2016 — or more than 36 percent — said they had experienced at least one unplanned birth. Among women who already had children, that rate was more than six in 10, or 62 percent. Marital status underscored the greatest difference in unplanned birth numbers, with married women having the lowest prevalence. Still, about half of married women reported an unplanned birth. Majorities of women said an unplanned birth would negatively affect their education, job, income and mental health. More than 40 percent said an unplanned birth would have a negative impact on their physical health. Brief authors Emily Johnston, Brigette Courtot, Jacob Fass, Sarah Benatar, Adele Shartzer and Genevieve Kenney report:

Women’s responses in follow-up interviews reinforced the negative reported perceptions of the effect an unplanned birth would have on a woman’s education, job, and income. For example, one 21- year-old woman said, “Kids are expensive, and I wouldn’t be able to finish my degree and get the high- paying job that I want. It would definitely change my future plans in a bad way.” When discussing the effect an unplanned birth would have on her life compared with that of her partner, a 28-year-old woman said, “Unfair as it is, it probably wouldn’t affect his career or education as much as it would affect mine.” One 35-year-old respondent expressed concerns about her mental health and stated, “Emotionally and financially we would be better prepared to have another child in a year, but we would make it work if it happened.”

Among 26 survey respondents participating in follow-up interviews, about half had a positive or neutral reaction to the idea of an unplanned pregnancy. However, women pretty much agreed that an unplanned pregnancy would have significant financial and emotional costs. Some women said having another baby would mean big new expenditures, like a new house, new car and additional childcare. Several said a new baby would result in them quitting their jobs. Quotes from respondents:

•Being a mom, I know that babies change things and you change your plans. We’ve always just managed to just change our work hours around so that someone was always home with the children. That may be a factor. — 44-year-old married woman

• I would be extremely scared and very upset and worried about my future. As a female I’m applying for grad school, and it would put a kink in my educational plans and financial plans in the long term. — 28- year-old single woman

• I wouldn’t be depressed, but I would be overwhelmed because I have a lot of goals to accomplish before that happens. — 22-year-old woman living with a partner

Among women who had experienced an unplanned birth, more than half agreed that it positively impacted their motivation to achieve their goals. Nearly half said it had a negative impact on their income and 40 percent said an unplanned birth negatively impacted their mental health. Hispanic and black women were more likely to report mostly positive effects than white women. The brief concludes:

Women’s concerns about the negative effects of unplanned births underscore the importance of access to reproductive health and family planning services, which allow women to plan their pregnancies and prevent unplanned births. For women who experience an unplanned birth, access to targeted services and supports could reduce the negative impact of an unplanned birth on a woman’s life.

The future of the Affordable Care Act is unsure. But every one of the 62 percent of women of reproductive age who use contraception — and the many, many more who’ll need it in the future — will be impacted by its fate.

Download a copy of the new policy brief at the Urban Institute.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.

kkrisberg Fri, 03/17/2017 - 13:02

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I am 60 years old and was a teenager when Rowe vs Wade was passed by the SCOTUS. It was a happy day for me not because I think abortion is a great thing but because I knew school teenagers that had to have abortions. Some were forced by parents with money sent to NY. Others were poor and scared and went to back alley butchers. This is why I want abortion legal. No women wants an abortion it is life or health reasons that make them choose. I doubt there are many that have more than one abortion in their life. But it needs to be legal and safe.

Insurance losses under proposed ACA replacement a matter of life and death

kkrisberg — Wed, 15 Mar 2017 17:30:02 +0000

Insurance losses under proposed ACA replacement a matter of life and death

As the Republicans push forward their abysmal Affordable Care Act replacement, much of the talk surrounding its impact focuses on insurance numbers and premium hikes. Those things are certainly important. But this is more important: The Republican plan will cause unnecessary suffering and preventable death.

How do we know this? Let’s start with the Congressional Budget Office report that scored the Republican replacement plan, titled the American Health Care Act. That report estimates that if the Republican plan is enacted, 14 million more people would be uninsured by 2018 than would have been under the Obama-era ACA. Then, as the American Health Care Act’s longer-term provisions begin to take effect, CBO estimates that uninsurance number would climb to 21 million in 2020 and then to 24 million in 2026. That translates to 52 million Americans being uninsured by 2026. (To give you a clearer reference point: The latest figures from the U.S. Census, released last September, found that in 2015, 29 million Americans were uninsured. That’s down from 49.9 million uninsured in 2010, the same year Obama signed his health reform law. If the Republican plan passes, we will literally be erasing years of valuable progress.)

And here’s the crux of those numbers: not having insurance significantly increases a person’s risk of death and disease. For example, this 2009 study published in the American Journal of Public Health found that even after adjusting for all kinds of variables — such as income, education, smoking and exercise — people without insurance were more likely to die than people with health insurance. More specifically, the researchers found that lack of health insurance is associated with nearly 45,000 deaths each year in the U.S., which is higher than the number of deaths linked to kidney disease. Another study published in 2014 in Annals of Internal Medicine examined changes in mortality in Massachusetts after the state implemented its 2006 health reform law. That study found a “significant” decrease in all-cause mortality as well as a decrease in deaths due to reasons that can be addressed via health care.

But wait, there’s more. In a 2012 article in the New England of Journal of Medicine, researchers examined the mortality impact of the ACA’s Medicaid expansion. (The Republican plan phases out the Medicaid expansion and then reduces federal funding for the program. For more on that read Liz Borkowski’s Monday article.) That study found the Medicaid expansions were effective in reducing all-cause mortality by nearly 20 deaths per 100,000 adults, with such reductions greatest among older adults, people of color and residents living in low-income counties. For cancer patients, this 2013 study found that those without insurance and those with Medicaid coverage had a higher risk of death than patients with private insurance. On the topic on immunizations, researchers find that having insurance makes a big difference too. For instance, this 2015 study on adult immunizations found adults with insurance had much higher rates of being vaccinated against the flu, cancer-causing HPV, shingles, hepatitis A and B, and pneumococcal disease.

Of course, that’s all just the tip of the iceberg — there’s way more research out there on the impact of having health insurance. The point is that having health insurance — actually having that card in your hand, not just having access to having it — is truly a matter of life and death. It’s not a stretch to say that members of Congress truly have people's lives in their hands.

P.S. One talking point that I just absolutely have to comment on. President Trump and Republicans in Congress incessantly note that having the ability to sell health insurance across state lines will increase competition and lower costs. There is no federal law that prohibits this practice — none. This is a state issue, regulated by state officials. In fact, a provision in Obama’s Affordable Care Act says states can form interstate compacts that allow insurers to sell qualified health plans across state lines. Learn more about this bogus talking point here and here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.

kkrisberg Wed, 03/15/2017 - 13:30

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