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Trumpcare: Who Will Suffer Under the New Plan?

For the past several years, the GOP has vocalized their opposition to Obamacare. Now that they have control of Congress and the Executive branches, they’re finally doing something about it.

The American Health Care Act, coined “Trumpcare,” is the Republicans’ response to the “failed” Obamacare.

Why Repeal Obamacare?

According to the GOP, Obamacare is collapsing, and it must be repealed in order to protect Americans. They point to health insurance premiums that were created by the law that increased markedly this year. Why? Insurers didn’t anticipate so many medical claims would be filed by their consumers. If you believe the GOP’s argument, Obamacare is unsustainable and will eventually leave millions without health care. According to the Speaker of the House of Representatives Paul Ryan, it is an “act of mercy” introducing a new health care bill.

But the proposed Trumpcare would actually leave millions more uninsured. Under Obamacare, most people are still able to get health plans for less than $100 due to subsidies provided under the plan, which taxes the wealthy in order to provide health insurance plans to the masses. Trumpcare no longer will tax the wealthy to help subsidize health care for those who struggle to pay for health insurance.

Who Will Suffer Under Trumpcare?Trumpcare

Trumpcare will leave millions of people without health insurance. It will potentially leave 14 million Americans uninsured under the new health care bill than under Obamacare in 2018, rising to 24 million by 2026.

There are also specific groups of people who will be most negatively impacted by Trumpcare.

Low-income Elderly

According to an analysis by the Congressional Budget Office (“CBO”), the American Health Care Act would be devastating to older Americans who obtain their insurance from the individual market. While the proposed bill will lower overall premiums in the individual market by 10 percent by 2026 as compared to Obamacare, the premium amounts depend on age and income. Specifically, a younger and presumably healthy person could pay less in premiums than an elderly person with many ailments.

The CBO gave this example: a person with an annual income of $26,500 that is 21 years would pay on average $1,700 in premiums for insurance on Obamacare, but on Trumpcare, that same person would pay $1,450. Sounds great, right?

But if that person is 64 years old with the same annual income of $26,500, he would still pay $1,700 in premiums under Obamacare, but pay a whopping $14,600 in premiums under Trumpcare. That’s more than half of his income toward medical premiums. For most, that is prohibitively expensive.

Women on Medicaid

The amount of women on Medicaid who seeks contraceptive care will lose that care in enormous numbers. The Trumpcare proposal plans to defund Planned Parenthood for one year. It will prohibit patients from using their Medicaid coverage at Planned Parenthood. Medicaid is a government program that helps low-income people obtain medical coverage.

Defunding Planned Parenthood will affect services that help women avert pregnancies. Moreover, there are few health care clinics or medical practitioners that are willing to serve the low-income population. Restricting access to contraceptive care can lead to several thousand more births to children that will eventually be on Medicaid themselves. Ultimately, this could cost as much as $21 million in 2017.

Trump Supporters

Ironically, Trumpcare will severely hurt many of those that voted for him. Research shows that the Trump voter does better under Obamacare than Trumpcare. How can this be? Most of the people who voted for Trump were older, lower-income citizens. It appears that despite all his promises regarding health care to his voters, Obama did more for them than Trump. When confronted with this reality in an interview, President Trump responded, “Oh, I know.” Go figure.

Trumpcare: Who Benefits From the New Plan?

After months of talk, the GOP released what is now being called “Trumpcare”. The health care reform bill, known as the “American Health Care Act,” is being presented in response to Obamacare, also known as the “Affordable Care Act”. During his campaign President Trump promised he would repeal Obamacare as one of his first orders of business. Now in two months, it appears he and the Republican party are making good on their promise.

But now that the GOP has presented their plan, people are starting to think Obamacare wasn’t so bad.

Obamacare

In 2009, the Democratic members of Congress passed the Affordable Care Act. It was signed into law by President Obama in 2010. Republicans hated it, although it has done a lot of good. For one, it guaranteed that people with preexisting health conditions could not be rejected by insurers or charged more than others. It also allows children to stay on their parents’ plan until they turn 26. As a result, more than twenty million uninsured people now receive health insurance coverage. Access to primary care, specialty care, medicines, surgeries, and treatment for chronic conditions has risen. It’s projected that Obamacare saves tens of thousands of lives every year. Obamacare also expanded Medicaid and helped people living near the poverty line obtain health coverage.

But for all the good Obamacare has done, it certainly has its problems. For instance, high deductibles for its Bronze plan users make up about 20 percent of its customers. Notwithstanding, people are realizing all the benefits they will miss now that the Republican-backed Trumpcare has been released.

TrumpcareHow Obamacare was Funded

The Affordable Care Act is funded by single taxpayers with incomes above $200,000 and couples making more than $250,000 annually. They pay an additional 0.9% Medicare payroll tax. There’s another 3.8% tax that applies to investment income properties which also helps fund Obamacare. The two taxes have been in effect since 2013.

Major Modifications for Trumpcare to Benefit the Wealthy

Under the proposed Trumpcare bill, people earning more than $1 million per year are projected to save approximately $165 billion in taxes over 10 years. The legislation is looking to eliminate two surcharges on the rich that helps pay for Obamacare, but the taxes would end after this year.

It’s not just the millionaires that benefit from Trumpcare. People who earn between $500,000 and $1 million per year also get a tax break of nearly $55 billion over a decade. Further, those with annual incomes of between $200,000 and $500,000 save approximately $53 billion.

Reaction to Trumpcare

The financial implications for the rich of Trumpcare have Democrats and Republicans alike upset. Trumpcare seems to benefit tax filers in the top 1%, or those who earn more than $772,000 a year, who expect to enjoy a $37,000 tax cut in 2022. The top .01% will receive a tax cut of more than $207,000. Clearly the bill will benefit the ultra wealthy.

At the same time, it’s the lower-income Americans that stand to suffer the most. Specifically, those who are insured through Medicaid or subsidized policies will suffer under the legislation. The new health care bill will potentially leave 14 million Americans uninsured than under Obamacare in 2018, rising to 24 million by 2026. In total, approximately 52 million people would be uninsured by 2026 under the GOP plan, compared to 28 million who would lack insurance under the current law.

Abortion: Arkansas Law Hopes to Protect Father’s Rights

A new Arkansas law that will go into effect later this year will allow a husband to sue a doctor in order to stop his wife from getting an abortion. Known as the Arkansas Unborn Child Protection from Dismemberment Abortion Act, or “Act 45”, it prohibits a particular type of abortion known as “dismemberment abortion.” The law provides no exemption for spousal rape.

Historically, Father’s Rights were to Prevent Abortions

abortionFathers historically have no legal rights with regard to their wife or the mother of their child choosing to have an abortion. If a man’s pregnant partner chooses to have an abortion, the father’s consent is not a legal requirement. A woman can choose to abort the pregnancy despite the father’s objections. In fact, the Supreme Court in Planned Parenthood v. Danforth ruled that laws requiring a spouse’s consent to be unconstitutional. The court reasoned that only one partner’s decision on abortion can prevail, and that the balance weighed in the woman’s favor.

Moreover, the Supreme Court concluded in Planned Parenthood v. Casey that the father does not have a legal right to be notified of an abortion. Most women discuss an abortion with their significant other, but those who do not may be in an abusive relationship. Therefore, requiring spousal notification places an undue burden on women who may fear for their safety.

What Kind of Abortion Does the Arkansas Law Stop?

Arkansas Act 45 prohibits a practice known as dilation and evacuation, also known as dismemberment abortion, in which fetal materials are removed from the womb through surgical instruments. It is the safest and most common method of abortion in the second trimester and is used in 95 percent of second-trimester abortions. It occurs after 12 to 14 weeks of pregnancy.

How Will the Arkansas Law Work?

Under the new Arkansas law, a father can sue a doctor to stop an abortion if the wife is in her second trimester and having a dilation and evacuation procedure. This means that the wife is over 12 weeks pregnant. What is controversial about the law is that it allows the father to stop an abortion even if he raped his wife.

Is the Arkansas Law Constitutional?

The American Civil Liberties Union (“ACLU”) of Arkansas argues that it is not. They intend to challenge the new state law as soon as practically possible.

The ACLU argues that the law not only bans what’s considered the safest and most common method of second trimester abortions, but it also does not make any exception for victims of spousal rape. This means that a wife’s rapist husband could sue to prevent an abortion.

Under Roe v. Wade, the Supreme Court established that it is a woman’s right to have an abortion until approximately 22 weeks of pregnancy or when the fetus is considered viable outside the womb. The new law puts a limitation on the woman’s ability to abort before viability, even though it is a guaranteed right. For this reason, it should not be considered constitutional.

Additional Concerns about the Law

While the Arkansas law affords the father more rights, it also strips away rights that have historically been given to the woman. The ACLU is concerned that with the limitation on dilation and extraction abortions, women may opt to use a procedure that is less safe. Such a procedure can put both the unborn fetus and the woman’s life at risk.

End of Obamacare: What Happens When Trump Repeals the ACA?

The GOP has hated what they’ve coined “Obamacare” from the start. Obamacare, also known as the “Affordable Care Act,” certainly has its kinks. For instance, high deductibles for its Bronze plan users make up about 20 percent of its customers. Nevertheless, the fact of the matter is that it has helped millions of people, most of whom are low-income or working class, who otherwise would not have health insurance. It has done this without raising taxes.

President Trump promised to repeal Obamacare as soon as he was elected. When he finally took office, he again promised to repeal Obamacare. Initially, indications from the GOP were that a repeal would occur within the first 100 days of Trump’s presidency. The repeal seems to have lost its initial steam.Obamacare

Possible Timeline

The Senate and House of Representatives started the repeal process in earnest. In January, both the House and the Senate passed a budget resolution that set the stage for introducing a bill that would strip major provisions from Obamacare.

In order to repeal Obamacare, the next step is for President Trump to the sign the budget resolution bill while simultaneously introducing a bill to replace key provisions of the Affordable Care Act, but the GOP seems to have faltered at this step. What they initially wanted to happen swiftly is now being pushed back to the end of 2017, primarily because the party is still trying to figure out what to replace Obamacare with.

Even when a replacement for Obamacare is presented and signed by President Trump, there will be delays built into the repeal bill in order to ease the transition. No one knows how long the delay will take, but it’s presumed a delay of two to four years is likely. For this reason, major changes are unlikely to affect Affordable Care Act consumers right away.

Why Delay Repeal?

For one, there are many parts of Obamacare that are popular. Under Obamacare, insurance companies cannot deny coverage based on a preexisting condition, and children stay on their parents’ plan until they turn 26. These provisions are popular among the majority of Americans.

Moreover, the Affordable Care Act has insured over 20 million people who otherwise wouldn’t have health insurance. Republicans have been bombarded with constituent concerns about the potential loss of coverage. There are stories of everyday Americans who say they would’ve died had it not been for the Affordable Care Act.

How Will Repealing Obamacare Affect Americans?

Under Obamacare, millions of Americans are insured and can’t be turned away despite pre-existing conditions. Senior citizens pay less for Medicare coverage and for their prescription drugs. Many Americans receive free contraceptives, mammograms, colonoscopies and cholesterol tests, Repealing Obamacare could threaten all these advantages.

For instance, “repairing” Obamacare could mean higher premiums and deductibles for those enrolled on Medicare, most of whom are on fixed incomes. Companies with at least 50 employees may no longer be required to provide affordable insurance to their employees who work more than 30 hours a week. This could affect millions of employees who work at least 30 hours per week but less than 40 hours. In addition, companies will no longer have to keep children on their parents’ health insurance plans until they turn 26.

Finally and perhaps most devastating, a repeal on Obamacare would no longer require nearly all Americans to obtain insurance or pay a penalty. Millions of Americans covered by the Affordable Care Act may be dropped by their insurance carrier with no way of obtaining alternative insurance.

Aetna Health Insurance Lied About the ACA and Triggers Anti-Trust Claim

The Affordable Care Act (ACA), also known as Obamacare, has been an extremely contentious bit of legislation.  The future of the act is currently extremely uncertain, President Trump signed an executive order his first day in office which–while vague enough to be nearly symbolic in nature–still serve to limit the law to some extent.  However, the law has also been at the heart of a recent court decision which put a stop to a $37B dollar merger between two health insurance behemoths.

Aetna ACA

The decision comes as part of the ongoing anti-trust case over the merger between Aetna and Humana–two of the five biggest health insurance companies in the nation.  The announcement of the merger agreement of these two companies in 2015 led to an immediate investigation, and ultimately led to the Department of Justice, eight different states, and the District of Columbia all filing lawsuits saying the merger was anti-competitive.

Aetna obviously disagreed and between the government and them they managed to produce millions of pages of arguments and evidence for each side as to the exact economic impact of the merger.  Aetna’s dedication to the issue is no surprise, beyond the desire to see the merger go through they had some serious skin in the game–a $1B dollar fee to be paid to Humana if the merger fell through.

What Did Aetna Claim about the Affordable Care Act (a.k.a. Obamacare)?

One of the most contentious arguments revolved around the ACA itself.  The Affordable Care Act created a public forum through which the public could purchase insurance plans, although it did allow insurance companies to offer alternative plans outside of this public market.  It also requires insurers interested in providing plans through this market to comply with certain obligations.  Just before the lawsuit began, Aetna withdrew from all but four of the states it offered insurance policies through the ACA.

Aetna said that they withdrew because the plans they offered under the ACA were not making them money.  The government argued that they did it as part of strong arm tactic.  They said that Aetna, knowing the impact it would on public perception of the ACA, threatened to leave the program if the merger wasn’t approved

There was a fair bit of evidence that many of the ACA programs were, in fact, making Aetna quite a bit of money.  However, the government struggled to produce evidence showing Aetna’s actual motivations in leaving the ACA programs.  That is, they were having trouble, until they produced an email from Aetna’s Chief Executive to the Department of Justice itself specifically stating that their participation in the ACA hinged on them being allowed to merge with Humana.  From there, they went on to produce conversations with Aetna officers where they heavily suggested, and one time outright stated, that if they weren’t happy with the merger results the government wouldn’t be happy with their involvement in the ACA.  They even found emails where, after a series of emails explaining that the withdrawal was to strengthen their position in their upcoming anti-trust lawsuit, Aetna executives actively mentioned they were trying to avoid leaving a paper trail indicating the reason they withdrew from the ACA and making efforts to shield any such evidence from being produced in a lawsuit.

A few weeks ago, in a 156 page monster of a ruling, the court finally agreed with the government and part of that ruling was based on the fact that Aetna had misled the public–and attempted to mislead the court–as to the motivations behind leaving the ACA program.  So in order to understand how, let’s first discuss exactly how anti-trust law works before looking at how Aetna’s deception as to the ACA effected their case.

How Do Anti-Trust Lawsuits Work?

Anti-trust law is basically the government trying to keep companies from becoming such an enormous market presence that they prevent other businesses from competing with them.  If you’ve ever played Monopoly you get the idea.

The government pays particular attention to health insurance companies in anti-trust cases because of how Medicare operates and specifically how the government pays insurance companies to provide insurance supplements to cover gaps for seniors on Medicare.  Where health insurance companies have huge enough market presence, it leaves seniors paying fees that make these gap-filler plans inaccessible.

In order to establish that a merger would violate anti-trust law, the government has to show that such a merger would “substantially lessen competition, or tend to create a monopoly.”  They don’t need to show that it will absolutely happen, but just that there is a probability that a merger would be anti-competitive.  Establishing this, as you could probably tell from the millions of pages of evidence and a 156-page ruling, is generally an incredibly complicated and in-depth process.  Where the government can show such a probability, there is a presumption that a merger is illegal.  However, a defendant in an anti-trust case, such as Aetna, can produce evidence to rebut such a presumption.

There was obviously an enormous amount of evidence here as to the economic impact of the merger, evidence supporting both sides.  However, the question ultimately came down to how much of the market Aetna would end up controlling–and that’s where their game-playing around their motivations behind leaving the ACA came into play.

The Repercussions of Aetna’s Lie

Aetna’s whoppers about the ACA weren’t the only or the deciding factor in the court’s ruling.  However, they were influential enough to one of the few elements they specifically mentioned in the summary of their ruling out of the over a hundred pages of evidence that ruling discusses.

So what did Aetna’s dishonesty actually mean for their case?  The government argued that because Aetna misled the public, the court had to ignore the fact that Aetna had in fact left the markets for those states and only consider Aetna’s market presence as it was before they withdrew.  The court didn’t buy this, however they still took Aetna’s deception into account.  They looked to the future to consider whether Aetna may expand into those markets in the future.  Given that Aetna was making money in those and only withdrew as part of a strong arm tactic, they felt it very likely they’d return to the markets they left after the merger completed.  They felt this true in Florida, where the ACA markets were actually found to be the only profitable part of Aetna’s business–a situation which led to confused emails from Aetna officials out of Florida–these emails received a hasty response to only discuss the matter over the phone.

With all this in mind, the court felt it was likely that Aetna would simply return to the markets it had abandoned post-merger.  As discussed above, likely is all a court needs in an anti-trust case.  Thus, in a very real way, Aetna’s approach to the ACA had a huge hand in killing their chances of a successful merger.

What Does This Mean on a Broader Level?

First and foremost, the most obvious lesson here is that judges don’t particular care for hiding evidence.  So much so that it took what could have been a fairly small issue and turned into an entire section of the court’s ruling.  However, the reality of the situation also impacts some of the arguments surrounding the ACA.

Just weeks ago, Aetna’s withdrawal was used as evidence to support the end of the act.  However, when the reality is a more profitable one than Aetna led the country to believe, it certainly muddies the water on the issue.  We’re almost certainly going to see a lot of changes to the ACA in coming months and years.  However, it’s important that we look at the facts as they are when discussing the issue–and not spin on the topic such as Aetna’s misrepresentations.