Obamacare replacement merits debate, not drama

The GOP's proposed Affordable Care Act replacement would be nothing short of "catastrophic" for the city's public hospital system and its low-income patients, the system's CEO says. The changes to Medicaid would be "disastrous for patients and could...

Obamacare replacement merits debate, not drama

The GOP's proposed Affordable Care Act replacement would be nothing short of "catastrophic" for the city's public hospital system and its low-income patients, the system's CEO says. The changes to Medicaid would be "disastrous for patients and could...

19 mart 2017 Sunday 12:45
2435 Reads
Obamacare replacement merits debate, not drama

The GOP's proposed Affordable Care Act replacement would be nothing short of "catastrophic" for the city's public hospital system and its low-income patients, the system's CEO says. The changes to Medicaid would be "disastrous for patients and could create a fiscal crisis for New York," adds a top official of the state health care association. The insurance market for individuals would sink into quicksand, according to the Community Service Society of New York.

Though facts mean little to President Donald Trump, opponents of the GOP plan should stick to them and put them in context. To wit: New York might not be the best example of the damage the Republican plan could do.

Start with Medicaid. The Republicans' proposal gradually trims the amount sent to states that expanded the program under Obamacare and then provides a per-capita amount each year rather than a percentage of the costs. Through March 2021, Gov. Andrew Cuomo says, New York would lose about $4.5 billion. In the last of those four years, the hit would be $2.4 billion.

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The state's annual health care spending now exceeds $50 billion, and Cuomo's next budget totals more than $152 billion. The lost funds would be 4% of health spending and 1.5% of all spending. The "millionaires tax" extension proposed by the governor is worth $4 billion per year, and because those rich people would receive a big tax break if the Affordable Care Act is repealed, the extension gets a political boost.

Nearly half the money New York would lose in 2021 is because the Republicans would eliminate the Essential Plan, which provides zero-premium health care to people with incomes a bit too high to qualify for Medicaid. Only New York and Minnesota take advantage of that ACA feature, the end of which accounts for a third of the projected loss in the next four years.

The switch to per-capita aid might not hurt New York if the state keeps Medicaid growth below national health care inflation—which Cuomo has done for several years now.

The bottom line: New York could handle the reduction in Medicaid without a fiscal crisis and without forcing anyone from the program. No massive increase in the uninsured would occur here.

The individual market is also more complicated than the rhetoric suggests. Through January, about 242,000 people had bought insurance on the state's exchange, a little less than two-thirds received a subsidy and the federal government's total cost was about $400 million.

Under the GOP plan, those subsidies would be replaced by tax credits. Insurance for younger New Yorkers would likely become less expensive, while older ones would pay much more. In addition, the state would receive significant funds—how much isn't known—to aid people with pre-existing conditions and other costly medical issues.

The Republican plan will be bad for some people and good for others. It isn't immediately clear what the balance will be, but the impact will not be that large.

The Republican plan might be bad for the country and even for New York, but hyperbole just undermines a responsible debate on the issue. 

The GOP's proposed Affordable Care Act replacement would be nothing short of "catastrophic" for the city's public hospital system and its low-income patients, the system's CEO says. The changes to Medicaid would be "disastrous for patients and could create a fiscal crisis for New York," adds a top official of the state health care association. The insurance market for individuals would sink into quicksand, according to the Community Service Society of New York.

Though facts mean little to President Donald Trump, opponents of the GOP plan should stick to them and put them in context. To wit: New York might not be the best example of the damage the Republican plan could do.

Start with Medicaid. The Republicans' proposal gradually trims the amount sent to states that expanded the program under Obamacare and then provides a per-capita amount each year rather than a percentage of the costs. Through March 2021, Gov. Andrew Cuomo says, New York would lose about $4.5 billion. In the last of those four years, the hit would be $2.4 billion.

The state's annual health care spending now exceeds $50 billion, and Cuomo's next budget totals more than $152 billion. The lost funds would be 4% of health spending and 1.5% of all spending. The "millionaires tax" extension proposed by the governor is worth $4 billion per year, and because those rich people would receive a big tax break if the Affordable Care Act is repealed, the extension gets a political boost.

Nearly half the money New York would lose in 2021 is because the Republicans would eliminate the Essential Plan, which provides zero-premium health care to people with incomes a bit too high to qualify for Medicaid. Only New York and Minnesota take advantage of that ACA feature, the end of which accounts for a third of the projected loss in the next four years.

The switch to per-capita aid might not hurt New York if the state keeps Medicaid growth below national health care inflation—which Cuomo has done for several years now.

The bottom line: New York could handle the reduction in Medicaid without a fiscal crisis and without forcing anyone from the program. No massive increase in the uninsured would occur here.

The individual market is also more complicated than the rhetoric suggests. Through January, about 242,000 people had bought insurance on the state's exchange, a little less than two-thirds received a subsidy and the federal government's total cost was about $400 million.

Under the GOP plan, those subsidies would be replaced by tax credits. Insurance for younger New Yorkers would likely become less expensive, while older ones would pay much more. In addition, the state would receive significant funds—how much isn't known—to aid people with pre-existing conditions and other costly medical issues.

The Republican plan will be bad for some people and good for others. It isn't immediately clear what the balance will be, but the impact will not be that large.

The Republican plan might be bad for the country and even for New York, but hyperbole just undermines a responsible debate on the issue. 

A version of this article appears in the March 20, 2017, print issue of Crain's New York Business.

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