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Who Knew Health Care Could Be This Complicated?

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A description of the Trump and GOP health care efforts to repeal Obamacare in early 2017

Published in: Healthcare
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Who Knew Health Care Could Be This Complicated?

  1. 1. Who Knew Healthcare Could Be This Complicated? Cedric Dark, MD, MPH Founder and Executive Editor, Policy Prescriptions®
  2. 2. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  3. 3. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  4. 4. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  5. 5. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  6. 6. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  7. 7. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  8. 8. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  9. 9. Overall Plan • Save $170 billion • 20 million lose insurance • Who knows what happens to Medicaid?
  10. 10. Warning: Star Wars Memes Throughout
  11. 11. Photo by Kevin Dietsch - Pool/Getty Images January 21, 2016
  12. 12. Sabotage
  13. 13. What is Congress up to?
  14. 14. Death Star By Powerpoint
  15. 15. Death. By Powerpoint.
  16. 16. What AHCA does… • Eliminates individual mandate • Changes to Individual Marketplace • Changes to Medicaid
  17. 17. The Affordable Care Act ACA Medicaid Expansion Obamacare (Healthcare.Gov) Everything Else
  18. 18. Medicaid changes in AHCA • converts federal Medicaid funding into a per capita cap, with a pre-set growth amount • ends the enhanced federal financing for newly eligible adults • repeals the requirement that state Medicaid plans cover essential health benefits
  19. 19. How much is getting taken away from the individual marketplace? $312,000,000,000
  20. 20. Socioeconomic Classes in America • Poor • Working Class • Middle Class • The Rich • The Super Rich (The 1%)
  21. 21. 1 out of 5 on Medicaid
  22. 22. Winners & Losers in AHCA • Changes to the individual marketplace – Winner: insurance more affordable for middle class – Winner: insurance more affordable for young – Loser: insurance more expensive for working class – Loser: insurance more expensive older people – Loser: the poor
  23. 23. Manager’s Amendment Photo by Justin Sullivan/Getty Images
  24. 24. Manager’s Amendment • Allows for regular block grant as well as per capita grants • Allows for work requirement in Medicaid • LimPhase out ACA taxes sooner • If tax credit > premium, you lose the difference
  25. 25. Source: Associated Press
  26. 26. AHCA Left for Dead
  27. 27. The Freedom Caucus’ Demands 1. No essential health benefits 2. No community rating
  28. 28. The MacArthur Amendment
  29. 29. The MacArthur Amendment • Keeps ACA’s market reforms: – Prohibition on preexisting condition exclusions – Prohibition on discrimination based on gender – essential health benefits – Guaranteed issue and renewability requirements – Coverage of adult children up to age 26 on their parent’s plans – Community rating, except as permitted by waiver • Waivers: – Allowed if: “reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre-existing medical conditions.”
  30. 30. What’s optional now? Pre-existing conditions • Can be waived if >63 day lapse in coverage • Allows for experience rating • Premiums may spike (surcharges) Essential Health Benefits • Can be waived (1) ambulatory patient services (2) emergency services (3) hospitalization (4) maternity and newborn care (5) mental health and substance use disorder services including behavioral health treatment (6) prescription drugs (7) Rehabilitative services (8) laboratory services (9) preventive and wellness services and chronic disease management (10) pediatric services
  31. 31. How much more? • Metastatic cancer $142,650 • Diabetes $5,600 • Rheumatoid Arthritis $26,580 • Heart attack $57,960 • Pregnancy $17,320
  32. 32. Obamacare dies…to thunderous applause!
  33. 33. Now onto the Senate
  34. 34. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers His grade after first semester as President
  35. 35. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  36. 36. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  37. 37. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  38. 38. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  39. 39. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  40. 40. Rebates in Medicare?
  41. 41. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers Campaign Promises on Health Care
  42. 42. Donald J. Trump • Repeal and Replace Obamacare with HSAs • Full deductions for health insurance • Block grant for Medicaid • Insurance Across State Lines • Importing drugs from overseas • Price Transparency for Providers His grade after first semester as President
  43. 43. Who Knew Healthcare Could Be This Complicated? Cedric Dark, MD, MPH Founder and Executive Editor, Policy Prescriptions®
  44. 44. ¯_(ツ)_/¯

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