tv Washington Journal Mary Agnes Carey Discusses GOP Health Care Bill CSPAN March 23, 2017 8:06am-8:27am EDT
this is going to mean an additional 57,000 dollars a year in tax breaks for people making $1 million a year. if you lined up all the millionaires in america and say do you think this is fair? i think they would say no. i honestly got believe they would say no. >> and that was former vice president biden at a rally at capitol hill yesterday. mary agnes carey is with the kaiser health news. she is joining us now on washington journal. how radical or different is the plan being voted on today than the aca? >> one of the biggest changes would be how they fund the medicaid program. now it is an entitlement, a matched federal state program. they get a 57% match from the federal government. it would now change the republicans health care plan
would change that to a set amount of money that states could then spend. they could take a per capita cap allotment, they could have block grants but the biggest change is that shift of about $880 billion in change from federal funding over the next decade. it takes it out of that entitlement status. that is one of the biggest changes. another is the tax credits. about that now. in the affordable care act the subsidies were based on income. and they were tied to not only your income but the cost of health care in your local area. so if that increases the house republican plan, really looks at age. there is an income threshold where the subsidies begin to taper down. that it tends to have less money for younger people, more money for older people but it seems to be far less money than what you would get under the formal care act. there are different plans out there to take the republican plan goes through.
host: so in watching all of this over the many years we have had this health-care debate in the united states, is the aca and that insurance market in a death spiral as the ceo said? guest: i would say this. there are pockets where things are going well and there are pockets where they are not. the premium increases on average are definitely higher, right? or is no doubt about that for 2017. for 2015 the average increase was 2%. for 2016 it was seven and a half percent. for 2017 it was an average increase of .5%, which is -- 25%. which is a lot. we had a lot of people come to the program early. some of the programs in the law help insurers take care of those sicker people. some of them didn't work as intended, some were not funded well. that became a problem. we have all heard about pockets of spikes in arizona, for example, for 2017 116% hikes.
but some were lower, 9% in wyoming. a lot of it depends on where you are and if you are getting a two digit hike you are not going to be happy but there is a lot of discussion about what does that mean for the market. will 2017 be a one-time deal? but with changes, we may not know that. if you go to a state like california, the exchanges offering dish -- operating well. it really depends on where you are, what is being offered. there is definitely people out there facing high increases. host: paul ryan has talked about competition and choice. lead there?ll guest: here is how it would work. they talk about the three bucket strategy, the bill on the house floor today is one package. the second bucket is the
regulatory changes that could be made at the department of health and human services. that might mean that the plans don't have to offer a generous benefit like they do now. will care act, you could buy a bronze, silver or gold or platinum plan. the more expensive plan you received, the hire of the share it would cost the insurance. platinum is 90% coverage. while these health benefits stay, unless they are removed, if those categories of coverage stay, tom christ -- tom price could look and say we have to satisfy these but we can do it differently with the plans don't have to offer generous benefits. variety bring in a of other plans that could be former cost premiums. example, a guy in
his 50's might say, i don't want pediatric coverage. i don't want to buy that. and so, those plans which might bring competitive forces in an might be cheaper on the premium could be more attractive. but the thing to remember about this is her total out-of-pocket cost. not just the premium, the deductible, the co-pay and some of those deductibles on the lower premium plans could continue to be high just as they are now. host: do you think that they will be voting on this plan today? guest: that is a great question and i think they will push to get the votes and i think they will definitely do this. there is just so much riding on it. they have set it up so dramatically, at the anniversary of president obama signing the .aw in 2010 the speaker has said it repeatedly and president trump has said the same thing, this is our time to act. this is this crescendo of drama
so the key will be, when? it may not be 11:00 this morning. it may not before :00 this afternoon. it might be into the evening hours or early hours tomorrow. but as we know we have this block of conservatives, the freedom caucus, who it is really up in the air. we will be taking your phone calls as we go this morning. host: talking about the house vote on the a hca, the aca repeal. harvey is in mexico, maine, democrat. caller: good morning. thank you for letting me come on c-span. the republican party as far as i am concerned, they only take from the poor people and they give it all to the rich. they have been doing this over and over for years and years. it isn't going to stop.
the thing is, obamacare, i believe, if they would work on it they could fix it. there is no need of taking something away from the people it was given by the democratic party. it is always about giving the rich a big tax break so that they can line their pockets with more money that was stolen from the poor people of this nation. they ought to hang their heads in shame. the whole thing is, what they ought to do is put term limits on everyone of them in washington, d.c. limithem a four-year term and let them all retire with no retirement, and what they should do is choose some of the people who have served in the united states service. because those are the true servants of this country. host: thank you, harvey in maine. if we could take what he said and use that to talk about the
tax credit issue and the overall tax issues involved -- guest: there are a lot of taxes and fees that would be revealed and some of the changes that have been made this week in the house republican plan, those tax changes would happen this year, next year. there are different fees and sectors on the insurance industry, the medical device industry, but one of the references is if you are an individual earning $200,000 a year or a couple earning $250,000 or more, you pay an additional 0.9% medicare tax. there is also an investment income tax. those would be repealed and those tend to benefit people in the higher income levels that make the kind of income. so the one thing i wanted to jump on, which he brought up, is this conversation we are not having. it might be interesting to have it if the aca were not so politically charged.
how could they fix the underlying bill? there has been a lot of conversation, could there be subsidy investments -- subsidy adjustments? could they make some adjustments? we are not their politically but as i talk to people around the country i hear that over and over again. why does it have to be either/or? have more compromise to try to help the people that are on medicaid or enrolled in its expansion and the people who are buying on this exchange? host: on the speaker's website it says, read the bill. i tried to read the bill and there are a lot of cross outs and references back to other laws. it is not a straightforward read. guest: it is tough to do. host: what is the best way to read this bill? guest: you can certainly look at the legislative language for some specifics but one thing you could look at that is on the website, ways and means and
energy and commerce is there are section by section summaries. those are fairly straightforward that will give you an idea of what they are trying to do. then you could look at this summary of the manager's amendment which is where they made some changes so far. if you go by the section by section descriptions you might be less lost. host: lori is in dell toner, florida, independent line. good morning. caller: i actually started my own business in 2000 and tried and tried to get insurance over and over again. every year, i called and the premiums were going up. this was before the aca. there was no getting it for me. i was disseminated against because i am a small business owner and i only have three employees. i am never going to have 50. i am never going to make the income they think we make as a small business owner. i believe the aca actually helped a lot of people start small businesses because they didn't have to stay trapped with
an employer they were happy with because no one in their family had health care. that is my main problem. before i got the aca, my daughter came up with type 1 diabetes. that full-year was horrible. i spent every night not knowing what was going to go on, whether i was going to lose everything i had worked so hard for because the insurance company -- because i didn't have insurance. i got the aca, she got her treatment, and i noticed from the first tier it costs me $700 a month for insulin. that same insulin is incredibly expensive now, it just keeps going up. toon't know what i'm going do and i am 51 years old, so that means i am not going to have insurance after today if they continue on this route. host: when you hear what lori has to say, how would -- if the a hca passes and goes through the whole system, how would it
affect her? guest:guest:. even if it became law, these changes would not start until 2020. she would receive a tax credit based on her age. she is in her 50's, so she would probably be in that 3000 to $4000 range. is,her thing to think about in some of the ongoing changes in the bill on the health side, they are setting up provisions that would allow the senate to forease that tax credit older individuals and could possibly give more money to people who are sick or. that is one thought. also, she will have to think about what the marketplace will look like if this bill became law? how would it change? how many insurers would come into the market? what will be the competition she would have to go through? planxercise in taking the
that she received, it covered her daughter's diabetes and her issues, it would be a lot of the work -- homework as it always is. host: so this bill would be delayed until 2020. caller: the changes would be delayed until 2020 but the key to look at is that the analysis so far by the congressional budget office and others has been that people who are older and sicker are going to receive less money unless this change were to be made on the senate side. so if you look at subsidies that are related now versus how they would eat under the house republican plan, again if they are not related to income and you are lower income you are probably going to get a lower subsidy. the key will be what is in the marketplace and what you can afford. host: when you hear what rand paul has to say about this bill and what congressman thomas massie of kentucky -- was the main conservative argument against a hca? >> that it is open to care light.
host: what does that mean? guest: in the sense that you still have subsidies. tax credits. there are conservatives that don't like that idea and they think it is too much money, too generous and they don't like the essential health benefits and categories of coverage that are required in the bill. they don't think they want that and they just don't like any kind of prescription, if you will, of what has to be covered in the health care bill. they want market forces to find that. those are the key. host: jonathan can be written, oregon. a democrat. caller: my name is john and i have 31 years experience in i.t. and 20 years experience in health care. i was working for a large health downsystem at hospitals through california. i work for a federally qualified
health center. one of the things, in terms of medicaid, from what i understand, is i took a form yesterday that had a number of ceos from hospitals. some lobbyists/health educators in washington, and one of the things that came out was the republican bill has written would basically, for oregon, right now we have 95% coverage. if it was fully up lamented, all of the games -- the gains from the aca would be eliminated. and also roman catholic, there are three tenets of health care. it is a human right, it is a it is not ait, and commodity. that was the other thing that was emphasized by all of the physicians on this panel. way were so upset with the
the republicans and even the inocrats treat health care this disembodied manner. that they failed to truly patient. the also, i am 58. i hope to retire in 2026. of -- it will be rates, for insurance my lifeve diabetes and is impaired. is that being compassionate? is that showing mercy? as paul ryan made his comment earlier last week? host: i think we've got your point. thank you for calling in. mary agnes carey? guest: john has raised a very
.ood point about being older the flex ability that will be there in the amount of money they will receive in the tax credit and what they will be charged. in the portal care act now, an older person couldn't be charged more than three times more than a younger individual. band, whatever you want to call it, can go five to one in the house republican plan . so that is incredibly important so it means they could be charged more so that their premiums will cost more. therefore, there is that thought about the tax credits increasing by age. if the changes are made in the senate, they get even additional money for that. that change from three to 1, 5 to one is really a big deal. but the other point he raised that i thought was very interesting was about the hospitals. i went to a forum last week with representatives of the american hospital association and they are very concerned about the
medicaid changes in particular. about this idea of limiting how much money the federal government spends, capping that amount, what happens to services they can offer to individuals, what happens to state funding, the funding they receive. or is a federal law that requires them to treat everyone that comes into the emergency room. if you submit a care payment, you've got to treat these folks with the afford will care act, many of these individuals have been able to get coverage and be covered. they are very worried about that interaction. will people lose their coverage? will the hospitals lose money to help people? hospitals are truly concerned about this, as our physicians and other provider groups. host: paul ryan and his wall street journal update this equips says this bill state insurance markets to take care of people with pre-existing conditions without driving up costs for everyone else he talks
about. he talks about states to faithfully serving high-risk populations by segmenting them into risk pools. guest: this is the idea that you take out the sickest individuals and that insurance is always about the risk so if you have a pool with a lot of sicker people er people, thethi idea is you police people out of the pool and put them in their own separate insurance pool and cover them. but the key will always be, if you've got a lot of sick people they are going to use insurance and cost a lot of money. so what sort of fees will they be charged? how much will that contribute to the high risk pools for insurers to come in? unfortunately the experience in many states has been the costs have climbed. sometimes there is a waiting for people to get care. there are definitely places that have worked but there are many
states where they have not and the concern about that is that just by segmenting sicker people, costs really increase and become the type of insurance that becomes more durable. host: do you think you will live to see the day where employer based health care is no longer part of our system? guest: no. some don't like to offer health care but they do it. it is something that they attract employees with. some employers do talk about how they want to take care of their employees and it is important to them. that said, a lot of them would like to get out of the business what you have to remember when the affordable care act became law there was this thought that employers would don't health insurance, they would get out of the market. that has not proven true. labor markete a that is tight, perhaps employers to be more willing to block -- drop their health insurance but we haven't seen that in mass. i think employers want to offer it.