Warning: House Budget Bills Bad for Your Health, Unless You’re Rich

Picking up where I left off, the House Budget Committee isn’t the only one working on radical spending cuts for health care. Two other House Committees have also passed bills to dismantle the Affordable Care Act.

Ways and Means Jacks Up Health Insurance Costs

House Ways and Means recently approved three “commonsense” measures that make no sense unless the only thing you care about is slashing federal spending.

They include a bill that would probably deter people from purchasing health insurance on an exchange — a Republican insurance of sorts in case the umpty-umpth effort to repeal the ACA fails.

It would uncap the dollar limits on what people who get subsidies must repay if they underestimate their income when they choose a health insurance plan.

As things stand now, individuals and families with incomes below 400% of the federal poverty line must repay only a portion of the extra they’ve received as so-called advanced tax credits, i.e., funds deducted from what they themselves must pay for their insurance.

The lower their income bracket, the less their repayment. So, for example, a poor or near-poor family would have to repay, at most, $600. Kill the caps and the clawbacks would be much larger for people who can ill afford them.

These aren’t people who tried to game the system. They had to ballpark what they expected to earn during the course of a year. That’s hard for most of us, as Families USA explains.

It’s especially hard for a low-wage worker with one of those many jobs that require more and fewer hours week to week — or even day to day. Equally hard for workers whose income consists largely of tips.

These workers — and some with steadier incomes — might well choose to pay the penalty for going without insurance, rather than face the prospects of an uncapped clawback. The former for a single person is only $695 this year.

All told, as many as a quarter of a million people would make this choice, the Joint Committee on Taxation has estimated. They’d be counting on the good health they enjoy, thus leaving mostly sicker people in the pool that companies offering insurance on an exchange must cover.

So premiums go up. More people drop out. Companies’ per person costs to up more. At least some of them decide to drop out of the exchange market. And the ACA dies, though not so swiftly as by repeal.

Energy and Commerce Targets Children and State Prison Budgets

The House Energy and Commerce Committee rolls back two other provisions in the ACA, each targeted to health care for a specific vulnerable population.

A bill it recently passed would repeal the higher federal match the law provided — and Congress extended — for the Children’s Health Insurance Program.

The District of Columbia and all states but Arizona have either a separate CHIP program or the equivalent within their Medicaid program. They’d lose a total of more than $3 billion a year if Congress extends CHIP funding again.

So as with the Medicaid block grant, one would expect at least some of the 30 that have expanded coverage beyond the required minimum to pare back.

Victims here would be immigrant children who came to the country legally or got authority to stay, but less than five years ago — the “waiting period” Congress established at the same time it ended welfare as we knew it.

The Energy and Commerce bill would take a direct bite out of Medicaid too. It would deny states their current federal match for health care low-income prisoners receive in hospitals and other in-patient facilities beyond the prison walls.

States can claim the match if they’ve expanded their Medicaid programs, as the ACA envisioned, and helped prisoners enroll — necessary steps because adults who weren’t severely disabled or aged generally didn’t qualify for Medicaid before.

The match covers all offsite healthcare costs for the newly-qualified now and will cover most indefinitely. So states stand to lose a lot of money, but a long-standing Supreme Court ruling would require them to still provide health care inmates need.

States would still get a match — whatever the base Medicaid law provides. So the lower match, in and of itself, would still make enrolling inmates better than not. But most will return to their communities. And many have chronic health problems.

States would have to pay an ever-greater share of treatment costs, unless they retrenched eligibility and/or covered services for a broader swathe of their residents, because that’s how the block grant achieves such eye-popping federal savings.

We don’t know whether states would seek comparable savings of their own. But we know enough to know they could achieve such savings only at the expense of beneficiaries.

If they left their Medicaid programs intact, they’d have to cut funding for other critical needs or raise taxes — an unpalatable choice, to say the least, that other pieces of the House budget plan would foist on them anyway.

Not a happy prospect for poor and near-poor people. And so another way that House Republicans’ bills should bear a warning like the one on cigarettes.




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