The RFI is not a serious attempt at gathering comments on how to stabilize the health insurance markets across the country. Trump and Price have already set in motion the slow dismantling of regulations that kept the ACA markets relatively stable. This is a thinly veiled attempt to generate regulation gutting suggestions that will further destroy meaningful health insurance for Americans. I can guarantee that any real suggestions that would work to contain health care costs, which are the real driver of ever escalating health insurance premiums, will be ignored.
The similarities between Medicare Advantage plan and the ACA plans through the Marketplace are straight forward. Individuals are enrolling in private ACA health insurance and the federal government is subsidizing part of the cost of the health insurance to make it affordable. One of the main differences is how the federal government reimburses the insurer. Medicare beneficiaries receive an indirect subsidy to purchase a Medicare Advantage plan according to county they live in and based on historical health care cost data. Individuals and families enrolling in a health plan through an Affordable Care Act exchange receive a subsidy based on their income.
HHS has already launched a new page aimed at touting their latest attempts to revise the Affordable Care Act. Providing Relief Right Now for Patients links to initiatives HHS hatchet man Price has started to improve (gut) the ACA. The page states, “We are going through every page of regulations and guidance related to the Affordable Care Act to determine whether or not they work for patients and whether or not they are making our health care system better.”
In order determine how my clients might be affected by the proposed new Premium Tax Credits under the American Heath Care Act (AHCA or Trumpcare) introduced by the Republicans in March 2017, I compared the current income based Premium Tax Credits under the ACA to the new age based tax credits of the AHCA. On average, my clients included in the comparison will lose $157 per month to help pay for their health insurance. Young individuals, under 30 years old, have the smallest change of premium tax credit under the age based rules. Within my clients, people over 55 year old will get hit the hardest losing $200 to $400 per month in premium tax credit assistance.
California Insurance Commissioner Dave Jones slammed President Trump’s Executive Order relaxing enforcement of the Affordable Care Acts provisions as potentially destabilizing to the health insurance market.
With all the discussion about congress repealing the Affordable Care Act, there is confusion over what exactly is an Obamacare health plan. Some people think the federal government is dictating the type of health plans that must be sold to individuals and families. It is up to each state to set the rules for their health insurance plans. The federal government under the regulations of the Affordable Care Act (ACA) stipulates what type of health plans are eligible for the Premium Tax Credits that make health insurance affordable for individuals and families.
I try to be pretty pragmatic when it comes to presidential elections. Regardless of the promises made by any candidate, we rarely see any real change in the U.S. with the election of a new president. However, Donald Trump ran on a platform to repeal and replace Obamacare. Since 90% of my income comes from enrollment generated by the Affordable Care Act, I am facing a drastic reduction of my income if Trump fulfills his promise.
Under the new GOP presidency and congress Obamacare looks to be repealed and the replacement to emphasize Health Savings Accounts. The economic rationale for Health Savings Accounts (HSAs) is that when consumers pay for their health care out of the accounts, they will drive down the cost of health care by favoring the least cost procedures. Unfortunately, HSAs without price transparency for the consumer does nothing to bring lower prices or efficiency to the market place. HSAs in our current market place are just scams.
For the first time in my life I can commiserate with people who are losing their livelihood because of a government action. Just as some workers have been displaced because the government outlawed a product, changed an environmental regulation, or enacted a trade deal that smothered their industry, I too am on the receiving end of government legislation that will decimate my income. If Obamacare is repealed and the subsidies that make health insurance affordable for millions of Americans ceases, I will lose 90% of my clients.
Some individuals and families who purchased their health insurance through a government exchange like Healthcare.gov or Covered California may be subject to the Penalty for Underpayment of Estimated Tax. The underpayment penalty is triggered when the federal income tax due is less than 90% of the previous year’s tax liability. If a tax household received thousands of dollars of the monthly Advance Premium Tax Credit (APTC) subsidy to lower their health insurance premiums, but earned too much taxable income to actually qualify for the Premium Tax Credit, the tax payer has to repay the entire subsidy. This repayment amount could easily trigger the underpayment penalty.