Posts Tagged ‘Obamacare’

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According to Donald Trump, “Nobody Knew Health Care Could Be So Complicated.” But the latest version of the plan to repeal and replace Obamacare, negotiated behind closed doors and finally publicly presented by Mitch McConnell and Senate Republicans, isn’t very complicated. In fact, it’s quite simple: the Better Care Reconciliation Act of 2017 trades the health of tens of millions of Americans for tax cuts that would be captured by a tiny group at the top.

According to the Congressional Budget Office, the Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, only slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation. By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

Moreover, the increase in the number of uninsured people would be disproportionately larger among older people with lower income—particularly people between 50 and 64 years old with income less than 200 percent of the federal poverty level. That’s largely because of the cuts to Medicaid, which would result in 15 million fewer Medicaid enrollees by 2026 than projected under current law. The Office also estimates that, by 2026, 7 million fewer people would obtain coverage through the nongroup market—because the penalty for not having insurance would be eliminated and, starting in 2020, because the average subsidy for coverage in that market would be substantially lower for most people currently eligible for subsidies (and for some people that subsidy would be eliminated entirely).

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Tens of thousands (perhaps hundreds of thousands) of additional deaths will occur as a result of the enormous increase in people without health insurance.

As Clio Chang succinctly states:

If we send people to war, people will die. If we consign people to live in poverty, people will die. If we take away health insurance, people will die.

And what will Americans get in exchange for those cuts in healthcare coverage and additional deaths?

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According to the Tax Policy Center, nearly 45 percent of the benefit of the tax cuts proposed in the Senate bill (much as in the bill the House passed) would go to the top 1 percent of households, those making $875,000 or more.

The lowest income 20 percent of households (that will make about $28,000 or less in 2026) would receive an average tax cut of about $180, or 1 percent of their after-tax income. Middle-income households (that will make $55,000-$93,000) would receive an average tax cut of $280, raising their after-tax incomes by about 0.4 percent.

By contrast, the top one percent of households (who will be making $875,000 or more) are in line for an average tax cut of more than $45,000, raising their after-tax incomes by 2 percent. And those in the top 0.1 percent (who will be making $5 million or more) would receive an average tax cut of nearly $250,000, boosting their after-tax incomes by 2.5 percent.

In the coming weeks, Senate Republicans will be debating details of the proposed healthcare plan and cutting deals to get some of their number to drop their opposition and vote with the leadership. That may get complicated (and already has, causing McConnell to delay a vote until after the 4th of July recess).

However, when it comes to death and taxes, there is no such complication: the Senate plan would take away health coverage from 22 million people, and likely kill tens of thousands of low-income Americans, in order to create an enormous tax cut that would largely benefit the nation’s highest income households.

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For over a century, the most effective way to stop attempts to reduce healthcare disparities in the United States has been to invoke the fear of “socialized medicine.” As a result, Americans have ended up with socialized inequality in their healthcare system.

And they know it.

According to a new study by Joachim O. Hero, Alan M. Zaslavsky, and Robert J. Blendon published in Health Affairs (unfortunately behind a paywall), 67 percent of respondents in the health module of the General Social Survey believed that “many” people in the United States do not have access to the health care they need. This is over 10 percentage points higher than the level in any other country, and over twice the median country rate of 31 percent. And even though only 54 percent of respondents viewed income-based differences in the quality of health care that people have access to as unfair (much lower than the median country rate of 68 percent), the majority of respondents—54 percent of those who viewed income-related disparities as fair and 73 percent of the respondents who viewed such disparities as unfair expressed their support for major health system reform.

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And reform is, of course, necessary.

The United States has the third-highest disparity—behind only Chile and Portugal—at 25.9 percentage points.* Among US respondents, 38.2 percent in the bottom income tertile reported fair or poor health, compared to 21.4 percent in the middle tertile, and 12.3 percent in the top tertile.

While many countries exhibited consistent disparities in health care across measures of access and care satisfaction, most had mixed or negligible disparities in all measures. The United States stands out by exhibiting large disparities in most measures, making it unique among high-income countries. In fact, the United States had the second-largest disparity in people forgoing needed medical treatment because they could not pay for it, at 16.5 percentage points (behind only the Philippines), and the third-highest disparity in people believing they would get the best treatment available in their country if they were seriously ill, at 15.5 percentage points (behind only Chile and Bulgaria).

We often forget that the Affordable Care Act, in addition to extending health insurance, bolstered efforts to address socialized inequality in a number of other ways, including improved standards for data collection, support for disparities research, provisions to support diversity in the health care workforce, and the funding of demonstration programs aimed at reducing health disparities.

According to the authors of the study,

Eliminating these efforts without providing clear alternatives would risk taking a step backward in an area where the United States is in sore need of improvement, and in a political environment where solutions with broad support are increasingly hard to find.

 

*Disparity is defined by the authors as the percentage-point difference between respondents in the top and bottom income tertiles.

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