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It Would Be Up to Florida to Dismantle Obamacare Protections If GOP Bill Advances

| May 8, 2017

obamacare repeal

It may be too late. (Tabitha Kaylee Hawk)

Under the Republican health bill, it’s up to states whether to dismantle key parts of the Affordable Care Act.


Red, or GOP-leaning, states are sure to be interested in rolling back the law’s coverage requirements and freeing insurers to charge people more when they have preexisting conditions. [In Florida’s case, where Gov. Rick Scott and the House have been militant foes of Obamacare, a roll-back is all but certain should the bill in its present form pass.]

As strange as it sounds, deep-blue, heavily Democratic states supportive of Obamacare, including California and New York, may be forced to do the same, according to experts, regulators and consumer advocates.

The American Health Care Act, which narrowly passed the House on Thursday and now heads to the Senate, would significantly cut the federal subsidies on which many Americans rely to buy coverage. Unless the legislation fails or changes substantially, many consumers across the country could see the amount they pay every year for premiums increase by thousands of dollars, making coverage effectively unaffordable.

Few, if any, states would be able to fund subsidies on their own. To keep insurers in the market and bring costs down, state leaders might feel compelled to seek exemptions from rules that require health plans to provide 10 “essential health benefits” and prohibit them from charging higher rates for sicker consumers. The new GOP health care bill would allow such waivers.

“With the skimpier subsidies, states are going to be under enormous pressure to apply for these waivers,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

These opt-out provisions could accelerate the unraveling of Obamacare, even in places that fully embraced the landmark law.

“Certainly the Californias and New Yorks of the world will do what they can to hold onto the ACA protections. But when confronted with insurer exits and big price hikes, many states with the best of intentions may feel they have little choice but to get a waiver,” Corlette said.

The idea of opting out is unfathomable to many liberals who fought so hard to win the consumer protections in the Affordable Care Act. They’re hoping the Senate will dump the bill or, in its quest for more moderate votes, at least make the premium tax credits more generous or eliminate the waivers.

Republican leaders insist the current health law isn’t worth saving because it has left consumers with double-digit rate hikes, onerous deductibles and little or no competition in some states, as insurers exit the marketplaces.

Rep. Kevin Brady (R-Texas), chairman of the House Ways and Means committee, said the GOP health bill grants states the flexibility they need to remove the “crushing mandates” that have led to “Obamacare plans you don’t want and can’t afford.”

House Speaker Paul Ryan (R-Wis.) struck a similar note in urging his colleagues to pass the bill. “Let’s make it easier for people to afford their insurance. … Let’s return power from Washington to the states,” he said on the House floor Thursday.

Consumer advocates in North Carolina, Colorado and other states are taking the threat of waivers seriously.

“No state is safe from such a waiver,” said Brendan Riley, a health policy analyst at the North Carolina Justice Center, an advocacy group focused on economic and social issues.

North Carolina would be one of the states hit hardest by the House bill, according to an analysis by the left-leaning Center on Budget and Policy Priorities. The state’s average premiums and out-of-pocket costs would rise by $7,549 annually.

Nationally, the average tax credit for enrollees in the online marketplaces would be 41 percent lower under the American Health Care Act by 2022, according to a study by the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

The GOP bill also ends the penalty for not having coverage, which experts say might increase premiums as fewer healthy people sign up, leaving health plans with a higher proportion of  sick patients.

All this could put the focus back on which benefits are deemed essential in health insurance — an all-too-familiar battle in statehouses before the ACA set a nationwide standard.

The health law now requires all plans sold on the individual and small-group markets to cover the 10 essential health benefits, including hospitalization, prescription drugs and mental health treatment. It has made coverage more comprehensive and prevented insurers from selling bare-bones plans that had cheaper premiums but often exposed consumers to huge medical bills after they sought care.

Before the ACA, coverage for maternity care, prescription drugs and substance abuse treatment often wasn’t available. State lawmakers were hesitant to approve new benefit mandates for fear of raising premiums.

Washington state Insurance Commissioner Mike Kreidler, a Democrat, said he sees a political fight over benefits on the horizon if the GOP bill advances.

I certainly think there’s going to be political pressure applied to make adjustments [in essential health benefits],” he said. “I’d be vociferously and violently opposed to those changes.”

Adela Flores-Brennan, executive director of the Colorado Consumer Health Initiative, said she too has faith that her state’s Democratic governor and insurance commissioner would uphold essential benefits and protections for people with preexisting conditions.

But she and other patient advocates said that resolve may be tested by the lack of competition in some areas, which insurers could use as a bargaining chip for more leeway on regulations.

For instance, Flores-Brennan noted that industry giant Anthem is the sole company on the state’s insurance exchange in 14 Colorado counties. She said she worries the company could threaten to pull out if the state doesn’t opt for weaker standards.

Even in California, a liberal bastion that enthusiastically implemented Obamacare, the law’s supporters are bracing for a fight over the waivers.

“As premiums go higher, it will create pressure on us to undercut the standards we have,” said Beth Capell, a lobbyist for the consumer advocacy group Health Access California.

In California, premiums and out-of-pocket costs would rise by $2,779, on average, under the House bill, according to the analysis by the Center on Budget and Policy Priorities.

“California policymakers will once again hear what we heard year after year before the ACA: ‘Some coverage is better than no coverage. More limited benefits are better than nothing,’” Capell said.

John Baackes, the chief executive of L.A. Care Health Plan, with about 26,000 enrollees in the California exchange, said state leaders would exhaust every other option before slashing coverage.

“California would be loath to cut benefits,” Baackes said. “If you’re selling a policy to a young adult without maternity care, that’s nuts.”

No matter the state, red or blue, experts anticipate vigorous debate over these waivers because consumer protections under Obamacare have become more popular.

Wisconsin Gov. Scott Walker, a Republican, experienced that firsthand last week when he suggested his state may opt out of the ACA’s preexisting condition rules — and then immediately backtracked amid strong opposition.

Michael Miller, director of strategic policy for Community Catalyst, a Boston-based national consumer group, said waiver requests won’t necessarily proceed “quietly even in the red states. … People have heart disease and cancer and asthma in those states, too.”

–Chad Terhune and Barbara Feder Ostrov, Kaiser Health News

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23 Responses for “It Would Be Up to Florida to Dismantle Obamacare Protections If GOP Bill Advances”

  1. Traveling Rep says:

    I realize this is an extremely hot button issue, with the left up in arms about the repeal/replace measures. The right up in arms about the extremely costly ACA making the mere thought of a doctor visit out of reach due to nutty deductibles – I am one of them.

    However, I think both sides have been barking up the wrong tree for entirely too long. Why is it that no one takes in to consideration the extremely high cost of “Healthcare delivery”? How in the world is it that an ER trip, with almost no treatment could cost $5,800 for 3 hours? When my wife was pregnant and got a stomach bug/dehydration, bad enough that we went to the ER, we were there for 3 hours and the only treatment she received (pregnant) was a saline IV and a few blood tests. Yes, the hospital billed our insurance $5,800 for 3 hours of monitoring, a few simple fluid tests, and an IV.

    The point being, why in the world won’t any of our elected officials face down what is probably the biggest cause of our out of control healthcare costs – the cost of delivery?

    I think the reasons are many: 3rd party pay system – consumer (patient) has no ability to put competitive force on supplier (healthcare provider(s)), drug companies with patented medicines/therapies, lobbyists – from all sectors (insurance, medical, pharma, device).

    Obviously there are tons of other forces beyond the consumer (patient’s) control at the point of product/service delivery – they have no idea what one provider charges their insurance versus a different provider. This is because all of the charges are hidden in a myriad of “codes” for each procedure. No one has any idea what these “codes” mean financially – even worse, they don’t care. Because the assumption is that someone else (insurance) is paying the bill. Not true, we all pay.

    We just don’t know how much until afterwards. Never mind that in many instances the patient (consumer) may be incapacitated due to their illness or traumatic event. These patients may be especially ripe for a “pocket biopsy”, when it comes to someone else (the supplier/medical staff) is deciding what is good for them.

    To sum up, to me it appears that we are not concerned about healthcare costs, we are ONLY concerned about how to beat up the guy paying the bill (not that he isn’t complicit in these high costs).

    How in the world is it that 18% of the U.S. economy is not put under the same competitive forces as the other 82% of the economy? Better yet, why is it that none of us seem to realize this?

    Anytime we, as consumers, go buy anything of value (say over $300) we do everything we can to get a better price – negotiate, shop the internet, call every supplier for a quote, etc.

    We do none of that when seeking medical care or subscribed products, unless we are paying the bill directly – such as in the case of cosmetic surgery.

    I am NOT making a case for government provided healthcare (single payer/universal). I think the government makes a mess of pretty much anything it touches, and stifles innovation. I have witnessed it first hand. I do like the idea of HSA’s/HRA’s though. I think that this helps force competition, without stifling innovation. It gives the patient *some* ability to apply pressure to the market.

  2. Fed Up says:

    Bravo Traveling Rep, you are one of the few that get it! It baffles me that people are arguing over insurance instead of addressing the elephant in the room, the cost of actual healthcare.

  3. Fed Up says:

    If you really want to talk about fixing our healthcare system this is a must read: https://market-ticker.org/akcs-www?post=232038

  4. Richard Smith says:

    I could care less about having the “10 essential health benefits”. I only want and pay for what is needed to keep ME healthy not all of the other crap that is completely useless to me. Oh, by the way, my wife has no health insurance for this year as it was already NOT AFFORDABLE. Yeah, rates will go up for the people who use it the most rightfully so. And I am anticipating that the rates will come back down for the people who don’t need every freaking health service and only need it for large problems.

    The people who want free socialized healthcare move to one of those left wing states where they like to hand out everything for free.

  5. #Bernie2020 says:

    This was a great read but the only option is we need a single payer system to end GREED.

    HSA’s/HRA are not the answer because I am already paying a premium. I shouldn’t have to put more money in a honey hole because of their shell game of how to interpret my coverage depending on how a procedure is coded and if they deem something experimental but another company doesn’t. This is insurance, I don’t have to put money away with my car and home owners insurance just to pay for the repairs. Why should I do that with my health?

    The reason this is a huge Trump issue is he and other men like him have to pay taxes to keep help the men and woman that clean his properties from losing their healthcare. The current system we use is outdated and broken. Fixing it is very easy.

    From Birth to Death, an American citizen can expect a basic standard of healthcare. You start phasing it in and allowing anyone 0-55 as if 2018 to be included. 56 to death stay on their current system but can use the same requirements the new law will expand to.

    Taxes will go up but you never have to pay another premium again. For instance, taxes can go by your income like an income tax does. So it will break down to be about 4 to 8 dollars a day or about 3K a year. NO deductibles no bills to show up months after treatment, no fighting with insurance companies. Just the worry of getting better.

    You pick the company you want and open a policy with them using your SS number. IF you don’t have a policy your fined.

    All polices provide the standards that Obamacare provides with coverage for Metal health, dental, addiction support and customized prescriptions (if you have a heart issue, you get them discounted or free) .

    The standard coverage is your base and if you want to have Silver or Gold Coverage you can buy additional benefits. For instance if you know your family history is prone to Cancer, you get a plan that discounts treatments for that. Also that will give you discounts on gyms , Funeral Services and other drugs and special treatments that you would have to pay out of pocket for.

    Since each American is free to use their basic coverage anywhere, that is where the competition comes from. The health insurance and medical companies will need to change the customer service and business models because everyone now has the money to get services. Millions of people will need treatment, support and DRUGS with their taxes paying for it. It’s a guaranteed payment with less billing or collections so that will create millions of jobs from people making coffee to doctors coming from all over the world to treat Americans. This will also push the limits on the FDA to pass more drugs and innovation will explode.

    This model makes sure every child born, ever Vet that comes home and any senior will never have to worry about their healthcare. We all pay in and get the results. Free market will weed out the bad companies and new companies will be built to replace them.

    It is really that simple. But Greed gets in the way. Republican or Democrat, it really doesn’t matter anymore. What is going on right now is the Ultra Rich is paying off our elected officials and hurting the people that voted them for help.

    They think we have no option.. but then again they said that on May 9, 1773…I wonder how that turned out..

  6. #Bernie2020 says:

    Richard Smith says

    “I could care less about having the “10 essential health benefits”. I only want and pay for what is needed to keep ME healthy not all of the other crap that is completely useless to me.”

    1st off, so much wrong with what you said. Your wife should have health care but Rick Scott refused to expand medicare to our state. If you don’t believe me, google it. States that did expand, had more affordable choices.

    Anyway back to your main point,

    What your saying is these 10 things that are mandated covered by the most basic policy is something you don’t want?

    Ambulatory patient services (outpatient services)
    Emergency services
    Hospitalization
    Maternity and newborn care
    Mental health and substance use disorder services, including behavioral health treatment
    Prescription drugs
    Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
    Laboratory services
    Preventive and wellness services and chronic disease management
    Pediatric services, including oral and vision care

    Your car, home/business and life insurance has basic benefits that you assume are covered when you pay your premium. Some are state laws some are federal. The 10 essential health benefits are saying no matter what the policy is or who you are, your expected to receive. Some policies before Obamacare said you had to call ahead for approval for an ambulance for Hospitalization. How is that possible if your having a heart attack or you where just in an accident? Maternity and newborn care with Pediatric services, including oral and vision care is also there to protect all those babies that are born that we want to grow up and lead this country. I mean Planned Parenthood is so evil we need to protect this kids some how. Go Fund me’s shouldn’t be a policy.

    Think of it like going to the Gym or going to a theme park, you can’t pay to just use the treadmill or just go to the Star Wars ride, you have to pay for a basic entry or membership. If you want to try the bike or pool, you allowed to, you want to ride another ride you can. If you want more… buy an additional plan to expand your needs.

    Regarding your Socialized left wing states comment.

    Here is the top ten states in the USA that are most Federally Dependent.

    How many here voted for Trump?

    1 Kentucky 76.16 6 5
    2 Mississippi 75.59 7 1
    3 New Mexico 73.88 3 17
    4 Alabama 72.45 4 14
    5 West Virginia 68.97 5 15
    6 South Carolina 68.17 2 31
    7 Montana 65.91 14 4
    8 Tennessee 61.76 20 3
    9 Maine 61.02 13 9
    10 Indiana 59.18 7 23

    Here is the bottom 10.

    40 Utah 33.28 28 35
    41 New Hampshire 31.11 37 36
    42 Connecticut 27.80 22 48
    43 Massachusetts 27.36 46 37 <–Romeycare…
    44 Nevada 26.94 25 47
    45 Kansas 25.39 39 45
    46 California 25.36 41 43
    A proposal is being considered by California lawmakers would substantially remake the health care system of the nation’s most populous state by eliminating insurance companies and guaranteeing coverage for everyone.dumping insurers
    47 Illinois 23.96 48 41
    48 New Jersey 23.84 49 39
    49 Minnesota 23.09 43 44
    50 Delaware 21.32 50 42

  7. A tiny manatee says:

    “I could care less about having the “10 essential health benefits”. I only want and pay for what is needed to keep ME healthy not all of the other crap that is completely useless to me.”

    HAHAHAHAHAHAHA

  8. Pogo says:

    @Traveling Rep, et al

    “… Why is it that no one takes in to consideration the extremely high cost of “Healthcare delivery”?…”

    No one? Really? I’d say just the opposite. And I can’t think of anyone who doesn’t.

    https://www.google.com/search?q=+steven+brill&ie=utf-8&oe=utf-8#q=steven+brill+america%27s+bitter+pill

    “…I am NOT making a case for government provided healthcare (single payer/universal). I think the government makes a mess of pretty much anything it touches, and stifles innovation…”

    Where it is a duty to worship the sun it is pretty sure to be a crime to examine the laws of heat.
    – John Morley

  9. Traveling Rep says:

    Fed Up – Thanks for that. The article was a real eye opener! I wish that we could all coalesce to achieve what is necessary to defeat the corruption that exists pertaining to healthcare.

    Bernie2020. – your ideals seem steeped in “kill the rich guy”, and a pie in the sky system of take from the rich and give to the able bodied guys that are too lazy to earn it. Don’t confuse that with the disabled/incapacitated, whom deserve every bit of our help. To clue you in…the rich aren’t going to just give it up that easy. They will skate out of any world that tries to pin them down, unjustly. They do not feel responsible for others lack of financial ability.

    The bright side is that every single last one of us has the opportunity to overcome adversity. Albeit, playing by the rules set forth by your adversaries. Think in those terms when postulating solutions. Greed will never end. The same Greed that drips from your comment – a Greed for free things, because…FREE. Bernie would be proud of you, though!

    But, Bernie’s ideas are soaked in socialist sauce, that will hopefully never come to fruition in the USA. Otherwise, we will be more enslaved than we are now. 90% tax rate…insane!

  10. #Bernie2020 says:

    Traveling Rep.. where in my comments did I say FREE and kill the Rich Guy?

    Comment:

    “Taxes will go up but you never have to pay another premium again. For instance, taxes can go by your income like an income tax does. So it will break down to be about 4 to 8 dollars a day or about 3K a year. NO deductibles no bills to show up months after treatment, no fighting with insurance companies. Just the worry of getting better.”

    The GOP congress bill Friday just gave the 1% and the insurance companies another tax cut and is raising prices on the poorest and Oldest Americans and cutting funding that will make people lose their coverage.

    Also I hate to bring this to your attention, their are far more able body people breaking their tails then lazy people not earning it. Lazy people can’t be your argument because most of the lazy people i know are lazy because their parents gave them a live they don’t have to worry about money. People are powerless right now so they can’t overcome the way the game is being changed year after year. My family finally got a tax break with Obamacare, and now we all have healthcare and they pay premiums and out of pocket expenses and now they may not have it. How is that Making America Great?

    People like me that support Bernie don’t want anything for free.

    In fact, I don’t even take samples at the store when they offer them to me. I’ve earned every penny I’ve made and I file and pay my taxes each year. I am tired of the outright Greed in our politics and it’s not about Socialism. It is about buying my democracy out from under me and saying it is freedom of access.

    Also if you don’t like Socialism, we can end our funding of the military, business grants and tax credits to large corporations and stop funding unemployment insurance and Social Security benefits. Running a Federal health care system to work like these institutions may not be perfect.. but it’s much better than what 90% of this country has now.

    Also, he never said he wanted a 90% tax rate.
    https://youtu.be/Ui-fHDUnZDg

  11. Richard Smith says:

    @#Bernie2020 – What I am saying is that my wife does not NEED all 10 basic health essentials so why should I have to pay for all 10. She doesn’t need maternity and newborn care or pediatric care including dental and vision care. Plus when I get auto, motorcycle or home insurance YES there are very basic minimums required in each state but I have the option to get more if needed.

    I don’t see why I have to PAY for those two “benefits” when they will NEVER be used by my wife. Let the people who want and need those benefits PAY for them instead of scamming the money from people who don’t.

  12. #Bernie2020 says:

    @Richard Smith..

    Your argument always goes back to the same thing.. Scamming and lazy people and YOUR money. It is the same line over and over and over again.

    Anyway, your talking about 10 basic essentials that are not impacting your overall policy at all. Your wife is going to use 8 and if you and her decide to have a kid, your covered. If your done with kids, your protecting the rest of the country’s youth. Seems to me that Makes America Great. Making sure parents get the coverage if they PAY for a policy when they have kids.

    Also your wife can buy a policy for $261.99 with a $4,500 on the healthcare.gov site so that is about $62.00 a week for healthcare.

    Quick question:

    Do you go to the Gym and complain you have to pay $10 a month and you only use the treadmill or go to a Chinese buffet and only eat the egg rolls for $12?

  13. #Bernie/Obama/HillarySuckEqually says:

    Well, Florida voted unanimously for DT; so this shouldn’t be an issue. To the winners go the spoils.

  14. #Bernie2020 says:

    No Florida didn’t. #alternativefacts again.

    Unanimously-without opposition; with the agreement of all people involved

    Trump 48.6
    Clinton 47.4

    Does anyone that supports the GOP or Donald Trump say one thing that has any truth to it? All talking points and headlines but never the facts…

  15. snapperhead says:

    The House bill is DOA….too many red state moochers will vote against the Senate GOP when they lose their big gubmint Medicaid. The states with the largest portion of the populace with preexisting conditions are all red states. No surprise there though as red states are at the top of the pack in lowest incomes, % that live in poverty, unwed mothers, lowest education achievements and highest obesity rates. Must be why almost everytime I see a Trump sticker it’s on a old beat up piece of shit vehicle. Usually close to a confederate flag sticker. Git-R-Dun

  16. Ws says:

    The good news is that Obamacare is going to die either way thank goodness. GOODBYE OBAMACARE! It was doomed from the beginning, but the democrats just couldn’t see that for some really weird reason. Oh well better late than never. Bye bye Obamacare.

  17. Richard Smith says:

    Obamacare was doomed right from the get-go. When our law makers had to pass the law first before actually reading it to see what it included as quoted by Nancy Pelosi, there is obviously a bunch of very stupid people running our government. Trump will drain the cesspool aka swamp, repeal Obamacouldcareless and give the citizens of America real healthcare. Why is it that the left and the media cannot see the forest through the trees? Maybe they should go see an ophthalmologist, that’s is if they can afford one.

  18. #Bernie2020 says:

    Richard Smith

    The only cesspool that needs to be drained is the Trump administration both by impeachment and votes. He is a liar, a communist and is colluding with another Nation to undermine the Government of the United States for his own gain. Both Trump and Pence need to go. Get Ryan in as President since the GOP did win the election and give him a guy like McCain, Romney, Kasich or Bernie Sanders as VP so we can get stuff done again.

    But I do want you to sit down when you read this because your going to say this again very soon..

    She may not read this but you will.
    Speaker Pelosi…

  19. Katie Semore says:

    @RichardSmith, how many republicans do you think have read the bill they passed in the house?

  20. Richard Smith says:

    @Katie – the same number of democrats – NONE. That’s exactly why the cesspool/swamp needs to be drained. And then get in a congress that wants to do their jobs to work for the citizens of this country instead of being so self-serving. I would bet that if every congress member was going to be affected by the Obamacareless health plan THEY would have read EVERY word of it BEFORE passing such a ridiculous law.

  21. Richard Smith says:

    Latest News about Obamacareless – Insurer Aetna announces that it is leaving all ObamaCare exchanges next year, a move HHS Secretary Tom Price says “adds to the mountain of evidence that Obamacare has failed the American people.”

    It won’t be long before there won’t be any health care insurer around and if there is ONE well prepare yourself to pay $10,000 a month for the policy with $50,000 deductible. So much for Obama’s Affordable Healthcare Act. HAHAHAHA.

  22. #Bernie2020 says:

    They are leaving because they said they are “losing money” actually providing insurance but if you look at their financials its another story.

    “Aetna’s 2016 results exceeded previous projections despite continued challenges in the public exchanges, and I have a great deal of confidence in the company’s future, including our long-term prospects for growth”

    Mark T. Bertolini, Aetna chairman and CEO.

    A quick google search shows the full-year 2010 operating earnings were $1.6 billion the year Obamacare became law and 6 years after Obamacare… they have increased to full-year 2016 operating earnings of $2.9 billion. 2015 it was 2.7 billion. Seems like the law didn’t really hurt them at all if they added A BILLION DOLLARS to their balance sheet .

    Again more Greed..but you keep listening to Tom Price and the GOP. If you don’t they might arrest you..

  23. Sherry Epley says:

    We will NEVER have reasonably priced health care services as long as those services are provided by hospitals, clinics, doctors, drug companies, medical device companies and insurance companies that are focused solely on the GREED of “Maximizing Profits”! Our current system is a completely corrupt shell game!

    Yes, I AM advocating a highly regulated/cost controlled system similar to “Medicare” for ALL! Yes, government agencies are not perfect. . . but they couldn’t do worse than the “private sector” has done!

    Countries in Europe often deliver “superior” health care to their citizens at a much lower cost than we pay. Yes, they pay for it through “taxes” but who cares whether that money is called “taxes”, “insurance premiums”, “deductibles”, or “co-payments”. . . “a tax by any other name”.

    We need to look at the bigger picture and we need a better, cost effective system. . . but it certainly should not be one that is different in every state!!! Good grief, it is insanity to create a system that keeps citizens tied to one state to keep their health benefits. Our citizens need to be able to move and live where their jobs/careers/lives take them. This whole idea of having any vital services vary state by state is ridiculous!!!

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