By Anne Dunkelberg
This week I joined CPPP Senior Policy Analyst Stacey Pogue for a Facebook Live discussion about what Congressional health care proposals might mean for Texas.
You can watch a recording of the discussion here.
Overall: The most distressing part of the Congressional plan is that it doesn’t provide a pathway to reach the remaining 4.6 million uninsured Texans, and instead would likely increase that number and erase the coverage gains of the last several years.
Some of the other key takeaways from our early analysis of the health care proposal coming out of Congress include the following:
Marketplace and Individual Market Insurance
• This proposal makes private coverage unaffordable for millions of Americans. Premiums will rise for many people getting affordable coverage today in the Health Insurance Marketplace, and out-of-pocket costs like deductibles will go up, too.
• The plan would replace the ACA’s sliding scale tax credits (which adjust for income, age, and cost of insurance where you live) with a less generous, essentially flat tax credit (that adjusts only for age). This means there would be clear winners and losers. People hit the hardest are lower income, older (ages 50-64), and people who live in rural areas, where the underlying cost of health insurance is higher. Note that about 900,000 Texans get a tax credit under the ACA.
• There are some provisions in the plan that just don’t make sense. A family of four who makes $100,000 per year, under this new plan, would get the same subsidy / tax credit as a family that makes $30,000 per year.
• Premiums would also rise under this bill because there is much less incentive for younger and healthier people to get coverage. Today, there is a penalty that encourages people to get insurance. Eliminating this provision changes who is covered. More sick people keeping coverage, and more healthy people dropping it would mean raising premiums for everyone.
• In Medicaid, starting in 2020, the plan would cap the overall federal funding available to Texas, preventing necessary increases to allow Texas to add life-saving innovations, bring up seriously inadequate payments to care providers, or fill current gaps in basic health care services.
• In other words, the plan would make it really hard to improve anything that we are not doing well today. For example, Texas hasn’t given doctors regular pay increases under Medicaid since 1993, and there would be no space under a “cap” to improve that.
• There are also over 200,000 Texans on waiting lists for Community Care programs, and they wouldn’t have a way to get off those lists if Congress caps Medicaid funding.
Stay tuned for more updates from CPPP as the health care debates in Washington and Austin continue.