This is truly ugly stuff folks.
This is the "Obamacare" repeal and replace option that is being peddled in the Senate.
I've read it.
Let me summarize:
- For states that wish to keep Obamacare, they can.
- For states that do not wish to keep Obamacare, they can "opt out."
- The underlying "replacement" is a ROTH HSA, which is the same basic mechanism of a ROTH IRA except that spending is restricted to "authorized" health care services (including health insurance.) All other withdrawals are subject to tax (10%) penalties (much like unauthorized withdrawals from a traditional IRA.) The primary change from existing HSA law is that the existing structure is an adjunct to a health insurance policy. This legislation allows the HSA to fund a health insurance policy.
- States that opt out can create their own standards for what constitutes a "legitimate" health insurance plan. This means that plans which are more or less-restrictive than Obamacare policies are authorized in such states and count. So if you don't want a policy that covers pregnancy, for example, you don't have to buy one. If you object to contraception, provided your state allows it, you can buy a policy that doesn't cover that. And so on. Note that none of this would ban a company from offering a coverage and states could require whatever they want.
- For states that opt out if you fail to maintain continuous coverage you can be penalized, including being denied entirely due to medical underwriting and it imposes a mandatory penalty (tax) to be paid to Treasury for your refusal to buy a policy if you come back in the future, even if you are healthy. If you maintain continual coverage, however, you cannot be denied nor medically underwritten. This changes the Obamacare requirement by effectively closing the "wait until get very sick, then apply" game but includes a cute "**** you" for those people who opt out, then decide to come back but are not trying to game the system by buying only when sick. In many ways this is worse than the "individual mandate" in that the penalty is on the back end and is not imposed only on those who game the system.
- For states that opt out they can default you into a ROTH HSA, which may or may not obtain a subsidy. You can opt out but you will have to do so explicitly.
- Subsidies are deposited directly into consumer HSAs, not to the state general funds (or otherwise) and are adjusted for local conditions (as is the case for existing PPACA subsidies, and in a very similar manner.)
- Subsidies phase out for MAGI over $90,000 for individuals, and $150,000 for joint returns. Married-filing-separate has a ZERO subsidy -- if you're married, you must file joint to get subsidies. This is a large increase in subsidy phase-out income levels and means that basically anyone in a state that opts out of Obamacare will have full subsidies available up to MAGI $90k. Note that MAGI includes tax-exempt interest and similar income; this is potentially very important for those with substantial non-wage income (as is the case for Obamacare now.)
- Imposes a $25,000 penalty per-instance on medical providers who attempt to bill out-of-network charges in emergency circumstances only. However, it does not bar the practice or impose any criminal penalty for this act of financial rape, which means that the effect of this provision is that you'll still get raped and the hospital will add $25,000 to the******amount so as to pay the fine with it! If you think this means the "out of network" emergency problem will get worse YOU ARE RIGHT, IT WILL GET WORSE AND IN A VERY, VERY SEVERE WAY FOR MODEST ISSUES. $25,000 isn't much additional screwing on a $500,000 bill. It is a very large additional screwing on a $20,000 bill! Forcing a victim to pay for his or her own screwing is not only cruel it ought to be considered a capital offense.
- Allegedly "requires" providers to post prices in a way the HHS Secretary directs. However, there is no penalty for failure to do so, nor is there any penalty for refusing to honor a quoted price.
There are other technical changes, such as specifying that paying a fee for concierge care (e.g. flat fee per month for access, etc) is a legitimate HSA expense, along with specifying limitations and parameters for the ROTH HSAs (which generally appear to be reasonable.)
There is exactly zero in this bill that addresses:
- The cost of medical care. Nowhere is there a penalty for failure to disclose prices or to actually bill at the claimed price. There is no requirement that "what you post as a price is what everyone pays", there is no sanction on the provider for failure to quote a true price, to bill at the quoted price, or if they discriminate for or against any particular person. The "requirement" to post prices is a dead letter as it carries zero penalty.
- For out-of-network emergencies the bill imposes a $25,000 fine on the provider if they bill materially above either Medicare or "Usual and Customary" prices. However, nothing prevents the facility from actually issuing or collecting that outrageously-escalated billing -- such is not deemed an unlawful practice and is not barred, in any way restricted nor is any criminal penalty imposed. This means that the existing problem of out-of-network emergency care, say if you have a heart attack while in another state, will actually be made worse as the facility will be able to simply add the $25,000 fine to the financial assrape that they are already imposing on you. The bill also does nothing about the (very common) practice of an out-of-network person appearing in your room when you are in-network and then billing you for an out-of-network event. The "fine", which you will be forced to pay, only applies to emergency circumstances. If you've been admitted and are stable and Mr. Out-of-Network Doc sticks his head in your room you're still ****ed.
- The bill does not eliminate the penalty for not having insurance. In fact it makes it worse than Obamacare in many instances. It contains no income exemptions for not having insurance (Obamacare does) and a new set of "screw you" provisions. Specifically, if you're young, healthy and poor but making it on your own and choose to opt out of buying insurance you will pay no penalty at that time. But, if and when you decide to buy health insurance in the future you will get penalized on the back end statutorily, even if you are still healthy at the time (in other words you didn't game the system, you just refused to buy something you didn't need!) For people who are both healthy and in the lower income strata (think young people folks) this will be a rude surprise that will go right up their poop chute when they decide a few years down the road to get married and start a family -- right about the time that buying insurance as a preventative act makes sense.
- The bill is completely silent on the rank violations of existing anti-trust law found in 15 USC; specifically, Sherman, Clayton and Robinson-Patman. An earlier revision (2015) of this text at least attempted to clarify some aspects of Mccarran-Ferguson which bears on insurance companies -- this one is silent on the same matter. Specifically there is nothing barring collusion between providers, price-fixing (whether overt or otherwise), differential billing based on your wealth, form of payment or for that matter whether you have red hair and other similar abuses, all of which are the very form and function of the existing medical financial rape-room circus served upon the American public.
As such this bill, proffered as a "replacement" for Obamacare, might well fit this description:
This is a Congressionally-imposed financial******room that in many ways is worse than the existing Obamacare system, and has no material positive changes evident with one exception: It increases the MAGI (substantially) that a person or couple may earn without losing their giveaway.
It does nothing to decrease costs, it contains no penalties that bar the imposition of excessive charges for out-of-network emergency services (or any other out-of-network charge which you might not be able to refuse or even know occurred until after the fact); a provider fined for trying to bill you said excessive charge can simply add that to your bill and thus force you to pay their fine, and it contains hidden back-door taxes imposed on anyone who tries to opt out of the insurance and medical scam entirely, even if they are healthy the entire time and thus did not either intend to or actually game the system.
**** you Mr. Cassidy, **** you Ms. Collins, Mrs. Capito and Mr. Isakson, **** you Mitch McConnell and the entire remaining leadership in the Senate and House and finally, **** you Donald Trump.
Oh by the way, **** you Larry Kudlow, who is once again talking "free markets" on CNBS as an "unofficial" Trump carnival barker while in fact the GOP and Donald Trump are protecting monopolists even further and screwing you even harder.
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