Consumer issues stemming from the GOP health care initiative – Washington Post

 In U.S.

WASHINGTON — Republicans in full control of government are on the brink of history-making changes to the nation’s health care system. The impact for consumers would go well beyond “Obamacare.”

Former President Barack Obama’s signature law is usually associated with subsidized insurance markets like HealthCare.gov. But the Affordable Care Act also expanded Medicaid.

Not only would the GOP legislation scale back coverage through the insurance markets and phase out the Medicaid expansion, it would also make fundamental changes to the broader Medicaid program. The federal-state program covers low-income people, from newborns to elderly nursing home residents, from special-needs kids to young adults caught in the opioid epidemic.

House Republicans have passed their health care bill, and Senate GOP leaders are driving toward a vote next week. President Donald Trump is waiting, eager to deliver on a campaign promise to repeal the law.

Against fast-moving developments, a look at some major issues for consumers.

WHY MEDICAID MATTERS

As health care costs have kept climbing, employers cut back on coverage, and Medicaid passed Medicare as the nation’s largest public insurance program. It now covers about 70 million people, including children and able-bodied adults mostly served by private managed care plans.

The GOP’s biggest Medicaid change involves limiting future federal financing. Since its inception, Medicaid has been an open-ended entitlement, with Washington matching a share of what each state spends. Instead, Republicans propose a per-beneficiary cap.

In addition, the GOP would phase out added financing that Obama’s law provided as an incentive for states to expand the program and cover more low-income adults. About 11 million are covered by the expansion.

The Congressional Budget Office estimated the House bill would reduce federal Medicaid spending by $834 billion over 10 years, and the program would cover about 14 million fewer people by 2026, a 17 percent reduction.

Governors of both parties have warned Congress that would mean a cost shift to states that undermines coverage for the vulnerable.

Medicaid limits got very little attention in the 2016 presidential campaign. The idea was a relatively late addition to Trump’s talking points. Indeed, candidate Trump had started out promising no cuts to Social Security, Medicare or Medicaid.

Economist Douglas Holtz-Eakin, a longtime GOP adviser, says the Republican approach is “180 degrees different in its economic and budgetary philosophy,” from the course steered by Obama. The Medicaid limit would move the nation closer to putting public health care programs on a budget, fiscal discipline that conservatives say is long overdue.

But the human consequences could be politically volatile. “No one wins on health care policy,” observed Holtz-Eakin.

WHAT DOCTORS ARE SAYING

Groups representing doctors and hospitals are overwhelmingly opposed to the Republican approach, because it’s likely to result in millions more uninsured people. Consumer organizations like AARP are also opposed.

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