The Great American Health Care Debate Continues… May 2017

Historic Governing Opportunity to Accomplish a Significant Agenda 2016 election consolidates control in the Republican Party Prior times in history when House, Senate, and White House were in Republican control: 1921–1930 1953–1954 2001–2002 2003–2006

Health Care Coverage in the United States Source: Boston University School of Public Health- US Healthcare: A Short Story

Source: Kaiser Family Foundation via FiveThirtyEight

Percent of Workers Offered Employer-Sponsored Coverage by Household Poverty Level, 1999-2014

Obamacare (ACA): Deeply Divided views by American Voters Source: KFF.org: Kaiser Health Tracking Poll: The Public’s View on the ACA

The Uninsured Rate Is At An All-time Low, But The Public Doesn’t Know It

Current Status Of State Medicaid Expansion Decisions

Key Objectives of ACA Repeal/Replace Repeal ACA tax increases Deregulate health insurance marketplace Expand HSAs Reduce federal outlays by reducing federal subsidies for health insurance coverage

Repealing ACA Taxes: A Meaningful Opening Act for Tax Reform Provision Revenue Impact (2017–2026) (JCT) Repeal 3.8% Net Investment Tax -$158 billion Repeal Health Insurer Tax -$145 billion Repeal 0.9% Additional Medicare Tax -$117 billion Delay Cadillac Plan Tax to 2025 -$49 billion Repeal Increase in AGI Threshold for Medical Deduction -$35 billion Repeal Fee on Branded Prescription Drugs -$25 billion Repeal Medical Device Tax -$20 billion Repeal FSA Contribution Limit -$19 billion Repeal Other -$8 billion Repeal Total -$576 billion HSA Expansion Total -$595 billion

Average net change in federal tax and health benefits in 2022 for a family earning: Source: “Under the Republican Health Care Plan,” New York Times, March 22, 2017. Graph from the Urban Institute’s Health Policy Center and the Urban- Brookings Tax Policy Center

Common Element of AHCA Reforms: Limiting federal budget exposure to rising medical costs Premium subsidy converted to fixed tax credit Medicaid federal share converted to per capita formula Cadillac Tax: Delayed but not repealed

Changes in Insurance Subsides Under the Affordable Care Act People using healthcare marketplaces and making less than $48,000 a year receive subsidies to help them buy insurance The amount of the subsidy is tied to a person's income and to the cost of insurance in the person's area

Changes in Insurance Subsides Under the AHCA Proposal People would still receive subsidies, which would phase out at incomes of $75,000 per year The amount would be tied to a person's age, not income, so low-income people would get less help. The subsidies would not vary with the cost of insurance, so people in high-cost areas would also not get as much help

AHCA Tax Credits Across Age and Income Groups

A Higher Uninsured Rate, Particularly Among Low-Income, Older Americans Source: “5 Charts That Explain The CBO Report On The Republican Health Plan,” NPR, March 15, 2017. Graph from the Congressional Budget Office

Share Of Uninsured U.S. Residents Would Rise Under GOP Plan Source: Congressional Budget Office via NRP.org

Majority Say AHCA Not Passing Is a Good Thing; But Divided on Their Reasoning

Health Care Spending Is Very Concentrated, With 10% Of Families Accounting For Half Of Spending

House Passes AHCA Along Party Lines With 20 Republican Defections How the House voted on the AHCA H.R. 1628: American Health Care Act of 2017 “A lot of us have been waiting seven years to cast this vote. Many of us are here because we pledged to cast this very vote.” House Speaker Paul Ryan (R-WI)

Contrasting Political Pressures on Senate Republicans 50 votes required 52 Republican Senators “Cost too much… and continues federal subsidies: “Obamacare light”” “Oppose elimination of funding for planned parenthood” “Oppose preexisting condition provisions in AHCA”

-Senate Majority Leader Mitch McConnell (R-KY) The Senate’s Turn… "The process will not be quick, or simple, or easy…But it must be done. It is the least both parties owe to countless Americans who suffer under Obamacare and will continue to suffer if we do not act.“ -Senate Majority Leader Mitch McConnell (R-KY)