Legislation

Infographics Part II: ACA Medicaid Expansion vs. AHCA Per Capita Caps

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NYT CBO

Medicaid beneficiaries stand to lose the most under the American Health Care Act (AHCA). According to the new Congressional Budget Office Report, Medicaid recipients would make up a disproportionately large share of 24 million people expected to lose health insurance coverage by 2026 if the GOP legislation becomes law.

Under the Affordable Care Act (ACA) 32 states expanded Medicaid eligibility to low-income adults earning up to 138 percent of the poverty line (about $34,000 for a family of four). The AHCA, as currently written, continues expansion for three more years before cutting federal funding to state Medicare programs through a per capita cap, limiting coverage to those enrolled before 2020. Vox recently provided a good explanation of per capita caps as does the Kaiser Family Foundation.

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Many of the best Medicaid infographics predate the release of the AHCA, but they still remain relevant to the current discussion. The KFF website includes a large collection of data on Medicaid expansion, including maps (like the image above) and detailed Medicaid State Fact Sheets.

The Center on Budget and Policy Priorities (CBPP) produced the following charts estimating the costs to states of the per capita cap.

Medicaid Cost Shift CBPP

MEdiciad Cuts Growth OVer Time CBPPCBPP also created a series of fact sheets illustrating the effects of Medicaid cuts in nine different states. Here is the fact sheet for Pennsylvania:

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Images in the slideshow below appear in The New York Times article “Republicans’ Changes to Medicaid Could Have Larger Impact Than Their Changes to Obamacare”

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See Part I: Tax Credits vs. Premium Subsidies

Coming Soon:

Part III: Individual Mandate vs. Penalty for Break in Coverage

Part IV: Cost Comparisons

The Best Infographics Comparing the GOP’s Healthcare Plan with the Affordable Care Act

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Part I: Tax Credits vs. Premium Subsidies

Infographics

In the week since the Republicans unveiled their Obamacare replacement plan multiple news outlets have  reported on what’s in the legislation, how it compares to the Affordable Care Act (ACA), who stands to benefit or lose, how much it will cost, etc.–many illustrated with helpful infographics.

Even if you follow the healthcare debate closely, the quantity of tables, graphs, and charts can quickly get overwhelming. After a while they all seem to look the same (actually, many are the same, or rely on the same data sources).

Want to know what’s in the American Health Care Act (AHCA) and how it might affect you and your community? We’ve compiled some of the best infographics from around the internet to help you make sense of it all.

Part I: Tax Credits vs. Premium Subsidies

One of the most significant changes in the GOP legislation is the replacement of premium subsidies (based on age, income, and geography) with age-and income-based tax credits, with no geographic variation. Several graphs from the Henry J. Kaiser Family Foundation (KFF) show how people of different ages and incomes fare under tax credits depending on where they live.(If you aren’t already familiar with the Henry J. Kaiser Family Foundation you should check out their website now.)

Their Interactive map provides county-and-state level comparisons of of ACA vs. AHCA tax credits  based on age and income level.

Note: To try it out, click on the picture below to go to the KKF site. Once the new page opens, scroll down a bit to find the interactive map.

KFF interactive

A related KFF report, How Affordable Care Act Repeal and Replace Plans Might Shift Health Insurance Tax Credits, includes the following charts, illustrating the effects of the GOP plan’s tax credits on individuals and families in different age and income groups in high and low cost states.

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Many prominent news outlets cite KFF as a source for their illustrations. For example, last week,  both The Los Angeles Times and The New York Times used similar graphics (in different colors) based on KFF data.

NYT maps_slideLATimes Graphics_Slide

Another good set of illustrations of how the GOP plan might affect individuals at different income levels is provided in an analysis by The Century Foundation.

For a state-by-state comparison, the waterfall graph (below) from The Center on Budget and Policy Priorities (CBPP) shows the difference between the average ACA subsidy and the proposed AHCA tax credit.

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Part II: Medicaid Expansion vs. Per Capita Cap

Coming Soon:

Part III: Individual Mandate vs. Penalty for Break in Coverage

Part IV: Cost Comparisons

 

Selling Health Insurance Across State Lines

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Did President Trump just call for federal regulation of the health insurance industry?

In his first address to Congress, President Trump enumerated his healthcare reform priorities. These include protecting coverage for those with pre-existing conditions, tax credits, health savings accounts, giving states more flexibility on Medicaid, and bringing down prescription drug prices. Then he said this:

…the time has come to give Americans the freedom to purchase health insurance across state lines…

This last line is the one we should remember. Allowing insurers to sell across state lines will require uniform regulations and will inevitably move us toward a system of federal health insurance regulation. Whether he intended it or not, Trump just succeeded in undermining the state regulation of insurance.

Interstate insurance sales have long been a component of Republican healthcare legislation and part of an ongoing debate about state vs. federal insurance regulation.

The Empowering Patients First Act (H.R. 3400) first introduced in 2009 and sponsored by then Rep. Tom Price (now Secretary of Health and Human Services) contains the following:

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Many of the current plans for repealing the Affordable Care Act contain similar provisions. From a draft proposal circulated in mid February:

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Speaker Paul Ryan is a big supporter of interstate insurance sales. A policy paper he released last summer lists it as a key recommendation.

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But we question whether Ryan really understands the conflicting policy implications of such a recommendation, because the same paper also contains the following:

States have been in the business of regulating health insurance for decades. They should be empowered to make the right tradeoffs between consumer protections and individual choice, not regulators in Washington. The federal role should be minimal and set a few broadly shared goals, while state governments determine how best to implement those goals in their own markets.

Sorry Speaker Ryan (and President Trump), you can’t have it both ways.  Allowing insurance sales across state lines will inevitably lead to federal regulation of the insurance industry.