ACA

John Dingell and the Pursuit of Healthcare for All

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This photo shows former President Obama signing the Affordable Care Act. What you might not notice is the gentleman sitting in the right-hand corner of this photo. That was former Congressman John Dingell Jr., who represented much of Washtenaw County for many years. Dingell--who died yesterday--introduced a health care bill into Congress every year from his start as a legislator until the passage of the ACA, and he served for 59 years. Thank you, Congressman Dingell, for your devotion to healthcare for all.

A Little Bit of History

John Dingell’s father (also John Dingell!) was in Congress before John Dingell. John Dingell Sr. began cosponsoring a national health insurance bill (what we would now call “single-payer” legislation) and fighting for universal health care when the issue was less about cost and more about health care as a right. John Dingell Sr. was also active in the fight for social security.

John Dingell Jr. enjoyed the world of twitter, and here is a bit of history—in Dingell’s own words.

John Dingell Sr. is at the back wtih the mustache as President Franklin Delano Roosevelt signs the Social Security Act into law.

John Dingell Sr. is at the back wtih the mustache as President Franklin Delano Roosevelt signs the Social Security Act into law.

When John Dingell Sr. died, John Dingell Jr. ran for his congressional seat and took up the mantle, introducing a single-payer bill into Congress every year. But John Dingell Jr. was practical, and also worked for extending health care incrementally when the opportunities arose.

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John Dingell Jr. said the honor was given to him because the speaker had been great friends with Dingell’s father, and Dingell’s father had worked hard to make Medicare a reality. Note the gavel at bottom left.

John Dingell Jr. said the honor was given to him because the speaker had been great friends with Dingell’s father, and Dingell’s father had worked hard to make Medicare a reality. Note the gavel at bottom left.

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John Dingell Jr., July 8, 1926 – February 7, 2019

We thank John Dingell for his relentless support of health care through his entire career and for his dedication to working for the people of the United States.

Read more details about John Dingell’s role in fighting to extend health care to all here.

John Dingell’s NYTimes Obituary

From the Detroit Free Press:

John Dingell: In love with his life, in awe of his luck

Barack Obama: John Dingell made life better for Americans

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A Word Of Advice: Don't Auto-Renew

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The new plans are out, and Open Enrollment is upon us! People who have been enrolled in Marketplace plans in the past may be getting notices offering for them to auto-renew their plans. That sounds easy, but it may not be in your best (financial, or health coverage) interests!

Provider Changes

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First, a plan may sound the same, but providers may decide to affiliate or disaffiliate from year to year. So you always to want to make sure that your doctors take your health insurance.

Financial Changes

The plans that are offered may change also. For instance, in Washtenaw County in 2019, there will be a new health insurance provider—Oscar—that has not previously been in the Michigan health insurance market. And even without that new insurer, some insurers may decide to charge less or more for their plans.

The pricing of these plans matters, because tax credits are based on the actual cost of the second lowest silver plan. That is the benchmark from which all tax credits get calculated.

Let’s say that your income is exactly the same between 2018 and 2019, and you qualify for tax credits. If you auto-renew, you could find yourself paying a whole lot more. Even if the plan has not changed, and the full cost of the plan doesn’t have a big difference, there could still be a big difference in tax credits.

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In this case, in 2018 the Pacesetter A plan was the lowest-cost plan, and in 2019 it is the third-lowest-cost plan. Even though the full cost of the plan only went up by $20, the subsidized cost went up a lot more. In this example, for the same exact plan, and with the same exact income, you could end up paying $70 more per month ($840 more per year), more than double what you paid the year before!

The Moral Of The Story?

Do not Auto-Renew.

Instead, give us a call at 734-544-3030; walk in to our Ypsilanti office M-F 9-4; or find local help at this link.

Remember, Open Enrollment on the Marketplace runs from November 1-December 15, 2018.

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Tax Day Is Coming! Here's What You Need

April 15th falls on a Sunday, and Washington DC celebrates Emancipation Day (the day Lincoln freed the slaves) on Monday, April 16th so Tax Day is Tuesday, April 17, 2018. 

April 15th falls on a Sunday, and Washington DC celebrates Emancipation Day (the day Lincoln freed the slaves) on Monday, April 16th so Tax Day is Tuesday, April 17, 2018. 

In 2017, you were required to have insurance all year unless you qualified for an exemption. You might have gotten your insurance from an employer, from public insurance (Medicaid, Medicare, VA coverage), or from private insurance (purchased separately or from the Marketplace). And now your 2017 taxes are due. Don't get confused, get organized!

 

Forms, Forms, Forms...

If you got insurance from an employer or public insurance, you should have gotten 1095-B or 1095-C forms from them. You can file your taxes without those forms, though, because they are also reporting to the IRS.

If you got insurance through the Marketplace, you need the 1095-A form. You can find that online in your healthcare.gov account. With the information you have on the 1095-A form, you can reconcile your tax credits, which you do using IRS Form 8962.

Find out more about how to reconcile tax credits with this handy explanation.

If you got private insurance without tax credits, your insurer should have your 1095-A, and you don't file for tax credits. You still have to submit the 1095-A as proof you had insurance.

 

I Didn't Have Insurance. Can I Get An Exemption?

If you didn't have insurance for the whole year, you might have qualified for an exemption. Common exemptions would be: 

  • you were uncovered for less than 3 months (perhaps you moved or switched jobs)
  • cost of insurance for the household was more than 8% of your income and was unaffordable
  • your income is below the tax-filing threshold 
  • you were living out of the country for all or part of the year.

There are other exemptions, too. You file for an exemption using IRS Form 8965. Find out more below. 

 

No Exemption?  No Insurance?  Pay a penalty.

If you don't qualify for an exemption, and you didn't have insurance, you might need to pay a penalty. For the 2017 plan year, the fee is calculated 2 different ways — as a percentage of your yearly household income, and per person. You’ll pay whichever is higher.

1. Percentage of income: 2.5% of yearly household income. The maximum is the total yearly premium for the national average price of a Bronze plan sold through the Marketplace.

or

2. Per person per year: $695 per adult or $347.50 per child under 18. The maximum is $2,085 per household. 

 

A Household Is Made Up Of Individuals

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NOTE: Think about each person in the household separately! In some cases, you may have one person on the Marketplace or with employer insurance, one person with an exemption based on affordability, and a child on Medicaid or MIChild.

If you finish your taxes, you realize you will owe some money, and you don't want that to happen again, come visit us at 555 Towner, Ypsilanti, MI M-F 9-4 p.m., or call us at 734-544-3030, for a free consultation.

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Get 'Em Now! Free Flu Shots Prevent Epidemics

A lot of people say ‘it’s just the flu.’ However, influenza is a serious respiratory illness. Nationally, it causes more hospitalizations and deaths than all other vaccine preventable diseases combined.
— Christina Zilke, Washtenaw County Health Department

What is the flu?

Symptoms of the flu can include fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue or tiredness.  Some individuals will report vomiting and diarrhea but these symptoms are more common in children than for adults.  Symptoms can last anywhere from a few days to about two weeks. 

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Some individuals are at a higher-risk of developing flu complications like sinus and ear infections, pneumonia, and bronchitis.  Pregnant women, young children, people living with chronic medical conditions, or people over the age of 65 are all at a higher-risk of developing flu-related complications.  In some cases complications can become severe and result in hospitalizations and can be life-threatening.

Flu across the country is widespread now. In Washtenaw County, the most recent data looks like this: 

To date (1/27/2018), 181 people in our county have been hospitalized this season and 4 adults have died. 

To date (1/27/2018), 181 people in our county have been hospitalized this season and 4 adults have died. 

More people are being hospitalized. 

I'm Healthy, Why Do I Need A Shot?

The Center for Disease Control (CDC) recommends that everyone 6 months and older should receive a flu shot during the year’s flu season.  

It is important for you to get the flu shot because it keeps yourself and your family safer. If you do get flu, you may be less affected. You are also less likely to transmit the flu. Keep your loved ones healthy!

Some strains of flu are stronger than others. In 1918, the flu killed tens of millions of people around the world. Read more about that in this Washington Post article

In 1968, my entire family got the “Hong Kong” flu. We were all sick for weeks. I still remember it. My mom set up cots in my parents’ bedroom. My grandmother wouldn’t come take care of us because she didn’t want to get sick herself.
— WHP staff member

I Got a Shot Last Year…Why Do I Need Another This Year?

The viruses that carry the flu are always changing.  Flu vaccines are made specifically for each season. Even when they are not completely effective, they still provide some protection. The second reason we get flu shots every year is that the antibodies from previous vaccine viruses will decline over time and no longer protect you from flu viruses.

It's Free, Thanks To The Affordable Care Act! Don't Delay!

Under the Affordable Care Act vaccinations are FREE for those with insurance--and that includes Medicaid and Marketplace coverage, as well as Medicare and employer coverage. Flu shots are given out at pharmacies, doctors, and even your local health department!

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It's Thanksgiving. We're Thankful for the ACA!

President Obama signs the Affordable Care Act. Sitting to his right is former Rep. John Dingell, who represented much of Washtenaw County. 

President Obama signs the Affordable Care Act. Sitting to his right is former Rep. John Dingell, who represented much of Washtenaw County. 

#THANKSACA

The Affordable Care Act. The Patient Protection and Affordable Care Act. 

It's easy to remember some of the things the Affordable Care Act has done.

  • 20 MILLION more people in the U.S. have health insurance. 
  • In Michigan, over 600,000 people are enrolled in the Medicaid expansion, the Healthy Michigan Plan which includes medical, dental and vision benefits.
  • Vaccines are FREE.
  • Need help quitting smoking?  Nicotine patches and medications are FREE.
  • You cannot be denied health care because of a pre-existing condition. It doesn't matter if you have asthma, cancer, or depression--you can still get health insurance.
  • Young adults can stay on their parent's health insurance until they are 26
  • Your annual physical (wellness) appointment is FREE
  • For 2017, your out-of-pocket maximum can be no more than $7,150 for an individual plan and $14,300 for a family plan.
  • Women don't get charged extra for health insurance, and pregnancy is a covered benefit.
  • There are no annual or lifetime limits for insurance. 

#THANKSACA!

thankful

It's Open Enrollment from now until December 15, 2017. Don't miss a chance to get Marketplace coverage! Have questions?  Know someone who needs health care?  

We Help People - Like You! 

Call the WHP at (734) 544-3030

Come see us Monday - Friday between 9am - 4pm.  555 Towner St. Ypsilanti, MI (Except Thanksgiving and the day after Thanksgiving--we're closed.)

Want to read more about the impact of the ACA? 

Kaiser Family Foundation: The Effects of Medicaid Expansion Under the ACA

Medical geek?  From the New England Journal of Medicine, The Affordable Care Act at 5 Years

Data Geeky?  Reform by the Numbers from the Robert Wood Johnson Foundation.

Concerned about efforts to repeal the Affordable Care Act? Here is a way to keep up to date

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Open Enrollment Tips, Part 1: An Educated Consumer Is Our Best Customer

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Some of you--of a certain age--may remember the Sy Syms commercial, with the tagline, "An Educated Consumer is Our Best Customer." Well, what's true for buying clothes is even more true (100 times more important, probably!) for choosing health insurance. 

So here are a few things to know, if you are shopping for health insurance. 

1. If you are very low income, you may be eligible for Medicaid. If you think you are eligible for Medicaid, do the MIBridges Medicaid application. Don't assume the Marketplace will send you there correctly--it is supposed to, but the two systems are not well-calibrated. (We help with those applications, too.)

2. If you had a plan last year, don't let it auto-renew. Spend the hour it requires to assess everything again. Provide revised income estimates, check your dependents, update your address. Most importantly, the plans have changed. In some cases, they have changed A LOT. 

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Make sure you are aware of which doctors or health systems are in-network or out of network for any plan that you choose. These networks can also change between plan years. 

Because costs are calibrated for tax credits based on the second-lowest cost silver plan, when the costs for that plan change (and this year they changed a lot!), the tax credits change a lot too. But if you were eligible for subsidies before, and your income is similar, you will pay the same or less--but you may need or want to change plans.

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3. If your income is a bit higher than Medicaid, but still under 200% of the poverty level ($24,120 for a single person, $49,200 for a family of 4) you will probably find the best deals with the Silver plans. (Probably. You may still want to compare the gold and bronze plans as well.)

4. If your income is between 200% and 400% of the poverty level ($24,120-$48,240 for a single person, $49,200-$98,400 for a family of 4), it is highly likely that you will find the gold and bronze plans more appealing. Gold plans, on average, will cover 80% of your medical costs and Bronze plans, on average, will cover 60% of your medical costs. 

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Explainer: The Trump administration made some last-minute changes removing cost-sharing subsidies, which are only applied to silver plans. Because of this, the cost of silver plans went up more than the cost of gold or bronze plans. But because tax credits are calculated based on silver plans, your tax credit will likely go further on the bronze or gold plans. If you want the details, read this

5. If your income is over 400% of the poverty level ($48,240 for a single person, $98,400 for a family of 4), you will not qualify for tax credits. But you might find better deals off of the Marketplace. Work with an in-person or online insurance broker, and make sure you are choosing from ACA-compliant plans. These should be marked as Bronze, Silver, Gold or Platinum. If they are ACA-compliant, they will have the same essential benefits, but the cost may be less expensive.

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Washtenaw Health Plan staff will answer your questions and help you figure it out.  It's complicated.  Different people in a family may get different coverage. Parents may qualify for the Marketplace, kids may qualify for Medicaid or MIChild.  An older couple might have Medicare, Medicaid and/or Marketplace.  No situation is too complex, no question should go unanswered.  We'll help sort it out.  

Call 734-544-3030 or walk-in to 555 Towner St. Ypsilanti from 9 am to 4 pm Monday through Friday.  

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Six Things I Learned about Healthcare While Working at the WHP

Editors Note: This post was written by a wonderful summer intern, Madeline Higgins, as a reflection on her work over the summer. Madeline is a student in the MPH program at the University of Michigan School of Public Health, and we are sure she will go on to do great things!

I was lucky to intern at the Washtenaw Health Plan this past summer, where I got to observe the services that WHP provides and work with a new program involving Community Health Workers. Meanwhile, the federal government was attempting to greatly reduce the Affordable Care Act, which had the potential to negatively impact the health of residents in Washtenaw County. While I learned many facts, protocols, and systems, the items listed stick out most in my memory.

 

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1. There is a significant gap in understanding of the reality of healthcare and policy impact from federal legislators.

I believe this stems from decision makers finding information that enforces their current worldview instead of looking at fact-based data. While watching and reading about the legislative process for healthcare reform, I was struck by the lack of listening and understanding from both sides of the aisle. While everyone utilized individual stories to demonstrate their points, there was little conversation about population-level health outcomes. After reading reports and statistics which utilized a population health framework, it is obvious to me that overall, the Affordable Care Act has positively impacted health in the US.

 

2. You can work minimum wage full time and not qualify for Medicaid (as a single individual household).

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I learned this towards the end of my time with WHP. I hadn’t done the math before, and it was hard for me to imagine living on the minimum wage in the Ann Arbor area in regards to housing costs, let alone health care. To me, this further demonstrates the need for a livable minimum wage.

 

 

3. Pre-existing condition protections help us all.

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At some point in our lives, we are likely to experience some health setback where we utilize the healthcare system. It is advantageous to us all to include people with pre-existing conditions in the insurance pool because one day that could be us!

 

 

4. Everyone has questions about healthcare- and it is important to find places to get good information.

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The Washtenaw Health Plan is a great place to ask for help! No matter your insurance plan, there seem to be terms and deadlines that won’t make a lot of sense until you ask an expert or seek reliable resources. I also wrote a blog post this past summer about reliable resources regarding health care access, and it totally changed the way that I look for information about health.

 

5. People who do direct service work can (and must) also do policy advocacy.

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Washtenaw County is organized and ready for action! I sat in on many meetings where people were putting their heads together to make sure they had the right information to talk to colleagues, legislators, and their clients about how federal policy change (for example, reduction in SNAP benefits) is detrimental to our community. This is vital to both keeping their jobs but also elevating the health status of the Washtenaw County population.

 

6. Above all, if healthcare was treated like a human right, the tone of this conversation would be very different.

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People at the WHP recognize that healthcare is more complicated than having access to insurance. Health is about access to nutritious foods, opportunities to relax, space to exercise, and of course the occasional donut from Dom’s. Working in the county government showed the interconnectedness of the systems that comprise of people’s access to health. I believe if we are more inclusive to people’s needs we can work together to improve the health of Washtenaw County.

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Fight Repeal and Replace (Graham-Cassidy-Heller)! Support CHIP (Children's Health Insurance Program)!

Never let your guard down!  An effort to Repeal and Replace [the Affordable Care Act] has reared its ugly head again, threatening to take away healthcare from millions by ending Medicaid expansion (the Healthy Michigan Plan); raising costs for everyone; eliminating protections for pre-existing conditions; cutting coverage for low income seniors, children and the disabled; and attacking women's health and family planning.  

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The Congressional Budget Office (CBO) will not have time to fully score this bill before September 30th, 2017, and so there are not as many details about the costs and implications of this bill as there would be otherwise. However, the CBO has rated similar bills, and under those bills, 15 million people would lose Medicaid alone, and 32 million people might lose insurance. The Graham-Cassidy-Heller bill also privileges rural states over urban/suburban states, and Michigan is a clear loser. Large cuts to funding begin in 2020 but accelerate over time. Follow this twitter thread for a lot of details.

Under this bill, there would be huge premium increases for people with pre-existing conditions

Compare the bill to the ACA using the Kaiser Family Foundation comparisons web site.

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But What About MIChild?

The Children's Health Insurance Program (CHIP), which provides coverage to children who do not qualify for Medicaid but whose families cannot otherwise afford health insurance, is also under attack.  In Michigan, CHIP is the MIChild program. CHIP funding is set to expire on September 30, 2017. Although there is, in principle, bipartisan agreement on extending the CHIP program, including MIChild, this agreement is being set aside while the Senate focuses on the Graham-Cassidy-Heller bill.

This piece from the Georgetown Center for Children and Families does a good job explaining the conflict between the two efforts. As Kelly Whitener writes,

For example, it would not be possible to have a good faith negotiation on extending CHIP funding (which covers 9 million children) while there is a live debate on gutting Medicaid (which covers 37 million children). This is not simply a matter of Congress learning to multi-task – you simply cannot work toward two totally different goals simultaneously.

Without CHIP renewal, MIChild will end when the state's reserve runs out (likely, early spring of 2018). This puts the health of over 40,000 of Michigan's children at risk. 

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What Are Cost Sharing Reductions And Why Do They Matter?

Under the Affordable Care Act, there are subsidies for insurance. Both parts of the subsidies--the Advance Premium Tax Credits (APTCs) and the Cost Sharing Reductions (CSRs)--are part of the law. To cover those costs, the government pays the insurance companies that participate in the Marketplace for these subsidies. President Trump has proposed just not paying the CSRs, BUT--as Vox explains--

If CSR payments were not paid, insurers would still be required to reduce cost sharing, but they would now have to do it without the government’s help. They would have to raise premiums dramatically to make up the lost revenue. The irony is that if plans do raise premiums, the federal government would be on the hook for much of those costs. The government absorbs premium increases through the tax credits that help people afford coverage. The law is designed to keep premiums manageable for people, so it falls on the government to cover any excess increases.

Some Background: Two Parts Make The Subsidies Work

There are two parts to the subsidies that people who get health insurance through the exchanges may receive.

Part 1--which most people are familiar with--is called the Advance Premium Tax Credits (APTCs). They assist people who are up to 400% of the poverty level ($98,400 for a family of 4), to help afford monthly premiums.

Part 2--which most people are not familiar with--are Cost-Sharing Reductions (CSRs). These support families whose income is between 138% of the poverty level (Medicaid cut-off) and 250% of the poverty level ($61,500 for a family of 4), by reducing what they would pay for co-pays, co-insurance, and deductibles.

 

For Consumers, Cost-Sharing Seems Like Magic

For households that qualify, cost-sharing applies to silver plans (only), and transforms them into something better--often much, much better. 

The truth is, if not for the CSRs, low-income families might be able to afford the premiums, but visits to the doctor could be cost-prohibitive, and high deductibles and maximum out-of-pocket costs would mean that getting sick could still turn a family's life upside down.

More than half of the people in the U.S. who got health care on an exchange got cost-sharing reductions (7 million out of 12 million)! 

Actuarial Value

Actuarial value is an estimate of the percentage of costs that--on average--a plan will cover. (For any one family, this might be a bit higher or lower.) Under the ACA, a household with income below 150% of the poverty level can get a silver plan that covers 94% of their costs; a household with income between 151%-200% of the poverty level can get a silver plan that covers 87% of their costs; and a household with income  between 201%-250% can get a silver plan that covers 73% of their costs.

Summary

Basically, taking away Cost Sharing does not save the government any money and will contribute to Marketplace insurers opting out of the Marketplace.  The only people who will be hurt are people who are low income but not low enough for Medicaid. Republicans were eager to eliminate cost-sharing when the repercussions would be seen as Democrat's fault but now that the the White House and Congress are Republican, we hope they do not want this cut to be seen as their responsibility. The ACA's solvency relies on Cost Sharing Reductions and Advanced Premium Tax Credits. #savetheACA

-Ruth Kraut 

Have a question?  Type it in the comments section and we will get back to you.

More Information:

Republicans are begging Trump not to sabotage Obamacare - Vox

What are cost-sharing reductions, and what happens if Trump ends them? - Michigan Radio

ACA Cost-Sharing Subsidies: How One Decision Could Disrupt Obamacare Marketplaces - Kaiser Family Foundation

Larry Levitt Tweets 

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What's Wrong With The Senate Health Care Bill?

UPDATE:  On 6/27/2017, Senator Mitch McConnell, facing mounting opposition, announced that he will delay a vote on his legislation to repeal the Affordable Care Act until after the Senate’s Fourth of July recess. However, after the July 4th break, this bill could come back, in the same or a slightly different form. If you are looking for sources to follow the debates on an ongoing basis, find them here.


The Congressional Budget Office released their analysis of the Senate Republican plan.  Here is what the bill means. 

 

22 million more Americans
would be uninsured by 2026.

New York Times, June 26, 2017  

New York Times, June 26, 2017 

The budget office projects that by 2026, 49 million people would be uninsured, compared with 28 million people if the current law remained in effect. (The total increase is 22 million due to rounding.) Note that the biggest increase in the uninsured comes in the first year, when it is estimated that 15 million people could lose their insurance.


15 million fewer people would
be enrolled in Medicaid by 2026.

New York Times, June 26, 2017  

New York Times, June 26, 2017 

The largest group to lose health insurance coverage would be people with Medicaid. In 10 years, the C.B.O. projects, there would be 15 million fewer Medicaid enrollees. In addition, Medicaid might cover fewer benefits, so even those who have Medicaid might lose certain types of healthcare.


Average premiums would decrease by 20 percent in 2026.  BUT the amount Americans spend on healthcare would be higher because plans would offer FEWER benefits and DEDUCTIBLES would be higher. 


Want to know how this bill will impact you?

Are you a WOMAN?          Do you have a PRE-EXISTING CONDITION?          Do you need MENTAL HEALTH SERVICES?        SUBSTANCE USE ABUSE?          Live in a RURAL area?        Planning to START YOUR OWN BUSINESS?        SELF-EMPLOYED?      

Compare Proposals to replace the Affordable Care Act with this tool from the Kaiser Family Foundation. 

Comparison tool from the Kaiser Family Foundation, June 27, 2017.

Comparison tool from the Kaiser Family Foundation, June 27, 2017.

Thank you and keep up the good fight, 

-Meredith Buhalis 

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