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senate Bill S. 1213

Should Obamacare’s Health Insurance Tax Credits & Subsidies Be Expanded?

Argument in favor

Health insurers that are making money from Medicare and Medicaid (both government-funded healthcare programs) should be required to participate in the ACA exchanges. That will help ensure affordable, accessible health insurance for more Americans along with expanded Obamacare tax credits and insurance subsidies.

jimK's Opinion
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08/08/2019
I believe that healthcare needs to be universally available. The ACA is a hard fought and well established foundation upon which to build and reach that goal. By enforcing compliance with rules and policies established for Medicare it ensures more of an Apples to Apples comparison of exchange offered plans with limited 'surprises' in what may or may not be covered. Further, it ensures that offerors are competing to structure the details of their plans and to offer a high quality of service in order truly compete with others by offering plans that best address chosen details of implementation and the services provided. For example, if one plan has higher deductibles or co-pays, this can be compared directly with a competitors plan that may cost more but with less out-of-pocket expenses. Let consumers decide. I think this is the best approach for intelligently transitioning to a cost effective universal health care program that best meets the needs of most people.
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Mark's Opinion
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08/08/2019
Gotta laugh at all the inane posts from conservatives regarding ‘socialism’. Make sure you don’t drive on any of those socialism roads on your way to work today.
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burrkitty's Opinion
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08/08/2019
On the way to a UNIVERSAL SINGLE PAYER HEALTHCARE SYSTEM.
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Argument opposed

Forcing health insurers into the ACA marketplace just because they make money off Medicare and Medicaid could put them into financially untenable positions, which have caused major insurers to leave the Obamacare exchanges in the past. This could in turn harm all consumers’ abilities to purchase health insurance.

Tom's Opinion
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08/08/2019
Let this dead horse lay. We need a new, workable program.
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David's Opinion
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08/08/2019
Socialized medicine will push us into bankruptcy much sooner. Obamacare is a third party payer system. Other people, spending other people’s money on other people. There is no control of cost or quality because Government is spending other people’s money on a service for someone else which doesn’t effect them so there is no concern for cost or quality. Besides that, Federal Government is constitutionally not allowed to do this.
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SneakyPete's Opinion
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08/08/2019
🤔 What Are the Cons of the Affordable Care Act (AKA - ObamaCare)? 🤔 Forcing health insurers into the ACA marketplace just because they make money off Medicare and Medicaid could put them into financially untenable positions, which have caused major insurers to leave the Obamacare exchanges in the past. This could in turn harm all consumers’ abilities to purchase health insurance. ACA (AKA-ObamaCare)POINTS ONE MUST CONSIDER: 1. It raises the cost of health insurance for many Americans.The Affordable Care Act (AKA-ObamaCare)was intended to bring in more low income households to the insurance market. Low income individuals could receive government subsidies to make their insurance affordable. For higher income families, those subsidies were not made available. The law also requires a wider range of services and benefits to be covered, which means health insurance plans had to be generic instead of specifically tailored to individualized needs. This has caused premiums to rise dramatically over time. 2. There is an individual mandate which requires insurance or a fine. Because the Affordable Care Act (AKA-ObamaCare) includes coverage for high risk groups of individuals, a mandate had to be implemented to include healthy individuals to offset the other group. This mandate requires insurance to be obtained or to pay a fine of up to 2% of one’s income. It is a fine that the Supreme Court viewed as a tax, so allow for it to be implemented. 3. More taxes were built into the Affordable Care Act (AKA-ObamaCare). Besides the individual mandate, the Affordable Care Act (AKA-ObamaCare)also requires additional taxes on medical devices and pharmaceutical sales. Individuals with high incomes also saw potential tax increases on certain income sources. Part of the funding also came from savings in Medicare payments, which reduced the number of doctors accepting this plan. In essence, the wealthiest in the US are being asked to fund the health care for the poorest. 4. It makes it difficult to access a doctor in some communities. In rural areas, the Affordable Care Act (AKA-ObamaCare)brought hundreds of previously uninsured families into the healthcare community. This created more appointments for doctors, which reduced physician access for everyone. Even in the first year of the law’s implementation, it was not unusual for a waitlist of up to 6 months to form when accessing optional services from local doctors. 5. Enrolling in the Affordable Care Act (AKA-ObamaCare) is an extensive process. Since having health insurance is required because of the Affordable Care Act, many are forced to endure a very complicated enrollment process. Public health agencies, hospitals, and other social services or medical providers set up assistance programs to guide consumers through this process, but the complication of finding the right coverage for the right need can be a somewhat tricky process to get right – even with help. 6. Some businesses cut employee hours to avoid the coverage mandates.Under the Affordable Care Act (AKA-ObamaCare), any business with 50+ full-time employees is required to offer insurance or make payments to cover employee healthcare expenses. To avoid this coverage mandate, some business owners decided to cut the hours of their employees to less than 30 hours per week, which allowed them to be classified as a part-time worker so that the required costs could be avoided. 7. Many private health insurance plans were canceled because of the Affordable Care Act. Because the Affordable Care Act (AKA-ObamaCare) requires 10 essential services to be provided, insurers canceled many plans instead of changing them. This caused many families to lose their affordable insurance, being forced to replace it with a higher cost plan that included services that many people didn’t need or want. Maternity care is often the most cited example of the problems this law created in this area. 8. It increased the medical expense deduction for all families. Before the Affordable Care Act (AKA-ObamaCare), families could itemize and deduct medical expenses which exceeded 7.5% of their income for that year. In 2013, the law changes this so that deductions couldn’t begin until families spent at least 10% of their income on medical expenses. For a family of 6 earning $100,000 per year, that meant an additional $2,500 that could not be deducted. SneakyPete.......... 👍🏻👍🏻👍🏻👍🏻👍🏻. 8.8.19.........
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bill Progress


  • Not enacted
    The President has not signed this bill
  • The house has not voted
  • The senate has not voted
      senate Committees
      Committee on Finance
    IntroducedApril 11th, 2019

What is Senate Bill S. 1213?

This bill — the Consumer Health Insurance Protection Act of 2019 — would require health insurers which provide coverage under Medicare and Medicaid to participate in the exchanges established by the Affordable Care Act (ACA or Obamacare). Its key provisions include  increasing federal subsidies for people buying ACA plans, expanding eligibility for ACA tax credits, capping premiums at 8.5% of income, ensuring plans cover essential health benefits, and imposing tighter controls on private insurers by banning short-term, limited coverage “junk” insurance plans.

Specifically, this bill would: 

  • Require companies to live up to the same standards that are set for private insurers when they participate in Medicare and Medicaid.
  • Set limits on insurance company profits to match those insurers can earn in Medicare and Medicaid.
  • Set up an ombudsman program to track consumer complaints about insurers.
  • Protect against unreasonable premium increases with stronger rate review standards.
  • Require insurers providing coverage under Medicare and Medicaid to offer coverage on the ACA exchanges in areas with limited insurer competition.
  • Increase premium tax credits, expand cost-sharing reduction (CSR) subsidies, and make more families eligible for premium tax credits to guarantee that every individual on the ACA exchanges has access to a plan that covers 80% of out-of-pocket costs and costs no more than 8.5% of income in premiums.
  • Guarantee payment of Cost Sharing Reduction reimbursement payments (CSRs);
  • Strengthen protections for essential health benefits.
  • Require all short-term insurance products to meet ACA standards.
  • Block the Trump administration's regulations on association health plans.

Impact

Health insurance purchasers; health insurance companies; health insurance companies making money off Medicare and/or Medicaid; insurance company profits; ACA; ACA plans; ACA marketplace; Trump administration regulations on association health plans; and CSR subsidies.

Cost of Senate Bill S. 1213

A CBO cost estimate is unavailable.

More Information

In-DepthSen. Elizabeth Warren (D-MA) reintroduced this bill from the 115th Congress to build on the Affordable Care Act (ACA), hold health insurance companies accountable and strengthen consumer protections in private health insurance

“A family's security can be swept away with just one bad diagnosis - just like with my little family back in Oklahoma. When I was 12, my daddy had a heart attack and we almost lost everything. So long as private health insurance exists, there is no reason to allow our health care to be held hostage by insurance companies that refuse to do better. Our bill will hold them accountable while significantly improving access to health care for millions of Americans."

Sen. Warren, who supports single-payer healthcare and is a cosponsor of legislation to that effect introduced by Sen. Bernie Sanders (I-VT), does not envision this plan as an alternative to more ambitious proposals. However, as she made clear in a January 2019 speech to the consumer group Families USA, she understands that enacting a single-payer plan would be difficult, and that private insurance probably wouldn’t disappear overnight. Thus, she envisions this bill as a way to get something done right away to subject the health insurance industry to the type of stringent consumer financial protections she’s already successfully championed in the financial sector. Sen. Warren tweeted to this effect when she introduced this bill in 2018: 

“We need #MedicareForAll – and until we get it, there's no reason private insurers can't provide coverage that lives up to the high standards of our public health care programs.”

Last Congress, original cosponsor Sen. Kamala Harris (D-CA), who is also an original cosponsor of this bill in the current Congress, said

"No one should have to choose between receiving quality healthcare and putting food on their table, a roof over their head, or retiring with dignity. This legislation is a critical step forward for Americans who are feeling their paychecks squeezed over rising costs of healthcare as insurance companies earn record profits.” 

Families USA is among a number of consumer advocacy groups that supports this bill. Its Senior Director of Federal Relations, Shawn Gremminger, says

“Families USA is proud to support Senator Warren’s Consumer Health Insurance Protection Act. This is a robust, comprehensive bill that is aligned with our mission to put consumers first.  It provides extensive reform to the private health insurance markets and strengthens consumer protections —including protections for individuals with pre-existing conditions. We appreciate that the bill aims to improve our current coverage system—which is critical to any component of the next generation of health care coverage. We urge members of Congress to support this legislation that takes real steps to improve access to affordable health care for America’s families.”

Writing for the Black Agenda Report, Margaret Kimberley argues that this bill props up a poorly-designed health insurance system

“This… is a plan to provide subsidies to pay for a system that is unnecessarily costly. Like Obamacare, it enshrines private sector control, which is the cause of all our health care problems.”

In March 2018, the CBO projected that funding CSRs (the Trump administration stopped funding them in October 2017, arguing that there wasn’t an appropriation for these payments) would actually reduce, not increase, Obamacare coverage. In an analysis comparing the effect of funding CSRs against a baseline where CSRs aren’t being paid, the CBO found that because funding CSRs would effectively cut subsidies for many subsidized enrollees, this would reduce healthcare coverage by 500,000 to one million people by 2021.

This bill has six Democratic cosponsors in the 116th Congress. Last Congress, it had six cosponsors, of whom five were Democrats and one was an Independent, and didn’t receive a committee vote. The bill is endorsed by Families USA, Consumers Union, Public Citizen and Community Catalyst.


Of NoteAlthough the Affordable Care Act (ACA) ended some of health insurance companies’ most egregious practices — such as annual and lifetime coverage limits and discrimination against those with pre-existing conditions — that they previously used to shift costs to patients, many patients continue to struggle with getting adequate, fairly priced coverage. According to Sen. Warren, three out of 10 American adults with health insurance now says they’re having a hard time paying their medical bills

Simultaneously, health insurance companies are pulling in nearly 60% of their revenue (over $200 billion in 2016) from Medicare and Medicaid. Simultaneously, some of these insurers claim they can’t afford to participate in the ACA exchanges.

In health insurers’ defense, it’s worth noting that since Obamacare’s inception, numerous major insurers have been forced to leave the ACA marketplace due to higher than expected expenses, especially in states that didn’t expand Medicaid under the ACA. Simultaneously, since Trump took office, there has been uncertainty as to whether the Trump administration would continue paying CSR payments to defray medical costs for low-income people on ACA plans. Should the Trump administration choose to stop making these payments (a relatively easy proposition, as it would merely have to stop appealing a 2014 court decision), it would leave insurers in the ACA marketplace liable for billions in medical expenses. 

Additionally, nearly a third of the 23 nonprofit health insurance plans (also known as co-ops) created by the ACA were out of business by the end of 2015. By July 2016, there were only seven of the original 23 co-ops remaining — and all had lost money in FY 2016, at a $1.7 billion cost to taxpayers in the form of federal loans. Lower-than-expected payments from the federal government were a challenge to these organizations’ fiscal health.

The Kaiser Family Foundation (KFF) reports that while a number of insurers exited the ACA marketplace or reduced their service areas in 2018 due to legislative and regulatory uncertainty, bringing the average number of companies per state to 3.5 in 2018 (versus 4.3 in 2017), this trend is reversing for 2019. In November 2018, the average number of companies per state for 2019 was 4.0, ranging from one company in five states (Alaska, Delaware, Mississippi, Nebraska, and Wyoming) to more than 10 companies in three states (California, New York and Wisconsin). For 2019, 58% of enrollees (living in about 23% of counties) had a choice of three or more insurers, up 10% from the 48% of enrollees who had so many options in 2018. 

A 2015 Urban Institute study assessing the cost of a plan with several features like this bill, including switching to a gold plan benchmark for subsidies, found that it would cost $221 billion over a 10-year period.


Media:

Summary by Lorelei Yang

(Photo Credit: DJHEAVYD via Flickr / Creative Commons)

AKA

Consumer Health Insurance Protection Act of 2019

Official Title

A bill to provide health insurance reform, and for other purposes.

    I believe that healthcare needs to be universally available. The ACA is a hard fought and well established foundation upon which to build and reach that goal. By enforcing compliance with rules and policies established for Medicare it ensures more of an Apples to Apples comparison of exchange offered plans with limited 'surprises' in what may or may not be covered. Further, it ensures that offerors are competing to structure the details of their plans and to offer a high quality of service in order truly compete with others by offering plans that best address chosen details of implementation and the services provided. For example, if one plan has higher deductibles or co-pays, this can be compared directly with a competitors plan that may cost more but with less out-of-pocket expenses. Let consumers decide. I think this is the best approach for intelligently transitioning to a cost effective universal health care program that best meets the needs of most people.
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    Kill Obamacare now. #MAGA
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    Gotta laugh at all the inane posts from conservatives regarding ‘socialism’. Make sure you don’t drive on any of those socialism roads on your way to work today.
    Like (68)
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    On the way to a UNIVERSAL SINGLE PAYER HEALTHCARE SYSTEM.
    Like (57)
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    One small step for the ACA. One giant leap for Medicare for All. Stop Trump and Republicans from decimating healthcare.
    Like (40)
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    Most every industrialized country in the world treats healthcare as a right rather than a business. America which has too long kowtowed to its business lobbyists should be working to bring healthcare to all of our citizens. I strongly support this legislation if and when (and that is in question with Moscow McConnell in charge) it is brought up for a vote.
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    Obamacare is all there is for many of us who are deemed uninsurable otherwise. Until Trump allowed some healthy people to opt out, it worked. Now it’s crippled but until we have Medicare for All, it’s what we have and we must provide enough for it to keep doing its jobs.
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    Anynomus, your ignorance is showing. Your big, fat, orange Daddy weakened the ACA, considerably, once he illegally assumed the title of President. The problem is the heartless pig and his Repugnant minions, who promise you the world then take it away, once you put them in power. Wake up, you fool. You are just a damned pawn... As to the answer to the question, it’s the least we can do! Shore it up and put the mandate back in. Sounds like a good idea to me. At least, until we have the same care for all. Oh, and while you’re at it, take away the ridiculously advantageous medical package our “leaders” get. Same care for ALL. WE ARE ALL THE SAME. Additionally, there should be no special care for these people as they are NOT doing their jobs! P.S. (Let’s takeaway their ungodly pensions, too! Social Security is good enough for you and me. Should be good enough for them also. Vote these current idiots out and let’s get some REAL legislation that supports ALL OF US, not just the “elite” enacted! )
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    There is no other alternative that’s been established despite 45’s promise to bring better health care to all. There needs to be some way for people to get good medical care as people are dying while waiting for the care we all deserve. They also needs to more competitive rates as some people are forced to pay a large percentage of their pay for insurance which comes with big co pays. As I said before, the people we pay get much better healthcare than the tax payers have & that to me is not right. Surely we would get better health insurance IF WE COULD VOTE OUR OWN IN.
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    Let this dead horse lay. We need a new, workable program.
    Like (15)
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    Obamacare should have never existed
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    Expand and work towards Universal Healthcare
    Like (13)
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    We need to reverse the damage Trump has done to the ACA and expand it on the way to implementing a Medicare-for-all system!
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    Yes. And the super wealthy citizens who free load off our tax dollars should pay for it. Along with the free loading corporations that pay $0 in federal income taxes.
    Like (13)
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    Yes. Strengthen ACA. Vote YES on Elizabeth Warren’s bill. Strengthen ACA We The People rely on ACA.
    Like (12)
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    Socialized medicine will push us into bankruptcy much sooner. Obamacare is a third party payer system. Other people, spending other people’s money on other people. There is no control of cost or quality because Government is spending other people’s money on a service for someone else which doesn’t effect them so there is no concern for cost or quality. Besides that, Federal Government is constitutionally not allowed to do this.
    Like (11)
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    Look at systems that has been working for decades in other more civilized countries!!!
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    Universal Helthcare just like every other industrialized country on the planet. As for the anti socialism conservatives. What do the Republicans have for you? What are the Repugnants doing to lower your premiums and deductibles? Repugnants have nothing to offer you. Zero, nothing...In all your misguided brilliance you deny those who are offering a solution to your problems in favor of a party who is raping you everyday. You have been gas lighted. You don’t even believe that you deserve better because you have been manipulated. Assholes🖕
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    The ACA helps many people. We need to expand benefits to be more inclusive
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    Until a new BETTER program is in place. The ACA needs to be kept in place.
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