Andy Slavitt: GOP healthcare bill built on 'faulty' math
The former head of the Centers for Medicare and Medicaid Services breaks down problem he sees with bill in 25-part Twitter thread.
Both supporters and opponents of the just-released Republican plan to replace the Affordable Care Act are taking to social media to share their thoughts about the proposed bill.
Chief among them is former Centers for Medicare and Medicaid Services Acting Admin Andy Slavitt, who took to Twitter Monday night to post a 25-part tweetstorm about the bill.
Here is that thread:
Reviewing #ACA replacement bill w number of experts. Later 2night, I will tweet out my top observations from bill.
Follow if interested.
-- Andy Slavitt (@ASlavitt) March 7, 2017
Spent evening talking to a number of people about policy and politics of AHCA, #ACA replacement bill. 1
-- Andy Slavitt (@ASlavitt) March 7, 2017
Some things are fairly obvious. But policy analysts going to work on the bill are finding a lot of implications that don't meet the eye. 2
-- Andy Slavitt (@ASlavitt) March 7, 2017
The headlines are all wrong, focusing on how similar/different insurance rules are 2 #ACA. The changes aren't good, but not the big story. 3
-- Andy Slavitt (@ASlavitt) March 7, 2017
True headline 1: the bill is basically a tax cut ($600 billion) funded by gutting Medicaid. 4
-- Andy Slavitt (@ASlavitt) March 7, 2017
The tax cuts r 4 wealthy, insurance cos, pharma, tanning sals, med device. Funding cuts from low income, seniors & kids. W permanent caps. 5
-- Andy Slavitt (@ASlavitt) March 7, 2017
Headline 2 is also fairly obvious. AHCA violates all President's commitments. Covers fewer, takes away protections, ⬆️ prems & deductibles.6
-- Andy Slavitt (@ASlavitt) March 7, 2017
It basically takes all the things Rs complained about & makes them worse. But the affordability problems have an even worse impact. 6
-- Andy Slavitt (@ASlavitt) March 7, 2017
Here r some of the affordability issues. Notice they hit ppl under 250% of FPL & > 55 hardest. Regressive but it leads to something worse. 8 pic.twitter.com/VE7DuVyCJn
-- Andy Slavitt (@ASlavitt) March 7, 2017
Headline 3: The math for AHCA is faulty. It leads to bad risk & a death spiral which means pre-ex protections are likely on paper only. 9
-- Andy Slavitt (@ASlavitt) March 7, 2017
Analysts are very clear on this point so worth explaining. It has to do with how tax credits are designed. 10
-- Andy Slavitt (@ASlavitt) March 7, 2017
First, tax credits vary by age, not income. For low income & seniors, makes premiums unaffordable. Unless you're very sick, you can't pay.11
-- Andy Slavitt (@ASlavitt) March 7, 2017
Second, tax credits don't vary by region. Premiums unaffordable in places like Alaska, except to very sick. 12
-- Andy Slavitt (@ASlavitt) March 7, 2017
As premiums increase, unlike in ACA, in AHCA tax credits don't rise. So lower income slowly drop out. Increases are pegged to CPI. 13
-- Andy Slavitt (@ASlavitt) March 7, 2017
In a nutshell, over time, low income can't afford their premiums unless they're sick. Compounded by no help w deducts, co-pays. 14
-- Andy Slavitt (@ASlavitt) March 7, 2017
And when the ind mandate goes away, premiums are estimated to increase 25%. And when employer mandate goes away, fewer employers cover. 15
-- Andy Slavitt (@ASlavitt) March 7, 2017
Headline 4: Less wonky, more marketing. Evidence of focus groups promote popular features, at expense of reality on deeper reading. 15
-- Andy Slavitt (@ASlavitt) March 7, 2017
For example, unpopular high risk pools out but money in block grant is there. Also expansion cuts, essential benefits delayed until '20. 16
-- Andy Slavitt (@ASlavitt) March 7, 2017
I admit I can't number my Tweets. 18
-- Andy Slavitt (@ASlavitt) March 7, 2017
The biggest marketing gimmick is to release it, or mark it up, or potentially even vote on it without a CBO score. 18
-- Andy Slavitt (@ASlavitt) March 7, 2017
Headline 5: Bad for Medicare. Reduces life of Trust Fund with the giant tax cuts. I believe this is done to force more draconian cuts. 19
-- Andy Slavitt (@ASlavitt) March 7, 2017
Headline 6: Bad for public health. Cuts prevention benefits, cuts tanning salon tax break, defunds Planned Parenthood. Costs lives and $. 20
-- Andy Slavitt (@ASlavitt) March 7, 2017
I'm wrapping up now. So what's the benefit? It doesn't solve the "sky is falling crisis" message. It doesn't cover more or reduce costs. 21
-- Andy Slavitt (@ASlavitt) March 7, 2017
But, AHCA accomplishes this: if healthy & can save, you win. If you want entitlement reform, cuts Medicaid & puts Medicare into a crisis.22
-- Andy Slavitt (@ASlavitt) March 7, 2017
This is a telling story. Price, per 1 Gov, told him he would "back into" size of the Medicaid cuts based on what's needed at Fed level. 23
-- Andy Slavitt (@ASlavitt) March 7, 2017
So broad strokes, cuts spending 7 cuts taxes while sending individual insurance market, millions of ppl into tailspin w cheap packaging, 24
-- Andy Slavitt (@ASlavitt) March 7, 2017
That makes this a terrible vote to ask ppl to take before considering the awful politics. No thanks. Done/25
-- Andy Slavitt (@ASlavitt) March 7, 2017
Twitter: @HenryPowderly
Contact the author: henry.powderly@himssmedia.com
