Nevada Representative Mark Amodei (R-NV2) is eager to let his constituents know that the District will not be negatively impacted by the GOP health insurance/tax cut bill currently being drafted in secret on Capitol Hill. Not. So. Fast.
First, there will be losses. Total coverage losses are projected to be felt by 37,500 under the AHCA, and 5,700 of those will be children, another 700 are disabled individuals in District 2. Representative Amodei is optimistic about what will happen to these constituents —
Any Nevadan who has enrolled in the expanded Medicaid program from its inception in 2014 through the end of 2019 is free to remain in the program so long as their income does not exceed 138% of the national poverty level; …
In short, according to Rep. Amodei, his constituents are to be carefree and happy about their health insurance coverage until the end of 2019. It’s now 2017. Thus the recipients are to be reassured for another two years because:
Nevada will continue to receive the enhanced federal Medicaid funding for enrollees that it is currently receiving for as long as that enrollee stays in the program;
Present expanded enrollees lose eligibility only if they exceed income of 138% of the national poverty level, or if they elect to take employer provided or private health insurance;
Lovely, until we peek into the House version (the basis for the Senate version) and find:
“Medicaid provides coverage for over 70 million individuals and relies on both federal and state funding to continue growing. Under current law, the federal government covers, on average, 57 percent of each state’s total Medicaid costs, no matter the amount. The states pay for the remainder.
In contrast, under the AHCA’s per capita cap Medicaid program, starting in 2020, the federal government would provide states with a flat, capped dollar amount of funding for each person they enroll. The dollar amount is based on states’ 2016-level per-enrollee spending.”
One way to interpret this is that the District’s enrollees will be fine for the moment, but should be aware that the sword labeled ‘the Medicaid Per Capita Lid’ is swinging over head. This has the potential to burst the first of Amodei’s bubbles.
Secondly, there’s this part of Representative Amodei’s eternal optimism:
“While we understand that Medicaid Expansion will eventually be phased out, we expect the recovery of our economy to continue, giving us reason to believe we will not need as robust of a safety net as we once needed at the height of the recession. Additionally, with Nevada leading the nation in job growth in 2016, we also can expect employer-based coverage to become available to more people.”
A bit of confusion reigns here — don’t worry about Medicaid expansion cuts because Nevadans will be covered — but notice that the Medicaid expansion will “eventually be phased out.” One really doesn’t get to have it both ways. But, there’s more.
Yes, the Gallup 2016 Job Creation Index gives Nevada top marks for job creation, but remember that this polling is based on asking workers if the employer is increasing hiring. It is also statewide. If we drill down we find positive news, but an incomplete picture.
“Employment increased in Nevada’s two large counties from September 2015 to September 2016, the U.S. Bureau of Labor Statistics reported today. (Large counties are defined as those with 2015 annual average employment of 75,000 or more.) Washoe County’s employment rose 5.0 percent and Clark County’s employment rose 3.7 percent.” [BLS]
What we are required to believe is that employment increases in District 2 will be sufficient to cover some 37,500 people who will need to find employer paid insurance coverage by 2020. Exactly how this is supposed to happen isn’t all that clear.
There are too many “ifs” in the proposition to adopt it with any enthusiasm. IF there is continued employment increases — in the face of the financial deregulation legislation in the House and Senate which threaten to recreate the Wall Street Casino environment that wrecked Nevada’s economy in 2007-2008. IF the employment increases in the rural portions of District 2 are sufficient to put Medicaid expansion enrollees into employer plans.
And then, there are the problems intrinsic in the AHCA in the employer sponsored insurance plans. Those believing that the AHCA will deliver the same level of health insurance coverage in employer sponsored plans as the ACA may be in for a rude shock.
“The amendment (to the AHCA) would allow states to apply for waivers to rescind two major regulations of Obamacare, if the state can prove that healthcare costs would decrease as a result. That has led to concerns about its potential effects on the individual insurance market, but it could also change insurance for people that get coverage through their employers.
One of those Affordable Care Act-implemented protections — called essential health benefits (EHB) — requires insurers to cover a baseline of 10 health procedures and items including emergency-room visits, prenatal care, mental-health care, and some prescriptions.
Under Obamacare, employer plans could not place a lifetime limit on the amount that the plans pay out on EHBs, and required plans to limit the amount of out-of-pocket costs an employee had to pay annually, according to The Journal. That made plans more costly for employers but also provided better coverage for employees.”
Thus, there are three problems — junk plans might be back in the market; essential benefits can be reduced; and lifetime and annual benefit limits could be reintroduced. We can safely assume that Representative Amodei’s analysis contains the usual measure of Trickle Down Happy Talk (if only the tax cuts are big enough all employers will hire enough people to make the magic happen! — See Kansas) and assumptions which sound superficially rationale but don’t hold up to much scrutiny.