Health care bill would mean more money in some pockets, less in others

The Republican health care bill working its way through Congress could make health insurance thousands of dollars more or less expensive each year for Northwest Arkansans of almost all ages, with older and lower-income people losing the most, a recent analysis shows.

The American Health Care Act filed earlier this month would replace or adjust several parts of the Affordable Care Act, or Obamacare. The proposal could change and has met opposition from several sides, but as of Friday it would decrease Medicaid eligibility and change the rules on how much older people's coverage can cost, for example, which would have their own effects on a family or individual's bottom line.

One of the most straightforward effects would come from the Republican replacement of Obamacare's health insurance subsidies for people with lower incomes with tax credits that would be open to far more people starting in 2020.

Those credits would range from up to $2,000 a year for people under 30 to up to $4,000 for people over 60, and would be open to anyone who's not covered by their employer or another source of coverage. A family could get up to $14,000 in all.

The benefits would start to taper off as a taxpayer's income reaches $75,000 and above, but someone making around $100,000 would still see some new dollars he could put toward monthly premiums. In contrast, Obamacare credits phase out once an individual reaches about $48,000 in income and are much more substantial for people near poverty.

Any tax credit is more than if the federal government gave no help, but the comparison with Obamacare's assistance is where the gains and losses appear.

Split picture

A 27-year-old in Washington or Benton counties making $40,000 a year would get $2,000 each year under the Republican proposal compared with nothing under Obamacare, for example, according to a county-by-county analysis from the nonpartisan Kaiser Family Foundation based on 2020 projections. The same person making minimum wage would lose almost $500 in aid and would have to pick up the difference.

A married-couple household in the Fayetteville-Springdale-Rogers metropolitan area makes about $70,000 a year at the median, according to census estimates. Such a pair in their 40s with two kids would get roughly $4,000 a year, or enough to shave about $300 off their monthly premiums.

Federal spending would go down by roughly $300 billion in the next decade through the reshuffling of tax credits, according to the Congressional Budget Office, the nonpartisan agency that estimates proposals' impact.

The change is enough of a windfall for some the office reported some people might drop out of employer-offered coverage to take advantage of the credit, though the plans could cover less and be harder to compare if they aren't on Obamacare's marketplaces.

"It'd benefit us greatly," said Michael Wanless, who was visiting Fayetteville from Tulsa last week with his wife, Johnna, and two kids.

A plan for all four on the Obamacare market would have cost around $800 a month, the Wanlesses said, so Michael stuck with his free employer coverage, they bought a $300 monthly package for the kids, and Johnna goes without. The new tax credit at their incomes and ages would be enough to completely cover that original Obamacare plan, though the price could change in the coming years.

"But, on the other hand, it makes you feel for the people that don't have that much," Michael Wanless said, noting he and his wife were making minimum wage when they married. "We were there 13 years ago."

Old and young

The loss for low-income people is greatest for people in their 50s and 60s who aren't yet enrolled in Medicare but have much higher health care costs because of their age, according to the Kaiser analysis. A 60-year-old with a $20,000 income in Benton and Washington counties would lose lose about half of their Obamacare assistance, almost $4,000.

They would be further hit by a provision of the bill that would let insurance companies charge its oldest policyholders five times as much as its youngest, compared with three times as much under Obamacare.

"It would be a big problem for them," said Jerry Mitchell, executive director for the region's Area Agency on Aging, which provides meal delivery, senior centers and other assistance for people age 60 and up or in Medicaid. The state is top in the nation for seniors who can't afford or access the food they need even without the further loss of aid, he said, and finding more work isn't always an option for them.

The Congressional Budget Office projected the number of people between 50 and 64 without insurance would more than double to almost one in three under the bill and many older, more costly enrollees would leave the insurance market because of higher prices and other factors. Republicans have countered everyone will have the ability to choose whether to buy coverage.

The Republican bill could affect the other end of the age range as well, and not just with tax credits. The bill would allow states to lower family income limits for Medicaid and other health coverage for children to near the poverty level, which is about $25,000 for a family of four, after 2019, said Marquita Little, health policy director for Arkansas Advocates for Children and Families.

Arkansas currently offers its ARKids First program to children in families with incomes up to around twice that.

More than 100,000 children in the state could lose that coverage for all or most of their checkups, dental care and other services if the state lowers eligibility in such a way, according to the liberal-leaning Urban Institute in Washington, D.C.

"Without ARKids we would have been broken," said Justin Lee, a single father of two and Air Force veteran in Fayetteville who's living in public housing while he works toward a master's degree and career in mental health services. ARKids has covered his 4- and 12-year-old's shots, dental checkups and needed ear tubes.

Lee's family would still be eligible under the Republican proposal, but he said other families are in similar situations and he'd oppose the decrease in coverage even if he were well off.

Looking ahead

Some or all of these provisions could change as the bill moves through Congress. The American Health Care Act has met sharply mixed reactions among members.

Democrats have derided it as "Robin Hood in reverse," and several Republicans have voiced similar concerns over the potential coverage losses or said the bill doesn't address the rising cost of health care itself.

"I think it's fixable, but it needs a lot of fixing," Sen. Tom Cotton, R-Ark., told National Review last week.

Rep. Steve Womack of Arkansas and others have said it's better than keeping Obamacare and could spur competition, foster personal responsibility, shift Medicaid control to states and lower both health insurance prices and federal spending overall.

A Fox News poll last week found half of voters have a favorable opinion of Obamacare, while one-third approve of the Republican proposal.

The Republican-controlled House Budget Committee on Thursday endorsed a handful of nonbinding tweaks, including a proposal from Rep. Tom McClintock, R-Calif., to narrow the bill's tax credits toward lower incomes rather than extending them to six-figure families.

Some more conservative Republicans have pushed to make the bill come into effect faster or say it doesn't do enough to repeal Obamacare. President Donald Trump said last week the proposal's being adjusted, though he didn't give much information about how.

"I want everyone to know I'm 100 percent behind this," he told reporters about the bill. "This is going to be fantastic."

NW News on 03/20/2017