Skinny Repeal. It’s not the latest weight loss treatment. Or a sequel to the Poison song “Unskinny Bop.” And, it’s not at all related to my favorite skinny vanilla latte. It’s the most recent effort on the part of Republicans to repeal the Affordable Care Act (ACA or Obamacare). Here’s what you need to know about how it might impact you and the challenges facing us as health care communicators.
Wait – how did we get from “Repeal and Replace” to “Skinny Repeal”?
The Senate rejected a proposal yesterday that would have repealed major parts of ACA, but Republican leaders are growing more confident about their chances of passing a more modest overhaul of the health care law later this week.
Ultimately, the Skinny Repeal is a tactic to “kick the can down the road,” so that Senators can bring something to conference committee, where the Senate and House will work together to rebuild the bill as an option.
What makes the repeal bill “skinny”?
It removes three of the least popular aspects of Obamacare (but notably, key aspects to making it work):
- The insurance mandate which requires nearly all Americans to obtain health insurance or pay a penalty
- The employer mandate, requiring companies with at least 50 full-time equivalent employees to provide affordable coverage to their full-time workers
- Taxes on medical device manufacturers (which will generate $19.6 billion in federal revenue over a decade), and perhaps also insurers
Implications of the bill
What’s not to like? While this option leaves Medicaid expansion untouched (which increased Medicaid coverage in 31 states and D.C. to include people with incomes up to 138% of the federal poverty rate), it would cause premiums to increase by 20 percent and increase the number of uninsured by 15 million people by 2026, according to a CBO analysis.
Why the increase in premiums and uninsured?
If it passes, the Skinny Repeal is expected to accelerate health plans leaving the individual market, increase premiums, and result in fewer Americans having access to insurance.
Remember when, nearly four years ago, I wrote about the importance of young people signing up for Obamacare? Of course you do. It’s all about the healthy balancing out the sick. And, it takes a lot of healthy people to balance out a much smaller number of people with chronic conditions – a study from the Department of Health and Human Services estimates that 5% of Americans are responsible for 50% of health care costs. Even with the individual mandate, it’s not always enough to balance out patients with conditions that are expensive to manage. For instance, in Iowa, all three insurers in its individual insurance market may ultimately leave due to the risk of caring for one teen who has severe hemophilia, which costs $12 million a year to treat. With only 30,000 Iowans in the individual insurance pool, insurers say it’s just not enough to manage the cost.
So who is going to pay more?
Individuals receiving government subsidies will be largely unaffected, as their increased premiums will be offset by larger government subsides. Rather, it’s the middle class that will be priced out of the market – these individuals don’t receive subsidies, and many utilize the exchanges because they are self-employed.
The impact for providers?
Many middle class people who were previously insured under the exchanges will be priced out of the individual insurance market and will return to their uninsured status. The uninsured are more likely to utilize the emergency room (and less preventive care) and drive bad debt for providers.
How about insurers?
It’s a nightmare scenario for insurers, who count on having a balanced risk pool for the reasons discussed above. According to the Chicago Tribune, “Joseph Swedish, the chief executive of Anthem – the nation’s second-largest health insurer – said on a conference call to review second-quarter earnings that the company is reassessing its participation in ACA marketplaces for next year. Anthem has decided to largely withdraw from the markets in three of the 14 states it participates in, and he said it may stop participating elsewhere unless the markets seem stable.”
And what about health care communicators?
At this point, it’s less about the known impact and more about the uncertainty. Some health care organizations are bracing themselves by cutting budgets and putting programs on hold. Others are investing even more in advocacy at the state level, because they know that is where change happens. One thing is for sure, communicators are coping with a new media environment, as health reform and Trump news leave little room for anything other than pitches tied to breaking news, controversies, or today’s trends. Bye bye evergreen story.
The Skinny Repeal has the most promise of any bill thus far in terms of advancing the repeal of Obamacare. Keep your seat belts fastened as it will likely continue to be a bumpy ride. In the wise words of Poison in “Unskinny Bop”:
What the hell is going on?”
Stay tuned to The Buzz Bin and we’ll let you know!