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Wednesday, June 28, 2017

The real winners and losers in the Republican "health care" plan


     It is easy to see the winners in the Senate Republican health care legislation.   Those couples making more than $250,000 or a single person making more than $200,000 will have a repeal of the 0.9% additional Medicare tax and 3.8% tax on investment income put in place with Obamacare legislation.   For someone with a million dollars in investment income that would be an additional $38,000 in taxes.   These taxes are to pay for the dollars to fund the subsidies given to lower and moderate income persons purchasing health care through the exchanges.
     While there are a variety of losers with the Republican health care bills there is one group that will probably be the biggest losers.    The Republican plan would have the amount spent on Medicaid over the next ten years at the amount spent in 2016.  Obamacare would have the amount spent growing by a little over 200 billion dollars in the ten years.    Before Obamacare Medicaid paid for medical care for elderly poor (mainly in nursing home care), the disabled, pregnant women and children.  Obamacare through expanded eligibility gave Medicaid to those making 138% the federal poverty level or $21,000 for a single person, $28,000 for a couple or $42,000 for a family of four.   Most of this expansion went to what we would call "the working poor."    Someone making minimum wage would make $15,000 a year and someone making $10 an hour would make $20,000.   With the Republican plan of no growth in Medicaid funding this group of working poor is where the cuts would be most dramatic.  The groups funded by Medicaid before the Obamacare will continue to have priority on the Medicaid dollars and it will be the working poor that will be most impacted by the reduction in funding.
       So there you have it.   People making over $250,000 get a tax break and the working poor lose their Medicaid coverage.  Sure these working poor can buy insurance in the health care pools but they will probably only afford the lowest level of coverage which has a $6,000 deductible every year.   This deductible will mean that most will go without any health insurance coverage.   Hospitals are against the legislation because they know that these working poor will be back using the emergency rooms for routine care that will be uncompensated care.

     Amazingly Trumps promises during the campaign seem to have fallen flat.  Here are some examples:
       1) You will get so tired of winning you will say stop I can't take anymore winning.   Here is his "winning" record.
        2)  If you elected Hillary Clinton you will have one investigation after another.  Now who should you have voted for if you were afraid of having a president under investigation?
        3)  What type of health care program does Trump want?  What plan does he deliver?  Obamacare still around over 100 days into the Trump Administration
        4) Trump accused Hillary Clinton of having too many Wall Street ties.
         5) Trump on destroying ISIS.  Has ISSI been destroyed yet?  Just like Nixon's secret plan to end the Vietnam War that lasted longer than his presidency.

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