OKPOLICY.ORG
By Justin Wingerter
Health care bills in Congress would increase insurance premiums for low-income and middle-class Oklahoma City residents buying coverage on a health care exchange but leave rates for high earners largely unchanged, according to a nonpartisan analysis.
Last week, the Congressional Budget Office released its report on the Better Care Reconciliation Act, a Senate bill and partial repeal of the massive Affordable Care Act, known as Obamacare. The Kaiser Family Foundation, a nonpartisan nonprofit that studies health policy, analyzed data from both the Senate bill and U.S. House legislation to repeal Obamacare.
The analysis found a 27-year-old in Oklahoma City making $20,000 per year would be charged a slightly lower premium under the repeal bills, but would receive nearly $2,000 less in tax credits. As a result, the 27-year-old would pay a net premium of $2,420 for a silver plan, compared to $960 under Obamacare, and $870 for a bronze plan, compared to $0 under Obamacare.
A 40-year-old in Oklahoma City making the same salary would pay the same premium under the repeal bills as he or she would under the ACA but receive $2,000 less in tax credits, the analysis found. The result would be $2,960 in premiums for a silver plan, compared to $960 under Obamacare, and $910 for a bronze plan, compared to $0 under Obamacare.
Older residents would be hit with significantly higher premium increases than younger residents, according to the analysis. A 60-year-old earning $20,000 annually would pay $6,830 in silver plan premiums — or 34 percent of their income — after tax credits. The same 60-year-old currently pays $950 in premiums under Obamacare. A bronze plan, which carries no premiums under Obamacare, would cost $1,000.
In Oklahoma City, a middle-class 60-year-old would be hit hardest by repeal of the Affordable Care Act and replacement with the GOP-backed bills, according to CBO data. This is because the ACA granted tax credits to those earning 400 percent of the federal poverty rate — about $48,000 — but the Senate and House bills cap that at 350 percent.
As a result, a 60-year-old making $50,000 annually pays $5,100 after tax credits for a silver plan under Obamacare but would pay an estimated $19,900 – or 40 percent of their income – for a silver plan under Republican repeal legislation. A bronze plan that costs $760 after tax credits under Obamacare would cost $14,070, according to the analysis.
“The Senate Republican health plan would make Oklahomans pay more for worse coverage on the individual marketplace,” said Carly Putnam with the left-leaning Oklahoma Policy Institute.
The Senate bill would also allow insurers to charge older consumers five times more than they charge young consumer. Under the Affordable Care Act, that ratio was capped at 3-to-1.
“The change in the age rating for premiums from 3-to-1 to 5-to-1 could mean that many older individuals can’t afford marketplace policies, yet they will have ever-increasing needs for the coverage,” said Elizabeth Street, a private patient advocate in Oklahoma and moderate Republican.
According to the Kaiser analysis, those in Oklahoma City with six-figure salaries will also see changes. A 27-year-old with a $100,000 salary would pay a lower premium under the Republican plans than he or she currently does under Obamacare. A 40-year-old with the same salary would see no change in premiums.
A 60-year-old making $100,000 would pay an estimated $5,000 more in silver plan premiums and $3,600 more in bronze plan premiums if Congress replaces the Affordable Care Act.
Republicans in Congress have been skeptical of CBO reports and figures. A senior Republican health care staffer said Tuesday that much of the Kaiser analysis is reliant on data from the House bill, which includes smaller tax credits than the Senate bill, rendering the analysis largely useless.
‘We have to act’
Oklahoma’s senators have said little about the Senate bill, a vote on which was delayed Tuesday until after Independence Day. U.S. Sen. James Lankford, R-Oklahoma City, said he is undecided on whether to vote for it. U.S. Sen. Jim Inhofe, R-Tulsa, said, “I’m not sure what it does. I just know it’s better than Obamacare.”
U.S. Rep. Steve Russell, R-Oklahoma City, said during an MSNBC appearance last week that the Congressional Budget Office figures are “disingenuous.” He later told the BBC he is confident the Senate will pass an Obamacare replacement.
“We have to act. I’m confident we’ll get to something that the Senate will vote on and we’ll get it over to the House and we’ll get it done,” he said.
During a telephone town hall Monday night, U.S. Rep. Markwayne Mullin, R-Westville, defended his party’s attempts at repealing the Affordable Care Act as he took questions from concerned constituents.
“We’re going to have insurance that’s affordable and that’s meaningful,” he said.
The Senate bill is opposed by the state’s largest health care groups, including the Oklahoma State Medical Association and Oklahoma Hospital Association, over concerns about fewer federal Medicaid dollars.
“In 2018, if it were to pass this year, I think it would mean about $80 million less in federal funds coming to the state,” said OHA President Craig Jones, “but that balloons over a 10-year period to something like $6 billion.”
Coburn weighs in
Former U.S. Sen. Tom Coburn says he would vote against the Republican health care bill because it fails to address the greatest flaw in America’s health care system.
“I didn’t like the House bill, and I don’t like the Senate bill,” the Republican and retired obstetrician said in an interview Tuesday.
“If I was in the Senate, I wouldn’t vote for it until they added price transparency in there,” he added.
Coburn favors a free-market approach in which a health care marketplace would be established. Through the marketplace, patients could shop around for the best procedures and physicians. For low-income patients, a medical savings account would cover health care costs for the first two years.
“If you want to fix health care, fix markets. I don’t think government will ever fix health care. Only markets will,” Coburn said.
“Congressional dillydallying is not fixing the real problem,” Coburn said.
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