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POLITICO New York Health Care: Republicans release Obamacare replacement bill -- Asking for the indigent -- Money for organ donors

By Dan Goldberg | 03/07/2017 10:00 AM EDT

Good morning! You are reading a complimentary synopsis of the POLITICO New York Pro Health Care newsletter. Pro subscribers receive a premium version of this newsletter, which includes an enhanced look-ahead and robust analysis of the health care news driving the day, weekdays at 5:45 a.m. Contact us here to learn more.

OBAMACARE LATEST - The House Republicans unveiled their plan to repeal and replace the Affordable Care Act on Monday night. Read POLITICO's full story here. Read the bill here.

Here are some highlights with help from my colleague Dan Diamond:

- Tax Credits - Republicans would replace Obamacare subsidies with age-based tax credits ranging from $2,000 to $4,000 to help individuals pay for coverage. The credits would begin phasing out for people who make more than $75,000 for individuals and $150,000 for households. They would disappear completely for individuals who earn more than $215,000, with a cap of $290,000 for joint filers.

- Medicaid - The plan unveiled Monday would freeze Medicaid's expansion in 2020 and phase it out over time. The bill would also shift Medicaid from an open-ended federal matching payment to a per-capita lump sum payment. About 70 million Americans are currently covered through Medicaid, with more than 11 million gaining coverage after the ACA took effect.

- Hospitals - While the bill would reinstate the disproportionate share payments that were eliminated when the ACA took effect, the planned cuts to Medicaid would likely lower hospitals' revenues and force them to ramp up their charity care spending. Hospital profit margins are currently at their highest level since before the 2008-2009 recession.

- Planned Parenthood - The program would be defunded for one year under the bill, a provision that conservatives want but which risks losing the support of some moderate Republicans. The White House had reportedly offered to allow Planned Parenthood to preserve its funding if it stopped providing abortions, a deal that Planned Parenthood rejected.

- High-net worth individuals - The bill repeals a slew of ACA-related taxes, like a 3.8 percent investment tax on the well-to-do and a 0.9 percent surcharge on wages above $250,000. The move would save the top 0.1 percent of earners about $195,000 annually, according to the Tax Policy Center.

- The device industry - The bill would repeal the 2.3 percent medical device excise tax opposed by the industry, Republicans and some Democrats. The tax, which took effect in 2013 before being suspended for two years in 2015, led to nearly 30,000 lost jobs, according to a report from the American Action Forum released last week.

- Mandates - The individual and employer mandate remain but the penalties for violating them are repealed. Why, you ask? Brush up on your Senate rules of reconciliation, which say only budgetary items can pass with 51 votes. A policy change such as repealing the mandates outright would require 60 votes to block a filibuster.

- Cost-sharing - Cost sharing subsidies, which help people pay for copays and deductibles, are repealed in 2020.

- Coverage for children - The bill allows parents to keep their children on their insurance until they are 26.

- Coverage for abortion - No one can use tax credits to purchase a plan that offers abortion coverage.

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AND MAKE SURE YOU FOLLOW Josefa Velasquez and me on Twitter @J__Velasquez and @DanCGoldberg. And for all New Jersey health news, check out @katiedjennings

LOCAL IMPACT - There will be more estimates in the coming days but I did some back of the envelope math on what the Medicaid change would mean for New York. My estimate is that if the state wanted to continue covering the same number of people through the Medicaid program it would need to come up with somewhere between $3 billion and $4 billion per year.

MATH PROBLEM - Four Republican senators from states that expanded Medicaid under Obamacare say they can't support a draft House repeal bill because it won't protect people enrolled in the health entitlement. Read more here.

... House conservatives don't like it either, according to my colleague Rachael Bade. A Republican Study Committee memo sent to chiefs of staff, obtained by POLITICO, echoed those comments and blasted the bill's continuation of the Medicaid expansion for three years. Read more here.

BEHIND THE SCENES - Why did Republicans means-test the tax credit? In part, it's about the optics of millionaires receiving government subsidies to purchase health insurance. But Christopher Jacobs, writing for The Federalist, says the real reason has to do with how the Congressional Budget Office is scoring the bill. Read the rest here.

... Here's the problem. Republicans have for years said one of the problems with Obamacare is that it disincentivized work. Aren't Republicans falling into the same trap?

COMPARE TAX CREDITS - The Kaiser Family Foundation has a nifty chart that allows you to compare the tax credits in the Republican plan versus the tax credits offered under Obamacare. Play with the chart here.

HERE'S WHAT WE DON'T KNOW - The CBO hasn't told us how much this bill will cost or how many people would remain insured. Also, what will be the reaction from the insurance and hospital industries? I suspect both will lobby hard against this version as it seems to take government revenue out of their pockets.

INDIGENT CARE FUNDING - The Community Health Care Association of New York State is asking Gov. Andrew Cuomo and the state Legislature for a $20 million increase for indigent care, which they argue will reduce the the financial strain to federally qualified health centers and other safety-net providers that treat the uninsured. Read more here.

SINGLE-PAYER QUESTIONS - As Assembly Health Committee chair Richard Gottfried and other Democratic state lawmakers use the uncertain future of the Affordable Care Act to push for a single-payer bill, new research suggests that the proposal could be far more expensive than its sponsors claim. Read more here.

NOW WE KNOW - Oranges taste better in the shower and NPR decided to investigate why. "Conclusively establishing why an orange tastes or smells differently in the shower would likely require years of careful study. In the absence of that, we asked Johan Lundström at the Monell Chemical Senses Center in Philadelphia to make an educated guess." Read it here.

DOLLARS FOR DONORS - In an effort to boost New York's anemic organ donations, state lawmakers are proposing a bill that would reimburse expenses incurred by living organ donors. Read more here.

DEPARTMENT OF EDUCATION - The union that represents State University of New York employees launched a $400,000 ad buy Monday, warning that the possible repeal of the Affordable Care Act will hurt SUNY-run hospitals. Watch the ad here.

MAKING ROUNDS - Dr. Fred Lado is the new regional director of epilepsy for Northwell Health's Central and Eastern Regions.

SCHOLARSHIP OFFER - The Nassau-Suffolk Hospital Council is offering a $2,000 scholarship for college juniors/seniors or post- graduate students who are studying journalism, marketing/communication or healthcare administration. More information here.


ICER: MS DRUGS NOT COST-EFFECTIVE - Most multiple sclerosis drugs are overpriced given the benefits they provide to patients, leading to access problems and financial burdens for those afflicted with the disease, a final ICER report on more than a dozen treatments found.


INVESTIGATIVE JOURNALISM - STAT has done some great investigative work, examining how the world's richest doctor gave away millions - then steered the cash back to his company. Dr. Patrick Soon-Shiong "got reams of patient data to help him build a new commercial product meant to assess patients' risk of rare and inherited diseases. He got a stream of cash for one of his struggling companies.

TODAY'S TIP - Comes from the Cleveland Clinic: "If you're avoiding dairy, cut out these 13 ingredients."


FERTILITY OPTIONS - Everolimus, a drug used to slow tumor growth, may also prevent infertility caused by chemotherapies, according to a study published in the Proceedings of the National Academy of Sciences by researchers at NYU Langone Medical Center. See more here.

DEBUNKED - Weill Cornell Medicine researchers say that anesthesia knocks us out by changing the function of proteins that reside on the surface of a thin membrane that forms a barrier around all cells, according to a study in the Proceedings of the National Academy of Sciences. Read more here.

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