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Trump’s Congressional Speech Debrief: 5 Changes He Has in Store for Obamacare

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Trump’s Congressional Speech Debrief: 5 Changes He Has in Store for Obamacare

In his first speech to Congress Tuesday night, President Donald Trump outlined the overhaul he and his administration plan to make to the Affordable Care Act, known as Obamacare.

The proposed new health care plan now heads to the Congressional Budget Office and could face more changes as Democrats and Republicans battle over it in the House and Senate.

Trump urged Congress “to save Americans from this imploding Obamacare disaster.”

The president promised to repeal and replace Obamacare. Here are five key ways he plans to dismantle the current health care system.

You could be in a high-risk pool if you have a pre-existing condition

“First, we should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the health care exchanges,” Trump said in his speech Tuesday night.

A draft of revisions to the Affordable Care Act leaked to Politico on Feb. 24 references high-risk pools, although Trump did not discuss them in his speech.

States would have the ability to create high-risk pools for people with pre-existing conditions who are searching for health care. According to the draft, states would receive $100 billion over nine years in “innovation grants” that would be used to fund high-risk participants, news outlets such as CNN reported.

“High-risk pools would need a lot of taxpayer funding to work properly, experts say,” the Commonwealth Fund, a private nonpartisan foundation that supports independent research on health and social issues, tweeted after Trump’s speech.

You could receive a tax credit — even if you don’t deserve one

Tax credits and expanded health savings accounts could help Americans purchase their own coverage. It should be “the plan they want, not the plan forced on them by our government,” Trump told Congress.

Tax credits based on age, with the elderly receiving higher tax credits, would take the place of Obamacare’s income-based subsidies.

“For a person under age 30, the credit would be $2,000. That amount would double for beneficiaries over the age of 60, according to the proposal,” reported Politico prior to the speech.

The credits were also heavily criticized by some GOP members.

“So the headline is that the GOP is reducing subsidies to needy individuals when in fact, the growth of the taxpayer-subsidized reimbursements will actually increase,” Rep. Mark Meadows (R-N.C.) told CNN. “The total dollars that we spend on subsidies will be far greater. So you can be a millionaire and not have employer-based health care and you’re going to get a check from the federal government — I’ve got a problem with that.”

“What are tax credits & savings accounts going to do for those who don’t have money to spend on healthcare in the first place?” tweeted Advancement Project, a national civil rights organization.

Chris Rylands, a partner in the Atlanta office of Bryan Cave LLP, says many people are worried that the tax credits will make it difficult for low-income participants to afford coverage.

Under the current system, many individuals eligible for a subsidy are immune to price hikes in insurance because the government picks up such a large portion of the cost. The proposed Republican system might make them better consumers, says Rylands, whose practice focuses on employee benefits.

“However, given the complexity of health insurance plans and the opacity of the pricing of health care services, it’s not clear whether individuals can really become well-informed consumers,” Rylands says.

You could lose Medicaid

Trump said his changes would give governors the resources and flexibility they need with Medicaid “to make sure no one is left out.”

Under the Trump administration’s revisions, Medicaid would be phased out within the next few years. Instead, states would receive a specific dollar amount per citizen covered by the program. States would also receive the ability to choose whether or not to cover mental health and substance abuse treatment.

“Medicaid is the nation’s largest health insurer, providing coverage to nearly 73 million Americans,” tweeted the Commonwealth Fund after Trump’s speech. In a follow-up tweet, it said capping spending for Medicaid will reduce coverage rates and increase consumer costs and the federal deficit.

However, the Center for Health and Economy, a nonpartisan research organization, reported in 2016 that block-granting Medicaid in the states will lead to additional savings. H&E projects that the decrease in the use of Medicaid funds, by block-granting Medicaid in the states and the repeal of the Medicaid expansion, would be an estimated $488 billion from 2017 to 2026.

Rylands points out that this will not be a popular provision in Congress.

“What I heard here — although [Trump] didn’t say so in so many words — is that they want to try to turn Medicaid into a block grant program, similar to what was done with welfare reform in the 90s,” Rylands says. “However, I suspect many governors from both parties will not like this because it could mean states will pick up more of the tab for Medicaid.”

You could pay less for drugs

Trump proposes legal reforms to protect patients and doctors from unnecessary costs that make insurance more expensive and bring down the “artificially high price of drugs.”

Alongside medical device manufacturers and insurers, the pharmaceutical manufacturing industry is obligated by the Affordable Care Act to pay a yearly fee. It was determined the industry would pay $4 billion in 2017, $4.1 billion in 2018, and $2.8 billion each year after. However, proposed revisions to the Affordable Care Act include repealing the tax.

Some consumer advocacy groups are hopeful that repealing the taxes will reduce drug prices.

“From life-saving cancer drugs to EpiPens, high Rx prices push critical care out of reach for those who need it,” tweeted AARP Advocates, a nonprofit advocacy group for senior citizens.

You could purchase cheaper health insurance across state lines

“Finally, the time has come to give Americans the freedom to purchase health insurance across state lines — creating a truly competitive national marketplace that will bring costs way down and provide far better care,” Trump told Congress.

Under the current law, many states have the choice whether or not to allow insurers to sells plans between states. However, even when allowed, there isn’t much incentive for health care providers to do so.

Difficulty building a network and attracting enough customers to create a large enough risk pool makes this option unappealing to insurers, the Center for Health and Economy reported.

Whether this proposed change will result in a healthy competition in the industry or in a race to the cheapest offer remains to be seen, says Rylands.

“This has the potential to undermine traditional state regulation of insurance … since it would allow insurance companies to sell into a state without having to comply with that state’s particular insurance laws,” Rylands says.

Katie Tiller
Katie Tiller |

Katie Tiller is a writer at MagnifyMoney. You can email Katie here

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Featured, News

5 Ways Your Obamacare Coverage Could Change This Year

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5 Ways Your Obamacare Coverage Could Change This Year

Humana’s announcement last week that it is dropping out of the Affordable Care Act (also known as Obamacare) exchange and President Donald Trump’s tweet Friday that the Obamacare repeal is “moving fast” capped a frenzied week for the embattled law.

The proposed rule the Trump administration issued last week could mean major changes and increased costs for those who have Obamacare as well as other coverage. Congress would have to act to change Obamacare.

Amid the uncertainty about what will happen to Obamacare, here are five potential ways you and your health care spending could be impacted if the changes succeed.

The main changes would include:

  • Giving insurers the ability to offer more products that also cost more.
  • Removing the federal government’s oversight of insurers’ hospital and doctor networks.
  • Cutting in half the open enrollment period.
  • Requiring paperwork in advance that proves eligibility for enrolling outside of the open period.

1. You might need to find a new health plan

Humana last week announced it will drop out of the exchange, saying it would no longer provide individual plans in 2018.

“That’s been a pretty consistent phenomenon for the last two years, where you might have a particular insurance provider and then they pull out of the exchange, and so now you’ve got to go find another one,” says Chris Rylands, a partner in the Atlanta, Ga., office of Bryan Cave LLP, an international law firm. His practice focuses on employee benefits.

Humana analyzed the customers who had signed up through the exchange and found too much risk

2. Your costs for women’s health benefits could rise

With the Trump administration’s vow to overhaul Obamacare, some American women are feeling insecure about their birth control options.

In one example, Cecile Richards, president of Planned Parenthood, told CNN’s Christiane Amanpour in January that Planned Parenthood’s patient requests for IUDs has jumped by 900%.

Sneha Bhakta, 22, is among the women who plan to look into requesting an IUD.

She and her parents pay about $500 each month for the three of them to have insurance through Obamacare.

“I follow the news extremely closely. Yes, my parents are concerned about the changing policies. Mostly because it’s all up in the air,” Bhakta says.

Bhakta, who lives in Atlanta, Ga., attended the Atlanta March for Social Justice and Woman in January, which was among hundreds of events the same weekend as the Women’s March on Washington. She says she’s scared about the possibility of losing coverage, especially the reproductive health care benefits, such as free birth control and pap exams.

3. Your deductible could go up

Proposed changes to the Affordable Care Act will create more leniency in how plans are classified. The greater leniency will allow for more diverse choices in the health care market, but could increase co-payments and deductibles for consumers.

All participating insurance plans have to cover 60% of out-of-pocket costs to qualify as a bronze-level plan, 70% for a silver plan, and 80% for gold. While the insurance plan pays for 70% of out-of-pocket costs for a silver plan, consumers would pay the remaining 30% through a combination of deductibles, co-pays, and co-insurance. Under the Obama administration, a two-point disparity was permitted, meaning that a plan could cover 68% of the costs and still qualify as a silver plan.

With Trump’s proposed changes to the Affordable Care Act, the disparity has been increased from 2% to 4%. Plans with only 66% coverage would still qualify as a silver plan.

It gives insurers a little more room to vary their plan terms,” Rylands says.

He adds that although there’s the potential for higher deductibles or out-of-pocket costs, the fact that the proposal extends it by only 2 percentage points means those increases will not be significant.

Already, Americans are showing they’re willing to pay for a plan with high deductibles in order to save money on premiums.

Over the last two years, enrollment in high-deductible health plans with a savings option by workers with employee-sponsored health insurance has increased 8 percentage points, to 29%, according to the 2016 Employee Health Benefits Survey by Kaiser Family Foundation and the Health Research and Educational Trust.

The survey found average premiums for those plans were “considerably lower” than the average for all plan types, at $5,762 for single coverage and $16,737 for family coverage.

4. You may have to be a bit more on the ball to enroll

The Trump administration’s proposal would cut the open enrollment period, typically three months, in half.

Under the new guidelines, those who need to enroll in health care for 2018 would have from between Nov. 1 and Dec. 15, 2017. Insurance coverage will end on Dec. 31, 2017, for all participants, no matter their enrollment date.

Not only would the open enrollment period be shorter, but the president has already slashed the advertising budget for Obamacare. Upon taking office, Trump cut $5 million in advertising days before the Jan. 31, 2017, enrollment deadline.

Enroll America, a nonprofit, nonpartisan organization that serves as the nation’s leading health care enrollment coalition, criticized the decision and its timing during the critical final days of the enrollment period for 2017. In a January statement, Anne Filipic, president of Enroll America, said, “their decision to halt outreach will have real impact on real people’s lives.”

Also last week, the Trump administration announced plans to place more stringent guidelines for the special enrollment period, in an effort to reduce the number of consumers registering outside the open enrollment period. For 2017, the enrollment period ran from Nov. 1, 2016, to Jan. 31, 2017.

The special enrollment period was originally meant for people who experience unexpected changes, such as unemployment, a new baby, or moving states. The Affordable Care Act allows consumers to enroll and submit proof later that they qualify for the special enrollment.

Insurance agencies have found that people signing up under the special enrollment period have higher health care costs, leading agencies to believe that Americans are signing up when already sick.

Under the proposed revisions, consumers will be required to provide proof before signing up for special enrollment.

Your providers could change

Proposed changes to the Affordable Care Act will also remove federal review of insurance networks. The networks were created by the Obama administration in response to complaints that there were too few providers accepting insurance policies purchased in the exchange.

The requirement for a minimum number of providers within a set distance from enrollees could be removed.

While this could reduce consumers’ access to health care within a reasonable distance, Rylands is hopeful it could allow more health insurance companies to continue providing services on the exchange.

“We’ll just have to wait and see if that happens though,” Rylands says.

Katie Tiller
Katie Tiller |

Katie Tiller is a writer at MagnifyMoney. You can email Katie here

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What Could Happen if Trump Rolls Back The Dodd-Frank Act

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What Could Happen if Trump Rolls Back The Dodd-Frank Act

The Dodd-Frank Wall Street Reform and Consumer Protection Act has been seen by many as legislation that helped dig the American economy out of the Great Recession by putting strict limitations on banks. Banks had to rein in their high-risk mortgage practices and meet stricter lending requirements.

President Donald Trump has begun the process to roll back parts of the legislation, which could eliminate the restrictions that banks had faced under Dodd-Frank. As recently as Feb. 3, Trump told business executives at the White House, “We expect to be cutting a lot out of Dodd-Frank, because, frankly, I have so many people, friends of mine that have nice businesses that can’t borrow money, they just can’t get any money because the banks just won’t let them borrow because of the rules and regulations in Dodd-Frank.”

The executive order that Trump signed on Feb. 3 asks for a review of Dodd-Frank. Many of Dodd-Frank’s key provisions can’t be undone without legislation, and Democrats have vowed to do all they can to protect the law; however, with a Republican-controlled Congress, there is a possibility of dismantling the legislation.

Consumers and small business owners could feel the impact of Dodd-Frank’s potential rollback in three key ways.

Relaxed lending standards.

The subprime mortgage lending phenomenon caused a surge in defaults when the housing market crashed about a decade ago. Nearly 9.3 million homeowners experienced a foreclosure, short sold, or received a deed in lieu of foreclosure between 2006 and 2014, according to the National Association of Realtors.

Some legal experts worry that a rollback of Dodd-Frank could expose homeowners to the same lending risks they faced prior to the financial crisis.

“If Dodd-Frank is repealed, homeowners should expect to see a return to the ‘anything goes’ days of the 1990s and early 2000s,” says David Reiss, a law professor at Brooklyn (N.Y.) Law School. “There will likely to be a loosening of credit, but also a return to some predatory practices in some parts of the mortgage market,” he says.

When signed by President Barack Obama in 2010, the Dodd-Frank law created several government agencies, including the Consumer Financial Protection Bureau (CFPB). The CFPB, which was tasked with protecting consumers by regulating complaints, conducting investigations, and filing suits against companies that break the law, created the Ability to Repay and the Qualified Mortgage rules. The rules were meant to ensure that banks and mortgage lenders were only issuing loans to homebuyers who could reasonably afford to repay them.

“These are really rules that require lenders to pay attention to who their borrower is, to make sure their borrower can pay back a loan,” Reiss explains. “It sounds kind of silly to have a rule to tell lenders to make sure borrowers can pay back their loan, but before the financial crisis, it was pretty common.”

One of the popular ways to entice subprime mortgage borrowers before the recession was to offer teaser rates. Teaser rates, Reiss explains, made a mortgage appear affordable in its first six months or 12 months, with low rates and low monthly payments. Once the promotional period was up, the rates and payments would skyrocket.

The subprime mortgages and other loans with higher risk for consumers, which can be profitable to banks, had much higher rates of default, Reiss says.

Dodd-Frank legislators originally reduced and prohibited these exotic terms in order to suppress the turbulent market at the time. Repealing Dodd-Frank and its restrictions will not only bring back lenders’ old habits but return the market to a more volatile state, says Reiss.

While the potential abolishment of Dodd-Frank may be a shame in terms of the loss of consumer protections, there is a bright side, says Paul Hynes, a certified financial planner and CEO of HearthStone, a wealth management firm based in San Diego, Calif. Many lenders have complained that heightened regulations have only increased their costs and made it tougher for consumers to get access to much-needed financing. Since the recession, the homeownership rate in the U.S. has declined by 4.7%, from 68.4% in 2007 to 63.75% in 2016, according to the U.S. Census Bureau.

“The increased cost of compliance with Dodd-Frank may also go away,” Hynes says, “reducing the drag on the economy caused by these costs, and perhaps stimulating economic growth, higher wages, and overall increase in the standard of living for all Americans.”

Possible benefits for small banks and businesses.

The rollback of Dodd-Frank should have a positive impact on small banks that have felt the effect of the regulations much more heavily than their larger Wall Street and corporate counterparts, says John Gugle, a certified financial planner with Alpha Financial Advisors in Charlotte, N.C.

The costs of complying with Dodd-Frank for banks totaled more than $10.4 billion and 73 million hours in paperwork in 2016, according to the American Action Forum, a conservative nonprofit think tank in Washington, D.C.

Small banks, which used to be an engine for loan growth in their communities, have struggled with the costs to comply with Dodd-Frank, says Gugle, a member of the National Association of Personal Financial Advisors (NAPFA) policy committee.

“If you’re a small lender, and having to meet these increasingly rigorous regulations, you don’t have enough money or resources to throw at it,” Reiss says. “So I think the regulatory burden is felt more by the smaller institutions who are just trying to manage to keep the doors open.”

The Dodd-Frank rollback could make it easier for small business owners to qualify for small business loans. Since the recession, lending to small business owners has declined by 17%, according to U.S. Small Business Administration research. While larger banks have focused traditionally on investment and corporate banking, smaller banks have been a primary source of loans to local communities and businesses, and they were hardest hit by the recession.

“For smaller community banks, the increased compliance and regulatory costs have impeded their ability to lend,” Gugle says. “By lowering the regulatory burden, it would make it more cost effective for banks to make loans, but I am careful to point out that small businesses will still need to meet the stringent borrower requirements that banks will impose.”

Another recession? Not likely.

While many financiers and officials have advocated for the repeal of Dodd-Frank, the public is hesitant to remove the restraints on American banks.

In a survey of more than 1,000 people, California-based Personal Capital Advisors Corp. found that 84% were supportive of efforts to protect consumers’ financial rights and concerned about the lack of protections without Dodd-Frank.

Experts agree that a repeal will likely lead to risk-taking by banks, but contend that a recession is not immediately imminent.

If Dodd-Frank is repealed, Hynes, a NAPFA member, says he thinks the U.S. initially will see a “more robust economy, more jobs, and higher economic growth rates.”

“The U.S. economy experienced solid growth, punctuated by occasional, more ‘normal’ recessions, from the end of the Great Depression, about 1940, until 2007 — without massive legislative imposition such as Dodd-Frank,” Hynes says.

Katie Tiller
Katie Tiller |

Katie Tiller is a writer at MagnifyMoney. You can email Katie here

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