West Lebanon
Health care providers in both New Hampshire and Vermont blasted the new proposal this week, with the Vermont Association of Hospitals and Health Services saying it “hurts vulnerable people and families” and would “limit subsidies available to help middle-class people afford health insurance for their families.”
One of those subsidies, and the basis of the foundation’s comparison, is a tax credit.
Under the Affordable Care Act, also known as Obamacare, individuals get tax credits that reduce the amount they have to pay in income tax.
Some tax credits are refundable, which means that if the credit is larger than the amount owed in tax, the person can apply the difference to premiums of health care plans purchased through the Health Insurance Marketplace.
Under Obamacare, those with the lowest incomes get the largest subsidies to help them obtain insurance they otherwise could not afford.
The Republican plan, known as the American Health Care Act, passed two House committees this week. It also would give tax credits, but on a different philosophy.
“The tax credits are, in fact, structured quite differently, with important implications for affordability and which groups may be winners or losers if the ACA is repealed and replaced,” wrote the authors of the Kaiser Family Foundation analysis.
The proposed replacement system is largely income-blind, so that those who make more get the same tax credits as those who make less. In county-level projections of tax credits that would be given in 2020 under both Obamacare and the AHCA, the Kaiser Family Foundation shows that the end result of the bill would be shifting money from low-income residents to higher-income residents.
“For current marketplace enrollees, the American Health Care Act would provide substantially lower tax credits overall than the ACA on average. People who are lower income, older, or live in high-premium areas would be particularly disadvantaged under the American Health Care Act,” the study’s authors wrote.
For example, under Obamacare, a 60-year-old making $20,000 in Grafton or Sullivan counties currently gets $7,060 in tax credits to help pay for health insurance premiums, while a 60-year-old making $75,000 gets no such tax credits.
The Republican plan would take $3,060 away from the person making $20,000, and give $4,000 to the person making $75,000.
It also would give $1,500 to a 60-year-old making $100,000 who currently gets no tax credits under Obamacare.
It’s a similar story in Windsor and Orange counties in Vermont, where the 60-year-old making $20,000 would lose $2,000, while the same person making $75,000 would gain $4,000.
Because the Republican plan emphasizes age more than income, people in their 20s would get less tax credit money than their older counterparts.
For example, in Windsor and Orange counties, a 27-year-old earning $20,000 would see a decrease in tax credits, from $6,000 to $2,000, while their peers earning $75,000 would see an increase, from nothing to $2,000.
Twin State Democrats have spoken out against the proposal, arguing it will take affordable health care away from millions of Americans.
U.S. Sen. Bernie Sanders, I-Vt., recently tweeted: “To Republicans I say: Do your job. Listen to your constituents. They do not want Obamacare repealed and to be thrown off their health care.”
U.S. Sen. Jeanne Shaheen, D-N.H., and U.S. Sen. Maggie Hassan, D-N.H., who have taken to calling the plan “Trumpcare,” have scheduled a joint news conference on Monday, during which they will “discuss the devastating impact it would have on the Granite State,” according to a release announcing the event.
Bruce Perlo, a vice chairman in the New Hampshire Republican State Committee who oversees the party’s interests in three counties including Grafton, said the plan is a good one, but “it obviously is going to need some tweaking.”
Perlo said that, while he has yet to acquaint himself with the bill’s details, the broad strokes that he does know about sound good.
“A couple of the things that I found to be very obnoxious about the Obamacare plan, for example the mandate, are basically going to be gone,” Perlo said.
He said he couldn’t yet pass judgment on the shift of the tax credits from lower-income people to those who make more, because he didn’t know how that piece fits into the larger picture.
“It’s possible it could be terrific, or it’s possible it could be awful, or anything in between,” he said.
If there are aspects of the bill that Republicans find objectionable, they haven’t yet penetrated down to all rank-and-file party members, some of whom said they would give any effort to repeal and replace Obamacare the benefit of the doubt.
Scott Dodson, a Lebanon resident who was out shopping Friday afternoon and has employer-based coverage, said he was unaware of the bill’s details.
“But I am a Republican,” he said, “so I’m probably in favor of it.”
Sandy Farrell, of Bethel, said that the bill wasn’t on her radar, also because her family gets insurance through an employer.
And Michelle Leviston, of Thetford, said that as a Republican, she didn’t like Obamacare, but was waiting to learn more about the proposal before she passed judgment on it.
Republican governors in both Vermont and New Hampshire offered cautious optimism about a bill whose flaws, they say, can still be fixed through legislative amendments.
New Hampshire Gov. Chris Sununu said he favors repealing and replacing Obamacare, but that a first look at the new proposal didn’t engender his immediate support.
“We have concerns, without a doubt,” Sununu told reporters earlier this week, citing a desire to preserve flexibility for the state to design its own system.
Sununu said he is in the process of reviewing the details of the bill, and hoped that amendments could be introduced to improve the legislation before it becomes law.
Rebecca Kelley, spokeswoman for Vermont Gov. Phil Scott, said Scott is investigating the impacts of the bill, but that his current position is that “the potential impact of the bill in its current form to Vermont and Vermonters is concerning.”
She also said Scott was working with President Donald Trump “and Vermont’s congressional delegation to ensure Vermont’s interests are represented as it moves through that process.”
One group of health care stakeholders that have not been shy about taking a stance on the bill are providers.
Besides the Vermont Association of Hospitals and Health Services, Steve Ahnen, president of the New Hampshire Hospital Association, also indicated that Granite State hospitals opposed the Republican plan, saying it would have a “troubling impact” on patients and providers.
“Hospitals in New Hampshire are estimated to receive approximately $1.5 billion less in Medicare reimbursements between 2018 and 2026 from these Medicare changes,” he wrote, “reductions that would be devastating to their ability to serve the patients and communities who depend on them if people lose their coverage.”
The bill’s passage remains in doubt, with opposition from both Democrats and some Republicans in Washington.
Matt Hongoltz-Hetling can be reached at mhonghet@vnews.com or 603-727-3211.