I spent some time this evening reading the Republican healthcare bill. It takes away a lot of the nasty stuff, like mandates, the additional taxes, and the general authoritarian approach to healthcare; and replaces these with a sort of eventual handover of healthcare to the States in the form of a healthcare fund that diminishes in value through 2026.

From my perspective, I don’t necessarily understand the gnashing of teeth over the change. ObamaCare didn’t give anything away. Everyone had to pay something. And in this case, everyone will still have to pay something, and you pay more for going without – only it isn’t enforced by the IRS.

The bill appears to be HSA-centric. The contribution limits have been raised to match deductibles and out of pocket expenses. Spouses may share a HSA. In addition to the pre-tax contribution to a HSA, everyone will receive a tax credit for maintaining health insurance per covered individual, based on age, throughout the year.

Granted, it is not the sort of free market, lazez-faire, libertarian ideal. But it is, at least to me, more of a carrot model rather than the stick model employed in ObamaCare.

If I were to offer a criticism of it, it would include points 11 and 12 in my list of summary points from the bill. Point 11 limits payments from Medicaid to provider cost – and it is left to wonder which providers would actually accept Medicaid when their net is zero. Point 12 that includes semi-annual recertification of eligibility has some problems too because we don’t have semi-annual tax returns or W-2 forms from the employer, and I wonder how that could possibly work.


  1. Rescinds unspent money on Obama Care
  2. Adds $442,000,000 to CHIP
  3. Prohibits funds to States for Planned Parenthood and like organizations
  4. Extends Medicaide starting in 2020
  5. Repeals ObamaCare Medicaid expansion as of January 1, 2020
  6. Coverage mandates sunset December 31, 2019
  7. Eliminates DSH cut– disproportionate share hospital – effective six months after passage
  8. Allowing States to disenroll lottery winners and other recipients of lump sums in excess of $80k (?!) – includes hardship exemption- effective six months after passage
  9. Added proof of citizenship requirement for Medicaid prior to program payments – effective six months after passage
  10. Updates allowable home equity limits for Medicaid (dollar amount contained in Social Security Act 1917(f)(1)) – effective six months after passage
  11. Payments may not exceed the providers costs for people on assistance or who have no health insurance
  12. Requires increased frequency of eligibility assessments – every six months – with civil penalties for noncompliance
  13. Automatic funding reduction for States with “excess” per capita expenditures
  14. Restores Medicaid cost-sharing plans
  15. Insurance cost-sharing subsidy is repealed
  16. A fund is established to allocate money to States for high-risk patients and to promote the individual insurance markets in the States starting Jan 2018. Also provides for vision, dental, mental health and substance abuse services
  17. Fund allotment amounts diminish, States required match increasing percentages through 2026
  18. Allows insurance companies to charge 30% of the monthly premium penalty for 63 consecutive days without insurance for the plan year
  19. Repeals coverage requirements as of Dec. 31, 2019
  20. Repeals changes to permissible age variations in rate determination
  21. Remuneration from insurers repealed – shall not apply after Dec 31, 2017
  22. Tanning bed tax repealed
  23. Other taxes repealed – prescription drugs, cadilac plan tax, net investment income tax
  24. Exchanges stay – but plans can receive tax credits if not sold on Exchange starting Jan 2018
  25. Advanced payments of tax credit can be made only to qualified plans on an Exchange
  26. Premium tax credit repealed effective Dec 31, 2019 replaced with new credits for small businesses
  27. Individual mandate penalties zeroed out as of Dec 31, 2015
  28. Employer mandate penalties also zeroed out as of Dec 31, 2015
  29. Employee health plans no longer taxed after 2018
  30. Tax on over the counter medications repealed
  31. MHS applicability expanded to regular savings accounts
  32. Tax increases on HAS’s repealed
  33. Limits on contributions to HSA’s repealed increases contribution limit to max deductible or max out-of-pocket. Spouses may share a HSA
  34. Excise tax on medical devices repealed
  35. Repeal tax on Medicare part D
  36. Repeal of increase of Medicare income threshold
  37. Repeal tax increase for Medicare
  38. Adds small tax credit for insurance coverage in general
  39. Excess health insurance credit payable to HSA’s