By Jueseppi B.
Food Stamp Cuts:
Republicans controlling the House are eying big cuts to food stamps as they piece together legislation to trim $261 billion from the federal budget over the next decade, hoping to forestall major Pentagon cutbacks.
The cuts to food stamps would reduce the monthly benefit for a family of four by almost $60, repealing increases that were enacted three years ago as part of President Barack Obama’s economic stimulus. The changes would also force up to 3 million people out of the program by tightening eligibility rules, the administration estimates.
The food stamp cuts would total $8 billion over the coming year and $34 billion over a decade. The program has been expanded greatly over the past few years — enrollment tops 46 million nationwide, up from about 33 million in 2009 — and now costs about $80 billion a year. The average monthly benefit for a family of four is about $500, according to the Center on Budget and Policy Priorities, a liberal research and advocacy group.
Paul Ryan (R-WI) not only attempted to defend the tax cuts for millionaires in his new budget, but also dove into greater detail about why he so drastically cuts support programs for poor and low-income Americans:
RYAN: With respect to these programs you mentioned. They’re growing at unsustainable rates. Food stamps have quadrupled over the last ten years, and that’s in excess of the recession. We have to remember that if we just keep these programs on this unsustainable path, then they will crash. Then we’ll have a debt crisis. Then we will not be able to service these people, because under a debt crisis you’re cutting indiscriminately across the board in a very ugly way… So what we’re saying is let’s get ahead of this problem, let’s pre-empt a debt crisis, and let’s get these programs working better so that they’re growing at a more sustainable rate.
It’s not clear what Ryan means by “quadrupled… in excess of the recession.” From 2000 to 2008, before the recession began, spending on food stamps (otherwise known as the Supplemental Nutritional Assistance Program) went from $18.3 billion to $39.3 billion — barely doubling. By 2011, it had increased to $77.6 billion. That is closer to a quadrupling from 2000, but this includes the effects of the recession.
More importantly, SNAP spending as a matter of dollar amounts does not indicate whether the program is sustainable. What counts on that score is spending as a percentage of GDP, or what share of the wealth produced annually by the American economy is required to fund the program.
In 2000, SNAP accounted for 0.19 percent of GDP. By 2008 that had risen to a slightly larger small slice of 0.27 percent of GDP. It then spiked to 0.52 percent in 2011 as a result of the recession. But over the coming years, as the economy recovers and fewer Americans will be in need of economic assistance, it’s projected to drop back below 0.3 percent.
Food stamps are just one of the cuts Republicans want to muscle through the House as a follow-up to the tightfisted GOP budget plan approved last month.
Cuts To ObamaCares:
Many Americans don’t get preventive care because office visits are expensive, even with insurance. It has been a rough time economically and because putting food on the table, paying for a roof over our heads and putting gas in the car to get to work seems more immediate, health care is often delayed.
Now that Obamacare is making preventive care available with no co-pays or cost-sharing, Americans can get advice they need to stay healthy and the screenings they need to halt a serious disease at an early, more treatable, and more affordable stage. Preventive care has given me the opportunity to live a long and full life; I urge every insured American to take advantage of this key benefit so you can, too.
Thank goodness for federal health reform that allowed parents to keep their children on family policies so they can receive preventive care. I feel optimistic that American families can help their children not yet employed, I am grateful you can stay on your parents’ plan until you turn 26 if need be. Obamacare has given every family peace of mind.
Affordability for small businesses
Obamacare’s small-business tax credits to help pay for health care are significant for any small business. This is one law that really does make a difference to small-business owners.
Over the past few decades, America’s health care system has been hurtling toward a crisis. Almost one-third of Americans either have health care coverage that is inadequate or have none at all. The primary reason is skyrocketing costs, which have priced out businesses and individuals alike. While wages have been more or less frozen the last few years, health insurance premiums have increased up to 20 percent.
Decisions about our health care are too personal and important to be left to insurance companies. The Affordable Care Act, dubbed Obamacare, is putting all of us back in the driver’s seat when it comes to our own health care. While full implementation of reform is being phased in over several years, health care reform has already helped hundreds of thousands of Americans access the health care they need.
Between premiums and deductibles, families with coverage spend an average of $5,307 on health care every year. That’s 10 percent of average household income, and it doesn’t even include co-pays and cost-sharing for office visits, procedures and prescriptions.
The families with coverage are the lucky ones; the number of people in America without insurance has been increasing. Eighty-five percent of uninsured Americans identify high cost as the reason they don’t have health insurance, and many cite shrinking employee benefit packages, as well. In just two years, employer-provided health care coverage has slipped significantly, from covering 64 percent of Americans to just 58 percent today.
The uninsured are less likely to receive preventive care; are often diagnosed with disease in more advanced stages; and are more likely to die prematurely than individuals with health care insurance. They also are more likely to first access health care through expensive hospital emergency rooms than ordinary office visits because they wait to seek care until a health crisis is well underway.
People without public or private insurance coverage are costly to all of us. In a familiar mechanism called “cost-shifting,” hospitals charge higher rates for services to those with insurance in order to offset the losses from uncompensated emergency department care. Insurers raise rates to cover the cost of inflated bills, and the uninsured and underinsured are sent to collection agencies and/or forced into bankruptcy. Companies respond by scaling back on or eliminating health care benefits for their employees, and more Americans fall from the insured universe.
Indeed, small businesses have struggled for years with the double whammy of escalating health care premium costs and the inability to secure the better rates that large companies are able to negotiate. Now business owners with fewer than 25 workers may qualify for tax credits to help pay for employee health care benefits, thanks to Obamacare. These tax credits inspired some business owners to start offering health care coverage benefits for the first time and allowed other struggling entrepreneurs to continue offering benefits in a challenging economy.
Obamacare is starting to hold insurance companies accountable, controlling the runaway costs that prevent Americans from access to health care. For example, insurers must now justify premium rate hikes. Just last month, the Department of Health and Human Services found that a Pennsylvania insurance company’s proposed rate increase of 12 percent was unjustified in relation to the benefits provided, and urged the insurer to rescind the rate, issue refunds or publicly explain their refusal to do so. While some states were already regulating rate increases, before Obamacare there were no national limits on what insurers could charge as administrative costs. Now at least 80 cents of every dollar must be spent on actual medical care.
Families are getting direct relief from Obamacare as well. Essential preventive care is now considered a basic benefit for those with insurance and is available without co-pays or other cost-sharing because it keeps people healthier. Everyone qualifies for annual checkups. Children may receive immunizations; women can access mammograms, contraception and domestic violence screening; and men benefit from prostate screenings and colonoscopies.
The heartbreaking practice of excluding children from coverage based on even the most minor pre-existing condition is already over because of Obamacare. In 2014, adults will enjoy this protection as well. Young adults just starting in the work world often do not receive health insurance in entry-level jobs and make up 28 percent of the uninsured in America. Now they can stay on their parents’ health care plan until age 26.
Obamacares just makes good common sense.
Aside from banning discrimination against children on the basis of preexisting conditions, the National Center for Health Statistics estimates that about 2.5 million young Americans have benefited from being able to stay on their parents’ health insurance until age 26. Seniors no longer have to spend thousands of dollars out of pocket before qualifying for assistance paying for their prescription drugs—help that fills the so-called “doughnut hole.” The Affordable Care Act has also eliminated the cap on lifetime benefits, which means people with serious health problems won’t find themselves overwhelmed with health care costs because their insurance company no longer wants to help pay the bills.
Medicaid & Medicare:
For Medicare, the Ryan plan would raise the age at which people become eligible from 65 to 67, even as it repeals the health reform law’s coverage provisions. This means 65- and 66-year-olds would have neither Medicare nor access to health insurance exchanges in which they could buy coverage at an affordable price and receive subsidies to help them purchase coverage if their incomes are low.
This change, which is not mentioned in the 73-page booklet on his plan that Chairman Ryan released, would put many more 65- and 66-year-olds who don’t have employer coverage and can’t afford insurance into the individual insurance market — where the premiums charged to people in this age group tend to be very high — leaving them uninsured. People of limited means, such as those who are trying to get by on incomes as low as $12,000 a year in today’s dollars, would be affected most harshly because they wouldn’t be able to afford private coverage.
The CBO estimates that the total health care costs attributable to Medicare beneficiaries would be considerably higher under the private insurance plans they would purchase under the Ryan plan than under a continuation of traditional Medicare, because private plans have higher administrative expenses and higher payment rates for providers. Since the Ryan proposal would reduce the federal government’s contribution for beneficiaries’ health care costs even as it caused total costs to increase, beneficiaries’ out-of-pocket spending would rise dramatically.
Health care costs at 65 would be 40% higher
In 2022, the first year the voucher would apply, CBO estimates that total health care expenditures for a typical 65-year-old would be almost 40 percent higher with private coverage under the Ryan plan than they would be with a continuation of traditional Medicare. (See graph.) CBO also finds that this beneficiary’s annual out-of-pocket costs would more than double — from $6,150 to $12,500. In later years, as the value of the voucher eroded, the increase in out-of-pocket costs would be even greater.
According to the Congressional Budget Office analysis of the Paul Ryan (R-WI) House Republican budget outline, at least what can be analyzed given that Ryan leaves huge unanswered questions about how his tax provision would even work, the plan calls for massive cuts in public health care spending. The result of the cuts would be millions of Americans ending up worse off. From the CBO the effect on Medicare:
Under the specified path, average real (inflation-adjusted) spending for new enrollees in Medicare would rise in coming decades but at a much slower rate than would occur under the other policy scenarios that CBO has analyzed (see Figure 2). Average net Medicare spending for 65-year-olds in 2011 was $5,500. Under the baseline scenario, average spending per 66-year-old in 2030 would be $8,600 in 2011 dollars (56 percent more); under the alternative fiscal scenario, that spending would rise to $9,600 in 2011 dollars (75 percent more); and under the specified path, it would be $7,400 in 2011 dollars (35 percent more). In 2050, the corresponding spending for a 67-year-old would be, in 2011 dollars, $17,000 under the baseline scenario, $19,100 under the alternative fiscal scenario, and $11,100 under the specified path.
By 2050, spending for new enrollees under the specified path would be 35 percent below that for the baseline scenario and 42 percent below that for the alternative fiscal scenario. The implications of that substantial cut in spending relative to the other policy scenarios are unclear, because they would depend on both the specific policies that were implemented to generate that spending amount and the ways in which the nation’s health care and health insurance systems reacted to those policies. Possible consequences include the same kinds of effects noted for the baseline and alternative fiscal scenarios—reduced access to health care; diminished quality of care; increased efficiency of health care delivery; less investment in new, high-cost technologies; or some combination of those outcomes. In addition, beneficiaries might face higher costs, which could in turn reinforce some of the other effects.
From the CBO on the effect on Medicaid and CHIP:
The implications of that substantial cut in spending relative to the other policy scenarios would depend on both the specific policies that were implemented to generate the specified spending amount and the ways in which the nation’s health care and health insurance systems, as well as state governments, reacted to those policies.
The responses of the states would be of particular importance. If states were given additional flexibility to allocate federal funds for Medicaid and CHIP according to their own priorities, they might be able to improve the efficiency of those programs in delivering health care to low-income populations. Nevertheless, even with significant efficiency gains, the magnitude of the reduction in spending relative to such spending in the other scenarios means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both. Cutbacks might involve reduced eligibility for Medicaid and CHIP, coverage of fewer services, lower payments to providers, or increased costsharing by beneficiaries—all of which would reduce access to care.
The Ryan plan calls for a massive decrease in federal spending on Medicaid with no indication it would be made up by the states or from lower costs. The most likely outcome would be millions losing access to basic health insurance and many poor people forced to pay even more out of pocket to get care.
The winners and losers in this budget proposal could not be clearer. The poor and elderly end up much worse off, but people with higher incomes will see their tax rates cut significantly.
This is a huge cut in Medicare spending. Since it does not contain proven cost controls, this will likely mean seniors will see big increases in their health care spending and/or substantially reduced care.
Or as I say:
The Rich Don’t Have Enough Money. The Poor Have Too Much.
Filed under: Causes, Health, Politics, POTUS Obama, Race Tagged: | BarackObama, Center on Budget and Policy Priorities, GOP, Obamacare, Paul Ryan, Republican, Supplemental Nutrition Assistance Program, United State