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healthcare financing

Jonathon Cohn games out how the debt-ceiling deal, both the potential trigger and the Super Congress, could affect health care programs, and is most concerned about the future of the Affordable Care Act.

He argues that the triggers would likely be preferable to the Super Congress, since "President Obama and the Democrats largely shielded the big entitlements and programs from the poor," whereas everything is on the chopping block for the Super Congress. But there's a hitch.

But don’t kid yourself: The automatic cuts will still hurt, because they’d still affect plenty of important programs. And among them may be the administration’s signature legislative accomplishment, the Affordable Care Act.

The new health care law will make insurance more affordable by providing subsidies to people who buy insurance on their own. And these subsidies come in two forms. There are tax credits, which people can use to offset the cost of their premiums. And there are subsidies to defray cost-sharing: In other words, the government will help reduce people’s out-of-pocket costs. Under the debt ceiling deal, the tax credits are exempt from automatic reductions, because they are a tax credit and not a form of spending.

But, as both administration and congressional sources are confirming, the cost-sharing subsidies are not exempt. They will decline. And that’s worrisome because the subsidies were already pretty low. In fact, many of us were hoping that, over time, lawmakers would see fit to raise them rather than reduce them. I can't be sure how much the subsidies would decline, as nobody I’ve contacted seems to have run the numbers yet. And I'm not even positive how reduced subsidies would translate into reduced protection, since technically the subsidies go directly to the insurers. (I don't even want speculate about the impact until I know more. I’ll update this item when I do.)

This, needless to say, poses a potentially serious problem to the signature accomplishment of the Obama administration, and to the goal of covering 30 million currently uninsured Americans. Digby nails the threat:

First of all it allows them to start cutting into the ACA before it even gets started in the name of projected deficit reduction. It doesn't get any more abstract than that and the fact that the administration that is credited with the reforms signed on is a very ominous sign.[...]

The worst of all possible worlds will be if the Super Committee decides to hold the HCA hostage as a way to pass their own hideous agreement and put liberals on the hook again for the same program. (Maybe they can sneak in some anti-abortion nonsense at the end and we can all party like it's 2010.) I certainly wouldn't put it past the Republicans to play both sides of that argument. After all, they win either way.

Throw into the mix the possibility of the Medicare eligibility age rising, and take BTD's scenario: "Imagine you are 62, making $40,000 a year with employer sponsored health insurance. How are you feeling about the next 5 years?"

The potential damage isn't just to the Affordable Care Act and Obama's legacy: it's to the idea of health care reform and the future reforms that could build on what's been done so far. Politically, for real, expansive health care reform that extends not just access to insurance but actual, universal health care to happen, the Affordable Care Act needs to succeed, or no one will want to touch the issue for another few decades.

Originally posted to Joan McCarter on Thu Aug 04, 2011 at 03:07 PM PDT.

Also republished by Main Street Insider: Capitol Hill Coverage and Daily Kos.

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