Three of 4 Americans do not want to see the Affordable Care Act repealed without an adequate replacement plan in place. Recently, a national health care research organization- the Kaiser Family Foundation- talked with people who voted for Donald Trump and receive health insurance through the Affordable Care Act’s marketplaces and Medicaid expansion. Kaiser President Drew Altman shares people’s concerns with congressional repeal efforts in a New York Times op/ed:
They were also worried about what they called “chaos” if there was a gap between repealing and replacing Obamacare. But most did not think that, as one participant put it, “a smart businessman like Trump would let that happen.” Some were uninsured before the Affordable Care Act and said they did not want to be uninsured again. Generally, the Trump voters on Medicaid were much more satisfied with their coverage.
Leaders in the nation’s health sector are worried too. Groups representing physicians have come out against a repeal plan that doesn’t include an adequate replacement, while providers stand to lose over a trillion dollars if repeal goes through. Paul Demko and Adam Cancryn report for Politico about the economic shockwaves repeal would send through the health system and overall economy.
Hospitals estimate that repealing Obamacare could cost them $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis” if sick people are unable to get care. Even before that happens, though, uncertainty about what might replace the law and how it could affect the bottom lines of hospitals, in particular, has spurred CEOs to cut spending. “Everybody is going to continue to belt tighten and take action fearing the worst is going to happen,” said William Conway, CEO of Detroit’s 1,300-physician Henry Ford Medical Group.
These concerns have led a rebel group of Republican senators, including Louisiana’s Sen. Bill Cassidy, to insist that a replacement bill be passed simultaneously with repeal. While Cassidy has outlined a health care plan in the past, Republicans in Congress do not agree on an exact package. Cassidy has not said whether he will oppose a stand-alone repeal bill, and newly sworn-in Sen. John Kennedy has not taken a position on whether the repeal bill that would strip health coverage from over 500,000 Louisianans should include an adequate replacement.
The future of TOPS
Low-income students would be hit the hardest if a new proposal for TOPS cuts moves forward without changes. The draft plan from the Board of Regents’ staff would slash state payments during the early years of college, leaving students and families to foot more of the bill. The Advocate’s Will Sentell has the story:
What students could collect from Louisiana’s popular college aid program called TOPS would be trimmed permanently under a draft report released Monday by the staff of the state Board of Regents. College freshmen would be eligible for 80 percent of their total tuition costs from the Taylor Opportunity Program for Students, according to the recommendations. Sophomores could get 90 percent and juniors and seniors would be eligible for 100 percent of the merit aid, which is based on modest academic requirements. The new rules would take effect for the freshman class of 2018. In addition, students would have to earn 30 credit hours per academic year to keep TOPS, up from 24 credit hours under current rules.
Funding needed for roads, bridges
The task force that’s been reviewing Louisiana’s transportation infrastructure needs published its final report this week, recommending $700 million per year in new revenue to fix the state’s shoddy roads and bridges. This would mean a 23 cent boost in the state’s gasoline tax, which hasn’t been raised since 1990. To prevent future transportation funding shortfalls, the task force also recommended automatic adjustments to the tax to account for inflation. In addition, the report responded to common misconceptions about the state’s Department of Transportation & Development. The Advocate’s Will Sentell has more:
Just 4.4 percent of DOTD’s budget is used for administration and support services, according to the study. “Through the travels and discussions across the state, there is a common misconception that transportation revenue in the state has been misused in the past and that trust must be regained before increasing the investment to address the state’s needs,” according to the report. Complaints that transportation dollars were moved to State Police overlook the fact that a 1990 statewide vote authorized the transfers, the study says. However, that practice has since ended.
Lessons from NOLA charter schools
President-elect Donald Trump’s choice to lead the nation’s education department, Betsy DeVos, has been a leading advocate for expanding the footprint of charter schools. Andrew Vanacore writes for Politico that DeVos should look to New Orleans as a model for charter school accountability and centralized enrollment, instead of the charter free-for-all DeVos pushed in Michigan.
The obvious contrast (to New Orleans) is Michigan, where DeVos has been critical as an advocate and political donor. Various entities in Michigan can authorize new charter schools, not just a state or local school board, as in Louisiana. Most charters operate as for-profit entities, something a handful of New Orleans charters have tried with uniformly bad results. Some have been allowed to operate for more than a decade without ever getting off the bottom of state rankings. And as The New York Times reported recently, DeVos helped kill a bipartisan measure in the Michigan Legislature that would have beefed up accountability. There are also worries about ulterior motives. POLITICO reported recently about an audio recording in which DeVos and her husband discuss how their Christian faith animates their belief in school reform, explaining that school choice leads to greater “kingdom gain,” an apparent reference to the Kingdom of God. It’s hard not to see that as a nod to the religious schools that often receive funding through voucher programs. Notably, the one in Louisiana has yet to produce the kind of measurable gains that the charters here have.
Number of the Day
$1.7 trillion – revenue loss realized by health care providers across the country between 2019 and 2028 if the Affordable Care Act is repealed (Source: Urban Institute via Center on Budget and Policy Priorities)