Wednesday, March 29, 2017

Blogger Candidate Forum: Cities And The American Heath Care Act

Speaker of the House of Representatives Paul Ryan holding a copy of AHCA
Getty Images
Hello Everyone:

It is time for the weekly edition of Blogger Candidate Forum.  Shall we talk about the spectacular failure that was round one of the American Health Care Act?  The much touted "repeal and reform" of the Affordable Care Act (i.e. Obamacare) could not even be brought to the floor of the House of Representatives for a vote because its massive lack of support.  After the fingers were pointed and tweets sent out into the digital universe, the House Republicans are going to try again.  Ironically, the partisan and in-party squabbling may lead to an expansion of the federal Medicaid program.  Meanwhile, let us take a look at house AHCA would affect American cities.

Laura Bliss, in her CityLab article "The Cities Trumpcare Would Hurt (and Help), asks "Which cities would hurt from the Trump-backed health care bill attracting withering criticism on both sides of Congress?"  A new analysis published by WalletHub (; date acted mar. 29, 2017) 2017's Cities Most Affected by Trumpcare by Richie Bernardo, found that "urban places with large populations of poor, non-white policyholders would see the tax credits they receive under the Affordable Care Act more than halved under the GOP's proposed plan,..."  Cities and towns in the suburbs, exurbs, and rural communities would also experience a reduction in tax credits and coverage.

Downtown Yuma, Arizona
Of the ranked 475 American cities with populations greater 75,000, Yuma, Arizona is the city hit hardest by AHCA, version 1.0.  "The average couple would lose nearly $8,000 in subsidies."  Yuma's population mirrors those who have reaped benefits from ACA; "18 percent of the city's residents lives below the poverty, 55 percent are Latino, and 21 percent are foreign-born, according to Census tracts (  Wallethub's methodology, which relied on the Kaiser Family Foundation's Health Insurance Marketplace Calculator, used a model two-person, joint-filing Yuma household-where neither half of the couple smokes, median age, and earn the city's median income ($43,663 according to; date accessed mar. 29, 2017).  The model couple would be eligible for nearly $13,000 in yearly tax credits under ACA's income- and location-based system.  Under whichever version of AHCA eventually makes it (if at all) to President Donald Trump's desk for his signature, the subsidy would drop to $5,000 under the age-based subsidy plan.

Downtown Anchorage, Alaska
Economically challenged cities populate the list of places greatly affected by AHCA.  These cities are notable because they feature "significant concentrations of low-income African-American residents: Syracuse, New York; Chattanooga, Tennessee; Birmingham, Alabama; and Bridgeport, Connecticut fill out the top 25.  One city in particular, Anchorage, Alaska, ranks behind Yuma as the second-worst affected city.  Anchorage is not a particularly economically challenged city but its remote location makes healthcare costs especially high.  Under ACA, Alaskans received some of the most generous subsidies in the United States.  In an aside Laura Bliss, "Relatedly, older, poorer folks who live in truly rural areas-in other words, Trump's biggest supporters-may have the most to lose with the GOP's bill out of everyone."

Aerial view of Newport Beach, California
Photography by D. Ramey Logan
There cities that would thrive under AHCA-in fact, quite a lot of places, according to WalletHub's 2017's Cities Most Affected by Trumpcare.   Specifically, three-quarters of the 457 cities on the list would benefit from more generous tax subsidies.  Wealthier cities, where many people receive little or nor subsidies under the current system would do particularly well: "Average households in affluent Newport Beach, California; the Woodlands, Texas; and Virginia Beach, Virginia all net $5,000 or $6,000 credits they don't currently receive."

Laura Bliss reports, "WalletHub divides the 457 cities into different population tiers for a more apples-to-apples comparison of different-sized cities.  Still, it is advisable to look at this ranking as an sketch, rather than a completer analysis, of Trumpcare's urban impact, because it uses city limits as its geographic metric, rather than metro areas."  A WalletHub analyst told Ms. Bliss, via email,  that this approach, provided as few data limitations as possible, "but it gives a misleading impression of how the most economically powerful urban areas in the country would be affected."

Downtown Washington D.C.
Metropolises such as Los Angeles, Atlanta, and Washington D.C. would also benefit if and or when the GOP-supported plan.  However, like many big cities, only "city proper" counts in the metric because "these places have higher concentration of wealth than the suburbs and towns that radiate around them."  Suburban Atlanta is notoriously poor, plagued with high rates of chronic diseases; thus repealing and replacing the Affordable Care Act with a zip code and income blind plan would be, to say the very least, very unhelpful.

Following this logic, Ms. Bliss writes, "Wallethub doesn't account for the share of city residents that are currently covered thanks to ACA, nor how many would be projected to drop out of the marketplace sure to the new plan's cost hikes."  Further, the analysis makes no mention about how rolling back Medicaid expansion would impact these cities.  In an aside Ms. Bliss notes, "Reliable Medicaid enrollment data is extremely hard to come by."

On Friday, Speaker of the House of Representatives Paul Ryan (R-Wisconsin) sounded a defeated note admitting that ACA is the law of the land for the foreseeable future.  Never one to admit defeat, President Donald Trump said that perhaps with would be better to let the bill die and the Affordable Care Act explode (it is not) so that he can negotiate a better deal.  The House Republicans are going to try again.  Perhaps they, along with the President, will learn from their mistakes and do better.  Blogger is hoping for a more bipartisan solution but is not holding her breath.     

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