When policy details, budgets and legislation are hashed out amongst legislators, it can often seem far removed from the average startup’s day-to-day operations.
But policy implementation doesn’t occur in a vacuum, and legislation has real world consequences. Regulations impacting taxes, immigration, wages, crowdfunding and health care all impact entrepreneurs as they set up their business, raise funds, create a company culture and hire and retain talent.
Introduced by House Speaker Paul Ryan (R-Wis.), the bill is slated for a vote before the full House of Representatives tomorrow, March 23. If it passes, the U.S. Senate will vote on the bill as early as next week.
As the bill stands today, it does nothing to Obamacare’s value-based care payment model, guaranteed coverage (when insurance companies can’t deny you for being sick or having a preexisting condition), or the insurance marketplaces/exchanges. And it doesn’t completely repeal Obamacare either. But three key differences are:
No more individual mandate, but still penalties for not keeping insurance—The individual mandate— the financial penalty used to incentivize Americans without health insurance to sign up for it under Obamacare is replaced with a penalty for gaps of 60 days or more in coverage. For example, if someone loses a job and goes more than two months without insurance, he’ll pay a higher rate for the following year than it he’d signed up on the exchange before the 60-day gap.
Tax cuts, for medical device companies and wealthy Americans—Part of Obamacare’s funding came from increased tax rates for Americans with incomes greater than $250,000, insurance companies and medical device companies. Under Obamacare, a 2.3 percent tax was added to all medical device sales. Under the AHCA, this tax would be repealed. The Committee for a Responsible Federal Budget estimates that tax cuts total $594 billion.
Winners and losers shift—Under Obamacare, older, sicker and poorer Americans pay less for health insurance from the marketplaces while younger and wealthier individuals pay a larger percent of their income on health care (in part) because they receive higher subsidies. Under the AHCA, the financial burden shifts. Older and poorer Americans will receive fewer subsidies, while younger and (sometimes) richer people receive higher subsidy rates. For example, the Congressional Budget Office (CBO) estimates a 64-year-old with an income at 175 percent of the federal poverty line would pay $14,600 in premiums per year under the AHCA. This person pays $1,700 today.
And then there’s the $880 billion in cuts to Medicaid—the insurance plan designed to assist low-income Americans.
Everyone is weighing in on this bill—from the typical political pundits to special interest groups and health care experts and advocates. But despite all the opinion pieces and explanatory articles, we’ve found very little feedback from the entrepreneurial community.
So we wanted to ask North Carolina’s startup founders and executives—especially those of you who create and sell products or services for the health care market—what you think of the bill.
How will it impact your business? How will it impact your sales, fundraising strategy, employees? Or will it not impact you at all?
No matter your response to any of these questions, we want to know. So we’ve designed a painless, five-minute survey to gather your feedback. Take it, then tell all your founder friends to take it. And those of you with startups that serve the healthcare sector with the drugs you invent, medical devices you create, digital health apps you design, or any other health care innovation, we especially want to hear from you.
So here’s the link or start the survey below. We look forward to reporting on your responses soon.
*Note: the survey is intended for startup founders and executives only.