Tag: ACA

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Obamacare’s Demise, and its Replacement Part 2

In addition to the ideological goal of nationalizing one-sixth of the American economy, Obamacare’s Progressive advocates support for the legislation was a reflection of their political alliance with lobbying interests from pharmaceutical corporations, the Trial Lawyers Association, and insurance companies, all of which had vested interests in opposing more viable reforms which would have truly and effectively reduced the cost of healthcare.

President-elect Trump, who made opposition to Obamacare a key part of his campaign, has proposed an alternative approach  to the failed concept:

“the House and Senate must:

  1. “Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
  2. “Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
  3. “Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.

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  4. “Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
  5. “Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
  6. “Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
  7. “Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

“The reforms outlined above will lower healthcare costs for all Americans. They are simply a place to start. There are other reforms that might be considered if they serve to lower costs, remove uncertainty and provide financial security for all Americans. And we must also take actions in other policy areas to lower healthcare costs and burdens. Enforcing immigration laws, eliminating fraud and waste and energizing our economy will relieve the economic pressures felt by every American. It is the moral responsibility of a nation’s government to do what is best for the people and what is in the interest of securing the future of the nation. Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.”

An American Action Forum (AAF)  study proposes tort reform as an additional means to lower health care costs.  “ AAF found multiple state medical liability reforms reduced total healthcare premiums by 2.6 percent,  Employer healthcare costs also declined by 3.5 percent, [and]  If these results were replicated on a national level, the nation’s insured could save more than $15 billion in premiums…Tort reform has taken several forms and gained prominence in the 1990s as a way to curb high jury awards. For example, legislators can cap damages, reform how damages are paid, and amend joint and several liability (allowing the plaintiff to collect money from anyone found liable, regardless of their degree of liability).”

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Health Care Challenges Rising

Health care in the U.S. is entering a challenging period. Both Medicare and Obamacare patients will experience serious obstacles

According to a study by The Kaiser Family Foundation (KFF) 21 percent of physicians are not accepting new Medicare patients. This compares to the 14 percent that have decided not to accept new privately insured patients. That is, the proportion not taking new Medicare patients is 1.5 times greater than the proportion not taking new privately insured patients. KFF notes that “Previous studies show that the vast majority of physicians accept Medicare, but the proportion taking new Medicare patients is smaller, particularly among primary care physicians compared with specialists…” This growing limitation of choice will limit choices for those who are aging into the system.

For those using Obamacare, premiums are set to rise. Bloomberg  reports that “Premiums for mid-level Obamacare health plans sold on the federal exchanges will see their biggest jump yet next year, another speed bump in the administration’s push for enrollment in the final months of the U.S. president’s term. Monthly premiums for benchmark silver-level plans are going up by an average of 25 percent in the 38 states using the federal HealthCare.gov website, the U.S. Department of Health and Human Services said in a report today. Last year, premiums for the second-lowest-cost silver plans went up by 7.5 percent on average across 37 states. Individuals signing up for plans this year are facing not only rising premiums, but also fewer options to choose from after several big insurers pulled out from some of the markets created under the Affordable Care Act, known as Obamacare.”

A Guardian review found that “ the ACA relies on competition between insurers to provide affordable coverage, and that is dwindling. Under the ACA, health insurance marketplaces, also called health exchanges, were set up to facilitate the purchase of health insurance in each state. Customers are free to choose from a set of standardized healthcare plans from participating insurers, and those policies are eligible for federal subsidies. But insurers have been fleeing the exchanges, arguing that they are loss makers and the types of people attracted to them make the risks too great for the insurers to provide affordable (and profitable) policies.”

A Breitbart analysis concludes that Obamacare’s (ACA) financial unsustainability is causing both insureds and insurers to abandon the system, “leaving President Obama’s takeover of the nation’s healthcare system on the verge of collapse.” Due to the high and rising costs, young, healthy people, whose payments and relatively light use of medical care were expected to prop up the system, are staying away in sufficient numbers to cause major problems.

Realclearpolitics fleshes out the details. “Economic reality is making it increasingly obvious that we are in the midst of Obamacare’s long anticipated death spiral. Most recently, Aetna  joined United Health care and Humana as the third of the ‘big five’ insurance firms to announce major cuts to its Obamacare exchange business. For insurers, it’s simple math: Premiums collected must exceed claims paid. If too few healthy, low risk individuals enroll to offset the costs of insuring unhealthy, high risk individuals, the math doesn’t work. This imbalance forces insurers to raise premiums on the low risk individuals who do enroll to cover the costs of insuring high risk individuals. The rising premiums cause even more healthy individuals to drop coverage – resulting in what has been called a death spiral…Aetna, for example, suffered a second-quarter pretax 2016 loss of $200 million and total pretax losses of more than $430 million since January 2014 when the exchanges opened for business. Aetna wasn’t alone…UnitedHealth lost $475 million in the exchanges in 2015 and expects to lose $650 million in 2016.”

The US. House of Representatives Committee on Energy and Commerce  recently concluded an investigation which found that lower-than-expected enrollment, higher-than-anticipated costs, and more complicated-than-anticipated technology challenges have caused state based exchanges (SBE) in Oregon, Hawaii, New Mexico and Nevada to fail, ( having wasted hundreds of millions of taxpayer dollars) and Kentucky will be added to that list next year. Only 12 will remain. Washington now appears to be encouraging state exchanges to close and join the federal exchange.

The major findings of the Congressional investigation noted that the state based exchanges will not be sustainable in the long term. As of September 2016, every SBE still relies upon federal establishment grant funds—20 months after SBEs were to be self-sustaining by law. Washington failed to enforce its own rules on Medicaid allocations, and did not recover  misspent dollars.

The looming financial collapse of Obamacare may finally clear the path for more viable options, such as:

  • Tort reform (which would significantly reduce the cost of practicing medicine,)
  •  Allowing nationwide competition between insurance companies (which would lower costs for purchasers of health insurance to be tried)
  • Tax credits to help make private policies affordable
  • Allowing the sale of more flexible policies with different types of coverage, a concept that will be far more attractive for healthier, younger people.

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Obamacare-Medicaid Connection: Back Door to a National Single Payer Plan?

President Obama is seeking to expand federal funding to states that expand medicaid eligibility.

One of the key results of the Affordable Care Act (ACA, better known as Obamacare) has been an explosion in Medicaid enrollment.  About 12 million people have signed up for Medicaid under the program. Some observers believe that the Medicaid-expansion provisions of the ACA were a stealth effort to lay the groundwork for a one-payer system.

A revealing study by the Henry J. Kaiser Foundation  notes that  “policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth…Medicaid enrollment and spending increased substantially in FY 2015, the first full year of implementation of the major ACA coverage expansions. Across all 50 states and DC, Medicaid enrollment increased on average by 13.8 percent in FY 2015, largely due to the ACA coverage expansions.”

Those states that accepted Medicaid expansion under the ACA experienced Medicaid growth far in excess of non-expansion states. The Kaiser study found that “Expansion states reported Medicaid enrollment and total spending growth nearly three times the rate of non-expansion states. A total of 29 states were implementing the ACA Medicaid expansion in FY 2015, up from 26 states in the previous year (FY 2015 additions include: New Hampshire, Pennsylvania and Indiana.)

“Across the 29 expansion states in FY 2015, enrollment increased on average by 18.0 percent and total spending increased by 17.7 percent; both enrollment and spending growth were driven by increases in enrollment among adults qualifying under the new expansion group. Of the 29 states expanding Medicaid in FY 2015, more than half (17 states) noted that enrollment initially increased faster than expected.”

“ Over two-thirds of expansion states reported that per member per month costs for the expansion population were at or below projections.  Across the 22 states not implementing the Medicaid expansion in FY 2015, enrollment and total spending growth was 5.1 percent and 6.1 percent (respectively), much slower growth compared to the expansion states. Increased enrollment among previously eligible parents and children was the primary reason cited for enrollment growth in non-expansion states.”

Obamacarefacts.com otes that “ObamaCare’s Medicaid Expansion Could Insure 21.3 Million Americans in the Next Decade. ObamaCare Medicaid Expansion is one of the biggest milestones in health care reform. “
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A Heritage review  found that the increased Medicaid enrollment under Obamacare has been accompanied by declining enrollment  in employer plans.

A Washington Examiner  review emphasizes that “There are 393 appearances of the word ‘Medicaid’ in the legislative text of Obamacare. The expansion of Medicaid itself is authorized in Title II, Subtitle A of Obamacare — a section called, ‘Improved Access to Medicaid.’ The Medicaid expansion is one of the main two ways through which Obamacare expands insurance coverage. By 2025, the Congressional Budget Office projects that Obamacare will add 14 million people to Medicaid. The Medicaid expansion will account for $824 billion (or slightly more than half) of Obamacare spending over the next decade, according to the CBO.

“It’s also worth noting that Medicaid is the one aspect of Obamacare that both left and right agree is explicitly a single-payer system. The logical implication of Kasich’s position of boasting about rejecting setting up a state-based exchange while expanding Medicaid is that Obamacare would have been better if it simply expanded single-payer healthcare in the U.S. instead of monkeying around with regulated exchanges that featured private insurers.”

Jeff Reynolds, writing in Freedomworks states that  “the expansion of Medicaid under Obamacare has come with all sorts of surprises and unintended (or perhaps intended) consequences. Medicaid expansion creates a two-tier medical delivery system that forces all but the most well-off into a single-payer system. Indeed, Obamacare’s similarities to Great Britain’s NHS are becoming more apparent. Another way this is being accomplished: the removal of asset limits for Medicaid qualification.

“In addition to the huge cost to the taxpayers, there is much to worry about in expanding Medicaid, particularly in the quality of care, notes Reynolds. “There is also strong evidence Medicaid provides substandard care. The Manhattan Institute’s Avik Roy wrote in 2012, ‘Medicaid patients were almost twice as likely to die as those with private insurance; their hospital stays were 42 percent longer and cost 26 percent more.’

“Many doctors refuse to accept Medicaid patients because payments are low. John Goodman of the National Center for Policy Analysis told Fox News, ‘One woman in Boston who was in Medicaid said she had to go through a list of 20 doctors before she found one who would see her.’ He adds, ‘I asked if she was going through the Yellow Pages,’ and she said, ‘No, I’m going through the list of doctors Medicaid gave me.”

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Medicaid patients encounter difficulties getting appointments

Disturbing information continues to build concerning the growing difficulty of individuals covered under the affordable care act as well as those under Medicaid in finding physicians who will treat them.

According to Healthline News, “many of the newly insured will have trouble finding a doctor. Those who do may have difficulty getting quick appointments. Many have gained or will gain coverage under the expansion of Medicaid. …A big problem, even for those who do live in Medicaid expansion states, is that there are not enough primary care physicians to treat people on the government insurance plan. This was a problem even before the expansion.” Healthline News reports that those not able to obtain primary care frequently end up in emergency rooms.

Part of the reason is that, this year, primary care doctors are receiving lesser reimbursement.

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To address the problem, which can greatly increase costs to states and local governments, which in many cases are responsible for the emergency room expenses incurred at public hospitals, “Fifteen states indicated that they will continue the primary care fee increase in 2015, at least in part” according to a Kaiser Family Foundation study.

Adding to the difficulties faced by Obamacare enrollees, a CNN Money study  finds that “Deductibles, co-payments, and drug payments are higher under the average Obamacare silver-level plans — the most popular — than employer policies.”