alternatives to obamacare – USA Gov Policy

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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It has become a standard line of those defending Obamacare (the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) that there is no alternative to the deeply flawed program, which has cost the taxpayers so much, and produced so little.

The National Center for Public Policy Research has compiled a list of alternatives that have been proposed, including those presented by the CATO Institute; Senators Hatch, Burr, Coburn, and Upton; the Republican Study Committee; Rep. Tom Price; and Senator Ted Cruz. The continuing statements by the White House, many legislators, and much of the media that no alternatives have been developed is manifestly incorrect.

In addition, many of the concepts to address the escalating costs of health care and health care insurance have yet to be enacted, and remain actively opposed by special interest groups, including lawyers groups and insurance companies. These include innovations such as allowing health care insurance to be sold nationally, instead of state by state to enhance competition and reduce prices; enacting tort reform, to address the skyrocketing cost of malpractice insurance for doctors and medical institutions due to non-substantive nuisance law suits; and permitting policies that more precisely fit the needs of the insured, such as coverage for catastrophic care only.

The need to address Obamacare has been summarized by the Heritage Foundation, which outlined how the legislation detrimentally affects Americans:

“Seniors: The law cuts an estimated $716 billion from Medicare over ten years. However, these “savings” are not set aside to preserve Medicare’s future, instead they are used to fund new spending created by the law. Nearly one-third of all seniors rely on Medicare Advantage, the private health care option in Medicare. Despite the program’s growing enrollment and beneficiary satisfaction, Obamacare makes deep cuts to the program that jeopardize its viability in coming years. In addition to payment cuts, Obamacare imposes new taxes on drug companies and medical device makers, and new regulations that will make health care more costly for seniors.

“Doctors: The United States is facing a severe physician shortage. By 2020, the nation will need an additional 91,500 doctors to meet medical demand. Obamacare exacerbates this problem by further increasing physicians’ workload and worsening their attitudes regarding the health care system.

A 2012 survey found that Obamacare is motivating doctors to change their retirement timeline, with 43 percent of respondents stating that they are considering retiring within the next five years as a result of the law.
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“Business & The Economy: The Congressional Budget Office estimates that the Obamacare subsidies will discourage Americans from working, and cause 2.5 million employees to drop out of the labor force.

Obamacare’s employer mandate will raise the minimum cost of hiring a full-time worker to $10.30/hour in 2015. Congress has already raised the minimum wage from an employer’s point of view, but the money goes to the government instead of the employees.

“States: Obamacare’s Medicaid expansion worsens the already heavy burdens facing states. By 2021, approximately 78 million people are projected to be enrolled in Medicaid—requiring billions of dollars from state budgets and taxpayers. In the individual market, Obamacare’s exchanges have on average decreased insurer competition by an estimated 29 percent nationwide. Furthermore, over half of the counties in the U.S. have only one or two insurers to choose from in their Obamacare exchange.

“Families: Obamacare adds nearly $2 trillion in new health care spending according to the Congressional Budget Office. Over the next 10 years, Obamacare will levy about$771 billion in new taxes and fees.

Obamacare imposes significant financial penalties on the decision to get or remain married – over $10,000 per year for certain couples.

“Uninsured: The Congressional Budget Office estimates that “between 6 and 7 million fewer people will have employment-based coverage each year from 2016 through 2024 than would be the case in the absence of [the new health law].”In 2024, after ten years of full implementation, 31 million people are projected to remain uninsured.”

Quick Analysis

Ukraine’s Frozen Conflict

As we approach winter in the northern hemisphere, the war in Ukraine is beginning to resemble a “frozen conflict” from many perspectives. Ukrainian President Volodymyr Zelensky recently told the media he hopes the war will end faster once President-elect Trump takes over in January. Opinions in Moscow, however, differ from that of the Ukrainian leader. Russian President Vladimir Putin argues that the North Atlantic Treaty Organization (NATO) needs to exclude Ukraine from joining in “exchange” for peace. If it does not, he says, then no end to the war is in sight. So far there is no Christmas solution. Several NATO countries, according to Vladimir Socor of the Jamestown Foundation, are tentatively considering “coalitions-of-the-willing” to provide security for Ukraine outside of the formal NATO framework. There is, however, no collective mechanism today under which such an arrangement is viable. According to the NATO Charter, while Ukraine is a NATO partner country, it may not join as a full member since it has not fulfilled the requirements for membership. That has not stopped NATO and allies from continuing “to provide Ukraine with unprecedented levels of support, helping to uphold its fundamental right to self-defence,” according to the organization. Socor says that keeping Ukraine out of NATO will not advance peace with Russia. Waiting for a peace settlement, he suggests, would only serve to encourage Moscow to continue the war indefinitely. Although the Biden Administration officially withdrew its support for Ukrainian membership in 2021, NATO maintains an “open door” policy toward membership-seeking countries. The current White House position led the way for European states to oppose Ukraine’s membership saying that a decision should be delayed until “conditions are met.” Biden pushed for changing “open door” to a “bridge” metaphor. It is not intended as an across-the-board NATO policy and has been implemented in the past on a case-by-case basis, says Socor. “The alliance’s open-door policy was not fully insulated from Russia’s non-statutory blocking power, and NATO-aspirant countries’ path toward membership was not always irreversible.” Russia has successfully blocked states like Georgia from joining, first in 2008 and again after the war in Ukraine began in 2014. Russia recognizes the value add of Ukraine to NATO is enormous and that Kyiv has a better case than some other nations. Putin’s invasion was, in part, intended to foreclose that option. By 2021, Moscow was pushing hard to maximize its war objectives, which included further annexations of Ukrainian territory. A main goal for Putin was, and is, to ensure there is no Ukraine left to join NATO. As President-elect Trump prepares to assume office in January, he is faced with the historical challenges presented by the war. Post-conflict security guarantees were the center of several proposals made during the 2023 military stalemate. The incoming Trump Administration has yet to outline how it intends to handle the Russia-Ukraine war. Analysts in Washington believe that the new Administration will expect its European allies to guarantee the majority of Ukraine’s security needs. As we approach 2025, several European nations have acknowledged that they do not view Ukraine as eligible for NATO membership as it would draw the organization into the middle of the conflict. Others want to wait until the war is over or pending a “peace” settlement before considering Ukrainian membership. Socor reports that some “influential voices” are suggesting that “Kyiv should join NATO after “freezing” the war along a stable armistice line, de facto accepting Ukraine’s partition, with NATO security guarantees applying de jure to the government-controlled territory only.” This would mean starting accession talks soon with the actual talks to commence only after a ceasefire is in place. Trump arrives in Washington at a time when Putin’s hybrid strategies of war in Ukraine have eviscerated commonly-held differences between war and peace. “Absent a political consensus in NATO over Ukrainian membership, certain European allies, including France’s President Emmanuel Macron, are holding informal consultations about post-conflict security guarantees to Kyiv by NATO members outside of NATO’s framework,” according to the Jamestown Foundation. The Biden Administration downplayed the discussions on possible forms of military assistance and defense industry cooperation by sending only an Assistant Secretary of State. For a European peace to hold the Trump Administration would need to formally extend the United States’ nuclear deterrence to Ukraine. Options under discussion in Europe include a “coalition of the resolute” to deploy forces to Ukraine as part of a possible armistice package, deterring further Russian attacks, says Secor. European officials are also debating, without any agreement, whether its military forces could perform non-combat logistical roles to free Ukrainian forces to fight. None of the possible courses of action has moved forward as all eyes are waiting on the incoming Trump Administration for clues about its intended level of support for a NATO framework and other non-NATO proposals. Daria Novak served in the U.S. State Dept.