Author: Cathy Wentz

Expert Post by Dr. Niran Al-Agba

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I follow pediatrician Dr. Niran Al-Agba, pictured here, on Twitter (Twitter handle – MommyDoc, @silverdalepeds), and I also receive email notifications whenever she adds a new post to her blog. I believe that the post I am linking to here on my blog is VERY important for people (and our national leaders) to know because it explains one of several drivers of high costs for health care, so I decided to go ahead and do something that was already suggested to me for my blog – establish an “Expert Posts” category where I will post links to blog posts and articles I feel strongly moved to share outside of the customary source linking I do for my posts.

https://peds-mommydoc.blogspot.com/2017/04/youve-got-facility-fees.html?showComment=1492017458996#c6483269634879565256


Here We Go … Another Round of Numbers!

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I wrote a blog post more than a month ago about the way numbers can be manipulated by government, media, or anyone else who wants to get in on the act to promote a particular point of view, and nowhere has that been more evident than with the Patient Protection and Affordable Care Act of 2010, especially in the midst of efforts by the Republicans to repeal and replace the sputtering law.

In my previous post, I dealt with how many people had been touting the “success” of the ACA because it had supposedly provided insurance coverage for an additional 20 million people, which gave President Barack Obama’s administration the opportunity to pat themselves on the back. However, my post also pointed out that the coverage of  20 million more people was inaccurate, according to most counts, and in fact, no counts on people covered by the ACA reached the 20- million mark as far as I could see. Although one estimate by the Rand Corporation of the people “newly covered” by the law placed the original number at 22.8 million, but then had also calculated that approximately 5.9 million people had also lost their “coverage” as a result of the law. This brought the grand total of newly covered people under Obamacare to approximately 16.9 million, quite a bit under the touted 20 million.

Where is the logic here?

The newest twist in numbers totally mystifies me, but if you read its details it is not as dramatic as one would think.

As Congress and President Donald Trump unsuccessfully attempted to pass the American Health Care Act last month, the Congressional Budget Office, which is supposed to be non-partisan, released some interesting figures regarding the anticipated effects of repealing and replacing Obamacare.

An article entitled “The GOP’s Obamacare Replacement Is Going to Disproportionately Affect One Group,” by Lydia Ramsey and Andy Kiersz (1), reported that when the CBO released its report on the effects of the American Health Care Act, the agency estimated that “24 million more people could be uninsured.”

I had an immediate question – 24 million MORE than what? More than the number of people who remain uninsured despite of or because of Obamacare? The article simply does provide any details on that.

Then a CNN report entitled “CBO Report: 24 Million Fewer Insured by 2026 under GOP Health Care Bill.” by M.J. Lee and Tami Luhby (2), stated that there would be 24 million fewer insured people in the United States by the year 2026, which is less than nine years from now. This article also said that as many as 14 million fewer people could be insured by next year if Obamacare is repealed and replaced by the AHCA.

As I mentioned earlier, none of the counts for the number of people who were actually “covered” by insurance under Obamacare ever reached as many as 20 million, much less 24 million. Now this is only the fourth year that Obamacare has been in place, and maybe many more people would have enrolled in the years to come, but maybe NOT because several large insurance companies were pulling out of the exchanges as the result of large losses blamed on the ACA.

There are too many unknown factors to make any real predictions.

One crucial point in all these rather bizarre estimations sticks out in my mind. How can the CBO, or anyone else, accurately predict what may happen in both the individual and employer-sponsored insurance markets over the course of 9-10 years? There are just too many unknown factors. For instance there are several policy areas that could change drastically over that time period that would allow for people to get different insurance plans that fit their needs better.

Here are a few policies that, if enacted, might cause the loss of insurance coverage under our customary insurance models for the last 30 years or so, but may result in a much wider variety of insurance plans being offered, as well as more individualized methods of providing for health care needs such as larger amounts in Health Savings Accounts.

  • The formation of high risk pools in every state that enable the chronically ill to buy insurance for their needs at affordable rates.
  • Making tax credits that have only been available to employers available to all citizens so people can decide whether they want to buy insurance through their employer or buy an insurance policy more suitable to their own needs in the individual market – either way the tax advantages would be roughly the same.
  • The removal of all mandates to buy insurance, including the essential benefit mandates that only served to drive up the costs of premiums for many people because a number of benefits had to be covered. This flexibility could enable people to buy truly catastrophic plans that they feel would meet their needs.
  • Increasing the annual amount allowable, by tax law, to add to health savings accounts as well as not requiring that they be tied to a high-deductible insurance plan.
  • Removing the tax-exempt status of most “non-profit” hospitals. This is one that I have not read or heard about anyone proposing yet, but it would go a long way in making health care providers (especially hospitals) actually have to compete for patients by lowering costs and improving the quality of care with real quality measures rather than useless government-mandated measures.

So while many people wave various and assorted numbers around to catastrophize anything our current national leadership does to restore a functioning health/medical care system, there are opportunities for people to come out of the whole mess with a much better deal than they have now, especially with the continued proliferation of innovative free market practice models designed to lower overall health costs.

Further reading:

  1. http://www.businessinsider.com/cbo-chart-on-how-healthcare-costs-could-change-under-ahca-2017-3
  2. http://www.cnn.com/2017/03/13/politics/cbo-report-health-care/

Perspective From Those in the Trenches

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Introduction

As I have educated myself about a lot of the issues with health care delivery and payment in the course of my employment with Dr. Randy Delcore and my own blogging efforts, I owe a lot of what I have learned to connecting with doctors and health policy experts on several of the social media platforms. I feel that many of those blogs and articles I have come across in that process, especially those written by doctors who work in the trenches of our health care system daily, lend even more insight than I can provide from my perspective as an average non-medical citizen observing the many dysfunctions AND innovative models present in our current health care environment. I will use these “expert posts”  to provide links to those blogs and articles with the purpose of providing an even richer understanding of how to improve the U.S. system of health care delivery with that great American pioneer spirit.


How Can the U.S. Really Make Health Care Truly Affordable?

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In many of my posts, I complain about the way our Congress and President (not to mention the Congressional Budget Office and media) harp about how people will or will not be “covered” for receiving medical care. This outlook ASSUMES that it is just too darn expensive for the “average Joe” to just pay cash for his visit to the doctor or surgery. The ultimate irony is that plans within the Obamacare exchanges require quite a bit of out-of-pocket expense anyway – high premiums, deductibles, plus co-insurance, etc. Forking out all this money does not constitute my idea of “coverage.”

What if health (or should I  say medical care) wasn’t generally that expensive?

When someone proposes that thought, many others express incredulity at such an idea. It’s as if people asking the question, “Does health care have to be outrageously expensive?” could be compared to someone asking “Is the Pope Catholic?” While there are situations in which the provision of medical care can become very expensive as in the case of heart attacks, strokes, critical injuries, etc., those are situations in which huge amounts of resources are required to save a person’s life and help them recover. That is what catastrophic medical insurance was always intended to do.

Then there are surgical procedures that can be quite expensive, but they do not necessarily have to be. Let’s just use the example of a hip or knee replacement. These procedures are often needed when someone’s arthritic condition has deteriorated to being “bone on bone.” I know personally how painful this can be because I experienced it with both my hips and needed to have them both replaced. Fortunately, medical science has made great inroads to replacing the bad joints and giving those with that condition a new lease on mobility and life.

However, joint replacements are not known to be cheap, and costs vary wildly.

I recently read an article that was published in February of 2013, but not much as changed since then. The article is entitled, “How Much Will Your Surgery Cost? Finding Out Cost of Hip Replacement Surgery is a Confusing Uphill Battle: Study,” which was credited to the Associated Press (1). The study the article discussed was published in the Journal of the American Medical Association Internal Medicine.

According to this article, researchers conducted a study of 122 hospitals in every state to find out how much a hip replacement would cost if performed on a healthy 62-year-old woman who was not covered by any insurance, but could pay out-of-pocket. According to this study, 15 percent of the hospitals contacted never provided even an estimate of a price, even after as many as five calls. The article reported that researchers were able to obtain cost information from approximately half of the hospitals contacted that included both the physician and hospital charges.

The study found that costs for hip replacement surgery could be as little as $11,000 or as much as $126,000.

The Associated Press wrote that American Hospital Association spokeswoman Marie Watteau commented on the study published in JAMA. She is quoted as saying, “hospitals have a uniform set of charges. Sharing meaningful information, however, is challenging because hospital care is unique and based on each individual patient’s needs.”

Really? It seems as if, especially in these times when patients even face high deductibles along with a responsibility for what is known as co-insurance, if they are insured, that hospitals could look at typical charges on a hospital bill for a total hip replacement and at least provide a ballpark figure with a disclaimer that complications could increase that cost.

It is interesting that a number of ambulatory surgery centers have begun to post transparent bundled pricing for many non-emergent surgeries. For example, at Cedar Orthopaedic Surgery Center, the cash price for the replacement of one hip joint is $17,500 (including the surgeon’s, facility, and anesthesiologist’s fees as well as the cost of the hip implant, initial consultation, and in-surgery radiology). This price is posted on COSC’s website. At Surgery Center of Oklahoma, the cost of a hip replacement is posted as $25,000 (which also includes the surgeon’s, facility, and anesthesiologist fees as well as the initial consultation). Each facility has a clear pricing disclaimer that enumerates any possible charges that are not included as part of the cash package as well as what is included, so there should be very little in the way of surprises. And yes, both of these facilities treats each patient as a unique individual.

So why is it so difficult for hospitals to provide at least a reasonable ballpark figure for costs? Well, I’ve given you quite enough to digest for today so I will cover that subject in my next post on health care issues.

Further reading:

  1.  http://www.nydailynews.com/life-style/health/surgery-cost-article-1.1261818

And The Beat Goes On …

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Congress and President Trump are both apparently revisiting the issue of repealing and replacing Obamacare. And I say, “Good!”

I was very disappointed when the last effort by the House of Representatives failed to get a bill passed that could go on to the Senate and get passed there. To their credit, our congressional representatives did not totally abandon the effort to repeal and replace Obamacare with something that permits a (hopefully)  more free market approach to “health care” and just jump over to tax reform, although that certainly remains on their agenda.

As the discussions continue between moderately conservative Republicans and ultra-conservative Republicans (who are identified as the Freedom Caucus), I worry that they are just in too big of a hurry to get some kind of a bill passed. I have one question:

Where’s the fire?

As I listened to Fox News late last week and throughout this week, the news coverage seems to center around how soon this can be done. In the end, from everything I have heard regarding the timetable for passing an Obamacare repeal and replacement bill, nothing is likely to happen until after Easter. And once again – I say “Good!”

Hopefully it doesn’t even happen too closely on the heels of Easter.

Yes, I do want to see Congress take action on enabling free market medical care as expeditiously as possible. However, I do not want them to hurry through this process and do a bad job at it. It seems like there is an obsession in news stories and in Congress (not to mention the Congressional Budget Office) with gauging how many people will end up with insurance “coverage” and how many people could end up losing it as a result of any repeal action of Obamacare.

I say Congress, and the media that reports on what Congress is up to, is too obsessed with this issue of insurance “coverage.” However, very few people are addressing the real reason that health costs are so high and people fear going into bankruptcy if they are not “covered” by insurance for medical needs. A lot of it has to do with the ways the insurance industry has deceived many people into believing that its contract negotiations with its “participating providers” (especially hospitals) are beneficial to them as patients and coverage holders. Not only that, but many of the deductibles in Obamacare exchange plans are HUGE!

Case in Point

Let me provide you with one example I recently read about in an editorial, “ObamaCare Subsidies Rob the Middle Class” by Alieta Eck, MD (1).

Dr. Eck wrote that most insurance companies have networks of “preferred providers” that most people assume are doctors, labs, hospitals, etc. that provide better rates for care. However, the opposite appears to be the case.

She wrote about one patient who had to spend a day in the emergency room. The grand total for the “billed charges” was $12,000. Because the hospital he/she went to was a one of those “preferred providers,” the actual charges came to $10,000. Coincidentally, the patient’s deductible was $10,000.

Here is the real kicker. A hospital “patient advocate”” informed this patient with the $10,000 deductible that he/she was responsible for paying this entire amount because he/she had not yet met the plan’s deductible. Because the patient had insurance “coverage,” there was no option to take part in any cash pay discounts the hospital might offer to patients not covered by insurance.

Dr. Eck also wrote that the total charge of laboratory work performed during the patient’s day in the emergency room totaled $3,500, and those labs would have cost less than $100 if done by a lab outside the hospital.

So did this patient’s insurance “coverage” in a “preferred provider” network do him/her any good? Anyone with a grain of sense would have to answer, “No way!”

So why is everyone obsessed with “coverage?” It could be a much better deal to get a basic catastrophic insurance plan that would pay for expenses for which few people can really plan. I believe that giving people the freedom (in terms of tax credits/deductions) to save for medical care expenses with Health Savings Accounts, find doctors with reasonable and up-front pricing (most likely outside the insurance networks), and buy insurance plans that fit their individual needs and budget is far superior to the insurance mandates in the Obamacare plans. All the “essential benefits” required to make insurance plans compliant to the Obamacare law are driving costs UP, not DOWN.

A memo to Congress – don’t just do it; do it right!

Congress and the president really do need to “get this.” They also need to slow down and really listen to doctors, nurses, other providers and patients who live the misery of government mandated coverage and interference in medical decision-making every day.

Further reading:

(1) http://aapsonline.org/obamacare-subsidies-rob-middle-class/

Image courtesy of canstockphotos.com


It’s Not Over Till It’s Over

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The past week or so has certainly been a roller coaster ride, with ups and downs and twists and turns, when it comes to the fate of the effort to repeal and replace the Patient Protection and Affordable Care Act (otherwise known as Obamacare). In the build-up to a possible full House of Representatives vote on the American Health Care Act (to replace Obamacare), the talk was thick and fast about the possibility of the bill passing. President Donald Trump had launched an all-out hard sell push while Speaker of the House Paul Ryan worked over his Republican colleagues in the House.

When the push came to shove though, Ryan was forced to admit Friday that he did not have enough votes in the House to pass the bill, even after extending the “deadline” for bringing the health care bill to the floor for a vote from Thursday to Friday.

What Brought the Repeal and Replacement Effort to Such an Abrupt Halt?

The bill had been hanging by a thread as members of the Freedom Caucus, a group of very committed conservatives, voiced their objection to the bill because it did not go far enough in addressing and correcting the problems caused by Obamacare. Upon reading an analysis of the bill by Jeffrey Singer, a surgeon writing on behalf of the Cato Institute (1), the bill clearly did not fully roll back many of the mandates that are making Obamacare incredibly expensive.

Dr. Singer wrote that the American Health Care Act proposed to remove the individual mandate for all U.S. citizens to buy health insurance, well – more or less. Instead of the individual mandate that would result in a penalty “tax” paid to the federal government for those who choose to go without health coverage during the year, the new bill would impose a 30 percent premium surcharge effective for one full year on anyone who goes without continuous insurance coverage for more than 63 days in a year and then gets insured.

“… Sounds a lot like a Republican version of an individual mandate,” Dr. Singer commented, noting that the ACA makes the individual penalty for going without insurance payable to the Internal Revenue Service while the premium surcharge for the skipping insurance for a while under the Republican plan would go directly to insurance companies. Hmmmm.

As the repeal and replacement bill moved through committee scrutiny, according to an article by Kimberly Leonard with U.S. News and World Report, “Republicans Make Changes to Health Care Bill” (2), it underwent some changes with the apparent purpose of keeping many factions in Congress happy. One of those changes was dubbed a “manager’s amendment” that appeared to be in response to “findings” (from whom; from where?) that one group of people that would take a hit with coverage challenges, such as higher premiums, would be older people who were not yet eligible for Medicare. This change was placed in the bill to instruct the Senate to add a provision that would set aside a $75 billion reserve fund to deal with that issue. However, this “manager’s amendment” did not appear to stipulate how that reserve fund would be used.

This article also reported a couple of changes made to make staunch conservatives happy, which included the following:

  • The repeal of taxes connected to the ACA one year earlier than planned in the original bill
  • Alterations to Medicaid that would give states the freedom to implement work requirements for some Medicaid beneficiaries and would give states a choice in terms of how they received funding for the program from the federal government.

Then there were provisions in the bill that were left unchanged despite efforts by the more conservative Republicans to jettison them. They were:

  • Keeping the provision allowing insurance companies to penalize people who allowed their coverage to lapse more than 63 days at time with a 30 percent surcharge on their premiums.
  • Phasing out Medicaid expansion two years earlier than planned in states that had accepted Medicaid expansion.

Another point of contention between conservatives and the more centrist members of the Republican party, not to mention most of the Democrats, was that of essential benefits mandated to be included in the ACA-compliant plans.  Such benefits included maternity care, mental health, prescription drugs, and several preventive care services that would not require out-of-pocket costs for patients. The logic of eliminating these mandates was that insurance premiums could decrease because insurers would not be required to pay for all those bells and whistles. Then consumers could choose plans with or without those benefits, depending on their personal needs or preferences.

According to an article in The Hill entitled “What the GOP’s plan to kill essential health benefits means” by Peter Sullivan (3), an aide to Senate Minority Leader Charles Schumer said that it would mostly likely not be permissible to repeal those essential health benefits in a Senate reconciliation bill, and a regular bill with that provision would be highly unlikely to command the 60-vote threshold needed to pass it.

Another Issue for Another Day

The issue of essential health benefits is very complex and requires much more discussion than I can give it at the end of today’s post, so I plan to give it some detailed and considerate attention in my next post.

Hope Remains for the Future

I was gratified to learn Monday that neither congressional Republicans nor President Trump are going to abandon the project of repealing and replacing Obamacare, but will return to the issue again (although they did not say exactly how soon). I retain hope that Congress can work something out that will benefit all Americans one way or another and that someone in leadership can tell us more about it than “it will be great.”  I am personally committed to helping educate our leaders with the real reason Obamacare is failing and some real solutions because I do not feel that Congress or the White House has dug deep enough into the real cost drivers for medical care.

Sources for further reading:

  1. https://www.cato.org/publications/commentary/failures-american-health-care-act
  2. https://www.usnews.com/news/health-care-news/articles/2017-03-21/gop-makes-changes-to-health-care-bill-among-inter-party-disputes
  3. http://thehill.com/policy/healthcare/325381-what-the-gops-plan-to-kill-essential-health-benefits-means

 

 

 

 

 


Episode 3 – Translating Confusing Language on My Own

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In Episode 2 of my series in which I attempt to interpret and analyze the American Health Care Act, I ran into a sentence very early on in the process that left me somewhat baffled.

This is it (Section 102):

“Effective as if included in the enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (Public Law …), paragraph (1) of section 221 (a) of such Act is amended by inserting ‘and an additional $422,000,000 for fiscal year 2017′” after ‘2017.’”

My Efforts to Get Information From a Congressman’s Office

So I sent an email to someone at the Washington D.C. office of Rep. Chris Stewart, R-Utah, because he is my congressmen. I wasn’t sure who I should contact there, but since I can count myself as a member of the media because I am a blogger, I went for someone who appeared to be a media relations person. However, I never received an answer to my request for an explanation.

I try to be a patient person, so I waited several days, and still received no response. By yesterday, however, I was tired of waiting so I called Rep. Stewart’s Salt Lake City office. A very nice young woman answered my question, more or less, by saying that she interpreted that sentence the way I told her I interpreted it.

Then I asked a follow-up question that she was not sure of, so she referred me to a health policy expert in the office and gave me that person’s email address. I dutifully emailed her yesterday with my question, and have not yet received a response. I am anxious to move onward with this analysis and commentary, so I am writing my own interpretation of this sentence and what follows it.  Hopefully, I am right about that. Something I heard on the news seems to indicate that I may have it right.

So Here’s My Take

Apparently this passage means that the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is to be amended so that an additional $422 million would be appropriated for the Community Health Center Program (I assume in addition to any other amount that program is already budgeted). After all, the wording does say, “and an additional $422,000,000 for 2017.” Note this is only 1 year (this year even). Once again, it appears that another law has been blended into the new bill, or that’s what it looks like from where I’m sitting.

We can ask, “Why is an additional $422 million being allocated to the Community Health Center Program?” I believe the answer is found in the following passage of the repeal and replacement bill (Section 103).

This section reads as follows (I have to warn you this is a bit long):

“Not withstanding … (this is a whole list of sections from other laws you can look up in the bill yourself if you’re so inclined) … or the terms of any Medicaid waiver in effect on the date of the enactment of this Act that is approved under section 1115 or 1915 of the Social Security Act (42 U.S.C. 1315, 1396n) for the one-year period beginning on the date of enactment of this Act, no Federal funds provided from a program referred to in this subsection that is considered direct spending for any year may be made available to a State for payments to a prohibited entity whether made directly to the prohibited entity or through a managed care organization under contract with the State.”

Here is the definition of a “prohibited entity.”

“The term ‘prohibited entity’ means an entity, including its affiliates, subsidiaries, successors and clinics –

(A) that, as of the date of enactment of this Act –

(i) is an organization described in section 501 (c)(3) of the Internal Revenue Code of 1986 and exempt from tax under section 501(a) of such Code;

(ii) is an essential community provider described in section 156.235 of title 45 Code of Federal Regulations (as in effect on the date of enactment of this Act) that is primarily engaged in family planning services, reproductive health, and related medical care, and

(iii) provides for abortions, other than an abortion –

(I) if the pregnancy is the result of an act of rape or incest, or

(II) in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself;”

Clearly the definition of a “prohibited entity” perfectly describes Planned Parenthood, that national organization known for its dedication to abortion as well as a callous attitude towards it.

My Conclusion

So to summarize, Sections 102 and 103, of the American Health Care Act states that the additionally appropriated $422 million being directed to the federal Community Health Center Program is money that COULD NOT be used to provide funds in any way to Planned Parenthood, or any similar organization. Although no organization is specifically mentioned in this definition of “prohibited entity,” the main target is Planned Parenthood.

This is an action President Donald Trump and most of the Republicans promised to take during the 2016 election season, and I am sure it was appropriate to place in the bill repealing and replacing the Unaffordable Care Act. After all, that act had attempted to force all employers providing medical insurance to their employees to pay for birth control, include abortifacients. Only a couple of groups were able to get themselves excused from the birth control mandate, and that was after long court battles.

I am personally glad that this was included in the Obamacare repeal and replacement bill because, as someone who objects strenuously to abortion, I do NOT want the tax dollars I pay to any government entity to fund that horrible procedure. If Planned Parenthood is so dedicated to the killing of unborn babies (since it is unfortunately legal in this country), that tax-exempt organization can raise money to support its heinous activities from those who do want the killing to continue. They can put their money where their mouths are.

NEWS FLASH!

I just heard news that Paul Ryan, Speaker of the House of Representatives, just informed the President that the House did not have the votes for the bill to repeal and replace Obamacare. So I guess my little project has become a moot point. Well, it was educational while it lasted, and how ironic that as I set out to help explain the bill to the average person, it failed.

So where does the country go from here? The word from President Trump was that if the House Republicans could not get the American Health Care Act passed and sent to the Senate, the country would be stuck with Obamacare until it collapsed of its own weight. This year ought to get interesting as far as health care is concerned. As far as I am concerned, I think there was an artificial timeline, and given time,  something could get put together that would have passed.


Ranting Time

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I’m going to take a little “time out” from my analysis of the American Health Care Act to rant a bit. What about? The sheer cluelessness of many of the people who report on the Obamacare repeal and replacement plan as well as those who are interviewed about it.

Many reporters (and Obamacare proponents) keep coming back to beat the same old dead horse – the subject of how many people will “lose” coverage. I have some questions and comments regarding these claims, and the first question is:

What coverage will they be losing?

If it is expanded Medicaid coverage and these are able-bodied people, I am not entirely sure it is the role of the federal government to make sure they stay healthy. Isn’t it their responsibility?

As a disclaimer, in past posts on this blog, I have praised Indiana’s Medicaid expansion program because, since that state believes it must do something, at least it has chosen a free market model to utilize, rather than the traditional complete government dependency model, ensuring that the working or temporarily unemployed poor have a health care safety net while being encouraged to move away from it. There are actually mechanisms in the Healthy Indiana 2.0 plan intended to enable beneficiaries to move from the Medicaid plan to commercial insurance. I hope that the people receiving a benefit from that plan will use that program as a temporary safety net, and not as a hammock.

However, the trouble is – too many people get used to government assistance and they become government-dependent, and that is why there are so many people screaming about the fear of losing “coverage.”

I came across a quote today that really “nailed” this government-dependency phenomenon in an editorial written in a local online news publication. The writer Brian Hyde says this:

“And let’s not forget about the disservice of creating dependency upon a system that can only thrive when those it purports to save are kept powerless. Politicians love to create classes of victims which they then pretend to save.”

This quote really goes to the heart of the Democrats’ attitude when it comes to keeping the same old health care and general welfare system that has not really done much good, but has managed to keep specific classes of people in its stranglehold of generational poverty and dependency.

Another group of people who are getting worked up about the possible repeal and replacement of Obamacare are those who receive generous subsidies at the taxpayers’ expense to buy insurance from the Obamacare exchanges. With some shame, I must admit I am one of those people buying a health insurance policy on the exchange and receiving subsidies, only it was not MY CHOICE, so I would be very happy if Obamacare went away.

How did that happen?

Neither my husband nor I get employer-paid insurance at this time. However, my husband has Type II Diabetes, and although he does a good job at keeping his blood sugar in check, he felt the need for some kind of “coverage” just in case something went terribly wrong with the diabetes. At this time, but hopefully not for too much longer, we are what one would call lower middle class, so we qualify for a subsidy.

I had originally told my husband that I did not want to be involved in getting the Obamacare at all, and would just take my chances and skip it (with about a billion good reasons why). Of course, I totally understood where my husband was coming from, but that didn’t mean I had to get that awful insurance (or so I thought). Well, guess what! I learned that when household income is considered for receiving Obamacare subsidies, it means I am required to be covered along with my husband on the same plan.

Talk about sexism!

Didn’t President Barack Obama and all his flunkies always rant about a “war on women?” Of course, that line was always pushed to create the narrative that any insurance women were covered by, even if it was a group insurance for a Christian company or other group like Little Sisters of the Poor, had to pay for birth control, even if it was an abortifacient. Refusing to provide that kind of coverage was the left’s idea of a war on women. God forbid they should take their birth control prescription to Walmart or similar discount store and get a good cash price for it.

Yet it’s not a “war on women” to FORCE a woman to be covered by the same Obamacare insurance as her husband whether she wants to or not? Those leftists scream about a woman’s right to the CHOICE of getting an abortion, but according to them, she does not have the right to CHOOSE whether she wants to be on the same Obamacare plan as her husband, which is very convenient hypocrisy.

Actually, my husband acknowledges that the Obamacare plan we have stinks; it has the typical very high deductible and it’s the only carrier in our area, which is basically a monopoly.

The trouble is that, as one doctor pointed out, the old type of catastrophic plans are illegal under Obamacare because they don’t have all the bells and whistles. I think my husband and I would both be better served being able to buy a very basic catastrophic plan and getting a health savings account to go with it. We  would probably have to resort to some kind of high risk pool because of the diabetes issue (if that will be part of the repeal plan), but at least we could skip other forms of coverage currently demanded by Obamacare.

The important thing is that if Congress does the repeal plan right, we can hope for all kinds of choices in health care coverage and access. That part about Congress doing the repeal right is a big IF because there are so many issues about the real cost drivers of health/medical care not being considered in the repeal and replacement process, at least not as far as I can tell.

A Rebel at Heart

In a future post, I will have to tell you about my outright refusal to use my “coverage” to get the two maintenance prescriptions I use, and the great results that come from that.

Photo Attribution:

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