Category: Obamacare

Running Out of Patience With Senate GOP

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For a little while now, I have been giving most of the Republican senators the benefit of the doubt (huge doubt) as they convened and tried to work out a good solution for repealing and replacing the Patient Protection and Affordable Care Act although I feared a lot of high payout deal-making, which always stinks to high heaven.

I think that now I am totally with both Sean Hannity and President Donald Trump in my frustration about the Senate Republicans’ deep, and apparently irreconcilable differences in how this repeal is supposed to work.

In my opinion, one of the biggest problems I see is some Republicans, that could really fit the description of Republicans in Name Only, are trying to “bring home the bacon” in their states. The repeal and replacement of Obamacare should not be something that senators are supposed to be paid off to accomplish. This is something desperately needed by the American people – those people who wanted this change so badly that they could not stomach four more years of the “same ‘ol, same ‘ol” top-down government control, so they voted for Trump instead of Clinton. Of course that is not the only reason they voted for Trump, but it was certainly high up on many Americans’ priority list.

One of the RINO “villains” in this repeal and replacement drama is Senator Lisa Murkowski. According to a July 13 article on Business Insider, the most recent version of the Senate repeal and replacement bill contains a provision that holdout Murkowski can take home to her home state of Alaska.

What is that provision?

The provision provides a pot of money to the state stability fund that would be given to states to help them offset high insurance premiums and encourage people to sign up for coverage. I’m sorry, but this sounds like warmed-over Obamacare to me because Obamacare was all about pushing people to sign up for insurance coverage.

Now here’s a novel idea, why not create a truly free market in both health care and health insurance? There are many ways to do this, and yet somehow this senator feels that her state must be paid off to make any move to repeal and replace Obamacare. In fact, the whole idea of repealing and replacing Obamacare is to allow people more choices in the way they personally manage their health care – it is not about delivering goodies to certain states to bribe a senator from that state to “come along.” I thought that one of Trump’s principles around his election was to “drain the swamp” in Washington. I would characterize any unusual amount of money Murkowski might get set aside for Alaska as pretty swampy.

Business Insider quotes the provision pertaining to Alaska as follows:

“The Administrator shall determine an appropriate procedure for dividing and distributing funds under this subsection that includes reserving an amount equal to 1 percent of the amount appropriated under paragraph (1) for a calendar year for providing and distributing funds to health insurers in States where the cost of insurance premiums are at least 75 percent higher than the national average.”

It just so happens, according to a report (cited by Business Insider) from the Department of Health and Human Services, that Alaska is the only state that qualifies for that provision.

The Business Insider article states the following: “Based on the amount of money set aside through the state stability fund, Alaska would likely end up with hundreds of millions of dollars annually toward its health insurance markets.”

So this is something offered to the state of Alaska by way of Senator Murkowski to basically bribe her to go along with repealing and replacing Obamacare. FOR CRYING OUT LOUD! Murkowski is supposedly a Republican senator, but with spend-crazy Republicans like her, who needs Democrats to run this country into the ground financially? Does she have any conscience whatsoever?

If I could have a crack at talking to her, I would tell her to talk to people who really understand what is going on in the health care sector of our economy (I could refer her to a few) and the fact that the high cost of health insurance premiums is the symptom behind the country’s “health care” woes, not the main problem (although insurance companies are complicit in the scam). I have written about this before, but more about this in a future post.

Murkowski is just creating continued dependence on the government by the people of Alaska and insurance companies that do business in Alaska. Instead, she should be getting an education concerning the true drivers of high health care costs and working to solve those problems, which would drive down health care costs, and in turn, the cost of health insurance.

In an editorial in USA Today (2), Senator Rand Paul wrote that the previous Senate bill (one that was roundly rejected by all sides in the Republican party for a variety of reasons) kept a majority of the Obamacare taxes and spending. It also contained a $200 BILLION bailout for insurance companies. Clearly, a good chunk of this would be going to Murkowski’s home state.

Not only that, Murkowski has a few other very “leftist-oriented” demands. She has also opposed cuts to Medicaid and freezing the funding for Planned Parenthood, even with the knowledge of those horrific videos in which abortionists talked casually about selling the body parts of unborn babies while eating and drinking. I question why Murkowski hangs with the Republican party; I don’t see an ounce of conservatism in her. She really needs to be more honest and just switch to being a Democrat (or at least go unaffiliated) because she is clearly a traitor to any true conservative principles. Of course, she’s not the only one I could say that about.

I, like my husband, am growing more and more frustrated with the Republican party. My husband finally ended his membership in the party and is now registered to vote as an independent. I am headed there, yet I have held out hope for a while that I could positively contribute to the Republican party by choosing people in primaries and caucuses who truly reflect its principles. However, that hope is growing dimmer and dimmer in the face of Republican antics like Murkowski’s.

Sources for further reading:

  1. http://www.businessinsider.com/senate-health-care-bill-bcra-alaska-lisa-murkowski-2017-7
  2. https://www.usatoday.com/story/opinion/2017/07/18/rand-paul-time-repeal-obamacare/490069001/

*As I have said before, I am just getting warmed up on the the subject of repealing and replacing Obamacare as well as encouraging a much freer market in medical and surgical care that could really decrease costs for everyone and make that care much more accessible. If you are curious to know what I have to say next about all this, I encourage you to sign up for my email list, which is at the top right hand side of this post.

Photo courtesy of canstockphoto.com.

 


More Flaws in CBO Estimate History

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Last week I pointed out clear flaws in the way the Congressional Budget Office analyzed the effect of the Better Care Reconciliation Act, otherwise known as the Senate bill to repeal and replace the Patient Protection and Affordable Care Act. In analyzing three of the most recent legislative efforts to repeal and replace the ACA (otherwise known as Obamacare), the CBO has come out with estimates that are difficult to fathom considering the vast differences in assumptions each estimate makes.

There is apparently another plan that has come out that is really no better than the other plans from what I am hearing from Senator Rand Paul’s objections on the news, and no doubt, the CBO will get around to weighing in on that one too. Why bother though? I don’t doubt that the agency will pick a number, any number, somewhere between 22 and 24 million as their estimate on how many people will “lose” coverage if that particular Senate bill were to pass.

Then that “dire” number will be trumpeted all over the media as those who will be “losing” coverage as a result of that bill. As Avik Roy pointed out in the Forbes article to which I referred in my last blog post, approximately 15 million of those people are not “losing” their insurance, but REJECTING their insurance. The sad aspect of that is, there will still be no insurance to which they can flee, because the only plans allowed will still be Obamacare-type plans. The Senate rejected Senator Ted Cruz’s Consumer Freedom Amendment – more about that in a future blog post.

I would like to once again, demonstrate how faulty the CBO estimates are concerning any issue of coverage or non-coverage whether Obamacare is in effect or not.

Let’s start with the CBO’s estimates in a 2012 report of how many people it predicted would sign up for Obamacare in advance of the sign-ups.

Here is a quote from that March 2012 report by the CBO entitled, “Updated Estimates for The Insurance Coverage Provisions of the Affordable Care Act,” (1) regarding how many people would gain coverage through the Obamacare exchanges.

“According to the current estimates, from 2016 on, between 20 million and 23 million people will receive coverage through the new insurance exchanges and 16 million to 17 million people will be enrolled in Medicaid and CHIP.”

So let’s look at how the numbers have actually shaken out so far.

An editorial in The Hill (2) about an early 2017 meeting of the House Budget Committee regarding the failures of Obamacare, says that Ed Haislmaier, senior research fellow with the Heritage Foundation, estimated that only 14 million people gained insurance through the Obamacare exchanges between 2014 and 2015. He added that early estimates of those receiving health insurance through the individual market for 2016 were another 842,028.

Other figures Haislmaier reported were as follows:

  • A decline of 1,128,597 individuals enrolled in fully insured employer health insurance plans.
  • Enrollment in self-insured employer plans increased by 776,780 people.
  • Individuals enrolled in Medicaid and CHIP (Children’s Health Insurance Program) increased by 2,044,809.

So, according to this editorial in The Hill, the approximated number of people that actually gained some form of health coverage in 2016 was 16.5. This number does not even come close to the 20 million to 23 million people the CBO estimated would gain “insurance” through the exchanges.

Clearly, there are no totals for 2017 yet as we are in the middle of the year. However, if the CBO did such a woeful job so far of predicting how many people would be covered from 2016 on, how can we possibly expect that office to provide any believable estimates for how many people might “lose” their insurance as the result of an Obamacare repeal with or without a replacement? Don’t forget that in its estimations of the people that would “lose” their insurance are an approximate 15 million who would not be losing it, but canceling it of their own free will and saying “Good riddance!”

My theory: the numbers that the CBO has been putting out regarding the number of people who would be without “coverage” are merely something the Democrat left and Republicans in Name Only (RINOS) can use as scare tactics – nothing more, just a useful propaganda tool.

Sources for further reading:

  1. http://www.cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf
  2. http://thehill.com/blogs/pundits-blog/healthcare/320969-debunking-the-20-million-obamacare-myth

 


Who Believes the CBO? Not me!

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As the Senate is now in the heat of discussions regarding the changes it wants to make to the Republican repeal and replacement of the Patient Protection and Affordable Care Act (more like Unaffordable Care Act), the Congressional Budget Office came out with its estimation a couple of weeks ago of the effect the Senate Bill, which bears the name the Better Care Reconciliation Act, COULD have on the United States overall.

Ever since that publication of the CBO estimates, the Democrats and some Republicans In Name Only, lovingly called RINOS by true conservatives, have been shrieking that somewhere between 22 and 24 million people will lose coverage, depending on with whom one is talking. The Democrats and RINOS throw that number out with the express purpose of making people panic and call their Senators with impassioned pleas not to take away their “health care.”

A Forbes article entitled “CBO Predictions About the Senate Health Care Bill Are Deeply Flawed,” written by Avik Roy (1) explains that the absurdity of the CBO predictions can be demonstrated by the various predictions this “august” government agency has thrown out in reference to three different bills meant to repeal the Unaffordable Care Act in one way or another.

Those three bills include:

  • The Restoring Americans’ Freedom Reconciliation Act (H.R. 3762 – 2016)
  • The American Health Care Act (2017)
  • The Better Care Reconciliation Act (Senate version of the AHCA – 2017)

According to this article, the RAFRA bill, which was intended as a repeal of Obamacare with no replacement, was analyzed by the CBO to cause 22 million Americans to be uninsured by 2026 with no subsidy provisions for coverage.

The article then states that the American Health Care Act, which is the House of Representatives’ version of repealing and replacing Obamacare this year, contains a system of flat tax credits that are not dependent on income. This system of tax credits proposed to spend approximately $375 million over the next 10 years to subsidize the purchase of health insurance. Yet the CBO estimates that, even with that $375 billion in subsidies, there will be 23 million more people without insurance than are currently covered under Obamacare over that 10-year period.

Roy describes the final kicker in these rather strange CBO calculations: the Senate bill that rejected the flat tax credits offered in the AHCA and spends $616 billion for means-tested tax credits over 10 years (which means that these tax credits/subsidies are directed toward low-income people), still results in a coverage loss for 22 million people in comparison to the number that are presently covered. Ironically, it appears that no matter how much money the federal government coughs up to make sure that as many people as possible are covered, there is very little improvement on the numbers of those who would ostensibly “lose” their coverage, at least according to the CBO.

The explanation Roy offers for these rather strange calculations is the individual mandate imposed by Obamacare that requires all U.S. citizens (with few exceptions) to consistently buy health insurance. So the CBO estimates that if the individual mandate is repealed, 15 million people will cancel their health insurance (or that which they are currently stuck with) in 2018. Clearly this is not a case of people being “thrown off” their insurance, but of reveling in the freedom of not being forced to buy insurance that they despise anymore. By my own calculations, this 15 million people is slightly short of 70% of the total amount of people who might be expected to be without health insurance coverage by 2026, and that would be immediately in 2018.

There are some other aspects of these suspect CBO calculations to be considered such as the question of whether 15 million people celebrating their freedom might not acquire some other form of coverage as a substitute for the burdensome Obamacare. What if all the essential benefit mandates were removed as a result of the repeal and replacement of Obamacare and people are free to buy the insurance of their choice?

According to an article by Justin Haskins in “theblaze” (2), Senator Ted Cruz (R-Texas) has proposed an amendment to the Senate bill since the CBO estimates that could provide many people with the flexibility they are looking for.  This amendment would allow insurers to offer a wide variety of plan types as long as they offered at least one plan with all the required Obamacare mandates. This is intended to create the ability for insurance companies to offer much more flexible plans and benefits than Obamacare provides. This newly acquired freedom could result in many of those 15 million canceling their expensive plans in favor of lower-cost plans being made available without all the required bells and whistles.

I would conclude, from all I have read so far, that the CBO is making some very loose assumptions with very little qualification that are being used by leftist groups to spread misinformation and panic about the real intent of the Republican proposals to repeal and replace Obamacare.

Sources for further reading:

  1. https://www.forbes.com/sites/theapothecary/2017/06/27/cbo-predictions-about-the-senate-health-care-bill-are-deeply-flawed/#321ea90779d4
  2. https://www.theblaze.com/news/2017/07/02/ted-cruz-could-save-the-senates-health-care-bill-and-some-conservatives-arent-happy-about-it

*I plan on using the next few posts, at least, to analyze the various facets of the debate regarding the proposed repeal and replacement of Obamacare. If you would like to be notified of future posts on the subject, please sign on to my email list to the upper right side of this post, and you will receive any new posts every Thursday morning. I am also planning a new offer in the near future.

Photo attribution:

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Where is Obamacare Repeal Going?

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There seems to be a temporary lull, as far as I have been hearing, regarding the progress of the American Health Care Act. This is mainly because a whole host of scandals are swirling around Washington, D.C. regarding a Russian connection to the Trump campaign, the firing of FBI Director Jim Comey, and one about whether President Donald Trump gave away some classified information to Russian officials during a meeting.

I think Senate Majority Leader Mitch McConnell is right in saying that less drama from the White House would help the Senate to concentrate on matters that affect the everyday lives of American people.

One of those issues would be health care in the United States and how to repair this very broken system that has become far too dependent on insurance coverage and government intervention. Although the talk in the media for the last week and a half has discussed the scandal du jour ad nauseam, it looks like there is a little bit of work regarding the nation’s health care policies going on in the background. Once again, it seems like some kind of “deadline” looms that is making Senate Republicans think that they may have to do something before June 21.

Why?

According to an article in the online publication Axios (1), this is the date by which insurers have to make a final decision regarding whether or not they will sell insurance  for 2018 on the federal Obamacare exchanges. I am not sure if the states with their own exchanges have alternate deadlines.

So, if the Senate can ignore the White House drama and plug away at the American Health Care Act that is now before it, they have a tough choice to make because they are faced with either passing a short-term stabilization bill of some kind to make sure that there actually insurers on most of the exchanges or try to work on the larger package of health care reform in a way that it could be passed and signed into law in time for that deadline. With all the deep division between the two major parties, as well as between different positions within the Republican party, I am not placing any bets on passing a larger package of sensible free market reforms that could be signed into law by the president in time for the June 21 decision crunch.

So what’s the Senate to do?

According to the Axios article, the Senate has the following options to consider:

  • Go ahead and fund the subsidies so the few remaining exchange insurers would know what they are dealing with in 2018 and would remain on the exchanges, at least for the coming year. (Hopefully such an action would only be considered temporary to provide a “bridge,” so to speak, as the Senate gives more in-depth consideration concerning the best way to repeal and replace Obamacare.)
  • Pass a bill by Senators Lamar Alexander and Bob Corker that would allow people to use premium subsidies to buy health care insurance not offered on the exchanges, which looks like it would only be available in areas where there are no insurance companies on the exchanges. (Once again, I hope this would only be a band-aid solution while the Senate mulls over the best way forward for a free market in health care.)
  • They could always just take their time to put out a bill, regardless of insurance decision deadlines, that allows a free market in health care that can really make health care and insurance affordable for the average person. (There is a great risk of widespread chaos in this scenario, but then maybe it is time for many people to have the government pacifier yanked out of their mouths; they may cry a lot for a while, but then those who know better could direct the ones being broken of their dependency into health care options that are so much better than what we have now.)
  • There may also be another option because Axios also reported that Senator Claire McCaskill has indicated she is planning to introduce a bill as well, but has not revealed anything about it.

Maybe I was at least partially wrong in one of my earlier blogs, when I said Congress needs to take their time to get health care reform right. On the other hand, the Senate cannot slap something together that can get passed and claim they have done the job for the American people. When that happens, I fear that people will just get used to the “new normal” and expect to always be able to buy insurance whenever and wherever they want with a subsidy from the government, which could be just as destructive as Obamacare.

The Senate prospects also look difficult because Republicans only have a narrow majority, so there will be very intense division in trying to repeal a law that Democrats doggedly defend.

For my part, I am going to try my best to communicate with my Utah senators, as well as other key senators, to impress upon them the necessity of getting health care reform right, and familiarizing them with some free market innovations they may not know about that can drive down health care costs without the involvement of insurance.

Source:

  1. https://www.axios.com/senate-grapples-with-looming-health-care-deadline-2411779537.html

Photo Attribution:

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It’s Half-Done Anyway, but Hopefully Not Half-Baked

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Close up of female African American doctor holding patient’s hand

For those who have been struggling under the intolerable burdens of the Patient Protection and Affordable Care Act of 2010 (affectionately or less affectionately known as Obamacare), this has been an encouraging day. Why? The United States House of Representatives passed the newest version of the American Health Care Act with the purpose of repealing and replacing Obamacare.

This is definitely a hurdle jumped, especially since the House was not able to pass the original version of the AHCA. Apparently there were too many problems with it in the eyes of the House Freedom caucus, the more conservative wing of the Republican party. So some celebration is in order. However, this bill still has a tough road ahead as it makes its way through the Senate.

I really was not sure what would happen. I honestly was concerned that the Republicans would blow their chance to get rid of what I consider a law that’s hated by many people and only lauded by a few. Even the Democrats talked about “improving” Obamacare, although ironically their solution would be to make our health care system worse because it would involve even more strong-arm government control.

I learned, through the last episode in March, not to try to go through an entire bill and try to explain it while trying to translate governmentese without a translator. However, I am well aware of one of the most difficult sticking points in the bill – the issue of how our nation addresses the problem of pre-existing conditions.

Pre-existing conditions are a tough issue because I personally believe that the vast majority of Americans, myself included, want everyone to have access to medical care, whether they are already sick or not. However, some Economics 101 comes into play here. How do we take care of those of us who are less fortunate while allowing much more freedom of choice to the healthier members of our society and not forcing them to pay for someone else’s health problems unless they personally choose to do that?

When Obamacare became the law of the land, guaranteed issue became mandatory that, in effect, required insurance companies to cover citizens whether or not they had pre-existing conditions. Then the “community rating” scheme required that insurance companies not charge those with pre-existing conditions any higher premiums than any one else. As a result, everyone paid the high costs of covering people who already had some kind of illness. This caused premiums to continue soaring year after year after the implementation of Obamacare because insurance companies continued to lose money covering very sick people.

The money lost by insurance companies has continued to grow to such levels that over the last couple of years, several big insurers have withdrawn from the Obamacare exchanges where people needing to buy insurance in the individual market have had fewer and fewer choices.

As the House Republicans celebrated their victory in passing the controversial bill in the White House Rose Garden, Representative Paul Ryan said that it is very important that the AHCA not only pass the House but pass the Senate as well.

“The problems facing American families are real, and the problems facing American families as a result of Obamacare are just too dire and too urgent,” Ryan said. “Just this week we learned of another state, Iowa, where the last remaining health care plan is pulling out of 94 of their 99 counties, leaving most of their citizens with no plans on the Obamacare market at all.  What kind of protection is Obamacare if there are no plans to choose from?”(1)

House Majority Leader Kevin McCarthy also made the point that it is difficult to care for people with pre-existing conditions when there is no care at all. Now the point he was making was that there were areas where there would be no chance for people with pre-existing conditions to have their care covered by insurance plans if there were no insurance plans. Of course, while his point is valid that one cannot get their pre-existing conditions covered by insurance if there are simply no insurance plans to cover them, I would like to point out that it doesn’t mean these people could not actually get care. The question is how would that care get paid for? This is a question for another day.

Although I certainly appreciate the sentiment that insurance coverage for people who are already sick would be very helpful, there are other ways – free market ways – for these people to receive excellent care at a low cost. It’s called Direct Primary Care, which I will discuss at length in my next post.

 


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/

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