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.
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.
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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.
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.
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.
Image courtesy of canstockphotos.com
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:
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.
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.
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.
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.
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Unlocking the Puzzle of the Obamacare Repeal and Replace Plan
As I said when introducing the American Health Care Act (aka Obamacare repeal and replacement), my first introduction to that bill was a host of punctuation directives after the introductory sentence. Many people are calling this Obamacare Lite, and when I read the first paragraph, I am forced to agree. Why?
The first paragraph reads as follows:
“Subsection (b) of Section 4002 of the Patient Protection and Affordable Care Act (42 U.S.C. 300u-11), as amended (emphasis mine) by Section 5009 of the 21st Century Cures Act is amended (emphasis mine AGAIN)–”
What Do I Think?
Let’s just stop here for a moment and take in the beginning paragraph of what is supposed to be the repeal and replacement of the Affordable (better known as Unaffordable) Care Act. However, the very first sentence uses the word “amended” TWICE as the first legislative action in the repeal and replacement action by our Republican majority Congress.
This first sentence appears to be more of a patchwork between two laws – the ACA and the 21st Century Cures Act, and not any basic repeal – just an amendment (at least in my eyes).
I wanted to find out what the 21st Century Cures Act is all about. I have heard about it, but I until I just looked it up, I didn’t know much about it. So this was a learning experience for me as well as you, my readers. First of all, it is a bill originating out of the House of Representatives 2015-2016 session, according to the website CONGRESS.GOV, and it has only passed the House, not the Senate so it is not yet law. How handy to have an old bill that has not completely passed Congress yet, or signed into law, to patchwork into the Obamacare repeal and replace bill. Maybe this is their idea of government efficiency.
The basic summary of the 21st Century Cures Act is, according to CONGRESS.GOV is this:
“The NIH [National Institute of Health] and Cures Innovation Fund is established and funds are appropriated: 1) for biomedical research including high risk, high reward research and research conducted by early stage investigators; 2) to develop and implement a strategic plan for biomedical research; and 3) to carry out specified provisions of this Act.”
In short, Congress proposes to appropriate some taxpayer money (everything the government has belongs to “we the people,” you know) to fund biomedical research.
It is also interesting to note in the 21st Century Cures Act I am looking at, the section numbers only go as far as 4061, so the Section 5009 referred to in the first sentence of the repeal and replace plan for Obamacare must be brand new.
Then the American Health Care bill goes on to add a series of conjunctions and punctuation directions as well as striking the phrase “each of fiscal years 2018 and 2019,” and inserting “fiscal year 2018.” Then about four paragraphs are stricken to be replaced with the following sentence and a few others after it, but for today, I am only going to focus on this one substituted sentence.
“(b) Rescission of Unobligated Funds. – Of the funds made available by such section 4002, the unobligated balance at the end of fiscal year 2018 is rescinded.”
I suppose that means that if Congress has not committed a certain amount in funds to any particular recipient by the end of that year, that amount cannot be paid out. Does that amount then go back into the federal government’s general fund?
The next question is – Where are funds being directed as a result of Section 4002 of the ACA? According to a fact sheet by the American Public Health Association, Section 4002 covers the Prevention and Public Health Fund. So the logical deduction for this first tidbit from the Obamacare repeal and reform bill is that if there are any public health funds that go unclaimed by the government’s Prevention and Public Health Fund at the end of fiscal year 2018, they will NOT be used by that fund at all.
It is interesting to note that, according to a chart on the APHA fact sheet, the amount that remains appropriated for the Prevention and Public Health Fund as of 2015 (after one cut in 2012 and a sequestration cut in fiscal year 2015, is $927 million. Who knows how much of that will remain unobligated by the end of fiscal year 2018? It’s possible this first section could be interpreted as a repeal provision of the ACA. We’ll see.
Stay Tuned for More
Whew! That was something else! I don’t suppose there is a translation somewhere for the “average Joe,” so I will continue to do my best to analyze this Obamacare repeal and replacement bill as it is worded in the text I have, and as my poor little brain can handle.
Sources for further reading: