Well, the Republicans in Congress finally rolled out legal language (and I do mean legal language) outlining their plan for repealing and replacing the Patient Protection and Affordable Care Act of 2010. Now there were outlines of a plan for a long time, and people could get a glimpse of what a replacement plan might entail in everyday English, but this plan is now codified into barely decipherable legalese so only lawyers can tell us exactly what in means. Believe me on that count because I have started to read it.
On the plus side, any citizen can actually download a copy of the proposed bill, which is known as the American Health Care Act. Fortunately, we are not going to revisit the Rep. Nancy Pelosi line, “We have to pass it to find out what’s in it.” Therefore, any citizen who can read and gets a kick out of legalese headaches, can “find out what’s in it.” If someone does not like what is in it, he or she can contact their elected representatives at the federal level to register their comments.
First, the basics in real English. I found what is being called a fact sheet from the office of Rep. Paul Ryan, Speaker of the House of Representatives. This fact sheet outlines the fundamental principles of the American Health Care Act. Here they are as presented in this fact sheet with a little bit of editorializing from me.
- The new bill keeps the promise made by Republicans and President Donald Trump to repeal and replace Obamacare.
- This bill provides for a stable transition from the Unaffordable Care Act as the country (hopefully) transitions to health care policies that encourage individual choice and less government interference in personal health care decisions.
- Finally, this bill aims to lower health care costs, allow more choices, and provide individuals with more control over their health care. (I really hope this one happens!)
So What’s Next?
Needless to say, I have been hearing a lot of bellyaching about this plan by people from every political stripe – yes, Republican and Democrat. The most important issue though is whether this plan has a chance to succeed in lowering costs and providing more choices in health care while protecting the most vulnerable in our society.
I have just begun to read the repeal and replacement bill, which seems to have a strong predilection for punctuation directives. But I am getting through it. Wow, I should have tried to read it when I was having trouble falling asleep last night!
In future posts, I am going to try to describe my impression of the bill for you, and whether I think there is a chance that it may accomplish the goals that Rep. Ryan expects it to.
If you are interested in being notified of future posts and other offers, please subscribe to my email list (the form is located to the top right side of this post), and be sure to contact me and let me know your thoughts about all of this. I’d love to read about what you are thinking.
Photo courtesy of canstockphoto.com.
Ah … numbers are enough to drive one crazy unless you’re a math fanatic. I’m definitely NOT!
So Why Did I Undertake Research on Obamacare Numbers?
I was inspired by a tweet from Gerard Gianoli, M.D., one of the doctors I follow on Twitter, to look into the number of people who had their health insurance plans canceled as the Obamacare exchanges opened in the fall of 2013, and people started to sign up (or in many cases, TRIED to sign up) for one of the Obamacare-compliant plans with all the bells and whistles. Then there have been cancellations for other reasons as well.
I had originally responded to an editorial in The Hill that Dr. Gianoli had posted, “Debunking the 20-million Obamacare Myth,” written by opinion contributors Justin Haskins and Michael Hamilton. The article showed how all the numbers that were used to make Obamacare look like a big success over the last three years were very fungible. And indeed they are.
My Foray Into Numbers – Ouch!
I’m not going to put you to sleep with a whole array of numbers here because frankly they make my head spin, but the basic premise of this editorial was that the oft-cited number of 20 million people in the United States who have gained health insurance coverage via the Affordable Care Act since it became effective in 2014 is closer to 16.5 million than 20 million. However, that estimate is not limited to those who gained commercial insurance through the ACA; it includes approximately 2,044,809 of those new “enrollees” being signed up for Medicaid and the Children’s Heath Insurance Program (CHIP) primarily because of the Medicaid expansion in many states, which offered “coverage” to able-bodied low-income people and was almost completely subsidized by government.
Dr. Gianoli brought up the point about the many people who lost insurance because of the ACA. I suppose that number could include those with individual insurance policies prior to 2014 who had them canceled because they did not meet the coverage mandates required by the ACA. It could also include those who lost insurance for a plethora of other reasons such as employers cutting employee hours so they didn’t have to provide benefits, etc. So I set out to do a little bit of internet research. Here is what I found, and the results of my research were dizzying.
According to the website FactCheck.org, the Associated Press had cited a number of people whose insurance policies had been cancelled because of non-compliance with ACA mandates to be 4.7 million. However, according to FactCheck.org, an article published on the journal Health Affairs’ website estimated that number to be more like 2.6 million. Apparently that estimate was based on the work of two researchers with the Urban Institute, which has been a known cheering section for Obamacare.
In an online editorial in Forbes entitled “How Many People Has Obamacare Really Insured” by Scott Gottlieb, he cites two different studies of the actual numbers that Obamacare can be credited with insuring – one by Goldman Sachs and one by the Rand Corporation.
According to Gottlieb, the Goldman Sachs study estimated that total insurance coverage as the result of the ACA increased by between 13 and 14 million in 2014 with a possible 4 million people being added to that number in the first five months of 2015, for a grand total of 17 to 18 million people “newly” covered in that period.
The Rand Corporation estimated that a total of 22.8 million people gained coverage under the ACA, and yet it also calculated that 5.9 million people lost coverage as the result of the law, which brings the estimate of actual covered lives as a result of the ACA to 16.9 million, which is really not far, in either direction, from the estimates of the Goldman Sachs study or the estimates in the The Hill editorial.
It is interesting to note that the Forbes article did not state the reasons an estimated 5.9 million people lost health insurance as the result of Obamacare. That may include those who lost it because their plans prior to 2014 did not meet the Obamacare compliance standards as well as those who lost coverage because of insurance carriers withdrawing from the Obamacare exchanges when they found they were experiencing too much in the way of losses. Who knows? That estimated number could even include those who decided the Obamacare plans were worthless and concluded that they would be better off not having insurance while Obamacare was still in effect, even though that clearly has some risk attached.
All in all, whether the number of people who lost their insurance as a result of Obamacare was 2.6 million or 5.9 million, or somewhere in between, the REAL number of people being covered by Obamacare has never actually reached the 20 million additional people the ACA proponents claim. No matter what, you can tell how easily manipulated as well as only partially reliable numbers can be.
Yet even today, I have come across “figures” being touted that 30 to 32 million people will “lose insurance” if the Unaffordable Care Act is repealed without a replacement. All I’ve heard from Congress and Trump is replacement, replacement, replacement … so where are those people getting their information? From the fake news?
This is a little departure for me – just posting a link. However, I think it really emphasizes how important it is to get health care policy right when Obamacare is (hopefully) repealed and something else is put in its place. This is just another example of how the way insurance has worked (or failed to work) in the United States for the past 30 or so years – between Health Maintenance Organizations and Preferred Provider Organizations that have done nothing but dupe us into thinking that we are getting some kind of great deal in health care.
I encourage you to watch the video in this link and think about ways you can encourage your elected representatives to look seriously at this issue and take common sense actions to restore a free market in health care with healthy (pardon the pun) competition instead of monopolistic maneuvering. There is plenty of room for all quality doctors, nurses and other health care providers to make the care needed easily available without a huge price tag that only leads to government intrusion into our lives.
But enough pontificating from me today. Check out this report, and I look forward to hearing from all of you who are reading my blog.
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We have all heard the doomsday laments of the left claiming that “health care” will be ripped away from the sick and the poor as well as the elderly. The premise of the left side of the political spectrum is that Republicans are heartless creatures who just want to throw sick and/or poor people out onto the streets to die in the gutter.
As a conservative Christian woman, I can tell you that is totally untrue! In fact, I have a strong desire to see everyone – from the poor to the rich (because we are all human and vulnerable) – taken care of if they have medical issues.
How Do We Make Government Care for the Poor Work?
Medicaid is the government program designed to care for the medical needs of low-income people.
I discussed, in my previous post, how unsustainable the Medicaid system has become, especially because it has been expanded in many states since Obamacare became law, with several states experiencing cost overruns because the number of enrollees has outstripped projections in those states.
However, one state stands out as a model for providing health care support for the poor that is light on government intervention and provides Medicaid recipients with choices – Indiana.
One of the problems with Medicaid has been that reimbursements to doctors for patient care have been so low that they do not even cover those doctors’ costs in keeping their practices open if they are running independent practices, so they either have to limit the number of Medicaid patients they treat or they have to totally opt-out of taking those patients. So those patients may have a card to show they have Medicaid coverage, but they do not have the access to primary care physicians that they need to stay out of emergency rooms if their illnesses progress too far.
Some people would like to blame “greedy doctors,” but how is a doctor supposed to remain in practice to treat anybody if they cannot even so much as cover the cost of treating individual patients?
How can that problem be solved while taking care of the medical needs of the poor? Enter Healthy Indiana 2.0, the Medicaid program for able-bodied adults living at or near the poverty level. According to a Health Affairs Blog article entitled “Healthy Indiana is Challenging Medicaid Norms,” by Seema Verma and Brian Neale, the state of Indiana launched this newest version of the Healthy Indiana Plan (HIP) in 2015 thanks to waivers approved by the federal government.
One of the most interesting aspects of Healthy Indiana 2.0, according to this article, is that it gives able-bodied Medicaid beneficiaries the opportunity to be prudent health care consumers. These beneficiaries receive a High Deductible Health Plan (HDHP) with a $2,500 deductible, which is paired with a “POWER” account of $2,500 that is very similar to the traditional Health Savings Account. Beneficiaries in this plan use the POWER account to pay for standard medical expenses up to the point that they meet the deductible for their health plan. At that point, the health plan will kick in to pay the rest of the medical expenses for that beneficiary.
Additionally, Healthy Indiana 2.0 pays for preventive services so the money for those services does not come out of the beneficiaries’ POWER account for the deductible, and they are incentivized to make proactive health choices.
Beneficiaries in these POWER accounts are also required to pay two percent of their incomes into these accounts to be used as available cash for medical expenses.
According to the Health Affairs Blog article, the incentives and consequences outlined in Healthy Indiana 2.0 are designed to “support transition” to a commercial or employer-sponsored insurance plan.
Then, according to Martina (last name not given) at Indiana’s Medicaid phone line, Indiana still enrolls elderly, blind, and disabled people in a managed care plan called Hoosier Connect Care. So the most vulnerable people are still taken care of.
I have little bit more to say about this plan, but that is for another day. However, I leave you with this thought today – that with the unsustainability of the current Medicaid system, our leaders need to be thinking “out-of-the-box” and be prepared to really innovate.
I am very frustrated by the outright lies the Democrats are trying to spread about the impending repeal of the Patient Protection and Affordable Care Act of 2010. Actually, the name “Affordable Care Act” is a misnomer. To most people who know better, the “reform” law, with its 2,500+ pages of economy-strangling regulations is more accurately known as the “Unaffordable Care Act.” I’ve seen this moniker cited by several people whose Facebook and Twitter pages I frequent.
Let’s Get Real
The Democrats’ new slogan about the likely repeal and replacement of Obamacare is “Trump wants to make America sick again.” Apparently Senate Minority Leader Charles Schumer (D-NY) and House Minority Leader Nancy Pelosi (D-Calif) engaged in a strategy session with President Barack Obama in the first week of the year.
According to a Jan. 4 article by the Washington Post, “Democrats: Trump Will Make America Sick Again,” a memo that came out of this strategy session partially reads as follows.
“Instead of fulfilling their promise to repeal and replace the Affordable Care Act, Republicans are going to make America sick again by offering no health care plan to the American people and actually dismantling Medicare, Medicaid, as well as the ACA.”
Although I will get back to the lie about the lack of a replacement health care plan, I am going to discuss the Democrats’ clinging protection of a crumbling Medicare and Medicaid system.
Let’s actually start with Medicaid, which is basically health care coverage for people with low-incomes. The scary truth is that states that are attempting to expand Medicaid under the rules of the ACA are finding that they face huge cost overruns.
For example, Arkansas is one of the states participating in Medicaid expansion, according to an Oct. 5, 2016 article entitled “Rising Cost of Medicaid Expansion Is Unnerving Some States,” written by Christina A. Cassidy on the Associated Press website. The article states that Arkansas has received 307,000 signups for the Medicaid expansion, which exceeds the projected 250,000. So the state is asking the federal government, which has been providing 100 percent of the costs for the expansion, for permission to charge some Medicaid recipients a premium for their coverage.
The same article states that Kentucky, another expansion state, has enrolled approximately 400,000 residents in Medicaid under the expansion. That state has budgeted $257 million for the fiscal years of 2017 and 2018, which far exceeds the original estimate of $107 million.
Creativity At Work
These are only a couple of examples of the budgetary havoc experienced by states that have expanded Medicaid based on the same old way of providing government coverage. However, there are bright spots of innovation that have the potential to actually provide needed health care for low-income people without busting a state’s budget or further inflating the national debt.
One of these bright spots include Healthy Indiana 2.0 (the latest version of the Healthy Indiana Plan), which utilizes Health Savings Accounts with contributions from the state as well as catastrophic insurance to cover for large medical expenses that cannot be anticipated. This program is already being used in Indiana. Another innovative proposal for covering the poor is being considered in New Jersey. This plan would incentivize physicians to work as volunteers in community clinics in exchange for state coverage for medical malpractice. This plan intends to provide primary care, and even psychiatric care, to low-income New Jersey residents at no cost to the residents, and has the potential to keep these residents healthy enough that the emergency room is very rarely needed.
Yes, there are great ideas out there for helping the poor receive health care, so any repeal of Obamacare does NOT mean that the poor would have the “rug pulled out from them.” I know that, as a conservative woman, I do not want to see anyone deprived of the medical treatment they need because of their inability to pay, but I feel that there are better ways of providing that care without increasing the national debt beyond sustainability or curtailing the free choices of American citizens because of “one-size-fits-all” government-controlled “health care.”
In the next few blogs, I will discuss some of these innovations at length.
Are you wondering why I have chosen the issue of health care to write about? Do you wonder what my background is that makes me knowledgeable about this subject even though I’m not a doctor and I don’t even play one on TV?
I could go way back to my experience working in claims and patient eligibility toward the beginning and midpoint of my working life, but I really don’t want to bore anyone to death with a long-winded account of my experiences. Although that experience shaped some of my ideas, nothing has shaped my current thoughts about it more than the last couple of years I spent working for Dr. Randy Delcore at Cedar Orthopaedic Surgery Specialty Clinic and Cedar Orthopaedic Surgery Center.
When I started working for Dr. Delcore as a public relations assistant, I had the tasks of assisting in the launch of a new website, working on an advertisement for local theaters, and taking care of any advertising. Another task he gave me led to the formation of strong opinions regarding the state of health care in America, which is a pretty big mess at the moment. Yes, it was in a mess before, but Obamacare only made it worse – not better, despite all the self back-patting he did at the end of his term in office.
A Time of Revelation
One day Dr. Delcore dropped a stack of magazines on my desk because he wanted me to educate myself about the general state of health care in our country, especially as it related to some of the issues he was experiencing as a fiercely independent physician. So I pored over all of them with voracious interest – some leaned left of center in perspective, others leaned right, and other publications were somewhere in the middle.
One article was a newspaper or magazine clipping (I don’t remember which) about a facility in Oklahoma City, Surgery Center of Oklahoma, that performed outpatient surgeries for prices much lower than average hospital prices. This piqued my curiosity because this was something Dr. Delcore was doing. I checked out the website and looked at the transparent pricing tool, which was something I already knew Dr. Delcore would want on the new website for his practice and surgery center.
In terms of educational material though, I was intrigued by the video blogs Dr. Keith Smith, the founder of SCO, had posted on the surgery center’s Facebook page. In fact, I could not resist throwing my two cents worth into the comments section. (I hope I didn’t wear him out with those.) Many of those blogs focused on the reasons that health care is so expensive these days. Some of the reasons Dr. Smith enumerated included government interference in health care and what he referred to as the large cartel hospital systems that overcharge insurance companies and then agree to some (still overpriced) reimbursement for medical services rendered. In fact, Dr. Smith has revealed all kinds of chicanery in the area of health care pricing as well as pointing to others that were writing about the same thing.
I have also communicated via Twitter and Facebook with many doctors who are truly frustrated about the direction in which the U.S. health care system is going as well as reading many articles and blogs they have written. By engaging in this discussion, I have seen the ways in which Obamacare has not improved the system, but has (I feel) made it only worse. I may have cast a protest ballot in the election (neither Clinton nor Trump), but I am truly hoping that President Trump does “drain the swamp,” especially in terms of the way health care works here.
Where Do I Go From Here?
I have so much to say about the current state of health care in the U.S., and can’t wait to share what I continue to learn about it. I honestly hope that if you, my readers, don’t already know about the many health care price drivers I will be writing about, you will be as outraged as I already am and motivated to communicate with your elected representatives to make some real constructive changes in this time of opportunity.
When the subject of health care is discussed, as it relates to repealing Obamacare, and what might replace it, one very important definition appears to be missing – that is health care.
A Source of Confusion
Here’s the problem – our 21st-century minds have come to equate health care with its payment. Granted, health care must be paid for by someone because doctors, hospitals, and other providers cannot work for free. However, the issue of health care has been convoluted with its payment with the assumption that unless someone has some kind of third-party insurance coverage for the medical care they receive, they cannot possibly have access to that care because the average person could not possibly pay for that care.
One of the problems is that health care in many facilities, especially in many hospitals, has become very expensive because of the price “negotiations” between those hospitals and insurers in which the hospitals charge some outrageous and unrealistic price and the insurer pays the price that it actually negotiated with the facility and calls it a discount even though that price may be very inflated. If you don’t believe me on that count, I would point you to an article I read several months ago and occasionally re-read just to keep it fresh in my memory. That article, written by Forbes Magazine Contributor Dave Chase,” is entitled, “Have PPO Networks Perpetrated the Greatest Heist in American History?”
To be quite transparent, I worked full-time for two years or so for Dr. Randy Delcore at Cedar Orthopaedic Surgery Specialty Clinic and Cedar Orthopaedic Surgery Center. I still serve him as an independent contractor. Dr. Delcore’s surgery center posts transparent cash pricing for many orthopaedic procedures at a fraction of the hospital prices for such procedures. With the huge deductibles that have resulted from Obamacare, patients have the opportunities to get their surgeries performed for much less than those high deductibles in many cases.
Free Market Health Care in the Midst of Obamacare
I will provide one example with a fictional patient. Let’s say Fred, your average middle class guy, needs a carpal tunnel release. The cash price for a carpal tunnel release at COSC is $1,850. That includes the surgeon’s fee, facility fee, and anesthesiologist’s services. So, Fred wants to find out how much it costs at a hospital nearby. I would tell him, “Good luck with that!”
I tried to comparison shop with hospitals in Utah. The University of Utah Medical Center advertises its carpal tunnel surgery, but does not even provide a price estimate online. I tried a few other facilities in Utah and did not find anything regarding price. One website for St. George Surgical Center provided an estimate of what the local hospital charges – $10,683.
The average Obamacare deductible has been approximately $5,000 if you get the least expensive plan in terms of premium, and let’s just assume that this was Fred’s choice in “coverage.” Therefore, the cost of a carpal tunnel release for Fred at COSC and many similar surgery centers around the U.S. (prices vary, but they are usually within approximately $1,000 of that price more or less) would not even come close to costing his entire deductible. So, in that case, Fred’s Obamacare “coverage” would not pay for his care at all. But could Fred receive the medical care he needed? Of course he can!
Dr. Keith Smith, founder of the Surgery Center of Oklahoma that also posts transparent surgery pricing on its website (in fact, I understand he was really the pioneer for posting transparent prices for surgery), said the following in one of his Facebook video blogs in November of 2015.
“What does it mean when a patient has one of these new Obamacare cards in their wallet but their out-of-pocket experience here at the Surgery Center of Oklahoma is better for them than if they had actually used that Obamacare benefit? What does that mean? That means they have coverage, but they really don’t have access to care … not that they’re not paying for completely out of their own pockets.”
So there you have it – having coverage does NOT necessarily get you “health care” under Obamacare – you may be paying for quite a bit of it yourself unless you are receiving Medicaid.
So how should our nation take care of the poor? Well, that’s a subject for another day. I promise to get around to this soon.
I watched the inauguration of President Donald Trump this morning as I worked at my laptop. I am always in awe of the moment of inauguration when the leadership of our country changes hands. President of the United States – what a huge responsibility for anyone to take on!
To be quite honest, I did not vote for Trump, nor did I vote for Hillary Clinton. I am afraid my vote was a protest vote because, in Utah, we had the opportunity to vote for conservative Evan McMullin if we were not crazy about either major party candidate. However, if I thought Utah was in real danger of going over to Clinton, I probably would have voted for Trump just to be on the safe side.
Why was I that opposed to voting for Clinton? There are many reasons, but not the least of them is that she would have continued and probably doubled down on Obamacare. There would have been even more government regulation of health care, hence even less freedom.
She was talking about increasing subsidies for health care plans, which only increases the government involvement in our personal business, not to mention an even more bloated national debt. I fear that she really does not understand the health care market and the fact that government has been the driver for more expensive health care, especially hospitals.
The crony capitalism that goes on between tax-exempt health systems, legislators and bureaucrats is one of those drivers. Large health care systems have the wherewithal to lobby and gain influence with our lawmakers. This is especially exemplified in an article I received from a new Facebook friend, Dr. Kathleen Brown who is a dermatologist in Oregon. The way these tax-exempt hospital systems are raking up bucks while providing fewer community benefits is disgraceful. I’ll let you read the article. Here’s the link.
It looks like many lawmakers in Oregon are getting frustrated with that situation. I think the tax-exempt status of cash-heavy “health care” systems is a non-partisan issue for two reasons.
- The way they come by all that surplus/profit (or whatever you want to call it) is by ridiculously overcharging insurance payers for patient services, but even the amount of reimbursement that is negotiated down leaves a profit margin for the hospital.
- Additionally, the fact that these tax-exempt “health care” systems are amassing so much money, much of it not being sunk into charity care, while they are not paying taxes is robbery of taxpaying citizens.
Because of government involvement in health care, the system has become way too complex and cumbersome, which leads to expensive health care.
I will be discussing in future blog posts the negative effects our bloated government has had on the delivery and payment of health care as well as some important definitions in the world of health care that I don’t believe the average person understands because of how these terms are convoluted in the mainstream media.
I wish everyone a great weekend as we (hopefully) really do look to a brand new day in health care.