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:
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.
Also, if you are enjoying these posts, please sign up in the upper right hand corner of this page to receive emails from me.
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.