Tag: American Health Care Act

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

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

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

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

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

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

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

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

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

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

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

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

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

 


It’s Not Over Till It’s Over

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

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

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

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

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

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

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

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

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

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

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

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

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

Another Issue for Another Day

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

Hope Remains for the Future

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

Sources for further reading:

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

 

 

 

 

 


Ranting Time

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

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

What coverage will they be losing?

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

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

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

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

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

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

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

How did that happen?

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

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

Talk about sexism!

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

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

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

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

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

A Rebel at Heart

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

Photo Attribution:

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Episode 1 – Obamacare Repeal and Replace

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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:

http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/documents/AmericanHealthCareAct.pdf?platform=hootsuite

https://www.congress.gov/bill/114th-congress/house-bill/6

https://www.apha.org/~/media/files/pdf/topics/aca/2015_pphf_fact_sheet.ashx