Originally posted 2/11/17: updated 2/22/17 and 2/25/17 Sky Hi News 3/1/17 print edition (in part)
Crowd chanting and party platforms cheered on GOP candidates to support repeal of Obamacare. in 2016. Now that the GOP controls both the White House and Congress, they are finding themselves on the receiving end of a consumer revolt. Twenty million are suddenly realizing they may lose high quality health insurance they can afford for the first time in years. The chants of audiences at the rowdy town halls are instead " don't take away my insurance ".
Donald Trump calls the town hall attendees a small, noisy minority of paid activists. The GOP and he are fooling themselves. Take a look at the polls. Those angry attendees represent the majority opinion. Obamacare for the first time is polling more popular than not.
Where were these defenders of Obamacare last November? They were lulled and fooled. They awoke in January/February. thanks to the marches and rowdy town halls. They had been soothed by promises of some in the GOP, and especially Donald Trump, that the health care law would be replaced with something “better”. Others were dreaming for single payer systems. Ignorance also shaped public opinion. 35% of Americans polled did not know Obamacare and the ACA were one in the same and are just learning their newly acquired insurance they may lose was indeed Obamacare.
Many of GOP plans in formation now would eliminate subsidies that make the plans affordable for those in the lower middle class, and even eliminate medicaid expansion , taking away insurance from those who cannot afford to pay even minimum premiums.
What polls do show is that "mandates" are what most voters want repealed. "Mandate " is a turn -off term. For most that means to eliminate requirements all must carry heatlh insurance or face a penalty. But "benefit" is a nicer word and the GOP wants to call "benefits" mandates, too. Those nasty mandates are benefits are required by the ACA to be included in all insurance plans, whether individually bought, employer provided, subsidized through the exchanges,and Medicare, Medicaid. They include: low co-pay annual physicals , and cancer screenings for both sexes such as mammograms and colonoscopies, pink and prescription blue pills, banning life time limits, and providing pre-natal care. The GOP wants to make these benefits optional in the name of being "patient centered".
Unfortunately those "mandates/benefits" are what makes the ACA affordable because it keeps the "pool" large enough so that those who do not use or need all of benefits now or in the future pay for those who do. The larger the pool, the lower the cost for all, an actuarial fact.
The GOP has challenges replacing the ACA. They will have to show that the costs to the federal budget will be less than is the ACA. Cutting benefits and to take away insurance from many who have it now will be an unpopular political option. The hottest political backfire will happen in the states Trump carried in 2016. 64% of the 2017 ACA subscribers are in those states. GOP governors are protesting repeal, too, since abandoning Medicaid expansion would seriously dent their budgets. Rural hospitals would lose paying customers and close their doors. Miners would lose black lung coverage. Jobs would be lost in the health care sector. The GOP has grabbed a political tiger by its tail.
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Some more thoughts:
The complaint about Obamacare most received in my inbox is that the premiums are too high for those who make too much income to qualify for subsidies. That can be fixed without throwing all of the ACA babies out with the bathwater. IThe most unpopular part about the ACA, per the polls, is the mandate that requires adults to have health insurance, but unfortunately that is element that keeps the cost and premiums low.
Not on the radar of the polls either are complaints that the ACA contains benefits some customers would never use, such as pre natal care or prostate exams. While the GOP dangles the lure of letting consumer cherry pick if any and what kind of benefits they want to pay for (they call that "patient centered choice") instead of the Obamacare required minimum eight benefits , they overlook the fundamental truth of insurance financing : the size of the pool and the mix of the number of those they forecast who would make claims vs those who do not.
That is going to be where the GOP's plans are going to run smackdab into reality. When the Congressional Budget Office scores the costs of whatever GOP plans that have been rumored so far, the deficit hawks are going to get their scissors out and the temptation would be to cut the numbers of voters who would be able to get affordable insurance. that will contain benefits consumers want
To deal with the cost problem, the GOP's panacea are permitting cross state purchases, which the CBO itself earlier said it would have minimal impact. High risk insurance pools have been less than successful in covering pre-existing conditions because of costs. Systemic problems keep multi state risk pools from succeeding.
Not only would taking away insurance from voters have a politiacl backlash, there could be some unintended consequences. It would result in job loss and rural hospital closings. A significant number of jobs added to the economy since 2009 have been in the healthcare sector. Over 20 million new paying customers have entered hospitals and doctors doors thanks to the ACA. Hospitals and doctors can count on getting paid instead of writing it off as charity or losing payments for services in bankruptcy court. To deal with the cost problem, the GOP's panacea are permitting cross state purchases, which the CBO itself earlier said it would have minimal impact. High risk insurance pools have been less than successful in covering pre-existing conditions because of costs. Systemic problems keep multi state risk pools from succeeding.
To deal with the cost problem, the GOP's panacea are permitting cross state purchases, which the CBO itself earlier said it would have minimal impact. High risk insurance pools have been less than successful in covering pre-existing conditions because of costs. Systemic problems keep multi state risk pools from succeeding.
That Obamacare will implode because insurance rates have gone up and it is a "disaster", the Trump and GOP mantra, is very misleading and those 12 million plus who signed up for it in the exchanges do not see it as a disaster, but a necessity . They just would like to see premiums cheaper and deductions or out of pocket expenses less.
That GOP claim is based on the knowledge that major insurance companies have not made as much of a profit as they hoped and left only one plan in some states's exchanges and that premiums have increased 600%. or doubled. (not in every state). Those getting subsidized or Medicaid insurance have seen increases in premiums and up front deductions. It has especially increased in the individual market but the facts are that the "cost curve" has been reduced...that is, premiums have not gone up as much as projected without Obamacare.Repeal Obamacare, and we would really see premiums soar. The real disaster will be dumped on those who lose insurance they have just now been able to afford. The other disaster: block grants on Medicaid to states which are really federal aid reduced and leaving the states holding the bag. That is not "better"by any definition.
That Obamacare will implode because insurance rates have gone up and it is a "disaster", the Trump and GOP mantra, is very misleading and those 12 million plus who signed up for it in the exchanges do not see it as a disaster, but a necessity . They just would like to see premiums cheaper and deductions or out of pocket expenses less.
That GOP claim is based on the knowledge that major insurance companies have not made as much of a profit as they hoped and left only one plan in some states's exchanges and that premiums have increased 600%. or doubled. (not in every state). Those getting subsidized or Medicaid insurance have seen increases in premiums and up front deductions. It has especially increased in the individual market but the facts are that the "cost curve" has been reduced...that is, premiums have not gone up as much as projected without Obamacare.Repeal Obamacare, and we would really see premiums soar. The real disaster will be dumped on those who lose insurance they have just now been able to afford. The other disaster: block grants on Medicaid to states which are really federal aid reduced and leaving the states holding the bag. That is not "better"by any definition.
Addendum: Feb. 27, 2017:
Ali Velshi on CNN interviews person from Columbia U. Half of the 20K covered by Obamacare get Medicaid Expansion (11 mil).. 31 states did Medicaid expansion; half have GOP governors. A total of 75million are now on Medicaid. Right now states and federal government split costs and GOP proposals floated would give the states a block grant, but no guarantee in future would be enough or would the block grants be the same.
Currently subsidies for those on Exchanges based upon sliding scale of income. GOP proposals would change that to one based on age and young people would get $2K credit (enough for catastrophic, but not much more) and older people would get $4K credit. However, cost of older people 5x younger so not enough for the older, sicker.
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For more about how GOP "patient centered" proposals would discriminate against women's health,
see my blog posting below of 2/3/17 "GOP and Trump planning to discriminate against women's health access"
http://www.usnews.com/news/data-mine/articles/2016-12-01/poll-americans-want-to-see-changes-to-obamacare
http://thehill.com/policy/healthcare/314610-obamacare-reaches-new-popularity-heights-poll
http://www.chicagotribune.com/news/nationworld/politics/ct-paul-ryan-healthcare-plan-20170214-story.html
http://fortune.com/2017/02/07/obamacare-affordable-care-act-repeal-poll/
http://www.cbsnews.com/.../millions-sign-up-for-obamacare-de...?
http://www.forbes.com/sites/brucejapsen/2016/10/10/sorry-trump-selling-health-insurance-across-state-lines-wouldnt-lower-costs/#841bf005f015
http://money.cnn.com/2017/01/02/news/economy/repealing-obamacare-health-insurance/
http://www.politico.com/agenda/story/2016/07/what-is-the-effect-of-obamacare-economy-000164
http://canadajournal.net/world/kaiser-family-foundation-poll-one-five-want-obamacare-repeal-without-replace
http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/
http://www.newsweek.com/obamacare-repeal-threatens-rural-hospitals-and-trump-voters-who-depend-them-538627
http://www.forbes.com/sites/brucejapsen/2017/01/08/as-obamacare-repeal-looms-hospitals-brace-for-job
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