Wednesday, October 30, 2024

Killing Obamacare, a last minute issue affecting 45 million people

 Speaker Mike Johnson just promised massive changes to Obamacare with seven days to go and most Americans  will not have a chance to consider  this. Democrat candidate for the House need to grab it and run and demand their opponents tell what they plan.  

A last minute sleeper issue affecting 45 million people. https:/ut /www.nbcnews.com/.../speaker-johnson-criticizes... What are the massive reforms? Chances are that those with pre-existing conditions will be the victims among other.Whatever the GOP does, it will be to the advantage of big pharma and health insurers. Be very afraid all those on Obamacare now. Trump only hints he has a concept, but if he is afraid to give details, they probably would be political suicide if he dared Here is what is probable. It is a reproduction of a prior blog posting of mine May 27, 2024.

The Democratic National Committee came up with a list of Trumpisms spouting how he plans to destroy affordable health care.  That one issue seems to get eclipsed by others, such as abortion and democracy, but the issue of affordable health care cuts across many more demographics, sex, age, and middle-class income. "Across coverage groups, a total of 45 million Americans are enrolled in coverage related to the ACA, the highest total on record. This represents 14.1 million more people enrolled than in 2021 (a 46% increase) and 32.5 million more people enrolled than in 2014 (a 258% increase, or more than triple).Mar 22, 2024"    https://aspe.hhs.gov/sites/default/files/documents/a1e8128c1b9996fd5a7eb98d0860d572/aspe-2023-race-ethnicity-marketplace.pdf


While I am usually reluctant to quote a political party's press releases, I thought this one used Trump's own words against him.  I think this issue has legs and I hope during the upcoming campaign, it gets more exposure.  Like the ending of Roe v Wade, most voters don't get the message in advance of its ending until the dirty deed is done, and all of a sudden, the access door is slammed shut in their faces. The only thing left for those who sound alarms left to say is "I told you so".  Chicken little warnings often get dismissed as "the sky is falling" hysteria.  In this case, it really could fall in when it concerns the ability to get health care to cover pre-existing conditions. afford premiums, and give a vehicle for 45 million to pay for it via Obama care. 

From the DNC release with links to sources     https://democrats.org/news/trump-on-the-aca-donald-trumps-plan-for-affordable-health-care-is-getting-rid-of-it-entirely/


Trump“We’ve really decimated Obamacare.”

“We’ve done a great job, but we’re going to be getting rid of it entirely.”  

As Trump pledges to repeal the ACA in a second term, here’s a recap of some of the most egregious statements he’s made about killing the program:

Daily Beast: “Trump Revives Plan to Dismantle Obamacare if Elected in 2024”

NBC: “Trump, by contrast, stood by his support for a lawsuit headed to the Supreme Court that seeks to invalidate Obamacare. The justices will hear the case one week after Election Day.

“‘I would like to terminate Obamacare, come up with a brand new, beautiful health care,’ Trump said at the debate, which was moderated by NBC News’ Kristen Welker.”

Trump: “Obamacare is a disaster. And I said, ‘We’re gonna do something about it.’”

Trump: “The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives. We had a couple of Republican Senators who campaigned for 6 years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!

Trump: “And what we’d like to do is totally kill [the ACA].

The Hill: “In a Truth Social post, the leading GOP presidential candidate claimed he’s ‘seriously looking at alternatives’ to replace ObamaCare, and that the failure to repeal the health law in 2017 while he was in office was ‘a low point for the Republican Party.’” 

Trump does not care that the majority of Americans support access to affordable health care and protections for people with preexisting conditions.

Washington Post: “But what’s clear is that an effort to ‘terminate’ Obamacare is not something Americans are pining for. Not only were the GOP’s efforts to repeal and replace Obamacare during Trump’s term historically unpopular, but the law also appears to have gotten more popular since then. … And when politicians talk of ending health insurance for tens of millions of Americans, dropping coverage of preexisting conditions and cutting Obamacare’s Medicaid funding, things get even dicier.”

Reminder: Trump spent his entire presidency trying (and failing) to get rid of the ACA while making it harder for people to sign up for health care.

NPR: “The very day President Trump was sworn in — Jan. 20, 2017 — he signed an executive order instructing administration officials ‘to waive, defer, grant exemptions from, or delay’ implementing parts of the Affordable Care Act, while Congress got ready to repeal and replace President Obama’s signature health law.” 

CNN: “Trump slashes funding that helps people sign up for Obamacare.”

NBC News: “Affirming its disdain for ‘Obamacare,’” the Trump administration on Thursday announced sharp cuts in programs promoting health care enrollment under the Affordable Care Act for next year.

“Advertising will be cut from $100 million spent on 2017 sign-ups to $10 million, said Health and Human Services officials. Funding for consumer helpers called ‘navigators’ will also be cut, from $62.5 million for 2017, to $36.8 million for next year.”

The Hill: “Insurance Experts: ObamaCare Mandate Repeal Driving Premium Increases.”

New York Times: “The Trump administration said Saturday that it was suspending a program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act, a freeze that could increase uncertainty in the markets and drive up premiums this fall.”

NBC News: “Trump approved a surprise decision to push for the complete elimination of the Affordable Care Act in the courts. If it succeeds, millions of Americans will lose their private insurance or Medicaid coverage and the health care system would be thrown into chaos.”


Some still push for Medicare for All as the best alternative to Obamacare. I am slowly coming around to Medicare for all. Not only are those who are middlemen corporate profit seekers taking their bloated administrative cut but there is also an actuarial sound theory at work. The larger the number of all participating, in the pool regardless of health status, the more the cost is spread around. Much depends on how Medicare for all is structured. Are "advantage" and supplemental plans allowed. Do participants have a choice of physicians? Are private providers allowed? Do you have to belong to a network or can you go anywhere you want for care? Is there rationing based on need and urgency? and everyone else can stand in line. How much of a co-pay is required? There are many varieties and versions of this in Europe now and each country has its own kind. The most restrictive of all is Canada. My granddaughter lives in Austria and is happy with that system and she has a choice of a doctor. All of these systems are heavily subsidized by taxes but in the long run, the outcome is the best measure. France and the Scandinavian countries often poll the best in patient satisfaction. In France, high-income taxes pay for it, but if the taxpayers like the system and get their money's worth, they do not mind...and seems to be a tradeoff that is OK.  I am not sure the tradeoff would fly in the USA 

https://www.internationalinsurance.com/health/systems/

 Until then we need to reform and refine Obamacare to do what it was designed to be: a safety net for those victimized without the income or ability to get insurance in the open marketplace, or not having employer-provided insurance and meeting some financial need criteria based on income. Obamacare was based on a proposal from a conservative think tank as an alternative to "socialized medicine, though the Heritage Foundation would like to avoid getting the blame.  What differs from some proposals is a law that requires all, a mandated law, to have health insurance. Obamacare does not have that mandate. However, both left and right felt they had to provide an alternative that was affordable to all consumers regardless of pre-existing conditions. 

High-risk pools have also failed. Experiments tried that failed were to put those with pre-existing conditions is a separate pool and subsidize that.  It was tried in Colorado and failed and if that is what the GOP has in mind, know that such a plan has never worked.https://cohealthinitiative.org/articles/high-risk-pools-been-there-done-that/       Why high-risk pools fail   https://www.commonwealthfund.org/blog/2015/why-high-risk-pools-still-wont-work

 Backers of Obamacare had hoped the cost of insurance would also be reduced by the competition to be the private insurance provider in each state. That, too, has not worked and it has instead become a boondoggle for private insurers, who as a whole and as an industry exempt from anti-trust laws can get away with collusion and price setting.


https://theconversation.com/conservatives-backed-the-ideas-behind-obamacare-so-how-did-they-come

From Google AI polls of satisfaction with healthcare systems shows only a quarter of those polled in the world are happy with them. However, relatively speaking countries with universal care poll much better that the US which ranks at the bottom. According to recent polls, satisfaction with universal healthcare systems varies widely across the world, with countries like the Netherlands, Belgium, Norway, Denmark, and Switzerland reporting the highest levels of citizen satisfaction with their healthcare systems, while the United States generally shows the lowest satisfaction due to its non-universal system, with many people expressing concerns about cost and access to care; a recent Harvard study found that only a quarter of respondents globally felt their health system worked well.

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