Showing posts with label high risk pools. Show all posts
Showing posts with label high risk pools. Show all posts

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.

Saturday, February 11, 2017

Where were those Save Obamacare activists last year? Asleep ? Fooled?

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.

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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