Showing posts with label universal health care. Show all posts
Showing posts with label universal health care. 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.

Tuesday, January 17, 2017

Where Trump has it right on health care insurance (updated)



Donald Trump announced a worthy goal, that everyone in the US should have health insurance, and it ignited a firestorm in the GOP, with a Congress that seems to be hell-bent in reducing the numbers who have insurance through Obamacare.  They were wringing their hands, too that Trump was planning to take on the powerful lobbyists of the drug industry, since a great deal of the cost of insurance and the health care system in general was due to rising drug prices. Trump also demanded that repeal had to have a replacement nearly simultaneously.

Recently Donald Trump indicated a slow down to next year in providing a placement plan. Reality is setting in that moving from a campaign slogan to a plan that meets his goals is not that easy and he is wise to look before he leaps. Immediately, House Speaker Paul Ryan said Congress will not wait, but find a replacement this year, underlining in nine years, they could not agree on a replacement and will have a difficult time now.


Many GOP politicians ran this year on a platform of repealing Obamacare, they won, and they believe they have a mandate to repeal Obamacare, in spite of polls showing that only 18% favor repeal with no replacement those same politicians could not agree on a replacement. In fact, their plans to repeal but not tell consumers what the replacement would be until after the next election cycle was shot down by Trump. The mandate is to replace it,  and/or  fix (repair) it, but with what quality at how many covered at what cost are questions still hanging.  The  legislative challenge  is how can the GOP  get enough Democrats on board to avoid a  Senate filibuster over replacement details.

Paul Ryan, House Speaker, in a briefing February 7, is pressing forward on repeal/replace, whether or not the Trump administration has their plan. Their pitch: Obamacare is failing anyway, so they will come up with a better plan. If the plan is like prior proposals the GOP has made, what they have in common is that their plans would fail even worse than they claim about Obamacare, discriminating against women's health, and not disclosing how many would get any premium support via a tax credit, or what the impact would be on the actual cost of their proposal.

The policy challenge is how they can find ways to finance a plan that meets their goals without blowing the deficit out of the water and without removing insurance from 22 million who benefit directly now and everyone else indirectly from required standards for all health insurance, public, private and employer provided.

For those who gloss over the iimplications on the defict of any fix should recall the Simpson-Bowles commission The Simpson-Bowles bipartisan deficit reduction commission examined the relationship of Obamacare to the deficit and recommended “Controlling health care costs by maintaining the Medicare cost controls associated with the recent health care reform legislation.”  In fact, cost savings to Medicare by Obamacare has added 12 years to the life of Medicare per recent government reports.

The GOP plan in controlling costs is "competition", freeing insurers to offer choices that do not conform to the standards required in Obamacare, including women's health, covering pre-existing conditions forbidding life time caps on coverage, and making partitcipation strictly voluntary with no penalties. First, what lowers costs is the size of the pool ..in any insurance plan, whether casualty, life insurance or health. The pool must have a mix of both those who pay in but never use vs those who pay in and use the coverage. The GOP plan narrows the pool by not requiring only those who think they will never get sick to join in the pool. It would also allow men who do not want to see any of their premiums support women's health to opt out of such benefits. That reduces the pool, too.

GOP proposes putting those with pre-existing conditions in a special pool of those who are bad risks and subsidize that. However, those pools exist now, have been tried before Obamacare passed, and turned out to be failures and extremely costly. Either they required a large taxpayer subsidy or their premiums were not reduced enough to make them affordable for many people. In Colorado, the high risk pool premiums were only reduced enough to bring them down to the level paid by those who had no prior conditions, which were still unaffordable for thousands without subsidies. Few in lower income brackets signed up

The other false premise advocated by the GOP is the concept of competition, including buying insurance in other states. Without nationwide standards, those other states would be free to provide substandard, cheap premiums and there would be a race to the bottom for all offering poor quality or fewer benefits. However even more fundamental is the fact that there is no competition in the market anyway. Major insurers have affiliates in multiple states, meaning your state may have Blue-Cross Blue Shield, and going to another state you will run into their affiliate. The other factor that keeps the insurance market from being compeittive is that all insurance is exempted from federal anti-trust laws, meaning they are free to get together with competitors, set prices and benefits.


Trump is closer to the thoughts of the electorate than is the GOP Congresspeople  as their members have found recent town halls and constituent meetings that have become very uncomfortably filled with  angry consumers who fear they will lose their life saving health insurance due to their Congressman/Senator/s vote to repeal Obamacare. Bernie Sanders has been able to rally large masses of voters, even in states like Michigan Trump won to support retaining Obamacare.


There are still those who bought into Sander’s proposal of Medicare for All, a single payer system, though Sander’s is not promoting  that for now. Instead  he is rallying  public pressure to retain the gains made by the ACA (Obamacare) in any form and is willing to work with Trump to achieve it.   Eventually just for economic reasons and known experience with single payers systems elsewhere in the world,  that alternative  will be revisited in the future because  a single payer system it is a far more efficient way to achieve the goal of insuring everyone. But now, given the issues at hand, Sanders is on the right track.


Improving Obamacare or Trumpcare s a goal  that should not get lost in the legislation.. It needs fixing. Aside from the morality of the issue and the life and death health concerns of so many, it has not achieved the goal of making health insurance available to all.    9 %  are still not insured and the high deductibles present their  financial burdens even for those who have insurance.


In the terms of sheer consumer financial worries there is motivation to fix Obamacare. According to the Federal Reserve, 47% of US families have only $400 in personal reserves to cover emergencies. A visit to the ER costs $1000 alone.  Before Obamacare, medical bills caused 60% of all personal bankruptcies. Most of those taking bankruptcy then had health insurance, but the insurance was  so poor with life time caps, high deductibles  and lacking in comprehensive coverage.   In 2016, of those with health insurance under the age 65, that number was reduced to  20%, still not good enough,  and for those without health insurance it was 53%.   The  obvious conclusion from that is that Obamacare standards and consumer protections need to be expanded to cover even more of the uninsured, not shrink the numbers with access to  affordable, quality, comprehensive  health insurance.


http://kff.org/other/state-indicator/total-population/?currentTimeframe=0

http://www.cnn.com/2017/02/07/politics/ryan-obamacare-replacement/

https://www.washingtonpost.com/news/fact-checker/wp/2016/11/14/paul-ryans-false-claim-that-because-of-obamacare-medicare-is-going-broke/?utm_term=.fc70481159b0

http://q13fox.com/2017/02/05/trump-says-obamacare-replacement-could-take-until-2018/

http://www.factcheck.org/2017/01/pelosi-stretches-aca-claims/


http://thehill.com/policy/healthcare/314149-poll-18-percent-want-full-obamacare-repeal


http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/


http://amjmed.org/under-aca-medical-bankruptcy-continues/




http://www.usnews.com/opinion/economic-intelligence/articles/2016-12-02/republican-replacement-plans-for-obamacare-likely-to-make-health-care-worse

https://www.cbo.gov/publication/52371