Today's Managing Health Care Costs Number is 15
The Senate voted 51-48 early this morning to set in place a reconciliation process to clear the way for a repeal of the Affordable Care Act by January 27 - just 15 days away. A single Republican senator, Rand Paul did not vote for this resolution. All Democratic senators voted against it.
The Affordable Care Act is a large, complex bill. As we heard all too often, the bill ran to over 1000 pages, and its regulations clocked in at over 10,000 pages in 2013 The ACA doesn't merely provide health insurance and subsidies worth $33 billion through exchanges which serve 11.5 million Americans. It doesn't simply provide health insurance through Medicaid to an additional 14 million at a cost to the federal government of $79 million. The Affordable Care Act impacts virtually every corner of health care.
This includes:
- Insurance rules that allow adult children up to age 26 on their parents' plans, prohibit annual and lifetime maximums, allow those with preexisting illnesses to purchase insurance, and restrict price differences based on age.
- Requirements that insurance covers essential services, and covers preventive services without out of pocket costs. This has meant increased access to contraception, including long acting contraception. It's no wonder that abortion rates are at historic lows.
- Minimum medical loss ratios with requirement to refund "excess" profit
- Decreases in rate of hospital increases for Medicare, which lengthens the life of the Medicare trust fund
- Elimination of the "donut hole" which forced seniors with Medicare Part D to pay for 100% of the costs of pharmaceuticals from about $2700 to $6000 a year
- An agency (Centers for Medicare and Medicaid Innovations) to implement and study new payment models
- An individual mandate - to help be sure that the insurance market doesn’t have adverse selection (that can lead to a death spiral)
- An employer mandate to offer adequate coverage that is affordable - helping keep employers in the game
- A series of taxes, most of which are levied on industry (which not has more paying customers) and the wealthy (including expanding the Medicare tax to income beyond $110,000 a year)
There is plenty more, too.
The ACA was passed after over a year of committee review and hearings. It fundamentally restructured an industry that represents 18% of the GDP - offering dramatic decreases in the uninsured rates with the most modest year over year cost increases in a quarter of a century. Over the last 7 years there has been no alternative credible plan that can maintain private health insurance, not increase the number of uninsured, and cost less than the ACA. It's unimaginable that a "replace" bill could be crafted into legislation in 15 days.
We're watching a public policy trainwreck here. And the losers will not merely be those 29.8 million likely to lose insurance -but will likely be all of us as we scuttle the most promising policies to improve health care access, quality, and cost, even though there is no reasonable alternative in sight.
9:20 am Correction - I initially posted that Susan Collins abstained. It was Rand Paul who abstained.
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