Today’s Managing Health Care Costs Number is 7
There are a lot of things I hate about the Affordable Care Act.
However, all of these will get dramatically worse if the American Health Care Act is passed.
1. The ACA doesn’t cover enough people.
The goal was to eliminate uninsurance. First we removed the illegal immigrants, and then we allowed states the latitude not to expand Medicaid, which left millions with incomes under 133% of federal poverty level (FPL) to languish without insurance.
The goal was to eliminate uninsurance. First we removed the illegal immigrants, and then we allowed states the latitude not to expand Medicaid, which left millions with incomes under 133% of federal poverty level (FPL) to languish without insurance.
The AHCA, of course, will throw 6-10 million more people off insurance.
2. The ACA exchange plans have excessive out of pocket costs.
Many have said “coverage is so stingy it isn’t even worth it.” The maximum family deductible is $14,300! It’s affordable for those with subsidies and eligible for the cost sharing reduction (CSR limits out of pocket costs for those at less than 250% of FPL), but it’s not affordable for others.
The AHCA will eliminate the CSR in 2019, so low income individuals won’t have a cap on total expenses based on their income. Subsidies will be lower – so the actuarial value of plans would have to go down unless the premiums shot up. So if you hate your current deductible and coinsurance – with TrumpCare it will be worse.
Many have said “coverage is so stingy it isn’t even worth it.” The maximum family deductible is $14,300! It’s affordable for those with subsidies and eligible for the cost sharing reduction (CSR limits out of pocket costs for those at less than 250% of FPL), but it’s not affordable for others.
The AHCA will eliminate the CSR in 2019, so low income individuals won’t have a cap on total expenses based on their income. Subsidies will be lower – so the actuarial value of plans would have to go down unless the premiums shot up. So if you hate your current deductible and coinsurance – with TrumpCare it will be worse.
3. The ACA does too little (some say nothing) to control health care costs.
It’s true! The ACA encourages payment reform through Centers for Medicare and Medicaid Services and expanded pilot programs. But corralling all the interests groups to get this extra coverage passed in 2009 didn’t leave much room for cost control.
The AHCA will do nothing structurally to lower health care costs. Medicare will not negotiate for drugs in Medicare Part B, and Tom Price has been an opponent of any approach that could constrain physician income.
It’s true! The ACA encourages payment reform through Centers for Medicare and Medicaid Services and expanded pilot programs. But corralling all the interests groups to get this extra coverage passed in 2009 didn’t leave much room for cost control.
The AHCA will do nothing structurally to lower health care costs. Medicare will not negotiate for drugs in Medicare Part B, and Tom Price has been an opponent of any approach that could constrain physician income.
4. The ACA doesn’t do enough to get healthy people to enroll – so that the insurance pool is higher risk than it should be.
The Obama administration hoped 40% of enrollees would be under 35 –and it’s been only 28%
The Obama administration hoped 40% of enrollees would be under 35 –and it’s been only 28%
The AHCA will eliminate the individual mandate. The only penalty for not having insurance for any length of time would be a one year 30% extra premium. This is not going to be a great way to convince the young invincibles to purchase health insurance!
5. The ACA left too many decisions (like Medicaid expansion and essential benefits) to the states.
And many states did not act in the best interests of their residents. In Alabama, adults are not eligible for Medicaid unless they are at 16% of the FPL- under $4000 for a family of four! States could have improved their economies, their budgets, and their tax revenues by expanding Medicaid, but 19 still haven’t.
The AHCA will unload Medicaid onto the states altogether, and fund it with $377 billion less over a decade.
And many states did not act in the best interests of their residents. In Alabama, adults are not eligible for Medicaid unless they are at 16% of the FPL- under $4000 for a family of four! States could have improved their economies, their budgets, and their tax revenues by expanding Medicaid, but 19 still haven’t.
The AHCA will unload Medicaid onto the states altogether, and fund it with $377 billion less over a decade.
6. Purchasing health insurance through the ACA is needlessly complex
The Obama administration misfired with the initial healthcare.gov launch – and worked hard to make enrollment easy. But it remains a complex chore, and many need help from brokers and enrollment counselors.
The AHCA will make shopping well-nigh impossible by eliminating the “metal” tiers – so insurance companies will go back to creating non-comparable products to seek to selectively attract healthier enrollees.
The Obama administration misfired with the initial healthcare.gov launch – and worked hard to make enrollment easy. But it remains a complex chore, and many need help from brokers and enrollment counselors.
The AHCA will make shopping well-nigh impossible by eliminating the “metal” tiers – so insurance companies will go back to creating non-comparable products to seek to selectively attract healthier enrollees.
7. Even with the ACA, funding for public health in the US is scandalously low.
The ACA included extra $1 billion a year in prevention funds – 1/8 of the CDC budget.
The ACA included extra $1 billion a year in prevention funds – 1/8 of the CDC budget.
The AHCA will eliminate this funding. But simply calling the next Ebola outbreak “fake news” won’t be enough to save lives.
So maybe I don’t love Obamacare. It’s deeply flawed.
But I’m discovering how much I love gridlock
EmoticonEmoticon