aside My Policy Wish For USA, Part IX (Fix Obamacare)

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The best data that I found addressing the current state of Obamacare which needs fixing now, versus avoidance is from an 8/21/16 Slate report by Jim Newell, “How the Democrats Are Failing Obamacare.” Here are some excerpts:

“On May 20, about a month after United Health care announced that it would pull out of Arizona’s exchanges, Rep. Ann Kirkpatrick wrote a letter asking for help. It was addressed to Health and Human Services Secretary Sylvia Mathews Burwell, and in her note Kirkpatrick, who had lost her seat in the Tea Party putsch of 2010 in no small part because of her vote in favor of health care reform, related her concern about the wobblier parts of Obamacare.”

.“I represent a sprawling, mostly rural district in Arizona,” wrote Kirkpatrick, the Democratic challenger for Sen. John McCain’s seat this November. “In several counties, United Healthcare is one of only two health insurance carriers selling marketplace plans.” After noting that the Affordable Care Act has “significantly dropped the uninsured rate in Arizona,” she addressed the problems it’s still facing. “[W]hat can we do to incentivize insurers to continue participation in the marketplace?” she asked.”

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“The news in Arizona has only worsened since then. Blue Cross Blue Shield, which had been the only carrier submitting 2017 insurance plans for all of Arizona’s counties—at an average requested premium increase of 64.9 percent—pulled its options for Maricopa County, by far the state’s most populous, and the more rural Pinal County to its south, citing $185 million in losses in the state. over two years.”

“And last Monday, Aetna, another of the country’s largest carriers, withdrew from markets in 11 of 15 states, including Arizona. Aetna, suddenly bearish on the sustainability of the exchanges where it had recently been so bullish , made the announcement not long after the Justice Department had challenged its merger with the carrier Humana. The timing of the move is now under major scrutiny. The fact (is) that it was losing hundreds of millions of dollars on the exchanges (on a market cap of some $42 billion) and was seeking consolidation as a remedy. With Aetna and UnitedHealthcare out of the picture and Blue Cross paring back, the competition in much of Arizona, particularly its rural areas, will be sparse or nonexistent in 2017.”

OBAMACARE GREAT CARTOON 5cdb3fee1bee33a71ac5fc6a0ed2f3b2“Is Obamacare working? The question assumes a single national program. “There are, in some ways, 3,000 different ACAs playing out across the country, because it’s playing out very differently county by county,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. Some carriers, especially in denser areas, are able to broaden their risk pools and participate in flourishing exchanges, and some, usually the less brand-name ones that offer narrow-network plans at cheap cost, are making profits.”

OBAMACARE GREAT CARTOON USE Geico-Aflac-Obamacare “But it’s becoming clearer that the Affordable Care Act is due for the sort of legislative maintenance that most major laws require after implementation. Two temporary federal programs, reinsurance and risk corridors, designed to cushion losses for insurers as they determined sustainable premium price points in new markets, expire in 2017. Carriers serving sicker-than-expected pools or rural areas find that their options are either to sharply increase premiums or to leave the exchanges altogether.. And Kaiser estimate in May projected the number of counties that could have a single exchange insurer in 2017 to be 664—70 percent of which are mostly rural—up from 225 in 2016.”

“One problem with legislative redress for Obamacare is that the legislators who are supposed to do the redressing seem less than eager to return to the front where not long ago they’d declared victory. The second problem is that, once again, the fight will almost certainly involve the public option.”OBAMACARE CARTOON W OBAMA PUTIN 091713GaryVarvel_Creators

“Despite the virtues of a government-offered health care plan that, with lower administrative costs, no profit expectations, and the bargaining power of the federal government, would compete aggressively alongside private plans, the (past) debate over it was the scene of much garment-rending and commie-punching last time around. But now both Obama and Hillary Clinton have come out in support of a public option, and the Democratic caucus is not what it was in 2010.”

“Obama and Clinton’s support for the issue, (Adam Green, a co-founder of the Progressive Change Campaign Committee) he said, reopened the book. “To have the two biggest figures in the Democratic Party calling for it and a clear villain”—Aetna—“the stars are aligned for a big campaign now.”

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“The ACA is undoubtedly a mixed bag, and mixed bags always make for terrible political discourse. Republicans wield each and every suboptimal data point about the Affordable Care Act’s implementation as concrete proof that the law has failed and must be repealed in full if the republic is to survive, but they offer no replacement plan that comes  close to meeting the ACA’s coverage figures. In the meantime, they refuse to be party to any legislative improvements.”

Democrats, meanwhile, are content to hide behind Republican incoherence and nefariousness instead of confronting the shortcomings of their signature legislative achievement.

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“All eyes now are on the 2017 open enrollment period that begins Nov. 1. The key question is how consumers will navigate the large projected premium increases, coupled, in many areas, with fewer options. “If open enrollment goes well and more people sign up, I expect a lot of these current concerns will fade,” Levitt said. “If enrollment for 2017 stagnates, it’s likely to trigger a debate about how to fix the law.”

“There is one Democratic figure who might be in office in 2017 who has treated the law’s shortcomings seriously and put together a bevy of health care proposals—and she happens to be the party’s presidential nominee.”

“Eventually Clinton would add a Medicare “buy-in” option for those 55 and older, and she also committed to doubling the money for community health centers from the funding mark set in the original ACA. She offered further inducement for states that haven’t already accepted the Medicaid expansion to do so and would grant the HHS secretary additional “authority to block or modify unreasonable health insurance premium rate increases,” increase resources for enrollment outreach, and expand existing exchange subsidies.”

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“And yes, she’s also pledged to “pursue efforts to give Americans in every state, the choice of a public-option insurance plan.”

  “Health care markets will inevitably differ from region to region,” Jacob Hacker, the Yale professor and so-called “father of the public option,” wrote in Vox on Thursday, “but there’s no reason every one of the existing marketplaces couldn’t offer a Medicare-like plan that’s stable; a plan with predictable costs; a plan that gives patients a broad choice of providers just as Medicare does.” It would also save money$158 billion over 10 years, according to a 2013 Congressional Budget Office estimate.”

“The main problem with Clinton’s plans for a public option, or any other legislative patches to the ACA, would be congressional gridlock.”

Obamacare-rocky-rd GOOD CARTOONBut even a strong push for a public option can be useful. If fixing the Affordable Care Act reaches the congressional docket with some urgency, it can serve as a central piece of Democrats’ opening offer that eventually gives way to other compromise solutions. It might be possible to peel off some Republican members of Congress who recognize that the law isn’t going anywhere, so why not improve on it. That may come in the form of increased exchange subsidies for families, doubled subsidies for community health centers, or a reauthorization of the reinsurance program.”

“Obamacare’s holes are being exposed, and Republicans are more than ready to fill them with the narrative that the law is beyond repair. If Democrats don’t rally around any ideas for a fix, the GOP will have succeeded in weaponizing its opponents’ political fear against their greatest accomplishment.”

11 comments

  1. Gronda, good post. Your writing is consistent with the messages I have been writing about as a retired actuary and former benefits manager and consultant. The ACA is working pretty well, but is complex and needs improvements. Instead of working together to do this, it became a lightning rod. As an independent and former Republican (and Democrat), I am frustrated by the GOP Congressional efforts to do every thing they can to make it be less successful and then say “see we told you.”

    Fifty repeal votes and naysaying it is a large part of why so many GOP voters have not signed up. I have an attorney friend here who helps largely GOP voters work through healthcare expense issues and bankruptcy because they failed to sign up. But, the states and Congress went further. 19 GOP-led states have still not expanded Medicaid, which would be a huge help to many of their constituents, rural health providers and the state economies says a George Washington University study as well as Kaiser Family and Commonwealth Foundations.

    Plus, Congress did not fully fund the risk corridors to pay for adverse selection. What does that mean? They are strangling insurers who were supposed to get extra funding for taking on “high claimant risk” from pent up health care demand. This is why the carriers are struggling.

    So, this imperfect law which has seen over 20 million folks covered, could be easily improved with these and other changes, if Congress worked toward that purpose and stopped the win/ lose modus operandi of governing. And, the sad irony of all of this, is the ACA is based in large part to a GOP idea, which was advocated by Tea Party leadership for the whole country.

    And, the final issue is this. We are aging country and the most obese country in the world. Plus, as the Epipen example shows, drug companies like to charge full margin to American consumers. So, for these reasons, healthcare costs will rise regardless of the system. The ACA helps, but could help much more.

    Great post, Keith

    • Dear Keith,

      The Medicaid expansion would also reduce infant mortality rates. The U.S. has the highest numbers of infant mortality births than any other developed country (As per CDC and CIA numbers). The ones stopping legislators from improving the product are the very same ones who are pro life zealots who won’t lift a finger to help expecting poor mothers who need pre and post natal care.

      I have conservative friends with family members who are on Obamacare. And they are grateful for it. The democrats should not play defense on this subject.

      I am a RINO, Gronda

    • Gronda, I see that piece about the infant mortality. Also, two other factoids are states with Medicaid expansion see much fewer rates of personal bankruptcy due to medical care and the hospitals have better collection rates of accounts receivables. One of the options the next president should consider is adding a public option where there is not enough competition. That will help with the deficit as well. We need more RINOs as they represent what the Republican party used to be about. Keith

      • Dear Keith,

        The public option in certain markets would be a major step in the right direction. Doing something about the sky rocketing costs of prescriptions would be another way to bring down costs.

        Thanks for your comments, Gronda

        • Jueseppi,

          It is hotter than Hades in Chicago this summer which is where I am. I am babysitting while my son and his wife move into their new home in the Oak Park area. I’ll be back in Florida sometime in September.

          Thank you for your kind words, Gronda

  2. I’m waiting to see if an investigate journalist is going to get involved in and report how some states who extended Medicaid coverage are lying to the Department of Treasury of providing coverage to people who they actually denied. If those states are receiving federal money for expanding Medicaid, they are committing fraud. As it is now, there is no government agency to oversee that. Complaints to the federal Health and Welfare are referred to the state agency committing the fraud.

    • Xena, I would love to find out this information. I do not like to see fraud when it is our tax dollars at stake. I’ll do some research on this issue. Thanks for the tip, Gronda

      • Gronda, I’m not sure if you’ll find any reports on this issue by major media. As it stands now, the Dept. of Treasury is maybe the only federal agency who can ferret out the issue. I’ve down some snooping of my own, even talking to some federal agency personnel who verified that people have received forms to file with their income taxes. The forms are from state agencies that administer Medicaid, yet the people say that they were denied Medicaid. It’s going to take an investigate journalist with plenty of time and the backing of a major news source to really get all of the necessary information from the Dept. of Treasury, and what it means for tax credits to the states.

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