healthcare

Alternative facts about ACA

  • The ACA is in a death spiral.

Not true according to the Congressional Budget Office (CBO).

  • Only 3-5 million people were covered under the ACA.

Kaiser Family Foundation reports 11 million were enrolled in Medicaid and Rand Corporation gives a low estimate of 15 million for purchasing health insurance through an exchange.

  • Unprecedented premium increases of 25-100% over the last year make Obamacare unaffordable.

HHS data shows an average increase of 25% this year, due to uncertainty in the market. Most purchasers qualify for subsidies that offset the increases. According to Kaiser, family premiums for employer-sponsored insurance increased by a cumulative 99% under Bush, while under Obama, they rose by 59%.

 

  • The Affordable Care Act was written in the dark of night and rushed through Congress.

Only if March through December 2009 is dark of night.  All major insurance and medical groups were included in the discussions.  The AHCA bill was kept secret with committee votes held before the CBO analysis was available.  All major medical groups and insurers (except one) have come out against the bill.

 

  • Purchasing insurance across state lines will increase competition and decrease costs.

Forbes- insurers can sell across state lines in some states to no effect, due to the high cost of building new insurance networks.  Interstate sales of insurance could lower costs by allowing insurers to choose their regulator, which makes insurers less accountable, and prevents states from helping consumers in their states.

 

  • Blame the ACA for everything you do not like.

Changes in recommendations for the frequency of PSA testing or mammograms among others have nothing to do with the ACA. Rates did not go up because of a requirement to cover transgender surgeries.  Be aware of blaming the ACA for cost increases before it took effect (i.e. from the date of passage) or using CBO estimates before the final bill was passed.

 

  • Block grants or per capita grants for Medicaid to states will allow more local control and will decrease costs

Both decrease costs by shifting costs to states and/or forcing people off of Medicaid.  In 2015, Medicaid accounted for 17 percent of the nation’s health care expenditures and covers 75 million people, a quarter of the population. 60% of  those in nursing homes pay for their care using Medicaid. To truly reduce the size of the programs, the elderly and disabled in nursing homes must loose benefits.

Alternate facts about the ACA

 

 

  • The ACA is in a death spiral. Trump, Ryan, Price, etc….

Congressional Budget Office (CBO) concluded in its report on the replacement plan that the “non-group” market, the individual insurance market in which people sign up on state or federal exchanges, “would probably be stable in most areas under either current law or the legislation.”  It can survive whether or not Republicans “repeal and replace” Obamacare, even when premiums spike, as they did in 2016, in large part because uncertainty over the law.   Those increases were offset by the federal subsidies people get under Obamacare, which rise as premiums rise, according to people’s incomes. Of the new signups this year, 84 percent were eligible for subsidies that covered 73 percent of the price of their premiums.

 

  • “The number of individuals who actually got coverage through the exchange who didn’t have coverage before, or who weren’t eligible for Medicaid before is relatively small. So we’ve turned things upside down completely for 3 million, or 4 million, or 5 million individuals.” Tom Price

Nonpartisan health care analysts at the Kaiser Family Foundation have concluded that, as of March 2016, more than 11 million Americans have gained access to health care as part of the Medicaid expansion. An additional 3.2 million Americans signed up for Medicaid but were previously eligible.  Rand corporation estimates that 4.1 million gained insurance.  So the figure is 15 million, conservatively .

 

 

  • “Right now, the American people are laboring under extraordinary increases in premiums. American families have seen an increase in premiums of $5,000. And this year, the average premium increase on families has been over 25 percent, and 100 percent in some American states. That all comes to an end when we set in motion an effort to repeal and replace Obamacare.” Mike Pence

Data released by HHS about average Obamacare premiums for four years — 2014 to 2017. The standard measurement the department calculates every year is what a family of four with a household income of $60,000 would pay for premiums on the second-lowest-cost silver plan. Premiums for this type of policy started at $9,468 a year in 2014, rose very modestly to $9,636 in 2015, rose somewhat more aggressively to $10,428 in 2016, and then rather substantially — 25 percent — to $13,080 in 2017.  Altogether, then, average premiums for this type of Obamacare plan rose by a cumulative 38 percent during that period. However, the raw dollar increase was less than what Pence said — $3,612.   This $3,612 figure doesn’t take into account the subsidies that most marketplace purchasers qualify for. Once the average level of subsidies is included in the calculation, the actual out-of-pocket premium cost borne by qualifying consumers actually decreased slightly between 2014 and 2017 — a drop of $60, from $4,920 in 2014 to $4,860 in 2017. Between 2013 and 2016, premiums for the average full-family, employee-sponsored plan rose by a cumulative 11 percent. That’s well below the increase for Obamacare plans.   According to the Kaiser/Health Research and Educational Trust studies, family premiums for employer-sponsored insurance increased by a cumulative 99 percent — basically doubling — under the eight years of Bush, while under eight years of Obama, they rose by a much more modest 59 percent.

 

  • Ways and Means Chair Kevin Brady (R-TX) criticized the Affordable Care Act as “written in the dark of night and rushed through Congress.”

The ACA bill took form March to end of December 2009 for final passage.  Although initially a bipartisan effort, the town halls diminished Republican participation.  All major insurance and medical groups were included in the discussions and were on board.  The AHCA bill was kept under lock and key.  Initial committee votes were held after marathon sessions before the CBO analysis was available.  All major medical groups and insurers (except one trying to get a merger approved) have come out against the bill.  There is no bipartisan support.

 

  • “The time has come to give Americans the freedom to purchase health insurance across state lines–creating a truly competitive national marketplace that will bring cost way down and provide far better care,” Trump.

Forbes-But insurers can sell across state lines in some states, and it hasn’t reined in costs or worked, largely because insurance companies haven’t wanted to spend the money contracting with more doctors and hospitals.  In reality, interstate sales of insurance would lower costs by allowing insurers to choose their regulator, the very dynamic that led to the financial collapse that has left millions of Americans without jobs. It would also make insurance less available, make insurers less accountable, and prevent states from helping consumers in their states.

 

 

  • Block grants or per capita grants to states will allow more local control and will decrease costs. Ryan

The block grant differs slightly from per capita caps. Under caps, states also get a fixed amount of money each year, based on how many people are in the program. Block grants aren’t based on individual enrollment each year.  States would not get more money if more people qualified for Medicaid. In theory, a per capita caps system would increase funding. But if, an expensive drug or procedure entered the market, the Medicaid budgets would not be able to absorb that increase.  Both decrease costs by shifting costs to states and/or forcing people off of Medicaid. The CBO estimates block grant proposals could cut Medicaid spending by as much as a third over the next decade. The cuts would start small, growing larger over the years, largely by cutting enrollment.  In 2015, Medicaid accounted for 17 percent of the nation’s health care expenditures   The 75 million people covered make up a fifth of the U.S. population. Almost two-thirds of people in nursing homes pay for their care using Medicaid. To truly reduce the size of the programs, the elderly and disabled in nursing homes must loose benefits.

Revamping Medicaid could also affect what services hospitals provide, and their economic strength. Specifically, hospitals and clinics that treat large numbers of Medicaid beneficiaries will alter/cut services they can provide reducing how many people they can employ.  Community hospitals are large community employers.

The debate also reflects how Congress treats other “entitlement programs,” such as Medicare and Social Security. The CBO estimates that spending on Social Security and other health programs will account for about 16 percent of all the country’s yearly goods and services — the gross domestic product — by 2046. A successful change in Medicaid bodes ominous for cuts in other programs.

 

  • Americans should be able to decide what level of coverage they want. Price

Understanding insurance is profoundly complicated. HR departments whose job it is to negotiate these policies often provide unreliable information to employees.  The fragmented nature of US healthcare complicates this-hospital room bills, doctor bills, test bills, test interpretation charges, medications, infusion of medications, etc… are all separate charges and bills.  What is in or out of network is obscure.  Unless you are an expert with time on your hands, it is impossible to tease apart.  High deductible policies are reasonable for the young (limited to age <30 in Obamacare).  But what seems like a bargain results in bankruptcy if you have to use it or forgoing care all together.  The average consumer simply does not have the background to make informed choices when it comes to health care.

 

  • The US has the best health care in the world.

America was 50th out of 55 countries in 2014, according to a Bloomberg index that assesses life expectancy, health-care spending per capita and relative spending as a share of gross domestic product. Expenditures averaged $9,403 per person, about 17.1 percent of GDP, that year — the most recent for which data are available — and life expectancy was 78.9. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower.

https://www.bloomberg.com/news/articles/2016-09-29/u-s-health-care-system-ranks-as-one-of-the-least-efficient