So far the response to the House Bill to allegedly “repeal and replace” the Affordable Care Act has gotten reviews that are a full-on raspberry from those on the Left and the Right. But like a tone-deaf musician the Trump administration keeps playing the same sour song without missing a measure, this time played by new HHS Secretary Price:
The President spoke last week, last Tuesday to a joint session of Congress, and he laid out his principles. First, wanted to make certain that those with preexisting illness and injury were not priced out of the market. Nobody ought to lose their coverage because they get a bad diagnosis.
In terms of affordability, health savings accounts -- growing choices for patients is incredibly important. Tax credits that allow individuals to be able to purchase the kind of coverage that they want, not that the government forces them to buy. We’ve always talked about -- in terms of what kinds of reforms need to be put in place, that we need to equalize the tax treatment for the purchase of coverage.
Those, again, in the employer-sponsored market, they get a tax benefit for buying health coverage. Those folks that are out there in the individual and small-group market, no tax benefit. And that’s what this plan would do.
State flexibility. It’s incredibly important that we allow the states to be the ones that are defining what health coverage is, have the flexibility, especially in the Medicaid program, to be able to respond to their vulnerable population.
Lawsuit abuse. The President mentioned, and it’s incredibly important, that -- the practice of defensive medicine wastes billions and billions of dollars every single year, and we need to make certain that we’re addressing that as well. The President also talked about a glide path, an appropriate transition to this new phase for healthcare for our country, and that’s important as well so that nobody falls through the cracks.
Buying across state lines, buying insurance across state lines. The President talked about this on the campaign over and over. The American people understand the commonsense nature of purchasing across state lines, and it increases competition. And we need to make certain that that happens, and then addressing the incredible increase in drug prices.
The way to evaluate this plan, is to compare what it actually does — to what they claim it does.
In réponse to the question of why not wait for a the CBO to score the Bill Sean Spicer proclaimed that the CBO “Isn’t that accurate.” That their projections were “way off by millions. They said there would be 20 Million people on Obamacare by now, but it’s only 12 Million.”
First of all they projected that each state would set up it’s own exchange and fully implement the Medicaid expansion but that didn’t happen either now did it? Secondly even despite both of those issues the estimate of 20 Million (12 Million within the Exchanges and 11 Million in the Medicaid expansion) is just about correct. Further the CBO has previously projected that if the ACA was repealed 18 Million People would lose their coverage while premiums would go up 20-25% in the first year, then it would get worse.
- The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026.
- Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.
So that’s our baseline. That’s what would happen with a direct repeal, however this plan claims to also be a “replacement” so how would their changes mitigate the above? Not much according to Molina Health care.
...J. Mario Molina, chief executive of Molina Healthcare Inc., a major managed-Medicaid company that also offers ACA plans in nine states, said he believes that striking the coverage mandate penalties could help push individual-plan premiums up by 30% or more next year—and more in the future, when the reduced subsidies kick in. That shift, he estimated, could shrink enrollment in ACA plans by three-quarters or more, leaving a smaller, less-healthy group of enrollees.
“You’re going to see big rate increases, and you’re going to see insurers exit markets…this is going to destabilize the marketplace,” he said. Dr. Molina added that the proposal’s help for insurers wasn’t enough to offset the removal of the mandate and other negatives. Molina has said it is reconsidering its ACA marketplace offerings.
If rates rise this quickly while insurers rapidly pull out then we will have the “death spiral” that the GOP has long predicted, only it will be based on their actions, not Obama’s.
Nobody ought to lose their coverage because they get a bad diagnosis.
Under the ACA insurers are prevented from dropping or denying coverage of persons who have developed persistent and chronic conditions. Rather than this TrumpCareless would punish people who’ve contracted this conditions by shuttling them into High Risk Pools which it provides just $100 Billion to fund, a number that falls far short of what is needed.
And when we last used High Risk Pools they didn’t work very well and only covered 200,00 people with premiums that were 150-200% above the standard market rates.
- Premiums above standard non-group market rates – All state high-risk pools set premiums at a multiple of standard (i.e., typical or average) rates for medically underwritten coverage in the non-group market, usually 150%-200%. Fifteen pools provided low-income premium subsidies that varied in comprehensiveness. The Oregon pool, for example, discounted premiums 95% for enrollees with income up to 185% of the poverty level, while the New Hampshire pool provided a 20% premium discount for enrollees with income below 200% FPL. Other pools required people to pay the full premium, regardless of income.
- Pre-existing condition exclusions – Nearly all state high-risk pools excluded coverage of pre-existing conditions for medically eligible enrollees, usually for 6-12 months. This made coverage less attractive for people who needed coverage specifically for their pre-existing conditions.
- Lifetime and annual limits – Thirty-three pools imposed lifetime dollar limits on covered services, most ranging from $1 million to $2 million. In addition, six pools imposed annual dollar limits on all covered services while 13 others imposed annual dollar limits on specific benefits such as prescription drugs, mental health treatment, or rehabilitation.
Many people currently covered with pre-existing conditions even with tax subsidies provided simply won’t be able to afford these plans — as they couldn’t afford them before — or won’t be able to jump through hurdles such as 6-12 month waiting periods, because going with out care that long may mean They Die. We shouldn’t call these “High Risk” Pools — these are Death Pools.
Tax credits that allow individuals to be able to purchase the kind of coverage that they want, not that the government forces them to buy.
As many have reported the tax credits suggested in this new plan as significantly less than those offered under the ACA and rather than being staged by income they are staged by age starting at $2000 for those under 30 years old and topping out at $4000 for those 60 years old. To this is a change in the rules that currently restrict the cost for seniors to be no higher then 3:1 over those younger to 5:1. If you’re fairly young and healthy this is a good deal, but if you’re older your are now settled with less premiums support and costs that are as much as twice as high as noted by AARP who have come out against the plan.
“Before people even reach retirement age, big insurance companies could be allowed to charge them an age tax that adds up to thousands of dollars more per year. Older Americans need affordable health care services and prescriptions. This plan goes in the opposite direction, increasing insurance premiums for older Americans and not doing anything to lower drug costs.
“On top of the hefty premium increase for consumers, big drug companies and other special interests get a sweetheart deal.
Another bad aspect of this plan is that it retains the Individual Mandate, but rather than having it be a tax penalty which maxes out at $695 for those who choose to forego health care — it instead changes it into a 30% premium increase for the first year that a person who skips coverage to re-enroll. For someone young with a yearly plan rate of about $3000 that would be a $1000 increase, $300 more than they would have paid current tax penalty. For a family though, who may have a yearly insurance bill of $12,000 — that premium increase could be as high as $4,000.
We allow the states to be the ones that are defining what health coverage is, have the flexibility, especially in the Medicaid program.
Again, AARP takes issue with this.
AARP opposes this legislation, as introduced, that would weaken Medicare, leaving the door open to a voucher program that shifts costs and risks to seniors.
This proposal would end Medicaid, fully sunsetting it in 2020 when no more signups would be allowed. Now similar to Ryan’s proposal on Medicare, this plan would offer a voucher to buy private care in the public market but there is no guarantee that any plan will be affordable at that price.
The 11 Million people currently on the Medicaid Expansion would lose their coverage outright only to receive one of these — very likely — completely useless vouchers. States would be left on the hook for the price tag of closing this coverage gap, and there isn’t much chance that they will.
The practice of defensive medicine wastes billions and billions of dollars every single year.
Incompetent doctors and hospitals who make preventable mistakes costs lives, hundreds of thousands of them per year.
Based on an analysis of prior research, the Johns Hopkins study estimates that more than 250,000 Americans die each year from medical errors. On the CDC's official list, that would rank just behind heart disease and cancer, which each took about 600,000 lives in 2014, and in front of respiratory disease, which caused about 150,000 deaths.
Medical mistakes that can lead to death range from surgical complications that go unrecognized to mix-ups with the doses or types of medications patients receive.
So exactly what should be the penalty for the loss of all those lives? How should we hold people accountable, a slap on the wrist? Or better yet how about we actually strive to reduce those numbers the way that Obamacare does?
From the infections patients get when they stay in the hospital (which kill about 75,000 people annually) to medical mistakes (surgeons left an impressive 4,857 items in patients over the last two decades), hospitals are places where lots can go wrong.
But hospitals are, just slightly, starting to get better at getting things right. A new federal report shows that improvements in hospital care saved 50,000 lives between 2010 and 2013, all by doing better at not making patients sick.
The number of patients who had a hospital-acquired condition — anything from an infection of a surgical site or a fall during recovery — fell by 17 percent between 2010 and 2013.
That translates to 1.3 million fewer harmful incidents than if the 2010 rate had held constant and 50,000 fewer patients death.
That’s an improvement of about 12,500 deaths prevented per year. But apparently all the TrumpCareless people actually care about is money, not lives.
The American people understand the commonsense nature of purchasing across state lines, and it increases competition.
The crown jewel of this plan is the Holy Conservative Grail of purchasing insurance across state lines. Big promises have been made about how this would increase “choice and competition” because rather than purchasing a local plan, you could buy a plan from across the country. Part of the problem with that idea is that this overrides the power of the each state to set it’s own rules for what kind of insurance is available, because technically any insurance provider can already offer a plan in any state they want to — that’s entirely up to them, not the government. And the fact is, the insurers aren’t interested in this.
The trouble is that varying or numerous state regulations aren’t the main reason insurance markets tend to be uncompetitive. Selling insurance in a new region or state takes more than just getting a license and including all the locally required benefits. It also involves setting up favorable contracts with doctors and hospitals so that customers will be able to get access to health care. Establishing those networks of health care providers can be hard for new market entrants.
“The barriers to entry are not truly regulatory, they are financial and they are network,” said Sabrina Corlette, the director of the Georgetown University Health Policy Institute.
...
In 2012, Ms. Corlette and co-authors completed a study of a number of states that passed laws to allow out-of-state insurance sales. Not a single out-of-state insurer had taken them up on the offer. As Ms. Corlette’s paper highlighted, there is no federal impediment to across-state-lines arrangements. The main difficulty is that most states want to regulate local products themselves. The Affordable Care Act actually has a few provisions to encourage more regional and national sales of insurance, but they have not proved popular.
Insurers have been muted in their enthusiasm for G.O.P. across-state-lines plans. Neither America’s Health Insurance Plans, the lobbying group for most private insurers, nor the Blue Cross Blue Shield Association have endorsed such a plan when it has come before Congress.
Part of reason we’ve seen the number of providers drop in many areas from 3 to just 1 isn’t because Obamacare has driven them out of the market, it because they’ve been gobbled up and consolidated into larger and larger conglomerates, something this bill does nothing about.
You probably haven’t heard — at least not lately — that some of the biggest health insurers are moving full steam ahead to merge with each other, which means that tens of millions of us — yes, millions — will be affected next year. And not in a good way. If the consolidation happens as planned, many of us will find ourselves in health plans with much worse patient satisfaction and customer complaint scores.
Here’s some context: Executives of UnitedHealthcare, Aetna and Humana made headlines this summer when they announced plans to quit selling policies on several Obamacare exchanges at the end of the year because they haven’t yet figured out how to turn a profit on that business. That means people enrolled in those companies’ Obamacare plans will have to pick a different insurer for 2017.
Employers, consumer groups, the American Medical Association and many other organizations have told regulators they think those mega mergers are not in the public’s best interest. The U.S. Justice Department and several state officials agree. They filed a lawsuit in July to stop both of them. Nevertheless, the mergers are far from dead.
…
Anthem scored the worst by far of any of the other health plans operating in the state. Data provided to OPA by the Department of Managed Health Care, which has jurisdiction over most of the state’s HMOs, showed, for example, that Anthem had 12.28 complaints per 10,000 enrollees. Compare that with Kaiser Permanente, the nonprofit company that rivals Anthem in terms of enrollment in California. Kaiser had just 4.50 complaints per 10,000. In other words, Anthem had nearly three times as many complaints as Kaiser.
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The American Medical Association has become one of the most vocal opponents of the mega-mergers, particularly the Anthem-Cigna deal. On September 21, the AMA released a report showing that Anthem’s “market power” would be significantly increased in several states and numerous metropolitan areas — especially in California — if the deal is approved.
So the disappearance of insurers in the exchanges are twofold. The limits on premium growth which are actually built into the exchange plans are growing as fast as their desire to increase their profits and also consolidation. And while these corporations become mega-corporations, the quality of their services declines, which also notes that allowing them to side-step local state regulators and use less strict rules from others states is, yet again, an increasingly bad idea.
As I’ve noted before there already is an plan to sell plans across state line included in Obamacare — it’s call the Multi-State Plan Program. As of right now only one insurer — Blue Cross/Blue Shield — has taken advantages of this program and only provided plans in 25 states.
This is the key lynchpin in the entire GOP plan. They go on and on and on — and ON — about “Choice” and about “Lower prices” and just about all of that is hung onto this idea. But there literally no evidence, NONE, that it has ever worked. Anywhere. This is a market delusion. It’s has no basis in lived reality.
The problem is that if this doesn’t work, if these magical super-flexible tailored and hyper-cheap plans don’t emerge, the entire house of wet cards collapses in on itself. The Medicaid vouchers and tax credits become either useless or almost immediately make almost any plan unaffordable, particularly for poorer and older persons who take the brunt of the price hikes directly on their backs.
About 18 mIllion people are still at risk of losing ability to access care.
If GOP didn’t want to cause a market disruption and put people into this risk they could be welcome to add their big bad ideas of health care savings accounts and buying insurance across state lines and if they WORK at increasing competition and choice, then start making other changes once it becomes clear that their vouchers and tax credits will be able to provide care for as many or more people than have it now.
But then again, it seems like they really don’t care about that at all.
Q: Can you guarantee that this plan will not have a markedly negative impact on the deficit or result in millions of Americans losing their health insurance?
Tom Price: What I can see is that the goal and the desire that I know of the individuals on the Hill is to make certain that this does not increase the cost to the federal government.
He hopes it doesn’t increase the cost to the federal government? Yeah, well it pretty much will since this bill is eliminating $600 Billion in revenue generation increasing the deficit as the CBO has always predicted it would.
This is in addition to the fact that despite their claims the cost of Healthcare on the whole — not counting some spikes and rises in some plans in some states -— has come down dramatically due to the ACA.
1. Premiums in employer-based coverage continued to grow slowly in 2016. The new Kaiser Family Foundation/Health Research and Educational Trust (KFF/HRET) survey finds that the average premium for employer-based family coverage grew 3.4 percent in 2016 in nominal terms, slower than the 4.2 percent growth rate recorded in 2015. This year’s slow growth extends the recent period of slow employer premium growth. The average premium growth rate since the Affordable Care Act (ACA) became law in 2010 has been 40 percent lower than the average growth rate over the preceding decade, and the most recent five years account for five of the six slowest growth rates reported since the KFF/HRET survey began in 1999.
So say good bye to that improvement with the implementation of TrumpCare. Oh, and that the Affordable Care Act extended the life of the Medicare Trust Fund.
The ACA addresses gaps in Medicare preventive and prescription drug benefits. It initiates ambitious testing of new payment methods to improve the value of care received by beneficiaries and, indirectly, all Americans. And it substantially extends the solvency of the Medicare Health Insurance Trust Fund by slowing the growth of future Medicare outlays.
So good bye to that too. And in addition to those who been saved in our Hospitals due to the avoidance of preventable mistakes, many more lives have been saved simply because people who didn’t have coverage with chronic disorders now have it.
A 2012 familiesUSA study shows that more than 130,000 Americans died between 2005 and 2010 because of their lack of health insurance. The number of deaths due to a lack of coverage averaged three per hour and that the issue plagued every state. Other studies have shown those statistics to be high or low, but all studies agree: In America the uninsured are more likely to die than those with insurance.
During that time prior to implementation of the ACA 26,000 people per year were dying because of their lack of insurance, approximately 30 Million people from the exchanges, With Medicaid expansion and young adults who’ve been able to stay on their parents plan until 26 have gained healthcare, another 29 Million people continue to remain uninsured. That means repealing Obamacare could put as many as 13,000 people at risk of death from loss of their insurance in addition to the previously mentioned 12,500 per year who have been prevented from dying due to medical mistakes, bringing the total to at least
25,500 per year saved by Obamacare— however some estimates
are as high as 36,000 deaths prevented per year.
Nearly 36,000 people could die every year, year after year, if the incoming president signs legislation repealing the Affordable Care Act.
This figure is based on new data from the Urban Institute examining how many people will become uninsured if the law is repealed, as well as a study of mortality rates both before and after the state of Massachusetts enacted health reforms similar to Obamacare.
That’s what is at risk if this complete disaster of a bill — or even a version of it that retains it’s many poison pills — gets anywhere near to being passed between 25,500 and 36,000 people per year could die.
If they want to do more Health Saving Accounts? Fine, do it. They haven’t done much of anything yet, but whatever. If they want to sell insurance across state lines - something that is already possible — fine, go for it. It’s never worked, ever, but if the GOP wants to try it yet again, alright. Have a party.
This isn’t to say that Obamacare is perfect and doesn’t need fixes, there are some issues in the small business market and rate hikes for people in the middle class that remain and are no joke.
But this bill doesn’t solve those problems, in fact, it makes all of them that much worse.