by Norman Halls, contributor
The United States of America is the only developed country in the world that doesn’t offer health care. The term is far different from the actuality. It appears they have no notion to assist their constituents. Possibly the lobbyists, health manufacturers, insurance companies and Trump are the ones.
“The Senate health-care plan isn’t a health-care plan. It’s a tax cut. That’s clear enough from how little thought it puts into actually stabilizing insurance markets versus how much it does into showering the rich with as much money as possible. Indeed, it would go so far as to retroactively cut the capital gains tax — something, remember, that’s supposed to be about incentivizing future investment — in an apparent bid to get people to create jobs six months ago. The way it would slash Medicaid to pay for this tax-cutting largesse, though, is even more important. It would be more than just a transfer of wealth from the poor and sick to the rich and healthy. It would be a transfer of financial risk from the government to individuals.” By Matt O’Brien Washington Post.
“At the heart of the insurance issue is the cost associated with risk pools. Insurance companies manage profit by covering a mix of people who are high risk, meaning they require significant payouts for coverage, with people who are low risk, meaning they are relatively healthy and do not have a lot of medical expenses. The Affordable Care Act subsidizes some of the high-risk cases and enforces a penalty for citizens who go without purchasing health care. However, many healthy Americans have chosen to pay the penalty instead of the premiums, which skews the average in the risk pool. As coverage becomes less profitable, many insurers stop offering their products in certain areas. That reduction in competition translates into higher premiums.” “I think the Republicans have put themselves in an impossible situation if they are really going to come through on their promises,” Field said. “They have sworn they are going to get rid of the individual mandate, which is what they disliked the most about Obamacare, but there’s really no viable alternative to making the insurance market work and getting healthy people into the risk pool. How do you make it accessible at an affordable price to somebody who’s already sick or older?” Wharton’s Mark Pauly and Robert Field discuss what’s ahead for the Affordable Care Act.
There are numerous possible ways to proceed. A piece from the Wall Street Journal by economist Robert Litan discussed three of them.
1. Patch things up: Since affordability is a big issue, the federal government could spend more money to bring down the costs that individuals and families face. This could be done directly by raising the level of subsidies available for plans purchased on the exchanges, or raising the income thresholds at which the subsidies phase out—or both. Alternatively, the government could offer more generous subsidies to insurance companies, particularly those serving high-risk populations, in which case they wouldn’t have to raise prices as much, or impose such large deductibles.
2.Apply some force: One of the big problems that insurers are facing is that too few healthy people, and too many sick people, are signing up for the plans sold through the exchanges. For insurers, that changes everything. Faced with higher claims per enrollee than they expected, they seek to raise their prices, which makes healthy people, especially young healthy people, even less likely to sign up the following year. If unchecked, this process could lead to a spiral of rising prices and falling enrollment. Generally speaking, private insurance markets only work well when there is a large and diversified risk pool. If we are going to rely on them to provide universal or near-universal coverage, the individual mandate will have to be enforced. That means raising the penalties for non-compliance and enforcing them effectively.
3.The Public Option: The rising cost of health care is an issue all over the world. The way most countries have dealt with it is by enrolling the entire population, or almost all of it, in a single-payer system, and using the bargaining leverage that creates (usually coupled with administrative) to keep down costs. So far, the American political system, which is highly vulnerable to capture by powerful interest groups, such as doctors, hospitals, and pharmaceutical companies, has resisted going down this route. But this may be changing.” John Cassidy, The New Yorker staff writer.
American Medical Association (AMA) President Andrew W. Gurman, M.D., issued the following statement today about proposed changes to the American Health Care Act (AHCA): “None of the legislative tweaks under consideration changes the serious harm to patients and the health care delivery system if American Health Care Act (AHCA) passes. Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill – that millions of Americans will lose their health insurance as a direct result of this proposal. “High-risk pools are not a new idea. Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions. The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage – if they are able to obtain coverage at all. “Not only would the AHCA eliminate health insurance coverage for millions of Americans, the legislation would, in many cases, eliminate the ban against charging those with underlying medical conditions vastly more for their coverage.”
Recommended reading list: Medicaid Politics and Policy by Judith D. Moore and David G. Smith; SICK by Jonathan Cohn; Health Care Reform Simplified by David Parks: also read the text H.R. 1628 American Health Care. Don’t forget to write to your Legislative Leaders in Washington and Senate Majority Leader Mitch McConnell. Express your concerns. McConnell telephone number 202-224-2541.
