The #GOP has been crying foul on Obamacare for 7+ years, multiple attempts to repeal it have failed. Now that they have the legislative power to repeal it, it hasn’t been repealed. I can only hope the reason is that they (some of them) have realized all the good that it does.
Many people don’t even realize that Obamacare is just an nickname for the Patient Protection and Affordable Care Act (Named because the ACA was based on an Massachusetts law, Chapter 58 of the Acts of 2006, which was colloquially known as RomneyCare after Governor Mitt Romney). While many people are “against” Obamacare, support for the Affordable Care Act is much higher. Which is ridiculous, as they are the same thing.
What good things you might ask? The good things include: insurance for young people up to age 26 on their parents insurance, preexisting conditions, an individual marketplace where people can buy insurance without having their employer provide insurance, and preventative care. Also in the good pile are subsidies for people who cannot afford insurance, and by extension medicaid for people who’s subsidies would end up giving them 100% coverage anyway. At least with medicaid the rates for the insurance are negotiated to much lower costs.
If you aren’t on subsidies or Medicaid you might want to repeal those provisions. They don’t affect you so they are a drain on tax paying citizens right? But other than those provisions, what other parts of the law do you want to give up? And if you are giving it up are you giving it up because you want your premiums to go down or because you don’t value the protection?
There are problems with the Affordable Care Act that must be addressed. I want to use this blog post to discuss changes to the Affordable Care Act, that I think will make things better. I may also discuss some changes that need to occur outside of the Affordable Care Act, that will help to solve problems. With all the blaming of the ACA, its easy to think it is the source of all your problems. In particular health care costs have been rising since well before the ACA, that’s why the Patient Protection and Affordable Care Act was drafted, to try to reduce the speed of those increases.
The fact that health care costs are too high is something that would have occurred even if the affordable care act had not been passed, and was true before the ACA was passed. Costs have continued to rise, and the ACA did not stop that, it just slowed it. The non partisan Congressional Budget Office recently stated that a full repeal of the ACA would result in insurance premiums doubling. To me that implies that the ACA has already limited the skyrocketing rates of premiums, and kept them to half of what they would be otherwise.
Let me first talk about something that is unpopular that cannot be changed. The individual mandate. Ooops…. I just lost a bunch of readers. People just don’t get why they should be FORCED to buy health insurance. It’s not like they need it right?
Some of you have made up your minds. You didn’t have to pay it before so you shouldn’t have to now. I’m just trying to be reasonable, and I’m not going to convince you if you aren’t willing to listen to reason so skip the next paragraph and move on. If you are open to reason, or just don’t understand then let me try to explain it through analogy.
Some states require that if you own a car you MUST buy car insurance. People understand that, they are okay with it, you never know when you might get in a car accident. You can choose to not buy a car, and you don’t have to buy car insurance. Likewise you should be able to choose to not have health and not buy health insurance. Like car insurance people who don’t make a claim still have to pay premiums, that’s just how insurance works. We could change car insurance so people only have to buy insurance when they have an accident, but then the premiums would be the cost of the accident, plus the cost of the insurance company. It wouldn’t be insurance at all. Likewise we could make it so people only had to buy health insurance when they were sick… and it wouldn’t be insurance. But… you just don’t want to buy insurance now.. when you get older you would get insurance right? Well if I can follow your logic, and if I pretend that it is complete then your premiums would still be much larger. Without the healthy younger people contributing to the insurance pool, your premiums when your risk of getting sick or incurring health care costs is higher would be more than you would likely be able to afford, it’s still not insurance. That is, if your logic was complete.. it’s not. The reason it isn’t is because we now allow people who have pre-existing conditions to buy insurance. So that means, if you can opt out when you are younger, you don’t have to wait until your older to join the pool, or you could wait until you were really old. It doesn’t matter, you just have to wait until it makes financial sense to join, which because everyone is doing the same thing it never would make sense, so nobody would ever buy insurance because they would just buy it when they got in a car accident, sick. Car insurance or health insurance, in fact either way you want it if you can get it only when you need it, it’s not insurance. So the individual mandate has to be in effect.
You might also argue that young people don’t use healthcare and they don’t have the money so they shouldn’t be forced to buy it. You know that isn’t completely accurate. Young people do use health care, and they should. Especially for pre-existing conditions, check ups, preventative care, pregnancies, accidents, sudden diseases, viruses, infections etc. Young people often don’t use healthcare or they get it from their employers. As far as affordability the subsidies and medicaid should take care of that. Those young people who do buy insurance can probably afford it, and those that are subsidized are contributing something and have access to health insurance, rather than not contributing and don’t have health insurance, it’s win win.
One of the biggest problems with Obamacare is the insurance premiums. Lets talk about why the premiums are high, then we can talk about how we can lower them.
Let’s first look at the cost of healthcare in the US. Healthcare costs are $3.35 Trillion dollars in the US right now. According to PBS, that’s $10,345 per person and health care costs are expected to grow by 5.8% for the next decade. That is SLOWER than the rate from 2007-2009 before the ACA was passed, but still faster than the economy is growing. Put quite simply the cost of health insurance must fall to be affordable.
By covering people with pre-existing conditions the insurance companies took a big risk. In many areas, people are much sicker than the insurance companies thought. As a result the premiums were not covering the treatment. The ACA said the government would share the risk with the insurance companies for the first while on this. By sharing the risk the government said if the costs were over 103% of the expected costs for the insurance region, the government would kick in some money to the insurance companies. If the costs were below 97% of the expected costs for the insurance region, the insurance company would pay the government some money. That satisfied many insurance companies, but when the Republicans got the votes to start repealing, and threatened to not fund the losses even though the law said they had to the risk for the insurance companies went up. As a result of increased risk, the premiums went up. Some insurance companies figured the risk was too high, and they stopped selling insurance in those markets. As a result some communities only have 1 provider in the individual market. After a few years of caring for people with these health care problems they will either die, or get better. In any case the risk will level out and the market will stabilize. The fix for this issue is to just honor and extend the PPACA as it was written for risk corridors.
Another reason for high premiums is that the cost of health care is skyrocketing. Medical test are high, medical equipment is high cost, and doctors charge absurdly high rates. One reason for those high rates is malpractice insurance. A new bill needs to be passed that limits the amounts people can sue for malpractice. If a doctor uses a tool that isn’t fully sterilized and that results in an infection, that’s a bad thing. But do you think most people deserve 10 million dollars for that? There should be damages for negligence, damages for gross negligence (operating while drunk?), and established rates for errors that could happen to anyone. Things that aren’t even errors can result in malpractice suits that get millions of dollars by a jury because the family or patient didn’t fully understand the risks despite the doctor providing the information. You might like to win the malpractice lottery, but you probably don’t like paying for it with each doctors visit. The fix for this is a bill that limits costs for malpractice.
Another cause for the high costs is the high drug prices. There are multiple fixes for this. During the 2016 election campaign, both major parties promised that Medicare and Medicaid could negotiate drug prices. Why wasn’t that one of the first things brought up in the congress? Quick and easy bi-partisan solution. The government buys a lot of drugs for the health care industry, they should get volume discounts and many other countries already do this. The next thing to help lower drug costs is to limit the length of the patent on drugs. You get companies like Turing Pharmaceuticals who are charging for $350 for a single aids pill that they used to sell for $1.00. Drug makers should be able to make a reasonable profit on the drugs they research and develop, but some of them are outright robbing people and getting away with it. Drug patents laws should be updated to protect people better while still allowing for profit for those that risk the R&D.
Another fix for high health care costs is a single payer system. I don’t think that has much chance of passing in the US, though many Democrats are pushing for it. It works in many other countries. It even works in the US for medicaid, medicare, and the VA, people love medicare, but the insurance companies and politicians that receive donations from insurance companies people have demonized single payer systems in the US.
Another thing that increases costs for insurance is lack of competition, The fix for this is doctors and insurance companies should be able to compete across state lines.
Another fix is to require that if an insurance company offers insurance in the state, the entire state should be eligible to buy the insurance. Don’t let insurance companies say their insurance is only available in St. Louis and not New Madrid.
Another problem with ACA is that many middle income families do not qualify for subsidies but need them in order to afford health insurance. The ACA should adjust the equation for subsidies allowing more people to get subsidies, and increasing the % of those subsidies for those in the middle class.
Another problem with the ACA is the tax on premium health plans. It makes no sense to tax people who have premium health plans. Yes the tax dollars have to come from somewhere, what with all these subsidies and such (not as much as it seems, I’ll discuss later) but taxing people with insurance doesn’t seem to make much sense. It would make more sense to move those taxes to things that CAUSE health problems like tobacco, marijuana, alcohol, pollution, oil etc. Fix – Remove the tax on premium health care plans, replace the income by taxing tobacco, marijuana, alcohol, pollution, oil, junk food.
Another problem with the ACA is it’s dependence on employers to pay for health insurance. Some employers say they can’t hire anymore people because the health care costs are too high, others say they have restricted employee hours because they can’t afford to pay health insurance.
Fix – Double from 50 to 100, the # of employees an employer must have before they must cover health insurance. Employers who don’t contribute to an ACA approved plan for their employees must contribute 3% of the greater of net wages/net profit, the wages would include full time employees and part time employees.
Deductibles – of course part of the problem with GOP suggestions to provide skinny insurance for people is that the insurance isn’t really usable anyway. That same problem exists with many of the ACA plans that are out there. After paying a fortune for the insurance itself people can’t use it unless they use up their incredibly high deductibles. The fix is to drastically limit the deductibles on common procedures. $20 to see a doctor for instance, $0 for a follow up appt. 5% on prescriptions up to a maximum of $50 per month/ prescription. Only large uncommon ailments would result in larger amts for deductibles. You want a cheaper plan, and you need treatment for a heart attack, you can expect that you might have to sell your care because you bought the cheaper plan. If that bothers you then fight for a single payer plan, or buy a more expensive plan, you can’t be upset that you HAVE to buy insurance, AND that when you buy the cheapest plan you can get you still have to pay higher deductibles.
I said I would discuss the costs of all the subsidies as well, you have to understand that people without health insurance are already costing the government loads of money. When people show up at emergency rooms they are costing money, when they can’t work and go on medicaid they are costing money (medicaid, and welfare). You may not be aware of all the money that goes into funding emergency medical insurance, but you probably already have some ideas on the costs of medicaid and welfare. By keeping people healthy you are turning them into tax payers, contributors which is what you want. When you leave people to be sick, you simply increase the costs on the healthcare industry. You will end up paying more to medicaid, food stamps, welfare, emergency room funding by leaving people to be sick, then helping them become contributors.