Posted: 03/08/17 00:42
by Dave Mindeman
It seems like some of us do not remember health care prior to the ACA.
The driving force behind the push for Obama's ACA was finding a way to cover everybody. Make it affordable. And make that coverage comprehensive.
The country had a lot of uninsured people. Pre-existing conditions was a method used by insurance carriers to dump sick expensive people off the roles. Businesses were locked into a health insurance inflation spiral....
September 16, 2009. Today, the average cost of a family health insurance offered by an employer is $13,375. That's up 131% over the last decade--a period in which inflation rose only 28%. And one estimate says that if costs continue on their current trajectory, premiums will go up another 166% in the decade ahead.
That was the motivation. Health care needed to be fixed. We needed to get more people covered with lower premiums and stem the tide of rising costs.
The ACA was a comprehensive plan with a number of moving parts. And all of them were meant to fit together to keep other parts in check. The individual mandate meant to offset the mandatory coverage of pre-existing conditions. The exchanges were meant to increase insurance competition. The risk pool funding was meant to ease the transition into the ACA and cover insurance overages. Prevention coverage was mandatory in hopes of making people healthier in the future. There were taxes on the very wealthy and on some of the medical manufacturers to help offset costs and make sure that the ACA did not contribute to the national debt. And there were mandates for businesses to cover their employees.
The ACA has accomplished a lot of the things it was meant to do. It has cut the number of insured in this country by over half. The premium increases were slowed down, although in the individual market, they have begun to move up again. Prevention coverages are improving outcomes. And the ACA has not contributed to the debt and has given Medicare a longer forward projection.
But there have been some glitches. The technical software issues have been a drag on effectiveness. The exchanges had a lot of dysfunction because of that - and have been slow to recover. And premiums are still fluctuating substantially.
In addition, the ongoing resistance from the Republican Party has intentionally sabotaged some of the mechanisms needed for the ACA to succeed. Republicans fought the Medicaid expansion in the courts and each state was then given this expansion as an option...and a number of states chose not to take it...even though it was paid by the Federal government. The risk pool funding was wiped out by Republican legislation and insurance companies had no recourse when some of their plans increased in cost beyond their own projections. And many companies dropped out of the exchanges as a result. A number of Congressional representatives attacked the tax revenue which supported the comprehensive program. Erik Paulsen has undermined the cost structure by removing the medical device tax; even though the industry benefited from the ACA with more demand for their product.
Despite all of those issues, the ACA insured more people with better coverage and saved many rural hospitals from closing down. The days of emergency rooms being besieged by uninsured patients began to taper off and helped stabilize financial structures for many providers.
But the longstanding opposition of the Republican Party finally took its full effect and they now control Congress with a Republican President. And after 6 years of distortions and sloganeering, they now can repeal this program from existence....and replace it? With what?
The Paul Ryan plan released this week will take large numbers of people off the health care roles. It wipes out the taxes that made the ACA work in a comprehensive way and replace it with a piecemeal plan that will bring back a system that is dictated by insurance carriers. Wipes out prevention coverage. Will raise the costs for sicker people by giving healthy people an option to opt out of any insurance. And again, put hospitals in jeopardy with uninsured emergency room visits. And affordability will be a huge question mark.
The GOP plan drops the intricate network of cost structures for another haphazard band aid of ideas that put us back to the path we were on prior to the ACA.
The GOP hopes to delay any voter backlash by stripping the revenue while keeping the program intact temporarily. Which, of course, will simply add more debt and deficits in the short run - but allow them to minimize the effects on patients until after the next election.
This is barbaric health care. It is short sighted. It is heartless. And it will be a bigger failure than the ACA ever was in their imagination.
Republicans cannot set aside politics. They cannot govern.