Health Care

Originally posted to Facebook on July 2, 2015.

Before this week’s issue, a note.  In truth, I started this little experiment to convince myself that no matter who became president, everything would be okay.  I wanted to move past the rhetoric and dig into the issues.  I wanted to understand all sides of every issue, so I have spent a lot of time reading opinions and articles from sources that I knew I wouldn’t immediately agree with.  The result:  I used to believe all people were good and generally wanted the same thing.  Now, I’m not so sure.  Maybe I’ll have more on that in another post.  For now, health care.

Health care.  Is it a basic human right or a for profit industry?  What is ObamaCare?  What is Medicaid?  Why are premiums so high?  There is a lot wrong with today’s health care system.  But, why?  In this post, I give an overview of Obamacare and Medicaid before offering where the candidates stand and providing my own bottom line.

Affordable Care Act (Obamacare)

The Patient Protection and Affordable Care Act (PPACA) more commonly called the Affordable Care Act (ACA) or Obamacare is the most significant overhaul of the U.S. healthcare system since the introduction of Medicaid & Medicare in 1965.  It was signed into law by Barack Obama on March 23, 2010.  It was a major part Obama’s candidacy platform for presidency.  It was intended to increase the quality and affordability of health care insurance and to lower the uninsured number.

Here are some of the more significant changes introduced by the law:

Protections for policyholders:

• Insurers can no longer deny coverage to patients due to pre-existing conditions.
• Insurers can no longer impose lifetime dollar amounts on essential benefits, such as hospital stays.
• It can no longer drop policyholders when they get sick.
• It established minimum standards for health care policies.
• Plans must cover preventative care and medical screenings and cannot charge co-pays or deductibles for these services.

Expanded protections:

• It expanded Medicaid eligibility.
• It allowed children to stay on their parents insurance until their 26th birthday.

Streamlined Services:

• Introduced health insurance exchanges as an on-line avenue where individuals and small businesses can compare plans before purchasing during open enrollment.
• Reforms and streamlines the payments system through Medicare.

Penalties for Non-Compliance:

• It mandates insurance coverage unless an individual experiences financial hardship or is a member of a protected religious sect.  Subsidies are available to help low income individuals.
• It enacted tax penalties for businesses (with 50 or more employees) who do not offer coverage for full-time employees but receives tax deductions for such a purpose.
• Penalizes hospitals with a higher than expected readmission rate due to the costs they incur to Medicare by decreasing their Medicare reimbursement rate.

Why people love it.

Most Americans benefit from the Affordable Care Act.  The inability of an insurance company to refuse people with pre-existing conditions has been life changing for many.  A member of my own family paid $800 a month due to a pre-existing heart condition because no insurance company would take him except the state.  The Affordable Care Act changed that.  For those that are currently sick or have been sick in the past, Obamacare is a really big deal.  Insurance companies used to be able to deny coverage or charge more, now they can’t.  Insurance companies used to be able to put lifetime limits on coverage.  Now they can’t.

The end to lifetime limits is another big deal.  I’ve been moved by numerous stories over the years about people, especially children, who have had to endure horrific illness from cancer to brain tumors and the end to lifetime limits has saved their families from financial ruin.

The requirement of preventive care and minimum requirements drives costs down by preventing people from getting sick down the road when the expense rises.

The uninsured rate has gone down considerably due to the affordability and accessibility.  Medicaid and CHIP coverage have also expanded.  Businesses must offer coverage for their employees.  Basically, people get taken care of in ways they didn’t before.  More people have health care than ever before.

But, why the mandate?

Granted, all of this additional coverage costs insurance companies a lot more money.  The sicker a patient is, the more money this is going to cost insurance companies.  This is why insurance companies traditionally denied those with pre-existing conditions or dropped them when they became sick.  Enter the mandate.  If insurance companies have to cover more, they need more policy holders which is part of why all people, even the traditionally healthy, must purchase insurance.  Otherwise, people would just wait until they got sick to purchase insurance which would truly “break the bank.”   The mandate was originally introduced in 1989 by the Heritage Foundation and was championed by conservative economists and Republican senators.

Why people hate it.

For some, it didn’t go far enough to prevent the rise in health care costs which have surpassed income growth for years.  While ObamaCare has slowed the rise in healthcare costs and premiums aren’t rising at the rate anticipated, they continue to rise and they are expensive!  It turns out that quality plans that meet minimum requirements cost more than plans that could drop you when you got sick or kick you out of the hospital.

To pay for the program, it raised taxes on high earners (the 2% making more than $250,000/year) and the healthcare industry.  People don’t like the mandate because they don’t like being told what to do.  Especially, the young and healthy who could go without and now have to pay for insurance.  

Some have called a job killer because companies would force their employees to part-time to avoid paying health care costs.

Smaller government advocates say it is an overreach of the government into people’s lives.

The biggest myths about ObamaCare:

Myth:  ObamaCare is causing premiums to increase.

Fact:  Health insurance premiums have been increasing at outrageous rates for years, long before ObamaCare.  ObamaCare has done a lot to curb premiums, like using the Health Insurance Marketplace to shop around for insurance.  As mentioned earlier, insurance companies have raised their rates as a result of offering quality plans that meet minimum requirements.  

Myth:  ObamaCare is killing jobs and increasing the deficit.

Facts:  The Affordable Care Act actually pays for itself through tax increases on insurance companies and high earners and spending reduction.  It has led to a deficit reduction.  As cited in my post on the economy, the deficit has shrunk every year Obama has been in office.  There is no evidence from the Bureau of Labor Statistics that that the law has had an impact on part-time workers seeking full-time work.  Again, as noted in my post on the economy, there have been 75 straight months of private sector job growth.

Medicaid:

What is Medicaid?  Medicaid is the government insurance program for people whose incomes are insufficient to pay for health insurance.  ObamaCare expanded Medicaid coverage to families whose incomes are up to 133% of the federal poverty level.  This would have covered about 15 million more families.  But, a bunch of states actually rejected that expansion.  Over half of the nation’s uninsured population lives in the states that did not adopt Medicaid expansion.

Why did they reject it?  The federal government subsidizes 100% of of the expansion through 2016, but that subsidy tapers to 90% by 2020.  The states that rejected it say that their 10% of their responsibility does not work within their budgets. Studies have shown that rejecting the expansion will actually cost states more due to increased spending on uncompensated emergency care that would have otherwise been covered by Medicaid.

Medicaid is the only option for many low-income Americans.  And, the truth is many people don’t want to use tax dollars to pay for those who can’t afford insurance.  But, the flip side of that is that taxpayers are responsible for tens of millions of dollars in unpaid medical bills for those who can’t afford insurance and turn to emergency rooms for care when they are out of options.

• 

 Adopted the Medicaid expansion

 Medicaid expansion under discussion

 Not adopting Medicaid expansion

Here are the candidate positions (which anyone who has followed an ounce of the election would likely know.)

Clinton:  Clinton defends the Affordable Care Act and wants to build on it and move to the next level of making premiums more affordable and lessening out-of-pocket healthcare expenses for those buying insurance on the Marketplace Exchanges. She wants to slow the overall growth of health costs (including prescription drug costs-spending on this rose from 2.5% in 2013 to 12.6% in 2014), and lower out-of-pocket costs like co-pays and deductibles.  She also wants to transform the system to reward value and quality of care.

She has a plan to encourage states to expand Medicaid coverage.  She wants to invest in marketing to make enrollment easier as many are eligible, but don’t know it.  She believes that anyone who wants to be able to buy into the Affordable Care Act should be able to, regardless of immigration status (currently undocumented immigrants cannot.)  She supports a “public option” (government run health care to work in competition with private companies) as a way to reduce costs and broaden choices.

Trump:  Trump calls ObamaCare and incredible economic burden.  He perpetuates the myth that ObamaCare is responsible for increased costs and higher premiums.  He also claims there is less competition and fewer choices.  He says it has raised the economic uncertainty of every American.  He proposes repealing the whole thing:  the prevention of denying someone due to pre-existing conditions, the prevention of imposing lifetime limits, the prevention of dropping someone when they are sick, the established minimum requirements, the requirements of covered preventive care and screening, the expanded Medicaid eligibility, and more.  All of it.  This is a Day 1 priority for him.

His alternative:  free-market healthcare completely free of government regulation.  Without government regulations, insurance companies can go back to denying people with pre-existing conditions or making their costs unattainable.  Without government regulation, it is basic supply and demand determined by insurance companies and the people.

My bottom line:  I believe that affordable health care is a basic human right which is why I support the Affordable Care Act.  I believe a government that is for the people is going to do more to ensure affordable and accessible health care than insurance companies that are for a profit.  There is much to be done to improve the health care system and we all have our horror stories, but the repeal of ObamaCare would be a step in the wrong direction.  Obamacare isn’t perfect, but it brought about much progress in the healthcare system and has saved lives and saved good people struck by horrible health scares from finacial ruin or lack of care.  That matters to me.  I value people more than I value any argument I have come across against the Affordable Care Act.