Presidential candidate Donald Trump has said he wants to repeal the Affordable Care Act and yet still “take care of everybody.” He has said repeatedly that he is different from other Republicans in this regard, implying that other GOP politicians don’t want Americans to get needed health services. Of course, Trump has never bothered to back up this slander with any evidence (and the media haven’t bothered to ask him for it).
Trump is apparently unaware of the plans to replace Obamacare sponsored by Rep. Tom Price and by Sen. Richard Burr, Sen. Orrin Hatch, and Rep. Fred Upton. These plans would insure as many Americans as are enrolled today under the ACA at a fraction of the cost.
The Affordable Care Act is now six years old. Perhaps more important for Massachusetts, this month marks the 10th anniversary of “Romneycare,” making it a good time to review that law’s impact.
Governor Mitt Romney’s original proposal was simple: Stop subsidizing hospital care and redirect the money to ensure that all residents have “minimum coverage”—in his mind, catastrophic insurance. Individuals could choose and pay for anything beyond that. The premise was that taxpayers should not have to cover the cost of care for those unwilling to pay for it.
A Health Connector was to serve as an exchange where individuals could buy insurance directly and which would test-drive market reforms. Unlike President Obama, Romney did not implement his creation.
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Supporters of the Affordable Care Act have declared victory on health care reform: they proudly note the decline in America’s uninsured rate, as well as the sizable enrollment of lower-income adults on the new individual-insurance exchanges (“ACA exchanges”). Yet after a brief rise, the number of insured Americans is now plateauing well below the ACA’s goal of universal coverage—rather than pay the ACA exchanges’ exorbitant premiums, middle-income adults are overwhelmingly opting to forgo health insurance and pay the individual-mandate tax instead.
Key Findings of this report from the Manhattan Institute:
- Nearly 30 million American adults remain uninsured.
- After an initial surge, enrollment on the ACA exchanges has slowed dramatically: since March 2015, only 1 million additional individuals have signed up for coverage.
- By February 15, 2015—the end of the ACA exchanges’ second enrollment period—fewer than half of eligible middle-income adults had signed up for coverage.
The CEA presentation is notable in reflecting the core components of ACA advocates’ case for the law. It is fourteen slides long, and I find that its points break down into five main themes (in my own words):
- The ACA represents a historic expansion of health insurance coverage.
- The ACA is achieving policy goals such as reducing patient harm and hospital readmissions.
- The ACA is helping to slow the growth of health care costs.
- The ACA has been good for job creation.
- The ACA is improving the federal fiscal outlook.
Donald Trump’s healthcare plan is a “whipsaw of ideas” and an “incoherent mishmash that could jeopardize coverage for millions of newly insured people,” according to conservative health policy experts. Mr. Trump’s health care platform “resembles the efforts of a foreign student trying to learn health policy as a second language,” according to AEI’s Tom Miller. AEI’s Jim Capretta adds that replacing the ACA would require a “herculean effort, with clear direction and a clear vision of what would come next. I just don’t see that in Trump’s vague plans to repeal the law and replace it with something beautiful and great.” Trump must “discard some of his ideas, like the importation of prescription drugs, because they would be damaging and unworkable,” according to Grace-Marie Turner. “And he has to flesh out his other proposals with much more detail if he hopes to persuade voters that he has a credible plan to replace Obamacare.” Robert Laszewski, a former insurance executive, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.”
After six years of Obamacare and three years of the exchanges Americans have learned a few lessons. The healthcare.gov disaster was due to the complexity of the website, an awful procurement system, and lack of adequate management by the administrationg. Establishing an insurance company is more than just paying claims, as you can see with the failure of half of the co-op insurers around the country. Finally, people don’t want to spend a lot of money on insurance.
In the March 8 rule, the Department of Health and Human Services (HHS) stated that Health Savings Account (HSA) eligibility was not a meaningful distinction for health plans because consumers can determine whether a plan is HSA-qualified by examining a plan’s cost-sharing amounts. Therefore, it will not require HSA-qualified plans to be designated as such.
Two main reasons why HSA-qualified plans will not survive is because plans must cover services below the deductible that are not considered “preventative care.” And the plans must apply specific deductibles and out-of-pocket limits that are outside the requirements for HSA-qualified plans.
The pharmaceutical industry, insurers and the Obama administration all want prescription drugs to be included in determinations about whether a certain pools of patients are riskier than others.
The determinations are important because insurers who take on riskier sets of patients are eligible to receive compensation under Obamacare. Right now, those determinations are made using just medical claims.
Drug companies and insurers generally agree that prescription drugs should be included in the risk adjustment models. They currently are not.
Obamacare to date has failed miserably relative to what was originally promised regarding how many people would get covered and the number of these who would obtain their coverage through the Obamacare exchanges.
The president’s claim that “America is on a stronger footing because of the Affordable Care Act” is dubious at best. Literally no major promise made for this law has been kept and some have been broken quite egregiously.
The Medicare Advantage Value-Based Insurance Design Model kicks off Jan. 1, 2017 and will run for five years.
Value-based insurance design, or VBID, refers to health plans that waive or lower out-of-pocket costs for healthcare and prescription drugs that are proven effective for patients with chronic health conditions.
The CMS wants feedback on ways to promote quality of care and reduce cost of care for enrollees in the Medicare Advantage program.