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Oct
18

What parts of Obamacare do you want to keep? eliminate?

The ban on medical underwriting and exclusion of pre-existing conditions?

The elimination of lifetime maximums?

The penalty for those who choose not to sign up for insurance?

The expansion of Medicaid to cover those with incomes up to 133% of the federal poverty level?

Requirement that Medicare control its costs or be subjected to stricter controls on useless or dangerous procedures and treatments?

The tax credit for small employers obtaining health insurance?

The requirement that preventive care is covered – at no cost to subscribers?

Tight restrictions on insurers seeking to cancel coverage when subscribers get sick?

It wouldn’t be good policy to eliminate many of these provisions, and, more to the point, it isn’t possible.

First, the policy problem facing Mr Romney.  Let’s take just one example; he’s said he

a) is going to repeal Obamacare on his first day in office, (let’s leave aside that he doesn’t have the ability to do that) while

b) ensuring anyone with pre-existing conditions can get coverage

I don’t see how that works.  In fact, Romney’s “assurances” about coverage for pre-ex are no more than what exists today; as long as you move directly from one insurance plan to another your pre-ex conditions are covered.  For those Americans who haven’t had coverage for a few months, you’re out of luck – insurers won’t have to offer coverage.

Oh, and there are no price limits on what insurers can charge you, so even though Romney says your pre-ex conditions will be covered, it may cost you two, three, even five times more than the list price for that policy.  Which means – really – Romney doesn’t guarantee pre-ex will be covered.

That’s just one provision that’s problematic for Mr Romney.  The reality is there’s a lot to like about Obamacare, as Romney has found – otherwise he wouldn’t be backpedaling on his earlier promise to kill the whole thing. Sure, most folks are only really interested in the one or two provisions that directly affect them – perhaps coverage of kids till they’re 26, or expanded coverage of Medicare drugs.  But he can’t – the practical reality is that unless he gets 60 senators to agree with him, he can’t overturn PPACA or significantly change any of its provisions.

So, the lack of any substantive discussion of health reform in the last debate was appropriate; it’s the law of the land and won’t/can’t be changed despite Romney’s occasional statements to the contrary.

 

 

 

 

 


8 thoughts on “What parts of Obamacare do you want to keep? eliminate?”

  1. If Governor Romney is a better private sector job creator than President Obama and I believe he is, this is one of the pieces of PPACA that he should strive to eliminate should he become President!

    Obamacare’s medical-device tax is estimated to destroy about 14,000 and perhaps up to 47,100 jobs. The 2.3 percent excise tax on medical devices is a savage blow to innovation. Note that this tax is on sales, not profits. It cuts into the top line, not the bottom line. If not repealed, this tax will start hitting medical-device makers on January 1, 2013.

    1. Brian – thanks for the comment.

      I’d suggest the claim that jobs will be destroyed is an absolutely worst-case scenario, the odds of this occurring are vanishingly small. In fact these device companies will have many more insureds who will have coverage to pay for necessary devices. In return for more volume, the companies agreed to the excise tax. This is similar to teh conduct of pharma, hospitals, and insurers, all of which will gain from PPACA.

  2. I can see a Number of Items that I personally would like to Modify:
    Such As Pre-ex- How about covering pre-ex but Doubling the co-pays and deductible the first year of Coverage. How about The carrier getting the Fine/Tax/Penalty for not having coverage.
    MLR Individual 75%
    Small-under 50 80%
    Large 50-250-85% NO MLR guidlines for Over250 lives. THey should know better
    Limited Underwriting, with a load of up to 50% for Individual coverage
    The new Schedule of Benefits is a waste of Money and a threat to forestry.
    Eliminate the confusion on Colonoscopys 1 every 10 years is preventative, Polyps etc. are a seperate billed item. It’s easy enough to do.

    THere’s a starting point..

  3. Joe, please clarify something you said.

    “Oh, and there are no price limits on what insurers can charge you, so even though Romney says your pre-ex conditions will be covered, it may cost you two, three, even five times more than the list price for that policy”

    I may be wrong so please correct me gently, but I don’t think that under PPACA there are any price controls. That’s the big complaint that I hear right now. Because PPACA expands what carriers must cover, those with health insurance are seeing their out-of-pocket costs go up substantially. This includes higher co-payments and deductibles. I’m also seeing more employers go to health savings plans (I may be using incorrect terminology), which really is increasing out-of-pocket costs.

    So the middle class, which both parties like to court so much, is really taking the financial hit under PPACA. Those who could not get or afford coverage are now able to get it subsidized by the goverment, and those who are wealthy don’t care so much about increased co-pays / deductibles. The middle class is the one facing the increased financial hardship because of PPACA.

    I’m not sure what the solution is, but being firmly entrenched in the middle class I’m concerned about what I am seeing right now.

    1. Mark – always a pleasure to hear from you.

      Under PPACA, insurers cannot charge different rates for those with pre-ex conditions, just as rates can’t be altered for age or sex.

      It is possible the people you are referring to are complaining about their current insurance plan, which, as it is not yet 1/1/14, is not subject to those controls/limits.

      While some provisions of PPACA have gone into effect, (e.g. 26 year coverage), the current price increases and benefit changes are not due to nor reflect PPACA.

  4. You are correct about the inability of a President to act on the law without Congressional action. However, Romney, if elected, could “gum up the works” – he could slow down the development of exchanges, he could alter various implementing regulations, he could hold up various funding mechanisms, he could use various items for bargaining chips in the broader ongoing issues of taxes, spending, etc.

  5. Joe- two other key provisions in this law.
    1) Uninsured patients (and there will still be an estimated 30 million + even after all the provisions take effect according ton the latest CBO estimate) will not be hit with very aggressive hospital charges as, under this law, non-profit hospitals can only charge the lowest rate they have agreed to be paid for comparable services by a health plan. Only law on the books that protects the uninsured and forces non-profit hospitals (who get tax relief benefits Grsslay’s sub-committee estimated may be worth as much as $20 billion) to give back to their communities.

    2) Funding and promoition of health cooperatives. Access Health (in Michigan) is a great example of this– has over 90% of the MDs and both hospitals in its community participating to offer affoirdable coverage for employees of small companies in the area. Costs under $1,000/year – 1/3 paid by individual, 1/3 by employer, 1/3 by hospuital using Dispro funds — and has been able to hold down annual cost inflation to around 2%/year for the past 10 years.

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Joe Paduda is the principal of Health Strategy Associates

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