Category: ACA Deathwatch

Mar
29

Another reason Single Payer is inevitable

Posted by Joe Paduda on Friday, March 29th, 2019 | Comments

Earlier this week President Trump called for the GOP to become “the Party of Great Healthcare.”

He wants three Senators to come up with a “terrific, beautiful” healthcare plan.

What Trump is actually doing is accelerating the day when Single Payer becomes reality.

In one tweet, here’s why:

Stick with me here. The President doesn’t know the difference between tax policy (deductibility) and healthcare benefit design (deductibles). Unless, of course, he was referring to the deductibility of health insurance premiums, which many think is “ridiculously high”. Except, of course, Trump wasn’t.

Many may say, “yeah, that’s just a typo”, or “doesn’t matter, we know what he meant”.

And those many are dead wrong.

Trump  – and his gang of three who are supposed to come up with a new Great Healthcare Plan – don’t know anything about the healthcare problem in this country, what’s driving it, how financing works, how people are affected, what the tradeoffs are, or anything else.

Healthcare is enormously complicated, accounts for 1 of every 6 dollars in our economy, employs 16 million Americans, and is deeply personal. The GOP has never come up with any plan that remotely addresses the problem with healthcare, namely prices are too high, many can’t afford insurance and quality is spotty at best.

Their go-to solution – the free market – is no solution at all.

In the “free market”, no insurer is ever going to insure your pre-existing condition, nor will it ever  cover your kids to 26, nor will it pay for all your care no matter how sick you are or how expensive it gets. 

About 5 minutes after Trump’s gang of three starts working on their Great Healthcare Plan their heads will explode. They have no idea what they are doing and a real solution requires them to abandon long-held fictions about healthcare and the economy.

Which is why Trump’s Great Healthcare Plan will make Single Payer reality.

To quote Winston Churchill;

You can always count on Americans to do the right thing – after they’ve tried everything else.

(here’s a very funny infographic on TrumpCare)

Mar
27

WTF are they doing??

Posted by Joe Paduda on Wednesday, March 27th, 2019 | Comments

Yesterday’s announcement that the Justice Department will move to kill the entire ACA – with NO replacement legislation – sent shock waves thru the healthcare world.

And will send many Americans straight over the edge.

If the Trump Administration is successful, 21 million of us will lose healthcare.

Up to 133 million Americans will lose coverage for pre-existing conditions for individuals and small employers.

Insurers will be able to charge older Americans whatever they want for insurance policies.

Seniors’ drug costs will increase dramatically – along with costs for wellness checks, copays, and premiums.

Hospitals will get hammered as they are forced to treat uninsured people with no chance of reimbursement.

Treatment for opioid abuse disorder will be cut by $874 million.

Insurers will be able to cap what they spend on your healthcare costs.

You may find your kids between 18 – 26 are no longer covered by your insurance.

What’s even more stunning is the Trump Administration is doing all this with no plan to fix healthcare.  No legislation, no regulations, nothing at all.

For the vast majority of Americans this is catastrophically stupid and for Republicans politically idiotic.

The Trump Administration is shoving Americans off a cliff, with no regard to what lies beneath.

What does this mean for you?

If Trump et al succeed, you’re going to pay a lot more for worse coverage  – if you can get it – that has caps on what your insurer will pay for and your kids over 21 are on their own.

 

 

 

Oct
24

This election is about your pre-existing medical condition

Posted by Joe Paduda on Wednesday, October 24th, 2018 | Comments

Will you be able to afford health insurance, and will that insurance cover your pre-existing medical conditions? For most, that’s the biggest issue in the upcoming election.

Congressional Republicans are planning to pass legislation that allows insurers to:

a) stop paying for your pre-ex conditions; and/or

b) charge you anything they want for your health insurance – which does the same thing

Ignore their claims that they will protect you, because:

What they do have is bait-and-switch.

Republican candidates are pushing legislation that would “force insurers to cover all pre-existing conditions” – but they could charge you anything they want for that insurance. 

If you just won the $1.4 billion lotto, you’re all set. If not, you’re screwed.

What does this mean for you?

If you or a family member have a pre-existing condition, this election is about you.

If you aren’t sure, here’s a list.

And if you think you can hide your condition, you can’t. 

Apr
25

Single payer is inevitable.

Posted by Joe Paduda on Wednesday, April 25th, 2018 | Comments

Some variation of “single payer” healthcare is going to happen, for one simple reason – the current “healthcare system” is going to blow up.

People are  broke, fed up, and angry – and support Medicare for All.

Health insurance is not useful for most of us: many can’t afford the deductibles, and premiums are just stupid expensive.

The people running Washington aren’t interested in or capable of fixing anything, they just want to blow stuff up.

While most think Medicare for all will happen, I lean more towards a standardized “Medicaid for all” option.  Medicaid:

  • allows for a lot of experimentation by states,
  • serves a much broader population,
  • is focused on the biggest problems in healthcare – the disabled, poor, disenfranchised, chronically ill, addicted, and
  • is a lot easier to understand than the alphabet soup of Medicare A, B, C, D etc.

Our last best chance of keeping the “healthcare system” we had was the ACA, a solution rooted in a Heritage Foundation plan that relied on private insurers. When the GOP gutted it, the writing was on the wall.

Here’s a quick summary of steps Republicans took that harmed ACA. (more here; a LOT more here)

  • Removed funding for risk corridors which kept co-ops and other plans alive
  • Didn’t expand Medicaid in 17 states
  • Hobbled ACA marketing efforts in multiple states
  • Sued the Obama Administration to block premium supports

I don’t know when this will happen, I just know that it will.

 

 

Mar
12

Why isn’t anyone talking about health insurance costs?

Posted by Joe Paduda on Monday, March 12th, 2018 | Comments

A couple years ago, we heard endless stories about how “Obamacare” premiums were shooting up, individual health insurance was unaffordable, and families were going bare because the morons that came up with the ACA screwed it up.

Now, with average premiums up 30 percent, we hear…crickets.

The reason premiums have gone up by about a third is simple; President Trump stopped the payments that subsidized low-income folks and insurers are scared he’ll stop enforcing the individual mandate. Unsurprisingly, many people dropped coverage, and insurers had to raise premiums because their risk pools worsened.  

Chart credit Charles Gaba, ACASignups.net

If CSR payments were still in place, and insurers assured the mandate would be enforced, premium increases would be less than half they are today.

What’s scary about this is how easily the media’s focus is influenced by outside efforts. Instead of informing us of this very real, and very important issue, the media is all wrapped up in arming teachers, death penalties for drug dealers, and Stormy Daniels.

What does this mean for you?

A reminder that all of us have to stay focused on the important stuff, not the shiny objects.

 

 

Dec
14

It’s not a tax bill, it’s a healthcare bill

Posted by Joe Paduda on Thursday, December 14th, 2017 | Comments

OK, a bit of hyperbole – but only a bit.

Here’s how the Trump Tax Bill will affect healthcare…

  1. Immediate $25 billion cut in Medicare spending followed by a total of $400 million over the next nine years
    This has to happen under “PAYGO” rules which require offsets in spending when revenues are cut (as will happen under the Trump Tax).  Medicare is NOT AN ENTITLEMENT, it is an EARNED benefit. Starting January 1, 2018, doctors, hospitals, and pharma are going to take the hit as Medicare will stop paying for some care delivered by doctors.
  2. 13 million (+/-) more people will lose health insurance
    If you can sign up AFTER you get sick, why would you pay premiums until you need insurance? The bill ends enforcement of the mandate, but insurers are still REQUIRED to take all comers. So, many younger and healthier people will not sign up, and when they don’t the “pool” of insured people will get older, less healthier, and therefore more expensive to insure.
  3. Individual health insurance premiums will go up about 10%
    So, Insurance companies will raise premiums by about 10% as healthcare costs for the older, less healthy population will go up.
  4. Drive insurers out of the individual and small group markets
    See above…
  5. Reduce drug development for “orphan” diseases
    Today pharma gets a major tax break for developing treatments for orphan diseases, such as cystic fibrosis, epilepsy, muscular dystrophy and Angelman syndrome. It appears that tax break goes away – and this will greatly reduce R&D. The tax credit has been cited as responsible for treatments for about 350 diseases; there are around 7000 in total.  Here’s one pretty amazing success story that will likely not be repeated due to the end of the tax credit.

With fewer people covered by insurance, and higher rates for those that are, we’re likely to see more insurers drop out of more markets.

The greatest impact will be seen several years down the road, when the overly-optimistic growth projections prove to be just that. Already, experts predict the Trump Tax Bill will add over a trillion dollars to our national debt. When that happens, there are going to be calls for massive cuts to ALL services – including Social Security, Medicare, and Medicaid.

What does this mean for you?

I’m thinking Medicaid for all by 2027.

 

Dec
4

Why the GOP tax bill increases health insurance premiums

Posted by Joe Paduda on Monday, December 4th, 2017 | Comments

I received several emails from readers challenging my statement Friday that the GOP tax bill will result in higher health insurance premiums.  Here’s how.

Briefly, the Bill lets you buy health insurance after you get sick – without a penalty. It’s as if this guy was signing up for auto insurance post-crash…

Both the House and Senate versions of the bills end the penalty for those who don’t have health insurance. This penalty does 2 things; it financially penalizes those who go without coverage, and it generates funds that help pay for healthcare for others.

What the tax bills DON’T do is change the requirement that insurance companies cover anyone who applies.

Imagine if you were able to buy auto insurance after you crashed. Why would you bother to sign up and pay those premiums if you didn’t have to?

BTW, there’s a ton of research and history that shows what a bad idea this is, how much damage it does to insurance markets, and what we can expect.

Folks, this is just ONE example of the dumb ideas in this bill, from people who claim to understand how the free market works.

What does this mean for you?

Insurance rates are going to go up. 

 

Dec
1

The tax bill’s impact on healthcare or; If you like your cancer care, you can’t keep it.

Posted by Joe Paduda on Friday, December 1st, 2017 | Comments

The GOP “tax reform” bill will directly and significantly affect healthcare. Here’s how.

It removes the individual mandate, but still requires insurers to cover anyone who applies for insurance. So, millions will drop coverage knowing they can sign up if they get sick.

How does that make any sense?

Here’s the high-level impact of the “tax bill that is really a healthcare bill”:

The net – healthcare providers are going to get hammered, and they’re going to look to insured patients to cover their costs.

The real net – The folks most hurt by this are those in deep-red areas where there is little choice in healthcare plans, lots of struggling rural hospitals, and no other safety net.  Alaskans, Nebraskans, Iowans, Wyoming residents are among those who are going to lose access to healthcare – and lose health care providers.

Here are the details.

According to the Commonwealth Fund, “repeal would save the federal government $338 billion between 2018 and 2027, resulting from lower federal costs for premium tax credits and Medicaid. By 2027, 13 million fewer people will have health insurance, either because they decide against buying coverage or can no longer afford it.”

Most of those who drop coverage will be healthier than average, forcing insurers in the individual market to raise prices to cover care for a sicker population. This is how “death spirals” start, an event we’ve seen dozens of times in state markets, and one that is inevitable without a mandate and subsidies.

For example, older Americans would see higher increases than younger folks. Here’s how much your premiums would increase if you are in the individual marketplace.

So, what’s the impact on you?

Those 13 million who drop insurance, which include older, poorer, sicker people, will need coverage – and they’ll get it from at most expensive and least effective place – your local ER. Which you will pay for in part due to cost-shifting.

ACA provided a huge increase in funding for emergency care services – folks who didn’t have coverage before were able to get insurance from Medicaid or private insurers, insurance that paid for their emergency care.

From The Hill:

[after ACA passage] there were 41 percent fewer uninsured drug overdoses, 25 percent fewer uninsured heart attacks, and over 32 percent fewer uninsured appendectomies in 2015 compared to 2013. The total percent reduction in inpatient uninsured hospitalizations across all conditions was 28 percent lower in 2015 than in 2013. Between 2013 and 2015, Arizona saw a 25 percent reduction in state uninsured hospitalizations, Nevada a 75 percent reduction, Tennessee a 17 percent drop, and West Virginia an 86 percent decline.

If the GOP “tax bill” passes, hospital and health system charges to insureds (yes, you work comp payer) are going to increase – and/or those hospitals and health systems will go bankrupt.

 

 

Oct
13

Trump’s ACA Orders – One’s big news, the other’s just political fluff

Posted by Joe Paduda on Friday, October 13th, 2017 | Comments

President Trump announced two major policy changes yesterday; one will do little to affect healthcare markets and insurance, the other will have a drastic and almost immediate impact.

Cost Sharing Reimbursement payments help those making less than 250% of the poverty level pay for deductibles and other costs.

Ending CSR payments will force health insurers to:

  • increase premiums by almost one-fifth to offset the loss of CSRs; this is already happening in many markets…many had already done this, but others are sure to do so immediately
  • and/or stop selling insurance immediately and cancel policies already in effect, ending coverage for poorer Americans.

Here’s the funny thing; ending CSRs will INCREASE costs to the taxpayers because people who no longer get the payments will get tax credits – and others will too..

The reaction from many in Congress was negative; CSRs had been funded in the Republicans’ bills to repeal the ACA, and several House and Senate Republicans expressed concern that the President’s move would harm their voters.

This may be an unwise political move as well;

Trump’s supporters (51%)…[and] eight in 10 Americans (78%) say President Trump and his administration should do what they can to make the current health care law work.

Trump’s other Executive order will have far less impact on insurance markets. In sum, the order allows insurance companies to sell policies across state lines and offer stripped down policies 

The first – selling across state lines:

  • is already allowed in 3 states, and no insurers participate because mandates do influence costs, but the underlying cost of insurance is the cost of care.
  • Contradicts Republican orthodoxy – and ACA repeal efforts – that keep states in control of insurance markets. The across-state-line sale of insurance guts state insurance regulatory authority.

As does the part of the order allowing sale of stripped down policies. These plans, known variously as association health plans, multiple employer welfare arrangements (MEWAs), and multiple employer plans (MEPs), have a pretty crappy history. Allowed years ago, many went belly-up leaving healthcare providers unpaid and members uncovered.

There’s a lot of detail to these, (see here) but the real issue is simple – policyholders often get screwed, and, like selling across state lines, MEWAs flout state regulation of insurance.

What does this mean for you?

These orders will further screw up the health insurance industry. The real effect will be to push us closer to single payer, a result unintended and with far more drastic consequences.

Sep
26

Susan Collins saves the GOP

Posted by Joe Paduda on Tuesday, September 26th, 2017 | Comments

With her announcement that she won’t vote for the Graham-Cassidy bill, Sen. Susan Collins (R ME) has ended GOP efforts to kill the ACA.

She also saved her party from the disaster that would befall it if the bill had become law.

here’s why.

  • millions of core Republicans would have lost health insurance coverage,
  • states that went for Trump in the presidential election would have lost billions in federal funds,
  • many of the people covered in the individual market in Trump states have pre-existing conditions; Cassidy-Graham would have allowed insurers to drastically limit their coverage
  • Key GOP states such as Arkansas and Kentucky would lose billions in Medicaid dollars over the long term

This doesn’t mean future efforts won’t seek to slash coverage for kids via cutbacks in the Child Health Insurance program (CHIP), limits on Medicaid, or thru budget machinations. But these will be much lower-impact, subtler moves that won’t be as potentially devastating to the Republican brand as Cassidy-Graham. CG would have shown core supporters the GOP’s “solution” to the healthcare mess was far worse than the current one.

So, what now?

Nothing much is going to happen with healthcare in Congress for some time.  That’s too bad, as ACA needs fixing – namely:

This would go a long way to giving certainty to insurers, certainty that would lower premiums and stabilize markets.

What does this mean?

While the result may be a failure to deliver on a core campaign promise, what’s really happened is the GOP didn’t do deeper and broader damage to itself.