Archive for the ‘Obamacare’ Tag

The Problem   Leave a comment

Less than half of the 24 million proponents of Obamacare who said they would sign up during the legislative process in 2010 actually did so in the last eight years.

Why?

Well, they ran up against the cost of socialized healthcare.
Premiums doubled in the first four years of Obamacare. Last year, the average monthly premium for individual insurance was $476 per person per month in the 39 states participating in HealthCare.gov.

Here is Alaska, premiums in the individual and small-group markets doubled in those first four years and have tripled in the three years since. Alaskans in the small-group markets pay an average premium in excess of $1000 a month.

It gets worse than that, however. As premiums have gone up, choices have gone down. In more than 80 percent of counties across the US, there are only one or two health care plans available on the Obamacare exchange. That means millions of Americans now have far fewer choices when it comes to their doctor and health care network.

For the 11 million who did sign up for Obamacare, over 86 percent of them were enrolled in Medicaid. That didn’t ensure they have access to medical care because increasing numbers of doctors and other medical providers are no longer accepting Medicaid because they are reimbursed at an unsustainable level for the amount of staff required to handle all the related paperwork.

Medicaid is notorious for long wait times and poor health outcomes. It is a costly and unsustainable welfare entitlement program that delivers low-quality medical care to many of its enrollees. Because most doctors don’t accept Medicaid, recipients have little choice but to seek non-urgent care in expensive and overcrowded hospital emergency rooms where they often receive inferior medical treatment. When they do need to seek urgent care, they are routinely assigned to less-skilled surgeons, receive poorer post-op instructions, and often suffer worse outcomes for identical procedures than similar patients both with and without medical insurance.

Medicaid has become too large to provide good services to people who genuinely need public assistance. Eligibility expansions have crowded out those who need care and can’t afford it because taxpayer funds are being spent on individuals who could afford private insurance coverage. This diverts resources from the genuinely needy populations of the program.

You could perhaps make an argument for this if states that have expanded Medicaid had experienced better health outcomes for their poorer populations, but there’s no evidence that has happened. While most of those enrolled in Medicaid are relatively healthy children and their mothers, a small subset of enrollees have serious diseases like diabetes, HIV, anemia, or psychosis. These Medicaid patients are typically in worse condition at the time of their diagnosis than either the insured or the uninsured. They also typically have worse average health outcomes after treatment than either of those two demographics.

Compared to the privately insured, Medicaid patients have a 22 percent great chance of complications and a 57 percent greater change of dying following colon cancer surgery. They are more likely to die in the hospital than the uninsured. That’s right – the uninsured. That statistic comes courtesy of the University of Virginia, by the way.

Medicaid patients typically spend longer in the hospital (10.5 days) than both the insured (7.4 days) and the uninsured (7 days). This is because they are more likely to experience complications and that might explain why Medicaid patients have a 21% higher cost for hospitalization than the uninsured and and a 26% higher cost for hospitalization than the privately insured.

These sad statistics are not limited to adults with cancer, but also show up in stroke recovery and in pediatrics. The vast majority of children in and out of Medicaid enrollment are healthy, but of course that’s not always the case. Researchers have found that a child with asthma is five times more likely to see an asthma specialist if she has private coverage rather than Medicaid. Children with Medicaid are 50% more likely to be seen by an emergency room doctor, in large part because of the dearth of private doctors who will accept Medicaid patients. Those same doctors will accept someone paying case, so uninsured patients actually have more access to medical treatment than those insured under the Medicaid system.

The worst part of all of this is that Obamacare’s shifting of lower-income coverage to Medicaid has resulted in a crowd-out of private insurance and patients it used to cover. Yes, some few uninsured who were not previously covered by Medicaid may now have insurance (with no assurance of actual medical treatment), but even for the previously-insured, getting into see a doctor is now much more difficult, resulting in higher prices and longer wait times. Obamacare’s paperwork requirements on doctors have reduced the amount of time they can spend with patients, increasing diagnosis and treatment errors.

And, none of it was necessary. There are better solutions.

Cousin Rick is a world-renown research doctor who works for a major medical center and    would like not to identify himself, as that would likely ruin his career under the current tyrannical environment of the medical community. He is a frequent guest on my blog whenever the current  medical insurance stupidity becomes so great that he feels it necessary to vent.

Confessions of an Uninsured Graduate | Marianne March   Leave a comment

A few days ago I donned my gown and my cap with its little gold tassel, and I graduated with highest honors from my college. Now that I am transitioning out of student life, I have many decisions to make. What will I do? Where will I work? What am I going to do without my generous Obamacare stipend?

Image result for image of the happily uninsuredImmediately following high school, I entered the working world as a retail manager. I enjoyed the hard work, the promotions, and the encouragement I received from my supervisors. I was making just enough money to live in a rented 2-bedroom townhouse with a roommate, and my full-time status qualified me for healthcare coverage through the company. At the same time, I longed for work that would be more meaningful for me. I was disinterestedly interviewing to be the manager of my own store when I decided to pursue my education.

My passion for politics steered me towards a degree in policy and economics. For over four years I diligently prepared for exams, listened to several hundred hours of lectures, and participated in group projects that made me wish I could strangle my classmates without repercussions. I also worked part-time jobs, volunteered, interned at three different organizations, and attended a semester abroad.

When I turned 27, I was no longer covered by Mom’s insurance plan. As a student with a low-wage part-time job and the occasional unpaid internship, my tiny income allowed me to qualify for bodacious healthcare stipends. As a wage-earner in the lowest tax bracket, over 90% of my Obamacare costs were covered by a so-called premium tax credit. In 2017, things will be more complicated.

Related imageAs a recent graduate, I imagine myself carving a path in the world with the same patience that the Colorado River took to erode the Grand Canyon: slow and tedious, but not when you think of the intensity of the rapids and the roar of water as the waves pummel through the canyons and stone is forced to make way for water. I am taking a chance and accepting a temporary apprenticeship which excites me and will give me an opportunity to test-drive a career of passion.

At least one person looked me in the eye and urged me to reconsider. After all, I’m 28, I live in my parent’s basement, and I had a post-graduation plan that included dental and a 401k, not a benefit-free six-month gig. I admit it, this choice is a gamble. What am I going to do about money and healthcare? I have six months before student loan collectors come a-knockin’. Sure, there are many jobs that will provide for a closet full of clothes, a pile of bricks, and a matching storage unit. However, this opportunity just might be the onramp to a life that I long for and that I didn’t think was possible.

Unfortunately, as a temporary employee, I am not eligible for benefits like a 401k or employer-generated healthcare. I will receive compensation for my work, but my modest income will render my healthcare stipend to nearly evaporate. I will be earning too much money to keep my government assistance, but earning too little to comfortably afford the monthly premiums. Of course, there is always a choice to make: I can go back to work that is completely unfulfilling but will allow me to pay for healthcare coverage, or I can try to earn less money so that I qualify for support.

I can even shove my fists in my eyes and out-ugly Kim Kardashian’s cry-face, or I can be grateful that my organization is taking a chance on me. I can be happy that, although my financial future is questionable, delayed gratification is the very hallmark of adulting. I can’t know the future, but I believe this is the best move I can make at present.

And so, when the enrollment deadline for HealthCare.gov rolled around, I had another choice to make. My decision is to go without health insurance.

For weeks, I have received emails, automated phone calls, and voicemails, sternly reminding me, “Don’t wait for your monthly health care costs to increase by 50 percent or more in January,” and, “Come back to HealthCare.gov and try to find a less expensive plan.” But the plans are already outrageous. So, last night, at the zero-hour for signing up for healthcare, I decided to go without.

It makes me nervous. I fear the penalty. It seems ridiculous that my choice to pay out of pocket for medical visits will be punished later, and at a rate of 2.5% of my income. I think we can all agree that a monetary penalty would be better spent compensating a doctor, nurse, or dentist for their skills. The incentives are completely out of whack.

Weaning off the government teat is painful, I don’t enjoy the sensation, but there are no satisfying alternatives. So pass the vitamins and kale chips, I can’t afford any illnesses for at least six more months.

Source: Confessions of an Uninsured Graduate | Marianne March

ObamaCare House of Cards   Leave a comment

The Congressional Budget Office scored the American Health Care Act and claimed the bill will reduce deficits by $119 billion over the next decade and result in 23 million fewer people being insured by 2026. So clearly, people would be better off if Obamacare were unchanged. This new report from the Department of Health and Human Services dispels that myth.

Reality Bites

The DHHS report shows that premiums in the individual market exchanges increased by 105% in the 39 states using Healthcare.gov from 2013 to 2017. This is equivalent to $244 per month ($2,928 per year) in additional premium payments for people buying insurance through the exchanges. People not eligible for exchange subsidies are fully exposed to these increases, while taxpayers will bear the brunt of subsidies for eligible enrollees.

Despite the promises that Obamacare would “cut the cost of a typical family’s premium by up to $2,500 a year,” average premiums on the exchanges more than doubled over this period. In some states, such as Alabama and Alaska, the average premium more than tripled. Welcome to my world.

B-b-but, Alaska is a small-population state with a huge land mass and people who have to travel long distances to medical care. Surely ….

No, the high average increase is not driven by a few outliers. Twenty-three out of the 39 states included in the analysis experienced premium increases in excess of 105%. Only three states, North Dakota, New Hampshire, and New Jersey, had cumulative premium increases below 50%.

 

As the report acknowledges, the composition of the population enrolling in plans through the exchanges has changed over time due to the adverse selection problems created by the law’s subsidy and regulation frameworks.

Example?

The community rating age bands, which dictate how much more companies can charge older, higher-risk enrollees, were set at 3:1 under Obamacare. A recent study by Milliman estimated that relaxing these age bands to 5:1 would reduce premiums for people aged 20-29 by 15% while increasing premiums for older enrollees.

Lower premiums for younger, healthier people would encourage more of them to enroll through the exchanges instead of foregoing health insurance because it is too expensive for them. Older, less healthy people make up a larger share of the exchange population now than in earlier years, which exacerbates the premium increases on that population.

Due to data limitations, the report does not deal with the population getting plans on the individual market but not through the exchanges. These people accounted for more than a third of the total individual market. They are not eligible for the law’s subsidies, so there is likely less adverse selection for the off-exchange population, but these enrollees have to bear the entirety of the costs of those increases.

Families choosing a plan through the exchanges have seen their premiums more than double since 2013. Alabama and Alaska, which have seen the two highest cumulative premium increases, are both down to only one insurer. In the entire country, only Virginia saw the number of participating insurers increase from 2016 to 2017. Just today, Blue Cross Blue Shield of Kansas City announced it would be exiting the exchange, leaving 25 counties in Missouri without a participating insurer for now.

The trend is absolutely unsustainable.

The lack of choices and competition in a growing number of places makes it unlikely that there will be an end to rapid premium growth without reform. While the CBO estimates will provide some insight into the effects of the bill in its current form, a working group of Senators is crafting a revised bill with major alterations.

Getting the design of replacement legislation right is important, and the CBO score will give the working group more information about which aspects of the bill that passed the House need the most adjustment. Provisions that allow for more competition and choice for people trying to get insurance through the individual market should help bring down annual premium increases.

Obamacare Failure   1 comment

I found this article on The Federalist and I liked what the gal had to say so much that I decided to post it here. M. G. Oprea is a writer based in Austin, Texas. She holds a PhD in French linguistics from the University of Texas at Austin. You can follow her on Twitter here.

Image result for image of obamacare failureIt’s that time of year. No, not New Years. It’s Obamacare enrollment time—that is, if you’re unfortunate enough to not have employer-sponsored health insurance.

There’s been a lot of media coverage lately about rising premiums. But the headache isn’t just financial, although that’s certainly part of it. With more insurance providers fleeing the individual market and coverage becoming worse and worse, getting the care you need can feel almost impossible.

To illustrate, I’d like to share my own experience buying insurance on the Obamacare exchange and trying to get treated for a chronic health problem.

My Health Insurance Couldn’t Be More Frustrating

For several months now I’ve been having nearly constant migraines or headaches and frequent vertigo. More than an inconvenience, this type of illness makes it hard to use a computer—where I do all of my work.

After five months with an excellent ear-nose-and-throat (ENT) doctor, as well as multiple rounds of steroids and antibiotics (not to mention ripping out half of my house doing mold remediation), we’ve come to the conclusion that I need sinus surgery.

Until September, my doctor (let’s call him Dr. A) was covered under my health insurance provided through the University of Texas. However, when I left the university and started working for myself, I had to begin buying health insurance on the individual market. The insurance options were limited so I bought a plan with Scott and White. This insurance, however, didn’t cover Dr. A. In fact, it only covered three ENTs in Austin.

One of these three doctors—let’s call him Dr. B—was well reviewed and liked by Dr. A. Great, problem solved. I get surgery with Dr. B and I’ll be in good hands. When I called Dr. B’s office to make an appointment last week and told them I have Scott and White, they said that they do indeed take that insurance. Wonderful.

Even Insurance Providers Have Had Enough

But there’s a catch. My health insurance covers office visits with Dr. B, but doesn’t cover surgeries with him. Wait, what?

That’s right, Scott and White only covers surgeries that are done in their hospital system, rather than in the far less expensive—and less dangerous— outpatient surgical centers. Dr. B, although a highly regarded ENT, doesn’t have admitting privileges in their hospitals.

Alas, this doesn’t matter. My insurance is being cancelled at the end of the year because Scott and White is withdrawing from the individual market in Texas. And they’re not the only ones. It turns out that several big insurance providers are leaving the individual market at the end of 2016, including Cigna and Aetna, the third largest provider in the country. This is happening all over the country.

The only plans that are available for purchase in Texas for next year are HMOs or EPOs with highly restrictive networks. Half of those are Blue Cross Blue Shield Blue Advantage HMO plans. The other half is some provider called Ambetter (an Orwellian name if there ever were one). 

And the Headaches Aren’t Over Yet

Thankfully, according to ehealthinsurance.com, Dr. B is covered by the BCBS plans. So, I called his office again and made sure there’s nothing tricky with BCBS like there was for Scott and White. The receptionist informed me that while Dr. B does take BCBS, he doesn’t take BCBS Blue Advantage HMO plans.

Unfortunately, that’s the only BCBS plan available for purchase. BCBS of Texas stopped offering individual PPO plans at the beginning of 2016. They reportedly made this decision after individual market claims exceeded premiums by $400 million in 2014.

So I’m back to square one, with no ability to buy insurance that will allow me to go to either of these doctors or to buy a PPO, no matter how much money I have.

What’s even more frustrating is that, even if Dr. B did accept an HMO plan, I would first have to go to a primary care physician to get a referral to see a specialist. Never mind that I have five months of medical records with a specialist and a CT-scan showing that I need surgery. What’s more, getting a referral approved by an insurance company requires a herculean effort.

What’s the Solution For People Like Me?

To illustrate, a good friend of mine has had a shoulder injury for years that recently got way worse. As a self-employed lawyer, he has an HMO bought on the individual market. It took over a month to get approved to see an orthopedist, meanwhile he’s in moderate to severe pain and wearing a sling. Even his doctor admitted that getting in to see a specialist was a long shot.

But let’s say I were able to get that sought-after referral, I’d still have a deductible upwards of $7,000, unless I wanted to pay $500 a month for insurance. In that case, the out of pocket max is still fairly high.

So what’s my solution? I’m going to get surgery at the Surgical Center of Oklahoma, and pay for subsequent ENT check ups with Dr. A out-of-pocket. 

The Surgical Center of Oklahoma is operated by doctors and anesthesiologists that work out prices directly with the patient. They charge a flat fee with no hidden costs. My surgery will cost $3500 plus the trip to Oklahoma City (thankfully just a six hour drive for me). This is potentially thousands of dollars less expensive than going through an insurance plan bought on the individual market.

This Is Healthcare In a Post-Obamacare World

This wouldn’t be the first time I’ve negotiated a price directly with a healthcare provider since getting my Obamacare-compliant individual insurance. I worked out a price I could afford with Dr. A and did direct pay to get a CT-scan of my sinuses in October.

Rather than go through insurance, which wouldn’t pay for the CT-scan anyway (at least not until I reached my $6,000 deductible), I called around and found the cheapest imaging center. You see, they don’t want to deal with insurance companies either, so they offer an enormous discount if you pay at the time of service. I was able to get a CT-scan for $247. 

At the end of the day, I’m paying hundreds of dollars a month for an insurance plan that doesn’t cover the doctors I need to see and has such a high deductible that I end up paying for most costs out of pocket anyway. And it doesn’t even allow the use of a Health Savings Account.

Maybe there’s something I missed. Maybe there’s some fantastic plan out there, one that neither me nor my husband (who worked for years in healthcare policy) nor my lawyer friend could figure out. But I doubt it. This is just the reality of getting health care in the post-Obamacare world.

Secretary Tom Price   Leave a comment

I am not a Trump supporter, but he’s done some really good things as president, namely putting reformers into some key cabinet positions … though he is screwing up with his replacement for Labor Secretary.

Tom Price, a Georga orthopedic surgeon and Congressman, actually managed to survive the confirmation process to become Health and Human Services secretary. It signals that President Trump is serious about undertaking major efforts to repeal and replace Obamacare, along with other entitlement reforms. But we also need to look at Price’s Empowering Patients First Act to see whether Price really understands what are we doing. While I’m at it, I want to look at the other Republican offerings for repealing/replacing Obamacare.

We don’t have cable TV, so lately I’ve been listening to a variety of cable news programs while I work out at the gym. The other day was CNN day. After three different pundits said the “Republicans have no serious replacement for the ACA” I decided it was time to get serious about looking at the proposed alternatives. I’m running my analysis by my cousin who is a world-class research doctor who has opposed Obamacare since it was Hillarycare. Because opposing Obamacare is career-risky for doctors who aren’t private practitioners, he’s allowing me to make his observations under my blog, which protects his career a bit.

Price’s nomination also illustrates why those efforts face a difficult road to passage and enactment.

As news of the Price appointment leaked out late on Monday evening, reporters spent much of their time breathlessly analyzing Dr. Price’s health-care legislation—H.R. 2300, the Empowering Patients First Act—for clues as to what it might mean for the replace effort. However, Price’s bill may be more noteworthy for what it does not include than what it does:

  • There is no premium support plan for Medicare reform;
  • It doesn’t reform Medicaid—whether by block grants or per capita caps; and
  • It doesn’t offer any spending reductions to fund the refundable portion of tax credits Price proposes as an alternative to Obamacare’s insurance subsidies.

In other words, despite releasing a 243-page health-care bill, Price, along with his Republican colleagues in Congress, hasn’t translated into legislative specifics his policy positions on many, if not most, of the important health-care issues the Republican Congress will face next year. For instance:

  • How should a premium support system under Medicare be structured? Should payments to seniors be based upon the average plan bid, the lowest plan bid, or another formula? How quickly should those payments rise in future years?
  • How quickly should Medicaid block grants, or per capita caps, rise in future years?
  • Should an Obamacare repeal-and-replace plan rely on pre-Obamacare levels of taxes and spending, or should it redirect existing Obamacare spending in a different direction?

Price’s legislation does not shed much light on these and other critically important questions that Congress will need to undertake next year.

Budget Gimmicks and Magic Asterisks

As chairman of the House Budget Committee, Price earlier this year released a budget blueprint that did include some ideas for entitlement reform. However, that document included only about four pages of proposals on Medicare, Medicaid, and Obamacare—some of which focused more on making the case against Obamacare than outlining the specifics of a Republican alternative. Even though the Republican budget document said it repeals Obamacare, that’s not exactly true. The budget, like those issued by House Speaker Paul Ryan when he was Budget Committee chairman, assumes Obamacare’s higher levels of taxes and lower levels of Medicare spending to achieve balance within the decade. Either the budget doesn’t repeal all of Obamacare, or it assumes that Congress, after repealing Obamacare, would go back and re-enact equivalent levels of tax increases and Medicare spending reductions.

 Price’s Empowering Patients First Act, which proposes a new refundable tax credit, includes only one idea to pay for that credit—a cap on the tax deductibility of employer-sponsored health coverage. Although administered through the tax code, refundable credits are considered government spending. Washington basically writes “refund” checks to individuals and families with no income tax liability.

Basically, the chairman of the House Budget Committee proposed raising taxes (the cap on deducting employer-sponsored health coverage) to pay for new spending (the refundable portion of the tax credit/insurance subsidy).

I don’t think Price is an evil guy who is pretending to reform federal health insurance policy. He’s trying to avoid many of the political minefields omnipresent in health policy. That deliberate soft-shoe allowed his Senate confirmation to go through.

 

Price will now have enormous power over the regulatory process, but we have to recognize that Congress has a truly heavy lift to repeal Obamacare in reality. Yes, it is vitally important to get rid of Obamacare — not just economically, because of the future deficits or taxes it will require, but also for liberty, because this represents the chains of economic slavery that will limit our individual choices going forward.

 

Posted March 2, 2017 by aurorawatcherak in economics

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US Beats UK in Lives Saved by Health Care | Ryan Bourne   Leave a comment

We don’t have CNN, so I’m going to have to go find this on You-Tube, but my cousin Rick, a research doctor who has opposed Obamacare since it was Hillarycare in the 1990s, gave me the heads up about it and I knew that Ryan Bourne, a British ex-pat who (I believe) recently became an American citizen, would have something intelligent to say about it.

 

Ryan Bourne Found on Fee

 

Last night’s CNN duel between Senators Bernie Sanders and Ted Cruz on the future of Obamacare was pretty illuminating for a recent arrival to the United States, with Senator Sanders’ playbook all-too-familiar to those of us from the UK.

Image result for image of uk hospitalsSanders wants a single-payer socialized healthcare system in the United States, just as we have in Britain. Any objection to that is met with the claim that you are “leaving people to die.” The only alternatives on offer, you would think, are the U.S. system as it exists now, or the UK system.

Sanders did not once acknowledge that the UK structure, which is free at the point of use, inevitably means rationed care, with a lack of pre-screening. He also failed to acknowledge that lower health spending levels (indeed, even public spending on health is lower in the UK than the United States now) are not the same as efficiency—which is about outputs per input.

U.S. survival rates are better than the UK’s for breast cancer, leukemia, and lung cancer.

In the face of anecdote after anecdote about those saved by Obamacare and the virtues of a government-run health system, Cruz countered with some anecdotes from the UK showing the consequences of rationed care: a Scottish hospital turning away pregnant women, a woman in Wales waiting eight hours on the floor for an ambulance to arrive after a fall, and a hospital in Essex canceling life-saving cancer treatment because there were no free beds in intensive care.

He could also have talked about the Mid-Staffs scandal, or a recent documentary showing doctors deciding between saving a cancer patient or a pensioner bleeding to death.

Anecdotes are powerful in helping to persuade people, and there are good reasons to use them in debates. Yet they are always susceptible to the charge that all health systems have extreme failures. Perhaps more powerfully then, the inadequacies of the UK system show up systematically in the data about how well conditions are dealt with (data from my former colleague Kristian Niemietz’s reports here and here):

  • In the United States, the age-adjusted breast cancer 5-year survival rate is 88.9 percent, compared with just 81.1 percent in the UK
  • The United States leads the world on the equivalent stat for prostate cancer (97.2 per cent) vs. 83.2 percent in the UK
  • Lung cancer: 18.7 percent in the United States vs. 9.6 percent in the UK; bowel cancer: 64.2 percent vs. 56.1 percent
  • Just in case you think I am cherry picking: U.S. survival rates are also better for leukemia, ovarian cancer, stomach cancer, and liver cancer—all of those for which I can find comparisons
  • The age- and sex-standardized 30-day mortality rate for ischaemic stroke is just 3.6 per cent in the United States vs. 9.2 per cent in the UK; for haemorrhagic stroke, the figures are 22 percent vs. 26.5 percent

I could go on. All of which is to show that your probability of dying from a range of common conditions is much higher in the UK than here. Perhaps that’s why (with no hint of irony) The Guardian’s write-up of a Commonwealth Fund Report suggesting the UK’s health system was “the best in the world” said “the only serious black mark against the NHS was its poor record on keeping people alive.”

Source: US Beats UK in Lives Saved by Health Care | Ryan Bourne

The Media’s Fake News about Obamacare | Alyene Senger   Leave a comment

Leave it to the media, which spent the latter half of 2016 highlighting how outrageously expensive Obamacare premiums were becoming, to suddenly shift gears in 2017 and stress the health law’s many “pluses.”

Such was the case in a recent interview with Heritage President Jim DeMint, in which CNN anchor Carol Costello suggested that lawmakers would need to preserve the so-called benefits of Obamacare if they repealed it.

In Costello’s words:

For example, this is according to the nonpartisan Congressional Budget Office and the Federal Reserve in Dallas. Preventative care provided by Obamacare … saves money and health care costs overall. In 2015, the cost of health care services increased 0.5 percent. The typical price increase before Obamacare, it was around 3 to 4 percent. Obamacare will lower the deficit by $143 billion over the next 10 years. So, there are pluses to Obamacare. So, how do you keep the pluses and get rid of the minuses?

DeMint shot back that those “facts” could fall “under the category of fake news.” This set Costello off to correct him that the numbers had come from the Congressional Budget Office.

Well, here’s what the Congressional Budget Office actually said about the cost of preventative care in 2009:

“Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.”

For Americans paying premiums, this year’s price increases speak for themselves. According to the Obama administration, on the exchanges, the average increase this year in the benchmark plan premium is 25 percent across the 39 states that use the HealthCare.gov platform. Certainly this cannot be considered a “plus,” even by the law’s most zealous supporters.

It is true that the Congressional Budget Office did originally say that the law would reduce the deficit, but that analysis was always based on questionable assumptions and the double-counting of Medicare savings.

Indeed, in 2014, the Senate Budget Committee went back and used the Congressional Budget Office’s same scoring conventions and found that Obamacare would increase the deficit by $131 billion over the next decade.

Americans now have fewer insurer options, higher insurance deductibles, and higher premiums than prior to Obamacare.

Although the details of this year’s repeal bill are not yet known, the Congressional Budget Office’s latest score of an Obamacare repeal—based on the reconciliation bill passed by the last Congress, which repealed the law’s major spending provisions and tax increases—was projected to reduce federal deficits by roughly $516 billion over the 2016-2025 period, accounting for the economic benefits that would result.

But on CNN, Costello wasn’t finished. “So, all those 20 million people enrolled in Obamacare, they’re all going broke and it’s not working for any of them?” she asked. Actually, 20 million is a debatable enrollment figure, given that it is based on survey data that can be off by millions of people.

Using actual insurer enrollment data, which is only available through the end of 2015, there was an increase in coverage of only 14 million Americans from 2013 to 2015, with the vast majority (11.7 million) being pushed into Medicaid coverage.

Moreover, the actual net increase in private coverage during this period was only 2.3 million due to a decline in employment-based coverage, which offset the increase in the individual health insurance market.

Furthermore, Costello forgot about all of the people (over 10 million) who purchase coverage in the individual market and receive no Obamacare subsidy. These people have been getting hammered by premium increases caused by Obamacare every year and have to pay the full cost on their own.

Costello asked, “How do you take care of people much better than they’re taken care of now?”

Considering that many Americans are now facing fewer insurer options, higher insurance deductibles, and higher premiums than prior to Obamacare, the need for real cost relief is immense.

The first step in providing relief is to quickly repeal the law and then do the legislative work that will allow for patient-centered reforms.

Source: The Media’s Fake News about Obamacare | Alyene Senger

A Truth about Obamacare Repeal   Leave a comment

The other night while I was unthawing my toes (Alaska, yo?), we watched an analysis on PBS News that basically made the very one-sided case that replacing Obamacare would lead to dogs mating with cats because almost all the people who enrolled in Medicaid due to the law would lose their health insurance.

Is that true? I had to go look it up. The worry is understandable, but it turns out to be mostly unjustified. Yeah, some people would lose their insurance coverage under Medicaid. Most would not, according to Jonathan Gruber, one of the architects to Obamacare.

Premium Subsidies, the Mandate, and Medicaid Expansion,” NBER Working Paper No. 22213,” is an April 2016 NBER study Gruber coauthored with Harvard’s Molly Frean and Benjamin D. Sommers. In it the authors showed Medicaid accounted for 60% of the increase in coverage due to Obamacare. Yeah, so much for that whole “paying your own way” message. These people are now on the welfare rolls and we’re all paying for their health care.

However, the authors also showed that 2/3 of that 60% were people already eligible for Medicaid before Obamacare began. These are people who won’t lose their coverage if Obamacare is repealed in its entirety.

Image result for image of the failure of medicaid expansionWhy was the number of people who were previously eligible but uncovered so high? If they were eligible, why weren’t they already receiving Medicaid? The authors don’t claim to know, but there are a few possible explanations.

It’s possible, maybe even probable, that these people didn’t know they were eligible for Medicaid until they were forced to sign up for Obamacare and then discovered they were eligible. For example, because it covers people up to 400% over the poverty level, families of four making $53,000 are eligible for Medicaid. I’m eligible for Medicaid, actually, and if I didn’t have employer-supported health insurance, an Obamacare Exchange worker would assign me to Medicaid … whether I like it or not.

Conversely, these eligible-but-previously-unenrolled-folks may have known they were eligible, but they didn’t bother with signing up for personal reasons that are as varied as the individuals under consideration. Among these reasons is the mandate effect. They knew they were eligible, but they didn’t want to enroll and only did so when it was required.

Believe it or not, there are still a lot of people who regard Medicaid as welfare and don’t want anything to do with welfare. To these Obamacare recipients, the program’s end will be a blessing. It will end the humiliation of being welfare recipients.

Most people newly covered by Medicaid expansion would remain eligible, but would now be free to choose whether to be covered or not. I know this shocks people who are convinced health insurance is something everyone needs, but there are many people who do not want it and would choose not to be covered simply because they don’t want to be.

Not having insurance does not mean you don’t have access to medical care. Before Obamacare, I knew lots of people who covered that deficiency with a catastrophic insurance plan and a savings account. Now, they’re broke paying premiums for health insurance they didn’t need or want and that they can’t afford to use because the premiums have eaten their savings. They actually have reduced medical care, even now that they have insurance.

By the way, Medicaid is HORRIBLE medical coverage. If you like waiting lists, limited medications, and having your personal life scrutinized by social workers … it’s a lovely system, but if you want actually medical care … not so much.

How do I know this? For 15 years, I was an administrator for a non-profit social work agency that was a Medicaid-recipient agency. I speak of what I know. No one who actually cares about their health should want to be in that system.

Posted December 17, 2016 by aurorawatcherak in Common sense

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Catalyzing a Change Election   1 comment

Why did the voters choose Donald Trump over Hillary Clinton?

There are myriad of reasons. You can’t put your finger on just one catalyst. Yeah, Wikileaks played a part … not the least of which were Hillary’s own words as found in John Podesta’s emails.

And, certainly, Donald Trump is an amazing entertainer who really knows how to play a crowd. Like hucksters in generations past, he gave his audience what they wanted and it paid off for him.

Image result for image of the failure of obamacareBut ultimately, when people walk into that voting booth, they cast a ballot for their own interests. So why did Trump win rather than Hillary?

People are profoundly unhappy with the direction of the country. Polls have shown that for 10 years. Barack Obama managed to use that to his advantage in 2008. He offered “change” and people voted for embrace it. Eight years down the road, people remain deeply unhappy with President Obama’s signature domestic policy achievement – the Affordable Care Act (ACA) — unaffectionately known as Obamacare.

You kind of have to be blind … or living under a rock … to not know that the ACA is falling apart. Oh, wait … Hillary Clinton committed to preserve and expand it! Wow! No, wonder Trump won.

Did Hillary think the voters were stupid? That was a miscalculation. Voters remembered the hollow promises that medical costs and insurance premiums would fall, if you liked your insurance you could keep it, and you could keep your doctor. Over the past two years, weekly surveys by Rasmussen Reports have showed that two-thirds of the adult population think the country is heading in the wrong direction. At one time that percentage was as high as 72 percent, but it never dipped below 62 and was as high as 72. Few things were as unpopular as Obamacare. — public disapproval from the moment it was suggested has always been more than 50%.

President Obama’s baby was pushed through by unconstitutional legislative maneuvers without a single Republican vote. Our memories are longer than the political cycle. As the election neared, insurers pulled out of healthcare markets all over the country while out-of-pocket costs (deductibles and co-insurance) skyrocketed, and insurance premium prices mushroomed. Premiums for enrollment starting November 1 of this year, just days before the election, increased 25% on average, which North Carolina saw increases of 40%, Pennsylvania increases of 53%, Minnesota increases of 59%, and Arizona increases of 116%. Yes, that is ONE HUNDRED and SIXTEEN PERCENT.

Despite all this evidence showing that it is a failure about to eat the middle class’s lunch, Hillary Clinton remained a steadfast Obamacare supporter, promising to expand it by adding a “public option.” The only way to get rid of it was to defeat Clinton and other Democrats.

House Republicans have been working on this issue almost since it passed and have already advanced a well-thought-out plan that could never make it past President Obama or Madam Clinton.There is no question that this election was a repudiation of President Obama’s policies, but more it was a correction of the electoral error made in 2008. Despite almost unanimous media forecasts that Democrats would regain control of the Senate and possibly the House, Republicans retained control of both chambers comfortably. Why?

Yes, Hillary Clinton was an awful candidate who deep flaws, but it’s unlikely any Democrat who refused to see the deepening problems with Obamacare could have won this election.

Donald Trump hasn’t given a lot of specifics about how he would “repeal and replace” Obamacare, but he has been really clear that, within his first hundred days in office, he plans to do that, with the help of Congressional Republicans and those Democrats who want to be on the right side of history.

Image result for image tea party obamacareHouse Republicans have already advanced a comprehensive plan that promotes consumer-directed health care to increase choice and flexibility, decrease costs, protect vulnerable Americans, increase innovation, and preserve Medicare and Medicaid without expanding federal control and regulation. All President Trump needs to do is sign it into law and he becomes the man who saved medical care in the United States by agreeing with the American people … who, by the way, knew all along that Obamacare was doomed to failure.

Remember the Teaparty?

Yeah, they were right! The backward idiots who opposed progress saw the handwriting on the wall.

The new system punched every middle-class person in this country right where it hurt the most. There were ever fewer choices as ever more insurers went belly up. If you managed to hold onto your coverage, you had no way of knowing whether your doctor or hospital would accept your provider because the ACA didn’t mandate that they do so. You had no way of forcing the insurer to actually cover what it said it would cover on paper. Demands for documentation as insurers sought to pay for as little as possible.Millions of people suddenly lived in a state of extreme anxiety where they had no way of knowing if the next doctor’s visit would cost them $40 or thousands.

All polls showed this to be an incredibly bad system. And yet, Hillary dismissed all concerns and proudly reminded the world that it was her idea first. We used to call it Hillarycare in the 1990s. We rejected it then too.

In the swing states that determined the outcome of this election, Obamacare was the thing that turned passive voters into active voters, Democrats into Republicans, and independents into Trump voters.

For example, Wisconsin is mostly a blue state and so it shocked everyone when it voted for Trump. The exit polls show Obamacare was the drive concensus among all the issues. Only 17% said it was fine as is. Fully 45% of those surveyed after the vote said that it had gone too far. Among that 45%, 81% voted for Trump. That alone was enough to turn Wisconsin from blue to red and provide a turning point in the electoral count.

 

It’s become so bad that Bill Clinton remarked negatively on Obamacare only a monght before the vote.

“So you’ve got this crazy system where all of a sudden 25 million more people have healthcare and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world.”

Apparently, someone forgot to tell him that his wife was saying Obamacare was just lovely. The next day, he walked back his comments and they were immediately buried.

Obamacare was Obama’s biggest domestic initiative. It had all the smart, elite people behind it and it flopped, destroying people’s confidence in something that is at the core of their lives. We all need to go to the doctor sometime.

So for those poeple who want to insist this is a “win” for racism, xenophobia, sexism or whatever …. No. Just take a pause and consider that the outcome of this election is a verdict on a failed system of medical insurance mascarading as health care delivery and the thought process that created it. That loss of confidence in a signature program of both the outgoing president and the Democratic candidate whose brainchild it really was reflected negatively on everything she said. If she couldn’t be truthful about the overwhelming evidence that her program wasn’t working, then she couldn’t sympathize at all with the problems people who actually have to budget to pay bills. How then could they trust her with the presidency? Nothing spoke of the disconnect the elite ruling class has with the middle class than the refusal to see the failure of Obamacare. This played right into Trum[‘s message that the elites don’t care about the people.

 

Of course, hating a bad system and punishing its champion and the party that supported her is a lot easier than fixing the problem. The pre-existing conditions aspect of the ACA is the most popular part of the program, but it is also what is driving up the costs of the program. This is why Trump already appears to be softening on some of his repeal and replace rhetoric. The future may see an endless stream of confusing proposals, complexities and regulatory tweaks rather than a clean fix.

Meanwhile, we have unfettered access to food, clothing, transportation, home repairs, auto insurance and communications and these services have improved and expanded magnificiently in the last decade. So why is our healthcare degrading? Is there something structurally different about medicare services that requires government to control their delivery?

According to my cousin, a world-class research doctor in neurology and immunology, the answer to this is “No!” Medical service is like any other service, except that it has been wrapped tightly in redtape and constrained by regulation to the point where the provider and the customer cannot interact directly with one another without essentially going through a middleman. It was bad enough when that middleman was the insurance companies, but if you make the government the manager of the system, you inject politics into the process.

The only way to fix the problem is to reduce government control of medical services and allow the market to work as it does so well in so many other areas.

 

Posted November 15, 2016 by aurorawatcherak in politics

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ColoradoCare Isn’t What it Seems   Leave a comment

Pierre-Guy Veer

Found on Fee

Image result for image of health care waiting listEvery few election cycles a proposition to have universal healthcare pops out. This year, Colorado voters will have to vote on Amendment 69, which would replace the present Affordable Care Act (aka Obamacare) provisions with a single public option; a kind of Medicare for all for the state.

At first, the proposition looks enticing. The present healthcare system is riddled with inefficiencies and high costs. Indeed, the U.S. spends 17.4 percent of its total GDP on healthcare; Canada is only at 10.2 percent despite universal healthcare. According tosupporters of the proposition, Coloradans would save $4.5 billion just during the first year thanks to lower bureaucratic costs, higher purchasing power thanks to bulk negotiations and less fraud. These claims are defended by the Canadian Union of Public Employees, even adding that fewer people die in a public healthcare system.

More Spending on Health, Less on Everything Else

However, by looking closely at the data one can doubt that Amendment 69 will save money in the long run. Healthcare expenditures are approaching 50 percent of the Quebec federal budget.Present trends inMedicaid – the universal healthcare program for low-income people – show that the program is taking a larger share of the states’ budgets. It therefore crowds out spending from other domains like transportation or even corrections.

Image result for image of health care waiting listSuch a crowding out is happening with universal healthcare. In the Canadian province of Quebec, nominal spending on the public healthcare system (through the Ministère de la Santé et des Service Sociaux) has increased 13.2 percent during the past 5 budgets, 46.6 percent during the past 10 years and 263 percent since the 1997-1998 budget.Excluding debt service, health care expenditures have gone from 37 percent of the budget 20 years ago to 49.6 percent of the budget. In other words, the Quebec government is becoming a huge ministry of health.

And since these healthcare expenditures are financed through general taxation – there is no dedicated tax unlike Medicare in the U.S. – the “free” care people received costs them about $12,000 a year for a family of three in Canada according to the Fraser Institute. The institute estimates that the real cost has increased nearly 48.5 percent for all households in 2015 in the past 10 years.

In Colorado, Amendment 69 proposes a $25-billion tax hike to pay for this program, which will be financed by a 10-percent payroll tax. Such a perspective discouraged Vermont to enact a similar measure just two years ago. Then-governor Peter Shumlin thought that “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

“Patients” Deserve their Names

The disruption of universal healthcare is just not economic; it’s also social.

In Quebec, despite spending all that money on health care – $33 billion for a province about as populous as New York City – waiting lists are growing. If one’s health is in immediate danger one will see a doctor as soon as one is available, but otherwise more populous regions will tend to have overcrowded emergency rooms – the only ones with physicians available on weekends. At the time of this writing, (October 21, 2016), Hôpital de l’Enfant-Jésus ER in Quebec City had an occupancy rate on the gurneys of 108 percent, with 4 patients waiting for at least 48 hours to get their own room. In Montreal, Hôpital général Juif is 200 percent full with 12 patients waiting for at least 48 hours.In order to cut on costs governments limit the number of patients doctors can see during a week.

Even for “medically necessary” procedures waiting lists test the patience of the people. The aforementioned Fraser Institute study found that, in 2014, the average waiting time for such procedures was 18.1 weeks compared to 9.3 weeks 20 years before. Those who can’t wait and can afford it will therefore travel abroad to seek the care they need. Or they will move and invite people to do the same, as Julie Lesage famously did to get the care her daughter might have never received – a doctor told her she would have a better shot in Houston, where she moved.

Why so much waiting despite a sharp increase in spending? It’s simple: in order to cut on costs, governments limit the number of patients doctors can see during a week. And they have to make a choice: either they work for the public system or they work in a private practice. They cannot do both; therefore many doctors (especially younger ones) are going into private practices. While this “migration” represents only about 2 percent of family doctors, 45,000 patients were still left without a “free” doctor.

This migration away from government-paid health care is also happening in the U.S. Since Medicaid only pays 60 percent of what private insurers will pay, more and morenew patients will likely have a hard time finding a doctor if Medicaid is their only means to pay. And with an aging doctor population (52 years old in 2014, compared to 50 in 2010) that will eventually retire, finding a doctor will become increasingly harder.

It would likely be even harder in Colorado. Since ColoradoCare would be financed through taxes there would have to be some limitations on healthcare spending so income tax brackets don’t look like Quebec’s – the highest marginal bracket is at 25.75 percent, and that’s not including the federal one at 29 percent. Therefore doctors’ reimbursement would be lower, likely creating dissatisfaction and a shortage.If competition works in markets for things like TVs and computers – both are cheaper andmore efficient – why can’t it work for healthcare? 

So if Coloradans want their fellow citizens to have access to better and cheaper healthcare, there is one simple solution: laissez-faire. By abolishing the monopoly of employment supported by the American Medical Association, by abolishing the thousands of pages of regulations on how and when to provide care, in short by letting market forces act as they should cost will very likely decrease.

If it works in (relatively) free markets like TVs and computers – both are cheaper and more efficient – why can’t it work for healthcare?Such a market is already expanding with concierge doctors – they deal directly with patients rather than through a third party like an insurance company. Costs are affordable for middle-class households – $4-5 per day – and, according to a peer-review study, their approach decreases hospitalizations.

Source: ColoradoCare Isn’t What it Seems

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