Wave Goodbye to Your Health Insurance

 

This is the third in a series of posts examining various components of the Republican replacement plans for the Affordable Care Act (ACA). 

Republicans Plan to Shred the Affordable Care Act

It’s here. The Republican plan to replace the Affordable Care Act. Bottom line assessment? If you like the health insurance you have today you can say goodbye to it tomorrow, particularly if that insurance comes thanks to expanded Medicaid programs or a federal subsidy.

Here are the just a few of the highlights of the two proposed bills:

1. Scraps the individual mandate; adds a penalty.

Currently, all Americans are required to have some kind of health insurance or pay a penalty. This ensures that healthy people buy into the system to help offset the costs of sick people, a requirement if you also mandate that insurers cover those with pre-existing conditions without jacking up the price of the insurance.

Under the new plan, you don’t have to have insurance. But if you don’t, and then you try to buy it, the insurer can charge you a 30 percent … Continue Reading

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Yes, Mr. President, Health Care Is Complicated

 

Toothpaste tubeI nearly fell off the couch when I read the President’s statement that “nobody knew health care could be so complicated.”

Um, Mr. President, everyone knew. In fact, health care is considered the most complex industry out there. That would be why, as you and your colleagues are finding, transforming the system is “incredibly complex.” It is also why it will be nearly impossible to repeal-and-replace the Affordable Care Act (ACA) with something better unless you move to a single-payer system.You can, of course, focus on fixing its weaknesses.

I remember a healthcare economics course I took when I was in my 20s. During the first class, the professor told us: “Take every basic economic concept out there, including resource allocation, supply-and-demand pricing, and rational consumer behavior, and toss it aside. Very few apply to health care.”

The past 30 years as a healthcare writer have reaffirmed that statement hundreds of times over.

The Health Care System as a Tube of Toothpaste

I have my own analogy to describe the US healthcare system. I think of it as a tube … Continue Reading

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ACA Affordable Care Act health insurance healthcare reform Obamacare

Replacing the ACA: Selling Across State Lines

A United States map with a stethoscope across it, symbolizing national health care policy and wellness of the population

A cornerstone of every Republican plan to replace the Affordable Care Act (ACA), including the president’s plan, is to allow health insurance companies to sell their products across state lines. The Republicans claim this will increase competition and drive down costs.

Health policy experts, including the National Association of Insurance Commissioners and the Center for Insurance Policy and Research, say it will do exactly the opposite: Drive up costs and reduce choice, particularly for those with medical conditions.

State Regulations on Health Insurance

First, a bit of background. States regulate all small group and individual health insurance policies through their insurance commissioner, although the federal government sets certain minimum requirements that plans must offer, like the 10 essential benefits required under the ACA.

States can mandate that their licensed insurers add certain benefits, like infertility coverage. They also determine how much older people can be charged for premiums on the individual market and how much money insurers must have available to pay claims.

… Continue Reading

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Replacing the ACA: Will Health Savings Accounts Work?

Desktop with calculator, cash, notepad with the phrase healthcare reform, high-deductible plan, health savings accountsThe problems with high-deductible plans and health savings accounts

Note: I am beginning a series of posts examining various approaches the Republicans are touting as replacements for the ACA. Sorry, but no alternative facts here.

Several years ago (ie, pre-ACA), I needed to buy health insurance on the open market. The cost of an individual policy and the deductible was atmospheric because I had a pre-existing condition. And, of course, the policy didn’t cover costs related to my pre-existing condition.

Luckily, I had just incorporated my business. Since I had two employees (my husband and I) I could get a small business policy. Still expensive but manageable with decent coverage since employer-provided plans can’t discriminate based on pre-existing conditions.

I chose the cheapest plan, which came with a very high deductible. This plan also allowed me to create a health savings account (HSA). Money deposited into an HSA is not subject to federal taxes, grows tax-free, and is not taxed when used for qualified medical expenses (but … Continue Reading

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Winners and Losers: Assessing the Ramifications of Repealing Obamacare

 

Opposing ropes pulling on a doctor stethoscope as a symbol of the US healthcare systemAfter voting at least 60 times over the past six years to repeal the Affordable Care Act (ie, Obamacare) only to see their efforts stymied in the Senate, the Republican House is fairly foaming at the mouth at their golden opportunity to reach Nirvana now that they also control the Senate.

Indeed, the Senate passed a budget resolution on January 4 to begin the process, instructing the House to have a repeal bill ready by January 27. You can read how this might work in this excellent article in The New York Times.

There’s just one problem: Despite the six years they’ve spent trying to kill the ACA, the Republicans still have no replacement.

So here’s just a sneak peek at what might happen if they follow through on their threats.

10 Things We Will Lose if We Lose the Affordable Care Act Insurance for more than 20 million Americans. Guaranteed coverage without higher premiums for those with pre-existing conditions. This would affect the 52 million Americans, … Continue Reading

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The Election and the ACA: Why I’m Sad, and Will Be For A Long Time

Ballot box with national flag on background - United States of America

I’ve been writing this blog on and off for about eight years. And in all that time, I’ve tried to keep it as apolitical as possible. But, at my core, I am a writer. It’s all I’ve ever done for 30 years. And when writers can’t make sense of the world, or don’t know what to do with their feelings, well, they write.

So, spoiler alert, I am devastated by Tuesday night’s results for so many reasons. For an end to women’s reproductive rights. For an end to what I thought was a decent, inclusive country. For an end to a free press. For an end to LGBT rights. For an end to the respect we once had from the rest of the world.

And for the horrific overt racism and homophobia that has been unleashed in this country in just the past few days.

But, since I earn my living as a healthcare writer, the one I’m going to focus on here has to do with the almost-certain death … Continue Reading

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Is The ACA As Big A Mess As Everyone Says?

 

Affordable Care Act – Image of pills and coinsMaybe. But many of the problems the Affordable Care Act (ACA) is now encountering – insurance companies on the exchanges pulling out, large premium increases in some states – are not unexpected given the design of the program.

Major problem? The Patient Protection and Affordable Care Act bill set the penalties for not having insurance too low. Far lower than the cost of the insurance to begin with. So there is little incentive for healthy people to enroll. Without healthy people enrolling, it was only a matter of time before the death spiral began.

It’s a simple equation: Sick people + no preexisting condition restriction – healthy people = high spending that outstrips existing premiums.

To add insult to injury the government was too lenient in allowing people to sign up outside of open enrollment, ie, when they got sick and needed the insurance. Plus, as The New York Times explained in a recent editorial, insurers set premiums too low in the beginning in order to attract enrollees.

Is the ACA … Continue Reading

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Doctors Are Angry. I Get That. But . . .

surgeonI knew this would be the toughest audience yet in my three years of teaching/speaking about the US healthcare system and healthcare reform. I even put on a flak jacket at the beginning of my talk as a way of breaking the ice (and protecting myself; I mean, these guys pack scalpels!). And I made it through the two-hour talk and their anger without losing my composure or my sense of humor (thank god for that sense of humor).

Now I’m sitting in the airport waiting for my flight home and find myself tearing up. Not because the doctors were mean or cruel — they weren’t — but because of how much distance there is between  reality and perception, how much anger is out there, how too many people rely only on anecdotes and commentary instead of facts to develop opinions, and how scary it is to look at where we are and where we need to be — and realize that, more and more, it is unlikely we will ever get there given the rhetoric and anger in this country.

The doctors this morning, most of whom have been in practice … Continue Reading

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ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; malpractice insurance Obamacare patient-centered care patient-centered healthcare Uncategorized

Welcome to the Roller Coaster Ride of the Affordable Care Act

I’m behind in the blog, I admit it. Last week I was planning a blog on all the good news about the Affordable Care Act (ACA), including the 10 million people who signed up; the lower-than-expected premiums; the lower-than-anticipated medical inflation predicted for the coming year, the result of which is due, at least in part, to the ACA.

Then came the ruling from a federal circuit court that the government could not provide subsidies for people to buy health insurance in states that did not set up their own exchanges. The ruling comes from a couple of sentences in the huge bill (about 900 pages) that states that the subsidies are available for people who sign up through state exchanges. Of course, that was when we thought the states would all set up their own exchanges (since the feds were paying for it).

How naïve were we?

Today, just 16 states and the District of Columbia run their own exchanges, with residents of the remaining 34 states buying insurance through the federal exchange. That means that about 5 million people who bought health insurance on the federal exchange and received subsidies may find themselves back where they started – … Continue Reading

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