Health Care and the Terrible, Horrible, No Good, Very Bad Day

 

Bad day in Washington over TrumpcareWell, they did it. They came up with the worst possible “replacement” for the Affordable Care Act.

The horrific plan that the House Republicans passed on Thursday threatens not only the health insurance of 24 million people, but those of us lucky enough to have employer-provided health insurance, anyone covered under Medicaid, and anyone who ever dreamed of leaving the security of an employer to start their own business or otherwise follow their dream.

Not only did they throw the baby out with the bathwater, but they buried her 10 feet deep in a remote spot in the Amazon.

In passing this appalling bill, the House Republicans: Confirmed, in no uncertain terms, that access to affordable, quality health care is a privilege, not a right. And it appears that the privilege is primarily available to rich white men. Clarified that they could care less about the people who put them in office, given the fact that fewer than 20% of Americans supported the earlier, less onerous version of the American Health Care Act (AHCA). … Continue Reading

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ACA Affordable Care Act healthcare reform Medicare Obamacare

Why Does an MRI Cost $2,500 Here and $250 in Finland?

 

JPen and money on CT-scan flim.ust had dinner with an old friend from Finland. He’s a physician so, of course, the talk turned to health care and the differences between our countries. I asked him how much an MRI cost in Finland. With a few clicks on his phone he had the answer: about $250. Not to be outdone, I pulled out my own phone. The average price of an MRI here? About $2,500.

And therein lies the problem. The US spends more per capita on health care than any other industrialized country in the world. The spending is driven by our high use of technology and the cost of health care. And before you say we have the best healthcare system in the world, let me tell you that we don’t.

Our country ranks last or near the bottom on nearly every health-related outcome compared to other high-income countries. In fact, life expectancy has actually dropped in the past couple of years for the first time in decades, with death rates rising for eight of the top 10 leading causes … Continue Reading

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Affordable Care Act blog health insurance healthcare costs high-deductible health plan

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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ACA Affordable Care Act federal budget health insurance healthcare reform Obamacare

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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ACA Affordable Care Act blog health insurance healthcare system; Obamacare

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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ACA Affordable Care Act blog health savings accounts healthcare reform high-deductible health plan Obamacare

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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ACA Affordable Care Act health insurance healthcare reform Medicare Obamacare

Goodbye 2016, Hello 2017

Bright beach with 2016 written in sand

Looking Back on the Year in Health Care: There Were Some Bright Spots

I don’t know about you, but I personally hate end-of-year columns. I had to write far too many when I was a newspaper reporter (back in the day when you got ink on your hands while reading a newspaper).

So why am I writing one, you ask?

Sigh. Blame it on the young lady who handles my social media. She’s making me.

So here goes.

2016 Highlights in Health Care

There’s a lot of moaning on social media about 2016 and what a terrible year it was. And yes, it did suck for many reasons, none of which I’m going to go into here. Instead, I’m going to talk about a few positives on the health care side for which I’m thankful.

Fewer Uninsured Americans Twenty million previously uninsured Americans now have health insurance. Put another way, the uninsured rate in this country has never been lower. Gains Under the Affordable Care Act Many aspects of the Affordable Care Act (aka Obamacare) … Continue Reading

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Dear Donald: Here’s How Health Insurance Works

handwritten lettter

Dear Donald (I can call you Donald, right?):

I really appreciate that you think there are certain parts of “Obamacare” worth keeping. Like continuing to be able to cover adult children up to age 26 on your health insurance (I’ve got one of those on our health insurance right now) and ensuring that health insurers can’t discriminate or charge higher premiums based on preexisting conditions.

There’s just one teeny, tiny problem. There is no way to keep the preexisting condition part without also keeping the mandate that everyone has some kind of health insurance.

It might be a little complicated for you, so I’ve done my best to bring it down to a first-grade reading level.

An Analogy for How Health Insurance Works

1) Insurance, any insurance, is based on a risk model. The more people in the risk pool, the less impact the truly risky have on the pool.

Think of it this way. If you put five drops of red food coloring in a swimming pool, there’s no change in color. If you put … Continue Reading

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Affordable Care Act health insurance healthcare reform Obamacare