Tag Archives: Congressional Budget Office

Straight, No Chaser In The News: The Real Meaning of the American Health Care Act and of Replacing the Affordable Care Act

Here’s the thing. It’s only one view that America bends toward an arc of diversity, inclusion and justice. There is another view – felt to be every bit as compelling to those who just happen to be represented by those who won the last election and control the various branches of government. In this view, personal responsibility and individual freedoms are the compelling freedoms of America, and redistribution of wealth toward the less fortunate is labelled an “entitlement” instead of part of what binds a nation together.

These competing interests have long played out in healthcare. It explains the reason that America has long been the sole major industrialized nation in the entire world that doesn’t provide universal health care and, by a large amount, demonstrates disparities in healthcare largely attributable to one’s financial status.
To say that America is a democracy is to say there are roughly equal parts liberal and conservative forces that can influence policy if and when given the opportunity. However, America is a capitalist nation without a counterbalancing force toward socialism. Historically, part of the social construct of nations with its citizens has been to, at a minimum, provide certain protections equated with socialism, including health, education, welfare and police protection. It is of interest to note that, in our capitalist society, there have always been efforts to further the capitalist experience and privatize these fundamentals. In the example of healthcare, these forces have outweighed the calls from those seeking universal healthcare or consideration of healthcare as a right.

It is in this vein that I view the current conversation on health care. One must appreciate the United States does not have a healthcare system. We have a healthcare industry that represents 1/6th (17%) of the U.S. economy (comparatively, the next largest country spends approximately 11% of it’s gross domestic product on healthcare). Appreciate this point. Of all the corporate “too bigs to fail,” the healthcare industry is especially legitimate. To shrink the healthcare industry by compelling a truly socialist healthcare system (meaning assets are owned and run by the government, complete with cost controls) would drive so many industries out of business, it would crash the economy beyond recognition. Right about now, for those of you who’d state that “healthcare for all” is the “right thing to do,” I should remind you that capitalism has no moral check. It’s governing principle is the so-called “invisible hand,” describing a force in a society in which everyone is pursuing their own individual gains, and in which the sum total of these efforts will generate desired end results across the board.
And so with healthcare, the purely capitalist approach would be to deliver care in total to the markets and the entrepreneurs chasing profits. Theoretically, competition would drive down costs and increase services in order to better attract customers. In this example healthcare outcomes are an offshoot of the industry, not the primary concern of a system.

Let’s look at five defining features of the American Health Care Act. I’ll list some facts first, then provide a bit of commentary.

  1. There will no longer be either a requirement or an entitlement to have health insurance. Of course this means there will no longer be a government-sanctioned entitlement to healthcare for all. If you believe in “personal responsibility,” you applaud this consideration. If you believe in a “social safety net,” not so much. Additionally, many of the taxes in place to fund the ACA would be eliminated.
  2. There will no longer be an employer mandate to provide health insurance. The employer mandate, which required companies with 50 or more full-time workers to offer insurance or pay a tax, will be going away. For many, the first impulse is to ask how employers could be so heartless. For others, the first question involves why employers have to provide insurance anyway. It was established a century ago as a competitive measure by companies, and later it became a requirement with the success of American unions. It just happens to be the case that the same levels of competition for employees and needs to provide benefits no longer exist, and employers are anxious to enjoy greater profits where possible.
  3. The Medicaid expansion created with the Affordable Care Act (aka ACA, Obamacare) will be phased out by 2020. For states having accepted the expansion, this will affect low-income families, pregnant woman, children, the disabled, and those over age 65 with incomes up to 138% of the federal poverty level (about $16,643). In this context, phased out means there will be no new enrollment and anyone allowing a lapse in coverage for more than one month will not be allowed to enroll.
  4. If you have commercial insurance, the so-called essential health benefits established under the ACA will remain. These include maternity care, mental health care and prescription drugs. Beginning 2020, state Medicaid plans would not have to meet this requirement. Additionally, young adults under age 26 will still be able to remain on their parents’ plans and insurance companies will not be able to deny insurance to those with preexisting insurance, given these individuals have preexisting insurance. However, under certain conditions, insurance companies will be allowed to charge up to 30% higher premiums for one year to such individuals.
  5. Financial assistance to help purchase insurance will change significantly from the ACA. The new plan would shift tax credit to those purchasing insurance away from income-based considerations to age-based considerations, even though insurance companies will be allowed to charge the elderly up to five times more for coverage than younger Americans. The net effect of this will be a lot less use of the system. Your insurance card will have a lot less value dollar for dollar compared to what you’ve had historically.

If you are in a rush to declare this bill a failure, it’s because you are of the mindset (in step with the rest of the world) that health care is a right, and insurance is necessary to provide healthcare. Of course, the point is that’s not the objective of those seeking to eliminate the ACA; in fact, the plan retains many, if not most of the programmatic elements of the ACA. It’s not just the ACA that these politicians are looking to eliminate. It’s the idea that healthcare is a right. It’s any notion that the government should financially support an entitlement. It’s the notion that the free market wouldn’t best regulate services and costs. It’s the notion that employers should be forced to provide benefits in this manner. So when the Congressional Budget Office tells you that between 6-10 million less people will be insured than currently are, and there won’t be cost savings to the citizenry, remember: that never was the objective. Remember this, which is perhaps closer to the true motivation of those perpetually inclined to distract you while pursuing truer interests in a stealth manner: the 400 highest-earning households in the country would get an average tax break of $7 million per year under the proposed American Health Care Act.
In the meantime, here’s what is expected to complete “access to care” for all of the newly uninsured.

Feel free to ask your Sterling Medical Advice expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: A Dream of Equal Access to Health Care

This weekend marked the celebrations of the 50th anniversary of the famous March on Washington. During this weekend’s remembrances, I couldn’t help but reflect back on Dr. Martin Luther King, Jr.’s most famous comments on health care in America.

“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”

Why would he say such a thing? Injustice in health care has taken many forms and resulted in predictably poor outcomes for those affected. I will be frequently reviewing these considerations and addressing health care disparities in this blog. Today, I will address the inequity in insurance coverage that formed the premise for the Affordable Care Act (aka Obamacare).
According to the Kaiser Family Foundation, in 2009-2010, 41% of low-income adults were uninsured, and 45% of poor adults were uninsured. Contrast this with the fact that only 6% of those who make four or more times the poverty rate were uninsured. This pretty clearly makes the case that health care is a desirable asset for Americans who can afford it, and a choice that too often can’t be afforded for others. Now consider that 14% percent of white Americans were uninsured, while 22% of African-Americans were uninsured, and 32% of Hispanic Americans were uninsured. Whether you believe this is just a correlation, coincidence or reflection of something more damning, it is a situation that screaming to be addressed and improved.
Even more recently, the Centers for Disease Control and Prevention released a survey showing that more than 45 million U.S. residents didn’t have health insurance during the first nine months of last year. Still even more people, 57.5 million, were uninsured for at least part of the 12 months before being polled (Be reminded that the total U.S. population is just over 311 million.).
Please take a moment and ponder the enormity of the numbers just presented. It begs the question “How can such be allowed to exist?” Dr. King’s comment begged the same question. The answer of course lies in the fact that the American health care system isn’t built on producing equality of access or outcomes. You’ve heard me say before that the American health care system remains the only system among all the major industrialized nations on earth that doesn’t ensure access for all its citizens. The American health care system is a business enterprise that has captured over $2 trillion annually, representing over 1/6 (17%) of the gross domestic product, and all the while leaving more than 45 million Americans uninsured. We are number one in money spent on health care by a large margin; in fact, the U.S. spends more on people aged over 65 than any other other country spends on its entire population. The business of medicine in America is business first. It is largely expected that good health care outcomes will result from good business in the same way that good cars, computers, smartphones, etc. are produced (theoretically). It’s important to note that according to the World Health Organization (the monitor of such things), the U.S. health care system was ranked #38 in the last WHO ranking based on standard health outcomes produced.
President Barack Obama’s health care reform law aims to extend health insurance coverage to a large portion of the uninsured. According to the Congressional Budget Office, health care reform will reduce the number of uninsured people by 27 million between 2014 and 2023. The Affordable Care Act (ACA) targets its assistance to the poor and near-poor who are least likely to have health care coverage. The ACA will provide Medicaid coverage to those with incomes up to 133 percent of the poverty level ($15,282 for a single person this year) — unless their home state opts out of the Medicaid expansion. People who earn between the poverty level and four times that amount will be eligible for tax credits for private health insurance.
Access to health care is the beginning of the process by which health care disparities can be erased. As long as failure to have equal access exists to the extent that it does, the types of disparities in life expectancy, disease rates and disease survival will remain predictably dismal for certain populations. This afternoon I will revisit the Affordable Care Act and it’s efforts to improve the current system. I welcome any questions or comments.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress