Obamacare’s Death and Replacement
In a 51-48 vote, The Senate recently took an important step to replace Obamacare. The measure was a nonbinding budget bill that establishes the path for a repeal of the failing Affordable Care Act within the next few months.
U.S. Senate Majority Leader Mitch McConnell (R-KY) stated “Too many have been personally hurt by this law. Too many feel they’re worse off than they were before Obamacare…Too many Americans say their Obamacare plans are too expensive to actually use. Too many say their Obamacare premiums have gone up and up though their options have diminished.”
While, as the 51-48 vote indicates, repeal is largely the work of the Republican majority, the reality is that Obamacare was collapsing under its own weight in what some pundits have termed a “death spiral.” Skyrocketing premiums, diminished choices, physicians opting to not take Obamacare-covered patients, a sharp decline in enrollments, and vanishing co-ops have been key indicators that its demise was inevitable. Public support for the 2010 Affordable Care Act legislation, which was passed without the public being informed of the details (former House speaker Nancy Pelosi (D-California) famously told the public that they would have to pass the bill to see what was in it) had dropped precipitously. Subsequent to its enactment, the laws’ architect, Jonathon Gruber attributed its passage to the “stupidity” of the American people.
Young people have been forced to buy policies which included costs for services they didn’t need. Seniors have been denied necessary treatments because of expense factors. Those with irregular incomes face constant changes in coverage. Physicians are drowning in inadequate reimbursement and bureaucracy. Obamacare in general charges excessive rates and imposes deductibles that make the concept of coverage more illusion than reality.
Many of the legislation’s own advocates had seen it as only an interim step towards the implementation of completely nationalized health care under a single payer plan. But that could not be sold to an American public that was well aware that the concept has failed wherever it has been tried. Indeed, many in the United Kingdom, whose National Health Service was, quietly, the admired model of Obamacare advocates, have sought methods to extricate themselves from their failing system.
Those advocates who have claimed that Obamacare has had some success are fudging facts. As the National Center for Policy Analysis, quoting a Heritage study noted in 2014: “while health insurance coverage — whether in the private market or in Medicaid — grew by 8.5 million individuals in 2014, the vast majority (71 percent) of that gain was due to increases in Medicaid. According to the authors, “[T]he inescapable conclusion is that, at least when it comes to covering the uninsured, Obamacare so far is mainly a simple expansion of Medicaid.”
The need to address Obamacare has been summarized by the Heritage Foundation, which outlined how the legislation detrimentally affects Americans:
“Seniors: The law cuts an estimated $716 billion from Medicare over ten years. However, these “savings” are not set aside to preserve Medicare’s future, instead they are used to fund new spending created by the law. Nearly one-third of all seniors rely on Medicare Advantage, the private health care option in Medicare. Despite the program’s growing enrollment and beneficiary satisfaction, Obamacare makes deep cuts to the program that jeopardize its viability in coming years. In addition to payment cuts, Obamacare imposes new taxes on drug companies and medical device makers, and new regulations that will make health care more costly for seniors.
“Doctors: The United States is facing a severe physician shortage. By 2020, the nation will need an additional 91,500 doctors to meet medical demand. Obamacare exacerbates this problem by further increasing physicians’ workload and worsening their attitudes regarding the health care system. A 2012 survey found that Obamacare is motivating doctors to change their retirement timeline, with 43 percent of respondents stating that they are considering retiring within the next five years as a result of the law.
“Business & The Economy: The Congressional Budget Office estimates that the Obamacare subsidies will discourage Americans from working, and cause 2.5 million employees to drop out of the labor force.Obamacare’s employer mandate will raise the minimum cost of hiring a full-time worker to $10.30/hour in 2015. Congress has already raised the minimum wage from an employer’s point of view, but the money goes to the government instead of the employees.
“States: Obamacare’s Medicaid expansion worsens the already heavy burdens facing states. By 2021, approximately 78 million people are projected to be enrolled in Medicaid—requiring billions of dollars from state budgets and taxpayers. In the individual market, Obamacare’s exchanges have on average decreased insurer competition by an estimated 29 percent nationwide. Furthermore, over half of the counties in the U.S. have only one or two insurers to choose from in their Obamacare exchange.
“Families: Obamacare adds nearly $2 trillion in new health care spending according to the Congressional Budget Office. Over the next 10 years, Obamacare will levy about$771 billion in new taxes and fees. Obamacare imposes significant financial penalties on the decision to get or remain married – over $10,000 per year for certain couples.
“Uninsured: The Congressional Budget Office estimates that “between 6 and 7 million fewer people will have employment-based coverage each year from 2016 through 2024 than would be the case in the absence of [the new health law].”In 2024, after ten years of full implementation, 31 million people are projected to remain uninsured.”
In addition to the ideological goal of nationalizing one-sixth of the American economy, Obamacare’s Progressive advocates support for the legislation was a reflection of their political alliance with lobbying interests from pharmaceutical corporations, the Trial Lawyers Association, and insurance companies, all of which had vested interests in opposing more viable reforms which would have truly and effectively reduced the cost of healthcare.
“the House and Senate must:
- “Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
- “Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
- “Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
- “Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
- “Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
- “Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
- “Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
“The reforms outlined above will lower healthcare costs for all Americans. They are simply a place to start. There are other reforms that might be considered if they serve to lower costs, remove uncertainty and provide financial security for all Americans. And we must also take actions in other policy areas to lower healthcare costs and burdens. Enforcing immigration laws, eliminating fraud and waste and energizing our economy will relieve the economic pressures felt by every American. It is the moral responsibility of a nation’s government to do what is best for the people and what is in the interest of securing the future of the nation. Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.”
An American Action Forum (AAF) study proposes tort reform as an additional means to lower health care costs. “ AAF found multiple state medical liability reforms reduced total healthcare premiums by 2.6 percent, Employer healthcare costs also declined by 3.5 percent, [and] If these results were replicated on a national level, the nation’s insured could save more than $15 billion in premiums…Tort reform has taken several forms and gained prominence in the 1990s as a way to curb high jury awards. For example, legislators can cap damages, reform how damages are paid, and amend joint and several liability (allowing the plaintiff to collect money from anyone found liable, regardless of their degree of liability).”
Originally published on New York Analysis of Policy and Government.