Obamacare Was Doomed
The debate over how to replace the already collapsing Obamacare system is poised to be one of the most contentious in the current Congress. There is little dissent in the need to undo the Affordable Care Act, (ACA) passed in relative secrecy. (Former speaker Nancy Pelosi’ comment “We have to pass the bill before you can see what’s in it” ranks as one of U.S. history’s most memorable examples of legislative incompetence.)
The reality is, no matter which party took control of the federal government in 2016, Obamacare would have required major surgery-or perhaps even a mercy killing. A Heritage analysis outlines the massive problems:
· 5 million lost prior insurance plans-President Obama’s promises that “you can keep your plan” and “you can keep your doctor” were completely untrue, and private sector enrollment increased by only 2.7 million, and exchange enrollment is only half of what was projected.
· Average deductibles are $12,000
· Premiums have increased by 25%
· 70% of counties have no choice of insurance providers
· 78% of Obamacare co-ops have failed, at a cost of $1.9 billion
· Medicaid spending has increased by $1 trillion-paid for by an equal amount of tax increases. Medicaid patients under Obamacare have received a lesser quality of care
· 5 million full time jobs were lost because the Affordable Care Act actually serves as a disincentive to hire full time employees
Obamacare hurt both young and old.
Although allowing young people to remain covered under their parents’ coverage until age 26, once they aged out, they were forced to buy policies that were overpriced due to mandated coverage of issues not typically affecting them. Indeed, a key part of the financing strategy for Obamacare was the subsidization of young, healthy individuals for the rest of the covered population.
At the other end of the age spectrum, seniors were hurt because, as Heritage outlines, Obamacare cuts $716 billion from Medicare over the next 10 years, according to the Congressional Budget Office (CBO), and uses these “savings” from Medicare to fund other entitlement expansions mandated by Obamacare. Medicare becomes a cash cow for Obamacare, and the Medicare “savings” from payment cuts are not put back into making Medicare solvent. Such massive payment cuts do impact Medicare benefits, as well as seniors’ access to those benefits.
Dissent against Obamacare by seniors, unless repeal occurs, is expected to grow dramatically. As noted by Modern Healthcare: in December: “A bipartisan coalition of hundreds of healthcare organizations is urging the new Congress to immediately repeal an advisory board that has not yet been filled but would be charged with finding cuts to Medicare. The Independent Payment Advisory Board was created by the Affordable Care Act. During debate of the ACA, some opponents labeled the board a ‘death panel’ that would make decision about end-of-life treatment. It is actually meant to make cuts to Medicare in the case that spending growth exceeds projections.”
It is reasonable to assert that Obamacare’s failure is attributable to the imposition of government-centric solutions to a health insurance affordability problem significantly caused by government action.
Laws and regulations that prohibit competition by health care insurers across state lines guarantee monopoly practices and prices. The National Conference of State Legislatures reports that “Insurance firms in each state are protected from interstate competition by the federal McCarran-Ferguson Act (1945), which grants states the right to regulate health plans within their borders. …The result has been a patchwork of 50 different sets of state regulations; the cost for an insurer licensed in one state to enter another state market is often high.”
A Boston Globe editorial by Jeff Jacoby reasons: “government policies protecting insurance companies from interstate competition are indefensible. There is no good reason to deny freedom of choice to Americans when it comes to buying health insurance. Yet licensing rules in virtually every state effectively prevent individual residents from shopping for health plans in any other state. Consequently, there is no national market for health insurance. There are only autonomous state markets, many dominated by near-monopolies that can get away with offering lower quality insurance at ever-higher premiums. As Michael Cannon …points out, it isn’t only insurance companies that are sheltered from the rigors of competition. Insurance regulators are insulated too. State governments, inveigled by special interests, can burden health insurance policies with more and more mandatory benefits, driving up premiums to cover services that many consumers would never willingly choose.”
Government mandates for the inclusion of coverage for treatment modes unwanted and unneeded by many serves to unnecessarily increase costs.
A Cato Institute study notes:
Like the federal government, all states increase the cost of health insurance by requiring consumers to purchase certain types of coverage, whether or not they want it. Many states require consumers to purchase coverage for services that many consider quackery, such as acupuncture (12 states), chiropractors (44 states), and naturopathy (4 states). Thirty-three states require consumers to purchase at least 40 types of mandated coverage. States have also required consumers to purchase coverage for medical treatments that later proved harmful to health, such as hormone replacement therapy (4 states) and high-dose chemotherapy with autologous bone marrow transplant for breast cancer (at least 1 state, Minnesota). States impose many additional regulations on insurance pools, from premium taxes to rules limiting insurers’ ability to manage utilization. The Congressional Budget Office estimates that, on average, state regulations increase the cost of health insurance by 13 percent. States prevent individuals (and employers) from avoiding unwanted regulatory costs by prohibiting them from purchasing health insurance from states with more consumer-friendly regulations.
Another approach ignored by those who enacted Obamacare was tort reform. A study by the South Carolina Policy Council analyzed the problem. “…medical malpractice tort reform…seeks to obtain a better balance between holding doctors accountable for mistakes and protecting physicians from frivolous lawsuits. In practice, medical tort reform seeks to cap the amount of monetary damages awarded in medical negligence cases. The impetus for this is escalating costs for doctors and insurance companies, on the heels of multimillion dollar settlements to individuals and multibillion dollar settlements to states…Estimates of the cost total of medical malpractice civil cases range from $252 billion (by the Tillinghast-Towers Perrin actuarial firm) to $865 billion by the Pacific Research Institute (PRI). PRI’s estimate includes $589 billion in wasteful spending that accounts for lost future productivity and lost sales ($367 billion) caused by less innovation. While not all tort costs are wasteful – tort law is imperative in a free market system to maintain the rule of law – there is plenty of room for reform…doctors feel they must practice defensive medicine in order to avoid being sued. This practice entails prescribing tests or treatments for patients whose symptoms would not ordinarily require such procedures…Dr. William Jackson, a radiologist at Beaufort Memorial Hospital, says most people would be amazed at how many defensive medicine lab tests are ordered every day.
Originally published on the New York Analysis of Policy and Government.