Our Health Policy Matters

There's a simple reason why (after more than a decade) Donald Trump and the Republicans have no plan to replace Obamacare. I'll explain in a few minutes. But first, some background. When the Affordable Care Act (or Obamacare) was passed in 2010, it was an effort to expand health care coverage to a lot of people who needed it, while controlling their costs. It had certain key provisions, not the least of which were that people couldn't be denied coverage for pre-existing conditions, that all chronic diseases needed to be covered fairly, and lifetime coverage caps had to be lifted. The problem was that if you left matters to insurers to set insurance premiums based on what this would cost, the price of insurance would rise dramatically. So the government took a look at three different programs and ultimately put them together into one system. For people whose income was so low that they couldn't afford any real cost-sharing, the government expanded Medicaid. For elders...

My wife Pam and I bought private long term care insurance about twenty years ago. It’s a pretty good deal. For about $100 per month, we will someday – when we need it – be eligible for up to $200 a day toward either home health care or nursing home care. Add it up – it could save us hundreds of thousands of dollars as we age. I’ve been a big supporter of long-term care insurance since I was a Connecticut State Legislator in the 1980s. But to be honest, it’s never quite gotten the traction it should have. One of the reasons is that when people are young and healthy, they aren’t thinking about what their long-term care needs might be thirty or forty years down the road. But that’s when premiums would be most affordable. The bigger problem is that it’s really hard for insurers to predict the costs of long-term care that far in advance, too. The costs of care often far exceed those that are estimated way in advance. As a result, the policies that Pam and I have aren’t even offered anymore...

President-Elect Donald Trump has suggested replacing Obamacare with a package of benefits that might include: Permitting Insurance to be sold across state lines Retention of the mandate covering pre-existing conditions Allowing young people to remain on parents’ insurance Creating high-risk pools to provide insurance to people with chronic diseases Using Health Savings Accounts (HSAs) as an alternative to tax credits Expanding the use of high-deductible plans to lower premium costs Let’s consider some of the challenges the President-Elect and Congress will face as they craft these – and other – provisions to amend the Affordable Care Act (ACA) .   Selling Insurance Across State Lines President-Elect Trump has been clear that he supports this idea, because it would bring more competition into state markets.  Here’s the challenge. Insurance is regulated by the states, and some states have tighter regulations than others. To allow insurance t...

President-Elect Donald Trump has suggested replacing Obamacare with a package of benefits that might include: Permitting Insurance to be sold across state lines Retention of the mandate covering pre-existing conditions Allowing young people to remain on parents’ insurance Creating high-risk pools to provide insurance to people with chronic diseases Using Health Savings Accounts (HSAs) as an alternative to tax credits Expanding the use of high-deductible plans to lower premium costs Let’s consider some of the challenges the President-Elect and Congress will face as they craft these – and other – provisions to amend the Affordable Care Act (ACA) .   Selling Insurance Across State Lines President-Elect Trump has been clear that he supports this idea, because it would bring more competition into state markets.  Here’s the challenge. Insurance is regulated by the states, and some states have tighter regulations than others. To allow insurance t...

I have never been the biggest fan of the Affordable Care Act.  I believe that since the government is already paying over 70% of our nation’s health care bill and we’re paying another 12% out of pocket, this colossal effort to preserve the small share financed by privately-funded private insurance without bankrupting the nation may not have been worth the effort.  Medicare-for-all would have been a much better approach. But now that an emerging group of at-risk Democratic senators have joined the Republican chorus to delay the individual mandate , I want to offer an opposing view to theirs.  Obamacare has been compromised enough. Since it was enacted in 2010, Obamacare has undergone the following significant changes: The minimum medical loss ratio requirements were delayed in several states. The long-term care insurance program has been repealed. The prevention fund has been raided. The reductions in payments to providers have been put off. The...

I have never been the biggest fan of the Affordable Care Act.  I believe that since the government is already paying over 70% of our nation’s health care bill and we’re paying another 12% out of pocket, this colossal effort to preserve the small share financed by privately-funded private insurance without bankrupting the nation may not have been worth the effort.  Medicare-for-all would have been a much better approach. But now that an emerging group of at-risk Democratic senators have joined the Republican chorus to delay the individual mandate , I want to offer an opposing view to theirs.  Obamacare has been compromised enough. Since it was enacted in 2010, Obamacare has undergone the following significant changes: The minimum medical loss ratio requirements were delayed in several states. The long-term care insurance program has been repealed. The prevention fund has been raided. The reductions in payments to providers have been put off. The...

As Congress lurches today toward what at best will be another short-term “solution” to the debt ceiling and government shutdown debacle, there is a reason to believe that it will never effectively tackle entitlements.  What we need and what we want are two different things.  And this inept Congress – which in the eleventh hour of its most recent manufactured crisis is still posturing over Obamacare – has no idea how to balance the two.  Source: US House Website We need our entitlements – that’s why they exist.  But we also don’t want to pay for them. Take the Affordable Care Act – in the crosshairs of so many politicians – as an example.  Next to no one wants it all repealed.  Coverage for pre-existing conditions, a guarantee that insurance won’t be cancelled even after an illness hits, and tax credits to lower the cost of health insurance are all needed and immensely popular. But these things cost money.  When Congress passed the ...

As Congress lurches today toward what at best will be another short-term “solution” to the debt ceiling and government shutdown debacle, there is a reason to believe that it will never effectively tackle entitlements.  What we need and what we want are two different things.  And this inept Congress – which in the eleventh hour of its most recent manufactured crisis is still posturing over Obamacare – has no idea how to balance the two.  Source: US House Website We need our entitlements – that’s why they exist.  But we also don’t want to pay for them. Take the Affordable Care Act – in the crosshairs of so many politicians – as an example.  Next to no one wants it all repealed.  Coverage for pre-existing conditions, a guarantee that insurance won’t be cancelled even after an illness hits, and tax credits to lower the cost of health insurance are all needed and immensely popular. But these things cost money.  When Congress passed the ...

The House of Representatives voted to repeal the Affordable Care Act for the 40 th time last week.  It did this before balancing the budget, passing a jobs bill, reforming election laws, or anything else that might actually improve its standing in the eyes of the general public. So what began for some members of Congress as principled opposition to federal “overreach” has turned into a political punch line: “How many more votes will it take for the House of Representatives to repeal Obamacare?  It doesn’t matter, because the House doesn’t count anyway.” The very first column I wrote after the mid-term election in 2010 was entitled “ Six Reasons Why Health Reform Won’t be Repealed .”  In it, I argued that there were at least five substantive reasons why the Affordable Care Act would not be repealed in spite of the Republican House takeover.  These included the popularity of the expanded Medicare benefits, the benefits to early retirees, the benefits to...

The House of Representatives voted to repeal the Affordable Care Act for the 40 th time last week.  It did this before balancing the budget, passing a jobs bill, reforming election laws, or anything else that might actually improve its standing in the eyes of the general public. So what began for some members of Congress as principled opposition to federal “overreach” has turned into a political punch line: “How many more votes will it take for the House of Representatives to repeal Obamacare?  It doesn’t matter, because the House doesn’t count anyway.” The very first column I wrote after the mid-term election in 2010 was entitled “ Six Reasons Why Health Reform Won’t be Repealed .”  In it, I argued that there were at least five substantive reasons why the Affordable Care Act would not be repealed in spite of the Republican House takeover.  These included the popularity of the expanded Medicare benefits, the benefits to early retirees, the benefits to...

You shouldn’t have to worry about anything during vacation season. So this column is my vacation gift to you. It is about all the health policy matters we seem to worry about the least.  I have written close to 150 columns.  If you look down the right side of the page, you will find links to the ten most-read ones.  The subjects won’t surprise you – fairness in mental health treatment, Obamacare and private insurance, and cursed football players lead the way. But do you ever wonder about the columns with the fewest readers? Based solely and unscientifically on my numbers, here are a half dozen or so health policy matters we seem to care about the least. Long Term Care.  Are you worried about continuing high unemployment rates, taxes on small businesses, or another stock market crash ruining your family’s financial security?   If so, you should redirect that worry.  Because US Trust CEO Keith Banks called long term care costs...

You shouldn’t have to worry about anything during vacation season. So this column is my vacation gift to you. It is about all the health policy matters we seem to worry about the least.  I have written close to 150 columns.  If you look down the right side of the page, you will find links to the ten most-read ones.  The subjects won’t surprise you – fairness in mental health treatment, Obamacare and private insurance, and cursed football players lead the way. But do you ever wonder about the columns with the fewest readers? Based solely and unscientifically on my numbers, here are a half dozen or so health policy matters we seem to care about the least. Long Term Care.  Are you worried about continuing high unemployment rates, taxes on small businesses, or another stock market crash ruining your family’s financial security?   If so, you should redirect that worry.  Because US Trust CEO Keith Banks called long term care costs...

The 2013 Medicare Trustees report is out, and it proves once again that the so-called Medicare funding crisis is a myth that has been manufactured by political leaders more interested in cutting the size of government than in assuring access to health care for all. Those may seem like strong words, but we have been waiting for a long time for government leaders to tell us the truth about Medicare.  That it hasn’t contributed to our budget deficit.  That its trust fund is solvent.  And, most important, that it would take only the tiniest of tax increases to preserve Medicare as we know it for everyone who is alive today. The 2013 report was released last week.  Nearly one in every six (or 50.7 million) Americans is covered by Medicare.  42 million of them are age 65 and over, but 8.5 million are younger and living with serious disabilities. The combined Medicare expenditures – for parts A, B, and D – were $574 billion in 2012.  Taxes, co...

The 2013 Medicare Trustees report is out, and it proves once again that the so-called Medicare funding crisis is a myth that has been manufactured by political leaders more interested in cutting the size of government than in assuring access to health care for all. Those may seem like strong words, but we have been waiting for a long time for government leaders to tell us the truth about Medicare.  That it hasn’t contributed to our budget deficit.  That its trust fund is solvent.  And, most important, that it would take only the tiniest of tax increases to preserve Medicare as we know it for everyone who is alive today. The 2013 report was released last week.  Nearly one in every six (or 50.7 million) Americans is covered by Medicare.  42 million of them are age 65 and over, but 8.5 million are younger and living with serious disabilities. The combined Medicare expenditures – for parts A, B, and D – were $574 billion in 2012.  Taxes, co...