Our Health Policy Matters

I have at least two members of my immediate family who would be affected directly by the so-called Better Care Reconciliation Act (BCRA). It could cost them – and others like them – their money and their lives. The Senate bill released this week has two important improvements over the House American Health Care Act. First, like Obamacare but unlike the House version, it requires insurers to continue to offer coverage in the regular marketplace to people with pre-existing conditions. Second, it corrects a major flaw in the Affordable Care Act – as interpreted by the Supreme Court – by extending health insurance subsidies to everyone below poverty who is ineligible for Medicaid. Today, the poorest pay the same as the richest for health insurance, because the subsidies are limited to those between 100 and 400 percent of poverty. That’s the good news. But it all quickly unravels after this. Here are ten reasons why. First, while pre-existing conditions are cove

Did Obamacare reduce access to care? That’s one of the arguments being made today by members of Congress who have rushed to judgment by voting for an inadequate replacement plan. It may surprise you that they call it “AHCA,” which sounds just like “ACA.” But it shouldn’t. Polling data always showed that “ACA” was a lot more popular than “Obamacare,” because many people did not know they were the same thing.  Republicans are hedging their bets – next election they hope they can tell a confused public that they were opposed to Obamacare but for AHCA. But back to the question.  Did Obamacare reduce access to care? That’s the argument made by the American Spectator, which counts among its editors the conservative, math-challenged, icons Jeffrey Lord, Ben Stein, and Grover Norquist. They argue that this is evident because of the 71 rural hospital closures since 2010 – approximately one per month. That’s pretty astonishing. Seventy-one rural hospital closures in six yea

The Affordable Care Act amendment offered by House leadership yesterday seems well-intended. But it falls far short of the “repeal and replace” promises that have been made for years. Instead of offering better health insurance, more choices, and greater affordability as promised, the draft proposal pushes more people into private health insurance exchanges, through which insurers will offer poorer coverage at a higher cost.  Older adults will immediately pay as much as 60 percent more for their health insurance. All individuals will find themselves subjected to a new “individual mandate,” disguised as a 30 percent premium surcharge for those who lose their coverage for more than two months and for those 26 year olds who fail to enroll as soon as they leave their parents’ policies. A new high risk pool for those with chronic diseases will become a multi-billion dollar unfunded mandate on the states by 2026. Employers will no longer have to provide insurance to t

As Congress works through the challenge of changing Obamacare, how the federal government pays its share of Medicaid dollars will be part of the debate. At first, Medicaid was designed primarily to offer to people with chronic conditions the long-term care benefits that Medicare did not. It pays much of our nation’s nursing home bill.  It was later expanded to provide safety net insurance to low income families, especially for women and children. Medicaid is a federal/state partnership program. The states design their own programs within federally-established rules, and the federal government reimburses half (or more) of the state’s cost. The Affordable Care Act added a new wrinkle to the cost-sharing formula.  For those states that expanded the Medicaid program to serve even more people, including uninsured single adults, it offered 90+ percent reimbursement for the new populations.  To date, 32 states have expanded. What’s wrong with Medicaid? Medicaid costs the federal g