Our Health Policy Matters

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 The long-term care insurance program has been repealed.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 The long-term care insurance program has been repealed.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...

Should the Affordable Care Act be repealed so that over a million people making more than $123,000 per year can avoid paying $3,000 in taxes beginning in 2016?  And should they be allowed to pass on the cost of their health care to everyone else? This week, a local newspaper quoted a lifelong Florida Democrat as saying she might vote for Mitt Romney because she believed ACA offered “a costly giveaway to freeloaders.” The irony is that the law actually does just the opposite – and Mitt Romney knows this better than most.  It requires nearly all health care “freeloaders” either to get insurance or pay a tax penalty. Eighty percent of those affected will get insurance.  But the Congressional Budget Office reported last week that it expects 6 million people to owe the tax penalty beginning in 2014.  The $8 billion the penalty will eventually raise will help defray the cost of uncompensated care. Six million people make up less than 2% of our total p...

Should the Affordable Care Act be repealed so that over a million people making more than $123,000 per year can avoid paying $3,000 in taxes beginning in 2016?  And should they be allowed to pass on the cost of their health care to everyone else? This week, a local newspaper quoted a lifelong Florida Democrat as saying she might vote for Mitt Romney because she believed ACA offered “a costly giveaway to freeloaders.” The irony is that the law actually does just the opposite – and Mitt Romney knows this better than most.  It requires nearly all health care “freeloaders” either to get insurance or pay a tax penalty. Eighty percent of those affected will get insurance.  But the Congressional Budget Office reported last week that it expects 6 million people to owe the tax penalty beginning in 2014.  The $8 billion the penalty will eventually raise will help defray the cost of uncompensated care. Six million people make up less than 2% of our total p...

Did the Supreme Court save private health insurance, or just drive another nail in its coffin? Ironically, it might well turn out to be the latter. Keep in mind that from a consumer perspective, much of the Affordable Care Act was about trying to keep private insurance affordable in America.  But “affordable” is a relative term.  When your employer pays most of the cost, insurance is a lot more affordable than if you’re paying the bill yourself.  At over $20,000 per year for a typical plan providing family coverage, health insurance now costs around 40% of the median household income of $49,445! Being mandated to take on that expense – even with the generous subsidies ACA provides – understandably rankles people.  It’s no wonder that millions of healthy people may still choose to roll the dice and go without. But even though we have spent so much time arguing about the cost of insurance and the private insurance market, the fact is that it pay...

Did the Supreme Court save private health insurance, or just drive another nail in its coffin? Ironically, it might well turn out to be the latter. Keep in mind that from a consumer perspective, much of the Affordable Care Act was about trying to keep private insurance affordable in America.  But “affordable” is a relative term.  When your employer pays most of the cost, insurance is a lot more affordable than if you’re paying the bill yourself.  At over $20,000 per year for a typical plan providing family coverage, health insurance now costs around 40% of the median household income of $49,445! Being mandated to take on that expense – even with the generous subsidies ACA provides – understandably rankles people.  It’s no wonder that millions of healthy people may still choose to roll the dice and go without. But even though we have spent so much time arguing about the cost of insurance and the private insurance market, the fact is that it pay...

The Supreme Court decision on the constitutionality of the Affordable Care Act is finally in. Before it was announced, most people seemed to think that the individual mandate would be overturned.  It did not play out that way.  The individual mandate was upheld – not under the Commerce Clause of the Constitution, but as a tax.  Justice Roberts proved to be the swing vote. Also left intact are the expansions of Medicaid eligibility and, as a result, the entire law, with all of its consumer protections. However, there is a major caveat here. States can opt out of the expansion of the Medicaid program without jeopardizing the rest of its Medicaid funding.  In other words, the Court is allowing a state to refuse to expand Medicaid eligibility to 133% of poverty and to refuse to cover all of the ACA-mandated basic benefits in its program.  If it does, it will only have to give up the new federal money that pays for these benefits. The consequen...

The Supreme Court decision on the constitutionality of the Affordable Care Act is finally in. Before it was announced, most people seemed to think that the individual mandate would be overturned.  It did not play out that way.  The individual mandate was upheld – not under the Commerce Clause of the Constitution, but as a tax.  Justice Roberts proved to be the swing vote. Also left intact are the expansions of Medicaid eligibility and, as a result, the entire law, with all of its consumer protections. However, there is a major caveat here. States can opt out of the expansion of the Medicaid program without jeopardizing the rest of its Medicaid funding.  In other words, the Court is allowing a state to refuse to expand Medicaid eligibility to 133% of poverty and to refuse to cover all of the ACA-mandated basic benefits in its program.  If it does, it will only have to give up the new federal money that pays for these benefits. The consequen...

Here’s why you don’t need to be holding your breath while awaiting the announcement of the Supreme Court’s decision on the Affordable Care Act. Its immediate impact on you may be a whole lot less than you think. And here’s why you should be holding your breath. How the Court rules could ultimately determine whether private health insurance or public health insurance is the way we finance health care in the future. The reason is this.  ACA expanded both the role of private insurance and public insurance in providing healthcare coverage in the future.  It added a projected 13 million people to the private insurance rolls and 17 million to Medicaid.  The 13 million were added to private insurance primarily through a mandate that individuals who can afford it buy insurance.  The 17 million were added to Medicaid through a mandate that the states expand the Medicaid-eligible population. The Supreme Court was asked to rule on the constitutionali...

Here’s why you don’t need to be holding your breath while awaiting the announcement of the Supreme Court’s decision on the Affordable Care Act. Its immediate impact on you may be a whole lot less than you think. And here’s why you should be holding your breath. How the Court rules could ultimately determine whether private health insurance or public health insurance is the way we finance health care in the future. The reason is this.  ACA expanded both the role of private insurance and public insurance in providing healthcare coverage in the future.  It added a projected 13 million people to the private insurance rolls and 17 million to Medicaid.  The 13 million were added to private insurance primarily through a mandate that individuals who can afford it buy insurance.  The 17 million were added to Medicaid through a mandate that the states expand the Medicaid-eligible population. The Supreme Court was asked to rule on the constitutionali...

The Affordable Care Act has finally had its days in court this week. And commentators who were certain on Monday that the Supreme Court would uphold the individual mandate were just as certain on Tuesday that it would not.  Perhaps they have some special insight into the thinking of the Justices. I don’t.  I’ll just wait for the decision.  In the meantime, I’m wondering not how each of us thinks the Court will rule, but how we hope it will rule. The answer isn’t so simple, because we divide into – and often move among – three competing minority camps about health reform in general: The Affordable Care Act represents the best compromise for insuring more people while preserving most of our current public/private payer system. Expanding reform to a single payer system like those favored by other developed nations would be better.  Replacing ACA with a private market-based system is at least worth a try. If we’re as uncertain as polls cited by ...

The Affordable Care Act has finally had its days in court this week. And commentators who were certain on Monday that the Supreme Court would uphold the individual mandate were just as certain on Tuesday that it would not.  Perhaps they have some special insight into the thinking of the Justices. I don’t.  I’ll just wait for the decision.  In the meantime, I’m wondering not how each of us thinks the Court will rule, but how we hope it will rule. The answer isn’t so simple, because we divide into – and often move among – three competing minority camps about health reform in general: The Affordable Care Act represents the best compromise for insuring more people while preserving most of our current public/private payer system. Expanding reform to a single payer system like those favored by other developed nations would be better.  Replacing ACA with a private market-based system is at least worth a try. If we’re as uncertain as polls cited by ...

How will the Supreme Court respond to an argument next week that might lead to the disintegration of health care in America? In recent years, we have been making slow policy progress in better coordinating and integrating primary and specialty care, and health and mental health care.  Two milestones were the passage of the federal Mental Health Parity Act in 2008 and the Affordable Care Act provisions in 2010 that prohibit insurance discrimination against people with pre-existing conditions, both in coverage and in cost. These are opening more primary care doors to people with mental illnesses.  80% of all mental health problems are first seen in a primary care office.  And it now pays for a primary care clinician to screen for mental health problems.  According to one recent projection completed by the Mental Health Association of Palm Beach County (available on request from that organization), a primary care practitioner can generate in excess of $...