Vail Daily column: Repeal, replace Obamacare
February 23, 2017
Earlier in 2016 and after the election, I characterized with an acronym the Affordable Care Act, known politically as Obamacare. Even now, most politicians on both sides of the issue can't mutter more than one sentence about its features, much less how to "repeal and replace" by the Republicans. Further, in some states the recipients of the Affordable Care Act did not know they were benefited by the program, as it had a local name that was vague to its origin. In Colorado, Connect For Health was clearly part of the Affordable Care Act.
Let's examine with conjecture the current possible outcomes in "dealing" with the features of the Affordable Care Act. So we'll peel the onion where "HELP" and "TIPS" are the benefits, with "AND" calling out financial underpinnings to support the program.
H: Help with premiums: Many millions above the Medicaid eligible level now have insurance via subsidies. Possible outcome? An age related direct "tax credit" — real money that is good toward helping pay insurance premiums, regardless if you owe income tax.
E: Expansion of Medicaid: States given funds for three years to get more enrollees: Note some states (not Colorado) turned down the federal government's help for political reasons. Possible outcome? Block grants to states, allowing them to customize to their individual needs — hopefully not like the tobacco settlements where the money was used for whatever.
L: Leaving young folks on parent's health policy till age 26: Every politicians' top of the list to save — it's something they can understand and remember. Possible outcome? Keep it in place, but keep it quiet that higher premiums must pay for it somewhere.
P: Pre-existing conditions not a penalty: Again high on the list of most politicians as its understandable. Possible outcome? Going back to the old "high risk" pools or you are not penalized with higher premiums if you had continuous cover for awhile. Is being female a pre-existing condition?
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A: Affordability with real competition amongst insurance companies: Clearly this has not worked out with skyrocketing insurance premiums and increased deductibles due to lack of competition, as many insurance companies are leaving states. The reasons given are not enough healthy folks signing up, but it's rumored there is more at play here. Possible outcome? The favorite long term solution is selling insurance across state lines, but the situation is so serious now that it will require "arm twisting" and certain promises by important leaders to get insurance companies to continue offering policies in some states!
N: Neutral mix of policyholders considering age and state of health: Driven by the incentive to get insured or face a penalty. Possible outcome? Clearly, the penalty must go, but could be replaced with some sort of auto-enroll of insurance through employers who do not have their own plans.
D: Departmental internal transfer of $700 billion savings throughout 10 years predicted savings from "regular" Medicare to the Affordable Care Act: Possible outcome? Can just be left in place as its out of the limelight.
T: Transferability of insurance allowing employment mobility, annual shopping around, etc.: Of absolute importance with the notion of more job growth. Possible outcome? None apparent.
I: Insurance through employers stays in place: Yes, but some employers have already given theirs up. Possible outcome? None apparent.
P: Preventive health screening covered: This is the one thing that might yet save the nation's health system, with our diabetes and heart attacks epidemic. Possible outcome? Will likely go, without any organized opposition, except from Planned Parenthood, with its general health preventive services.
S: Seniors with Medicare: The Affordable Care Act also added preventive health screening under Medicare and is gradually closing the doughnut hole in Medicare Part D drug plan. Possible outcome? It will just quietly be left in place as nobody wants to take on AARP.
So who are the key players among the repeal and replace folks with white papers or at least some back of an envelope ideas? Speaker Ryan has specifics as part of his "A Better Way" program. Then we have the newly appointed head of Health & Human Services, Tom Price. And yes, one of our Colorado Republican members of the U.S. House has a detailed plan, but with caution that some of the time lines being discussed are too optimistic. Regardless of one's political views, it's important we get through a period of unknowns that is starting to back up important decisions by both organizations and individuals. This is not "healthy."
Paul Rondeau lives in Vail.
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