Vail Daily column: Talk meets reality
December 8, 2016
In March, I attempted to explain the Patient Protection and Affordable Care Act, usually shortened to the "Affordable Care Act." Politically it became "Obamacare," just as its predecessor model, "Romney-care," was named after the former governor's signature legislation during his time governing Massachusetts. During our recent presidential campaigns, it was clear most politicians couldn't mutter more than one sentence about Obamacare features — for or against. Further, the behind-the-scenes money poured into negative ads for Obamacare simply cherry picked a single issue to create an overall image of a complex and comprehensive program.
My March explanation used an acronym for recall: "HELP AND TIPS"… where HELP plus TIPS call out eight benefits, with AND calling out three financial aspects that are the glue to hold it all together. Now that the election is over, let's see how easy it will be to "get rid of every word" (per Sen. Cruz's view), "keep the good and get rid of the bad" (whatever that means) or make the obvious adjustments (that were not made due to gridlock). In any case it would be called "Trump/Ryan Care." Keep in mind the Affordable Care Act was designed not to cost the government anything, unlike both normal Medicare and George W. Bush's Medicare, Part D for drugs!
"HELP AND TIPS" deciphered and challenges to undo:
Let's examine the implications of trying to remove various benefits (HELP plus TIPS), coupled trying to keep some of the financial legs (AND) to support any follow-on to the Obamacare program:
H: Help with premiums: Many millions above the Medicaid eligible level now have insurance — with the feelings of self-worth that goes along with this and keeping non-emergencies out of emergency rooms. So how will this be taken away?
E: Expansion of Medicaid for lower income folks — noting some states turned down the federal government's help for political ideological reasons: So how will this be taken away in states where it was accepted, like Colorado?
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L: Leaving young folks on parent's health policy till age 26: So how will this be taken away, even as they continue to live with their parents?
P: Pre-existing conditions not a penalty: So do we go back to the old "high risk" pool and the associated stigma — where the pre-existing condition in many cases was just being human?
A: Affordability with real competition among insurance companies: Clearly the biggest problem area, noting many "one-liner" experts say the solution is to allow health insurance to be sold across state lines — in total conflict to the notion of strong states' rights as the solution for most of our problems?
N: Neutral mix of policyholders considering age and state of health — driven by the political "lighting rod" incentive to get insured or face a penalty: So how do you sort this one out to establish a balanced mix of policyholders?
D: Departmental internal transfer of $700 billion savings over 10 years predicted savings from "regular" Medicare to the ACA: Just leave in place — unless some Congress members want fame by moving the money to their pet home state projects.
T: Transferability of insurance allowing employment mobility, annual shopping around, etc.: Of absolute importance with the notion of more job growth, but if you turn the clock back the way it used to be, how the heck do you keep this needed feature?
I: Insurance through employers stays in place: Yes, but as some employers have already given theirs up, how do you put "Humpty-Dumpty back"?
P: Preventive health screening covered: Since this is the one thing that might yet save the nation's health system, how do you get rid of it?
S: Senior's Medicare Drug "donut hole" where after initial benefits, you would normally "be on your own" till one hits the "catastrophic" level — noting Obamacare now paying just over half and closing the hole entirely by 2020: Here the drug companies saw a chance to drastically increase prices, forcing folks into the donut hole, but softening the blow as the government pays half or more. So how will the Obamacare help be taken away with AARP strong objections or will the next administration use tough tactics and reprisals to bring drug companies in tow?
In summary, talk is cheap, until it meets reality.
Paul Rondeau lives in Vail.
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