Until we come to grips with what the Affordable Care Act is rather than what we were sold, we cannot wisely consider proposals to change Obamacare or replace it. So far it’s been an uphill battle as consumers express their continued surprise and disappointment with the law rather than understanding that we were selectively informed about the law in order to obtain our buy-in. Selectively informed? Let’s call it for what it was…Lied to.
But Republicans, in my opinion, only CONTINUE AND WORSEN what we will experience under their CARE Act, which is NOT the direction consumers require.
It seems to me that in their attempt to resurrect their old plan that Republicans perpetuate and worsen current trends to take more out of consumer pockets in terms of what they pay for and what insurance payers pay, that they want to lessen demands on what the purchase of these more expensive policies must cover, that they want to cut out the poorest consumers who have benefited from Medicaid expansion and they want to replace an individual mandate with something worse, an individual continuous coverage requirement in the form of higher insurance rates for any individual who has a lapse in coverage and can be described as having a pre-existing condition.
For these reasons and others, in my opinion we consumers must be warned that Republican CARE is not an improvement for consumers compared to Obamacare. The Republican CARE Act is a thinly disguised same-old effort to implement a plan already rejected by consumers. Otherwise we would have seen a real consideration of how to improve the IDEAS that citizens thought we were supporting in supporting Obamacare to begin with rather than essentially the same old from Republicans.
On February 5th 2015, Republicans published their repeal-replace plan, “Patient Choice, Affordability, Responsibility and Empowerment Act,” dubbed CARE.
Let’s go back to the sales pitch, what sold consumers on Obamacare and what Republicans are going to do to “replace” the law.
QUALITY AND AFFORDABILITY OF HEALTH INSURANCE: BOTH Obamacare and Republican CARE FAIL.
Junk policies, health insurance policies that don’t protect individuals from either physical or financial devastation in the face of illness in terms of obtaining and paying for treatment is one of the key areas where both plans FAIL.
One of the decades-old lessons of health insurance in the US and a tremendous flaw in Obamacare is that “having health insurance,” any old health insurance was not enough to prevent individuals from sacrificing physical and financial devastation in the event of illness is the fact of the under-insured.
Historically, the very rich who worry less about out-of-pocket payments and the very poor who were on Medicaid worried less about under-insurance than the middle class. For the middle class historically, the most common remedy was that if two partners, married or otherwise, each have a health insurance plan and cover one another as a dependent, then each could submit to their primary insurance company and then to their secondary insurance companies…This is the coordination of benefits aspect of health insurance.
Both the cost of health insurance policies which has gone up for most Americans and the increased non-availability of the purchase of dependent coverage where there is other health insurance available under Obamacare has made it more difficult for partners to have reciprocal coverage where coordination of benefits will help them pay for bills not covered by one insurance plan or the other.
Further, as all plans raise out-of-pocket expenses for consumers in the form of higher deductibles, copayments and coinsurance, even plans that typically provided less insurance coverage, catastrophic and 60 percent (bronze level) plans are actually worse in many cases than their historical predecessor plans.
The Republican CARE proposal is worse still with a heavy emphasis on pushing HSAs, my least favorite health insurance plan because not only do they market themselves in terms of “savings” accounts that individuals put money into AND yea! you can take a tax deduction, but they cover less than other plans because they’re high deductible and often have higher cash payments required from consumers in the form of copayments and coinsurance. (Therefore making the “savings” fake unless you’re healthy or wealthy).
I hope that every individual reads about the history of HSAs before buying into the push. They were known as the healthy-wealthy plans, in other words health insurance plans for people who don’t need health insurance, the healthy and the wealthy.
The idea that having 100 percent tax deductible contributions of up to $3,500 for a single person and $6,650 for a family (with an additional $1,000 possible contribution for those 55 or older) would help anyone who faced the expenses of illness is absurd when you consider the costs of health care services. In exchange for that tax deductible contribution you get an HSA with a higher deductible and frequently higher copayments and coinsurance as well. Obamacare has actually made these anti-consumer plans SEEM better as other health insurance plans worsen, but that’s not the same as improving HSAs, it’s only noting that other plans are sinking to the level of HSAs.)
HSAs have also been seen as a tax shelter for the rich who don’t worry about out-of-pocket expenses for health and therefore, it’s another way of saving money that is tax deductible whereas poorer people will find their HSA contributions devoured quickly for needed medical care. There were also new requirements put in place for how HSA money was spent as the chronic use of funds for unverified expenses grew (rather than clearly being used for medical expenses). The Republican CARE Act would remove these verification requirements.
AFFORDABILITY OF COVERAGE, PAYING FOR COVERAGE YOU DON’T WANT/NEED: DEMOCRATIC OBAMACARE AND REPUBLICAN CARE: FAIL. Under Obamacare consumers are financially injured in many instances by the forced coverage of preventive checkups and services, a cheap attempt to standardize insurance plans.
These preventive services are the darling of insurance companies because it’s cheaper to cover the finite costs of checkups than it is to cover the unknown expense of treating illness or injury.
Not only does Obamacare raise the cost of health insurance by forcing the inclusion of these “free” preventive services because insurers justify increases in health insurance plan costs to cover these “free” services, but in the attempt to standardize insurance policies Obamacare has left everyone responsible for paying for health insurance coverage costs for things like children’s dental and women’s annual wellness checkups, included “free benefits” that are unavailable to other adults.
It would be one thing under Obamacare if everyone was getting similar benefits and the cost of such benefits were being spread over the insured population, but Obamacare creates an entitlement paid for by other individuals purchasing health insurance plans.
For instance, single, non-parent males are forced to purchase health insurance that pays for a wellness checkup for women when their own wellness checkup is not included in the standardized requirements of Obamacare preventives, much as even non-parents are forced to pay for children’s dental when their own dental is not included.
The Republican plan is not clear, but it appears, once again, it is a Back to the Old Days idea of cover-what-you-want for insurers rather than a pay-for-what-you-want for consumers.
Since none of us doubts that insurance companies pay for as little as they can, it is likely a backwards step to skip opportunities for meaningful and unbiased standardization requirements for health insurance plans.
For instance, changing provisions of “free” services to exclude dental for children as a requirement unless coverage for a dependent is purchased, makes perfect sense rather than charging every adult for coverage NO adult can use UNLESS they purchase coverage for a dependent. Similarly, charging males for wellness exams for females and failing to include annual wellness exams for males is also idiotic. Republicans might have but didn’t address these issues.
The Republican plan also promises to “Empower” PAYERS rather than consumers through its recommendations for “transparency” that makes the impossible promise that it will improve on Obamacare’s Statements of Benefits and Coverage by including the “actual” cost of services. No one believes that the way our healthcare system is set up that people can avoid being “surprised” at their “ACTUAL” medical expenses regardless of how “transparent” the information is. It’s a silly solution to helping consumers clarify ACTUAL expenses rather than taking meaningful steps to help consumers calculate ACTUAL expenses.
For instance, it would have been better to see some improvement of federal law in the form of expanding the definition of out-of-pocket costs to include ACTUAL expenses, the real money laid out by consumers rather than the insurance company definition of out-of-pocket that frequently excludes significant amounts of money laid out by consumers, who can’t understand why they haven’t reached the out-of-pocket max even in the face of all the bills they’ve paid.
It also would have been helpful if Republicans had considered a balance billing provision preventing non-participating providers that patients are unaware are non-participating providers from being billed for fees in excess of what is “allowed” by their insurers (balance billing).
(Obamacare made an insufficient stab at this with its emergency room covered charges) but overall as in Obamacare, the Republican “plan” ignores this issue that would significantly contribute to consumers being able to calculate “ACTUAL” costs of medical services. Instead we get this new version of the same old Obamacare Statement of Benefits and Coverage for transparency stuff.
LIFETIME LIMITS: The Republican CARE plan seems to provide consumers with MORE PROTECTION than Obamacare, which if it worked out that way would be a SUCCESS for the Republican CARE Act. The text says, “Under our proposal, insurance companies would be prohibited from imposing lifetime limits on a consumer,” Patient Choice, Affordability, Responsibility, Empowerment Act.
Under Obamacare, (see HHS.gov), “Plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not considered essential health benefits.”
Individual Mandate: Don’t get fooled. Though they don’t call it the individual mandate, both the Republican CARE Act and Obamacare threaten individuals with penalties for not having health insurance, a FAIL for Obamacare and the Republican CARE Act.
The individual shared responsibility provisions, the individual mandate under Obamacare requires that unless exempted individuals must purchase health insurance. The Republicans indicate that they would not have an individual mandate, but in fact they do and it presents more risk to consumers than the current individual mandate. See below: Continuous Coverage.
Republican “CARE” Act, an individual mandate by any other name: Pre-Existing Conditions. The Republican CARE ACT has buried a NEW individual mandate where you buy insurance or else you pay a penalty in the form of its proposed pre-existing conditions provision.
As science has improved we know that most Americans have or soon will have a pre-existing condition. Obamacare prohibits either a denial of health insurance or a higher premium to be charged to individuals based on pre-existing conditions.
The Republican plan is especially BAD here, promising to cover those with pre-existing conditions without increasing their premiums from year to year AS LONG AS THERE IS NO LAPSE IN COVERAGE. They call it “CONTINUOUS COVERAGE PROTECTION.”
If there is a lapse in coverage, new higher rates could be charged. This continuous coverage provision combined with the Republican Back to the Old days approach of high-risk pools of insureds, promises to raise the insurance premiums for individuals with pre-existing conditions.
Treatment of OLDER INDIVIDUALS, Obamacare and Republican CARE Act: FAIL.
The Republican plan is a loser for older citizens because in addition to penalizing those with pre-existing conditions (likelier older citizens) with high risk pools, it provides for a Back to the Old days approach of five to one, rather than the three to one ratio as it is under Obamacare (older people can be charged up to five times as much as younger people in premiums).
Combined, higher rates in high risk pools and a standard that permits a five times as much premium charge would negatively impact both affordability and accessibility to health care for older citizens.
Treatment of YOUNG INDIVIDUALS Republican CARE Act Fails: While the Republicans provide for Back to the Old days five to one ratio that permits charging the old up to five times more in premiums based on their age than younger people, which would favor young people rather than the three to one ratio under Obamacare, the Republicans intend to get rid of expanded Medicaid that includes availability of medical insurance for young and often less financially well-off citizens.
By trying to disguise the “option” to not purchase insurance without the consequence of the individual shared responsibility tax under Obamacare, this provision actually is Back to the Old days approach, the forget-about-them pool of individuals who will not have health insurance in spite of wanting it because they can’t afford it and will again increase the number of uninsured, many of them young, in our nation.
Regarding parents covering their children up to age 26 on their health plans which is not merely a “creation” of Obamacare but is codified by Obamacare as an OPTION, the Republicans include some unclear language that promises that the “…proposal would also require health plans to offer dependent coverage up to age 26 in the interest of stabilizing the market during the transition.”
During the transition? Sounds like that availability would disappear over time leaving access to better or any health insurance unavailable to younger citizens who might have been insured by their parents’ plans. Right now parents ARE NOT REQUIRED to cover their children up to age 26, it’s an option and removing an OPTION to cover your grown children is harmful to consumers.
FAVORING THE RICH: As explained above, HSAs are a rich person tax shelter, and are a Back to the Old days HEALTHY-WEALTHY insurance plan that we’ve settled for in the face of being unable to afford anything else, and the Republican CARE Act has a big push for them.
Also, as considered above, the Republicans would do away with expanded Medicaid which has worked in expanding the number of poor individuals who can have health insurance.
Under the CARE plan, while the Republicans provide for some tax subsidies, (entitlement money) for individuals enrolling in health insurance plans, it narrows the group who could get those subsidies by INCOME based on the Federal Poverty Level which would reduce the number of subsidy-entitlement recipients currently eligible under Obamacare. This is more of an increased expense to lower middle class rather than poor individuals since besides expanded Medicaid, Obamacare provides no hugely meaningful solutions for the very poor.
While I don’t like the Obamacare subsidy entitlement, the Republican subsidy approach is idiotic because it focuses on reducing INCOME eligibility rather than addressing one of the biggest flaws of the Obamacare subsidy approaches, the approach that considers a household’s ASSETS rather than INCOME for eligibility for government subsidies for health insurance.
Currently, Obamabucks, what I call subsidies are available to individuals meeting income criteria WITHOUT looking at how much they’re “worth.” Such an approach means that someone with millions of dollars in real estate or stocks could qualify for subsidies as long as their income fell within prescribed limits. It’s idiotic and is continued under the Republican “replace” plan.
BIG Government: Republican CARE Act, FAIL. Never too proud to benefit themselves as legislators, the Republican proposal seemingly does not address the superior benefits that federal employees get at the expense of citizens. Though the Democrats are as guilty of this as Republicans, the “flexibility” provided under the Republican plan will likely encourage federal employees to improve and retain their superior benefits that we all pay for while we struggle to pay for our own coverage.
The Republican plan also “…envisions a health financing office at the U.S. Department of Treasury charged with ensuring that the health tax credits are administered in a manner that is secure, responsible, and safe.” Expanded federal government.
PLAYING TO THEIR BASE: The Republican CARE Act naturally implicitly plays into the “fears” of “Big Guvment,” the term I use for phony fears such as the single-payer arguments that Republicans used while negligently failing to identify the actual threats to consumers under Obamacare.
There are endless references in the Republican “CARE” Act to putting things in the hands of states as they were Back in the Old days, you know, the days that helped create our healthcare crisis.
There is more backwards than forwards or even staying in the same place with most of the Republican CARE Act provisions and that should really alarm consumers.
But it’s even more insidious than that for consumers. While defining their “big” ideas, Republicans are using the hatred of “big guvment” as a means of entrusting the states with tasks they’ve already failed at.
Under Obamacare states have enormous options including their choice about expanded Medicaid that is overwhelmingly paid for by the Federal government. Some states already provided that parents could cover their children up to age 26 and beyond before the option became a federal law. Some states have attempted to attack balance billing. Some states have addressed the needs of their poorest. But many haven’t.
Using the guise that the best approach is to let States decide for themselves hasn’t worked because Back in the Old days, states already had authority to act and still we had a healthcare environment that propelled the election of President Obama with his promise of reform (no matter that it turned out to be false in many ways).
Consider the Republican plan for a Back to the Old days return to the five-to-one ratio for insurance premiums which WOULD favor cheaper insurance for young people. The Republicans also include the option for states, “…to adopt age and family rating rules that are more or less restrictive than the federal standard. If this were the case, that state would simply need to pass a law opting out of this provision for the plans it regulates.”
Notice the MORE OR LESS RESTRICTIVE phrase meaning that states that have large populations of older people could make premiums 6, 7, 8 times more expensive than they are for younger residents simply by opting out. That’s not a state discretion that consumers should want to see.
CITIZENS VS NON-CITIZENS: For me it is a loss that we’re so enamored of being politically correct that we’ve moved towards treating LEGAL non-citizens equivalently with illegal immigrants often resulting in unjust preference of the illegals, by definition lawbreakers, over citizens and legal non-citizens of our country.
I consider Obamacare and the Republican CARE proposal equally politicized on this matter and both FAIL.
While Obamacare states it’s not available to illegals, it is available to non-citizens who are legally here. Not a bad provision except in lieu of the Administration’s amnesty activities unjustifiably expanding the group of “legally here” the Democrats have essentially made Obamacare available to illegals.
Republicans in their CARE Act go the other way, needlessly confining the availability of tax credits to “citizens,” perpetuating the argument that all non-citizens are the same. They are not and those who are legitimately here should not be lumped with those who are illegally (or but for recent amnesty) here.
Based on their 9-page proposal, I don’t want to see another 900 page Obamacare-like plan that continues the trend of squeezing consumers by permitting endless increases in what we pay while inadequately addressing common-sense ways of making sure that other stakeholders behave more responsibly as participants in our healthcare system.
To date, Obamacare and the Republican “CARE” Act FAIL consumers. The Republican plan dismantles what has worked under Obamacare, expanded Medicaid and fails to address CONCEPTS (as opposed to realities) that appealed to the American people such as saving money on health insurance through increased participation and standardizing some provisions that all health insurance plans must have in addition to stopping insurance companies from dropping or overcharging those with pre-existing conditions.
Instead, the Republican CARE Act perpetuates the same basic flaws of Obamacare including squeezing consumers for more money to either pay for their own or other people’s health insurance while providing little real protection in the form of standardization for the risks of financial ruin that many individuals face in the event of illness.
It is stunning that in the face of publicized consumer sentiment over the past nearly five years, the outcry and experience, that Republicans omitted examining other stakeholders and how to limit the elements in our system that have given our system the notoriety that even since Obamacare we have the WORST rank of healthcare systems in developed nations as reported in this summer’s Commonwealth Fund survey of 11 countries surveyed (you can look this up).
Even those who went through the Commonwealth survey desperately trying to excuse why we came out worst, like Sally Pipes in her 7/14/2014 response in Forbes.com, “US Has the Worst Health Care? Not By a Long Shot,” are forced to conclude, “The Commonwealth Fund is right about one thing — the U.S. healthcare system is too expensive,” Sally Pipes, Forbes.com, 7/14/2014.
What have the Republicans done to promote cost controls? As long as we have no limits on what can be charged we will remain stuck in the endless circle of our insurance plans costing more and covering less as they chase the costs of paying for medical services in the US and look to cover those costs by increasing the amounts individual policyholders must pay.
Like the Democrats, the Republicans are focusing on how to get consumers to cover more of healthcare costs which does not improve healthcare but actually discourages getting healthcare, which is borne out by current information (Refer to the January 16th post, “State of the Union: Obamacare”).
Strengthening incentives for group insurance, a meaningful way in our system for groups to negotiate better rates for their members by promising more customers in exchange for better prices is not addressed either by Obamacare or the Republican CARE plan, both of which simply assume that consumers can carry more and more of ever-increasing medical expenses.
Stopping the wrongful payment of money to providers that accounts for BILLIONS of dollars is not meaningfully addressed by either Obamacare or the Republican CARE Act. Obviously these billions of dollars in wrongful payments, would positively impact consumer expenses. Yet, there is no fix to the Obamacare 80/20 rule that actually discourages reclaiming those wrongful payments to providers because those costs associated with finding and recovering wrongful payments are characterized as “administrative” expenses and insurers are prohibited from spending more than 20 percent of premium money on such expenses under Obamacare. The Republican plan is SILENT.
Instead Republicans argue for tort reform, limiting recoveries of patients injured from malpractice when THE INSURANCE JOURNAL, on July 13, 2012, reported in an article by Andrew G. Simpson, “Malpractice Claims at Record Low, Not Driving Health Costs: Consumer Group.”
The Republican CARE Act is not only nothing new but attempts to resurrect older policies including some that have already proven failures, such as giving states complete freedom in how they make deals with insurance companies.
The proposal is out of touch with the CONSUMER EXPERIENCE of Obamacare and instead resorts to stereotypical assumptions about Republicans, that they stupidly and automatically will approve of anything as long as it seems to be anti “big guvment,” or that they automatically think that states without some federal government governance will “do the right thing,” or that they believe that the illusion of some “free market,” that exists without Obamacare (though not without all our other laws) will somehow resolve our healthcare crisis. It’s a disappointment.
