Muftic: Obamacare revisited: heads up for good, bad, and ugly proposals
Just as certain as hot temperatures in summer, repeal and perhaps replace Obamacare is a topic of party platforms and soaring oratory at the party conventions. What is certain is that Obamacare needs tweaking or replaced. What is not an option is simply to kill it. 24 million would lose their insurance now.
The political problems are thorny: How much of government participation can the majority tolerate and what benefits are covered. To what extent are we willing to cough up the money in co pays, higher deductibles, more expensive premiums, or taxes.
I received a livid call from a subscriber to an Obamacare policy bought through an exchange not in Colorado. His premium just increased by 25%. (In Colorado, this year’s increase was close to the national average of 11%). I congratulated him for having too high an income to get a premium subsidy. In many ways Obamacare is successful. Government subsidies make it affordable for either the near poor via Medicaid expansion or lower middle income. Benefits have greatly improved for everyone, including employer provided insurance. All insurance must cover pre-existing conditions and free annual physicals and cancer screenings and more. The costs of premiums and all of health care went up less quickly than if Obamacare had not been in place and the number of uninsured has been more than halved. In fact, cost savings to the government added years to the solvency of Medicare.
So why have those premiums jumped? Per the Motley Fool’s Sean Williams (www.fool.com) the healthier have not enrolled as originally projected because the penalties have not been enough to force them into a health plan. The result: there are not enough healthy paying in to pay for the sick and there are no effective controls of private insurance premiums. There is no effective non-profit competition, either. Now, nearly all insurance in exchanges are provided by private for profit insurers.
New replacement plans are being proposed. The Democratic plank is shaping up to having government play a larger role, by lowering the age to qualify for Medicare, and providing a government provided option which would be cheaper than private ones, providing competition to private for profits. Donald Trump’s earlier proposal would leave 18 million without health insurance.
Another, like Bernie Sanders’ proposal of Medicare for All, a single payer system, is on the ballot this fall in Colorado, but it would require much higher taxes on payroll, all income, and on businesses to pay for it. Lower wage earners, middle class workers and small businesses would feel the pain the most.
Ezekial Emanuel and Tophir Spiro writing in USAtoday, July 1, looked at the GOP replacement plan just proposed by House Speaker Paul Ryan. The plan would gut Medicaid, partially privatize Medicare, eliminate prescription drug, maternity and mental health care coverage, increase average deductibles by more than $2700 and repeal limits on out of pocket costs. It eliminates subsidies for low income Americans and it costs $25 billion to cover few people in high risk pools who would still have to pay high cost premiums. It would give less tax advantage to employers’ coverage and the estimate is that 6 million workers would lose insurance by 2019. An estimated 5.5 million seniors would be thrown off Medicare as the eligibility age would rise to 67 years old.
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