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Off-Topic => Political Debates - Thick Skin Required for Entry => Topic started by: kickingandscreaming on January 16, 2017, 11:04:48 AM
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50 ways to lose your coverage if Obamacare is repealed
BOB DOHERTY | POLICY | JANUARY 5, 2017
The Republican congressional leadership appears to be determined to move forward with a high-risk “repeal, delay and replace” plan, very early in the new 115th Congress to repeal (at least on paper) the Affordable Care Act’s key coverage provisions—Medicaid expansion, subsidies to make private insurance sold through the exchanges affordable, the individual and employer mandates, and the taxes to pay for coverage—by a simple majority vote, while delaying when the repeal would go into effect to give them time to come up with a replacement.
The problem is that this isn’t likely to work, not without disrupting care for millions. As I point out in a commentary The Demise of the Affordable Care Act? Not So Fast, published online on Tuesday in the Annals of Internal Medicine, I think it is magical thinking to believe that one can repeal the ACA, delay the repeal from going into effect, avoid loss of coverage, and then replace the ACA with something that keeps the popular parts while jettisoning the unpopular ones.
Much more likely, according to many independent and non-partisan studies, the result of “repeal, delay and replace” will be that many millions of Americans will lose their coverage as early as 2017, and many more if the ACA is full repealed without an alternative that offers comparable coverage.
So many, in fact, that I found from the studies that there must be at least 50 ways you could lose your health insurance if the ACA is repealed (my apologies to songwriter Paul Simon). Under ACA repeal, you could lose coverage if:
1. You are the one of nearly 59 million who would lose coverage if the ACA is fully repealed.
2. You are one of the 7.1 million who would lose coverage because of an expected “near collapse” of the individual insurance market while Congress tries to come up with a replacement.
3. You are one of the 4.3 million who would lose coverage as early as 2017, because “if Congress eliminates the individual and employer mandates immediately, in the midst of an already established plan year, significant market disruption would occur.”
4. You are one of the 52 million people, 1 out of every 4, with a pre-existing medical condition, because insurers may once again be allowed to turn you down or charge you more for coverage.
5. You have a specific “declinable” medical condition—like asthma, diabetes, cancer, or hepatitis C—that could become ineligible for coverage in the individual insurance market.
6. You live in one of 11 states, most of them red (Republican-leaning) states in the South, where at least 3 in 10 non-elderly adults have a pre-existing “declinable” medical condition.
7. You have a “declinable” pre-existing condition and lose your employer-based coverage, say because of a lay-off, and then find that no insurer in the individual market will cover it.
8. You are a miner, baggage handler, EMT first-responder, off-shore oil driller, or one of dozens of other occupations that places you at risk of suffering job-related injuries needing medical attention. Before the ACA, many people in such higher-risk occupations could be turned down for coverage.
9. You are a woman, because insurers would again be allowed to treat being female as a pre-existing condition, allowing them to charge you higher premiums.
10. You are a woman having a baby, because insurers could again begin to deny coverage for maternity care and breastfeeding support, supplies, and counseling.
11. You are a woman using contraceptives, because insurers would again be allowed to deny coverage for contraception.
12. You are a survivor of domestic or sexual violence, which often was counted as a pre-existing condition before the ACA, making you ineligible for coverage. You could also lose the ACA-mandated coverage for interpersonal domestic violence screening and counseling.
13. You are a pregnant woman who has a medical need for gestational diabetes screening, an ACA-required benefit that could be taken away.
14. You are a sexually active woman who benefits from the ACA-required coverage of STI counseling on sexually transmitted infections (STIs), which can reduce risk behaviors in patients; for high-risk human papillomavirus (HPV) DNA testing every three years, regardless of Pap smear results; for HIV screening and counseling; and for contraceptive counseling.
15. You are a sexually active man who benefits from HIV screening and counseling and STD screening, benefits which may no longer be offered if the ACA is repealed.
16. You are or have a childwho gained coverage from the ACA and now might lose it, doubling the number without health insurance, like the 67,000 children in New York state alone who would are at risk of being dropped.
17. You are one of the 12.3 million people who live in a state that has expanded Medicaidunder the ACA and could be dropped from coverage if it is repealed.
18. You are a low-wage person who lives in a red state that was considering expanding Medicaid, and are now likely to put the brakes on expanding eligibility.
19. You are one of the 14 million who would lose their Medicaid coverage, or no longer gain coverage in the future, if the ACA’s Medicaid expansion is replaced with block grants to the states.
20. You are in a red state that has expanded Medicaid because ACA repeal could cut off funding for the “more than 2.5 million people in GOP-represented states [who were] were enrolled in Medicaid through the expanded eligibility” created by the ACA.
21. You are one of the 60 million people suffering from a mental or behavioral health condition or substance use disorder who could lose your coverage because “full repeal of the health law would gut major benefits and protections …”
22. You are one of the 1.4 million young adults who get coverage from their parents’ plan but could lose it.
23. You are an entrepreneur with a pre-existing condition who may have to give up your start-up to get a regular job that offers coverage.
24. You have a pre-existing condition and end up being stuck with a job you don’t like—job lock—because you might not be covered if insurers in the individual market can again turn you down or charge more for coverage.
25. You are one of the 10.7 million seniors or disabled persons under Medicare who to date have saved $10.8 billion on prescription drugs because the ACA phases-out the “doughnut hole” in Part D coverage.
26. You are one of the over 39 million seniors who have received no-cost preventive services guaranteed by the ACA, like “flu shots, tobacco cessation counseling, as well as no-cost screenings for cancer, diabetes and other chronic diseases” and “annual wellness visits wellness visit so they can talk to their doctor about any health concerns” at no out-of-pocket cost to you.
27. You are a senior enrolled in Medicare who would likely see higher premiums, deductibles, and cost sharing for Medicare-covered services.
28. You are white working class person because 56 percent of those at risk of losing coverage from ACA repeal are white, most of who are from the working class.
29. You are Latino or Hispanic because 22% of those who could become uninsured from repeal are Hispanic, a disproportionately large share of those at risk.
30. You are African-American because 12% of those who have gained coverage under the ACA are black, and now are at risk of losing it if the law is repealed.
31. You are one of the 7 million people who are eligible for cost-sharing subsidies under the ACA; if these subsidies are repealed, your maximum out-of-pocket costs will increase substantially.
32. You are one of the 9 million people who make between 100 and 400% of the Federal Poverty level who receive ACA’s premium subsidies to make insurance affordable.
33. You are older but not yet Medicare age, because if insurers are again allowed to charge older people 5 or 6 times more than younger ones (the ACA limits it to no more than 3 times more), your premiums in the individual market will go up.
34. You are one of the 133 million people with at least one chronic health condition who could find yourself again turned down for coverage or charged more.
35. You are one of the millions of patients who are, or will sometime in the future, be diagnosed with cancerand who now benefit from the ACA’s prohibition against excluding or charging more to patients with pre-existing conditions, no-cost coverage of preventive and screening tests, and a ban on annual and lifetime limits on coverage, leaving many cancer patients “frantic and scared” about loss of coverage.
36. You are one of the 137 million people (55.6 million women, 53.5 million men, and 28.5 million children) who have received no-cost coverage for preventive services from private insurers since the ACA’s required coverage of such services went into effect.
37. You are one of the millions of Americans who received combined $2.4 billion in refundsfrom your insurers because they spent too much on administration and too little on direct patient care; protections that would go away if the ACA was repealed.
38. You are a gun violence victim, because the ACA “has brought coverage to tens of thousands of previously uninsured shooting victims, often young African-American men, who, once stabilized in emergency rooms, missed out on crucial follow-up care and have endured unremitting effects of nerve injuries, fractured bones, intestinal damage and post-traumatic stress disorder.”
39. You are one of the 105 Million Americans, many of whom are middle class, who could again be subjected to lifetime limits on coverage under ACA repeal.
40. You are LGBT, because the ACA protects you from discrimination in coverage.
41. You live in a “red” (Republican leaning) statebecause you are more likely to be at risk of losing coverage under the ACA and your state will have fewer state resources to help you keep it, compared with “blue” [Democratic-leaning] states that have fewer people at risk, and more resources to maintain coverage for those who are.
42. You don’t have a college degree, since an estimated 80 percent of adults at risk of becoming uninsured if the ACA is repealed do not have at least an associate degree.
43. You are one of the millions of non-elderly veterans who have gained coverage since the ACA was enacted, reducing the uninsured rate among veterans from 12% in 2011 to 8.6% as of 2015.
44. You are one of the approximately 15 million people with incomes below 200% of the federal poverty level, approximately 48,000 for a family of four in 2016, who would lose coverage under full ACA repeal.
45. You are one of the 700,000 who would lose coverage from your employer.
46. You are insured and end up paying more for your hospital care, because hospitals are forced to cost-shift to you the $166 billion in losses that would result from ACA repeal.
47. You are one of the 1.7 million non-seniors who live in Florida and have signed up for Obamacare coverage sold by private insurers, the most of any state, and would stand to lose it if the law is repealed.
48. You live in California, the state that “has the most to lose” if the ACA is repealed.
49. You live in any of the 50 states or the District of Columbia, all of which would see big losses in coverage; it’s just a matter of degree.
50. You one of the 36,000 Americans who could die each year if the ACA is repealed.
To be clear, you can’t add up all of the numbers above, because people at risk of losing coverage could fall in multiple categories. But no matter how you slice and dice it, ACA repeal, particularly without an alternative that would cover as many with comparable benefits and protections, will lead to massive losses in coverage, touching just about everyone in some way, in some fashion. Yes, there are at least 50 ways you could lose your health insurance if the ACA is repealed, and probably, many more.
Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at the ACP Advocate Blog.
http://www.kevinmd.com/blog/2017/01/50-ways-lose-coverage-obamacare-repealed.html
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The biggest problem with repeal then replace is the wacko wing of the Republican Party. They will fight for the conservative view point of restrictive private insurance. With 52 senators only 3 defections would stop the senate from passing replace.
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Congratulation K&S , I think your writer has found every single negative thing that could happen. As if the American People are going to let this happen!! Or as if Congress will let that happen. You are a very intelligent woman and all of your posts are well written, however, your depression is so obvious, it ruins them. Hope you get some help somewhere so you can be enjoyable also. Thanks for all the enjoyable info tho.
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How very presumptuous of you! Please mind your own business. I'll deal with my own issues, thank you very much. If I am depressed it's because of the horrific man that you have helped elect and the damage he is doing to this country. Your oblivious denial keeps you from seeing the truth. There is only one way to "cure" this depression and that is to impeach him. Hopefully, our legislators will have the gumption to begin that process very soon before he hands over the whole country to Russia and takes away all of our rights.
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Thank you for posting this, K&S.
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LOL!!!
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The only thing I have to say is we survived 8 years of Regan, 4 years of Bush the elder, 8 years of Bush the lesser. I think we will survive 4 years of Drumph the Idiot.
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Good story. Anyone who thinks that our leaders will repeal the ACA and give us something with exactly the same benefits but magically less costly etc is deluded. Someone has to loose and likely it will be people like us who cost the insurers (or Medicare).
Honestly I don't really follow this too much because I know people will die as a result of any repeal, but I did see some random quote this weekend that the reasons the republicans don't already have a replacement ready is because Obama basically accepted the plan they have been pushing for forty years. This seems to support that:
http://www.politifact.com/punditfact/statements/2013/nov/15/ellen-qualls/aca-gop-health-care-plan-1993/
Qualls said the Affordable Care Act "was the Republican plan in the '90s." The bill she had in mind did have a strong roster of Republicans behind it, and it did share many major features with the Affordable Care Act. There were some significant differences but in a side-by-side comparison, the similarities dominate.
One area that Trump might do some good is cost containment across the spectrum of heath care and drug spending, but I don't think our house and senate leaders will accept that, unless he gets them over a barrel somehow.
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The only thing that I can say is that Hitler, who was at heart a big Leftwing Socialist, could only have dreamed of devising such a plan. If Trump is indeed going to do something like this, he won't end up having any physical voters left! Clearly preposterous.
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Anyone who thinks that our leaders will repeal the ACA and give us something with exactly the same benefits but magically less costly etc is deluded.
They cannot reduce the cost, but they can shuffle around who pays.
Remember, under the current system there is a disconnect between what an individual pays and the free market value of insurance provided to that person.
I doubt they will go to "no subsidies, everyone pays a free market price" (the old system), but they can shuffle around who pays what surcharge (or tax burden) to transfer from policy holders on the basis of of their ability to pay and to other policy holders on the basis of their need. I expect Trump to shift the burden from non-subsidy exchange customers to taxpayers in general.
"From each according to his ability, to each according to his need " - Mark, Karl 1875
One area that Trump might do some good is cost containment across the spectrum of heath care and drug spending
Trump can shine a bright light on senators and congresspeople who refuse to repeal the law prohibiting Medicare from negotiating drug prices. This won't make any difference in solid red or blue states, but in swing states, the reps will have to balance the influence of the lobbyists against that of the voters. Imagine attack ad "Rep xyz voted to keep medicare drug prices at full retail".
I probably should be concerned since Gilead (the humanitaran org that charged $95K for the Hep-C cure) is one of the top holdings in one of my mutual funds.
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So Simon Dog, what kind of replacement bill would you like to see Congress give to Trump? What do you see as the ideal, and what do you see as POSSIBLE?
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So Simon Dog, what kind of replacement bill would you like to see Congress give to Trump? What do you see as the ideal, and what do you see as POSSIBLE?
I think Ryan is on the right track - free market insurance like the old system, with a tax subsidized high risk pool for those who are not attractive to those selling free market policies. Each insurer would be required to participate in the risk pool at the same percentage they are in the fee market section of insurance. I would set the risk pool rate at a modest (perhaps 25%) over the free market rate. This would spread the "take from" across the entire population in proportion to the income tax they pay.
As to drugs:
#1: Remove the federal ban on large scale importation of drugs from foreign distributors
#2: Make it a criminal offense to "ration" shipments to foreign markets or take other steps to prevent re-importation
#3: Put Medicare/Medicaid on a "best customer" basis
#4: Set up a Medicare/Medicaid formularly and require negotiation to get on the formulary
#5: Require all members of congress to buy insurance through the high risk pool
#1 would help end the practice of "gouge each customer the most they can pay" - something currently done only in medicine, higher education and, to an extent, car sales.
As to #3 - "Best customer" clauses are common in govt contracts. The vendor guarantees that the govt pays no more than the lowest price paid by any other buyer, often retroactive for a period of time as well. Indians would pay a lot more than $1000 for Harvoni and US resident would pay a lot less.
#5 is the only one outside the realm of possibilty.
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Simon Dog, you know what? I really do appreciate you taking the time and making the effort to answer the questions I pose to you. I may not agree with some of your replies, but I deeply respect and am grateful for the fact that you give coherent and well thought out answers, so cheers to you! :clap;
I'll think about all of your recommendations when I get more time, but one thing that caught my eye and deeply disappointed me is in reference to your point #1. Looks like the Senate has already shot that one down, although the vote is being touted as "symbolic". Even some Dems voted against it!
http://observer.com/2017/01/cory-booker-bernie-sanders-amendment-prescription-drugs/
http://www.thestranger.com/slog/2017/01/16/24803190/wait-why-did-washington-senators-vote-against-importing-cheaper-drugs-from-Canada
Could you explain to me a bit more about how you see a tax subsidized high risk pool working? Would this be for people who already have an expensive pre-condition? How would this work for a person who was just diagnosed with, say, cancer? Who would get to define conditions that are "high risk"? Obviously, all of us on IHD would be "high risk", which brings me to my next question, which is do you think that ESRD should remain under the auspices of Medicare?
I hear the phrase "high risk pool" a lot, but I realize that I am not sure what it actually means. Any explanation you could offer would be welcomed! Thanks.
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I doubt they will go to "no subsidies, everyone pays a free market price" (the old system), but they can shuffle around who pays what surcharge (or tax burden) to transfer from policy holders on the basis of of their ability to pay and to other policy holders on the basis of their need. I expect Trump to shift the burden from non-subsidy exchange customers to taxpayers in general.
i.e. a single payer system?
I'll think about all of your recommendations when I get more time, but one thing that caught my eye and deeply disappointed me is in reference to your point #1. Looks like the Senate has already shot that one down, although the vote is being touted as "symbolic". Even some Dems voted against it!
Don Byer one of the people from my area voted against this. He is a democrat.
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Could you explain to me a bit more about how you see a tax subsidized high risk pool working? Would this be for people who already have an expensive pre-condition? How would this work for a person who was just diagnosed with, say, cancer? Who would get to define conditions that are "high risk"? Obviously, all of us on IHD would be "high risk", which brings me to my next question, which is do you think that ESRD should remain under the auspices of Medicare?
High risk would be anyone the insurance companies would not voluntarily insure at their standard rate.
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High risk would be anyone the insurance companies would not voluntarily insure at their standard rate.
I have more questions!!!! Aren't you glad? :P
I assume this high risk pool would be funded by tax subsidies as you've mentioned. With an ageing population that's not necessarily doing so "gracefully", and with the introduction of newer and more expensive drugs at such a rapid pace (I mean, how many drugs are now available to treat diabetes?), I worry that this pool will be chronically underfunded. Do you trust Congress to institute a mechanism by which the subsidies will automatically increase, and do you trust them to not faff about with said mechanism (like with COLA)?
Wouldn't there be some sort of political backlash when people realize that their tax dollars are going to someone else's healthcare, i.e. funding a high risk pool?
Putting "insurance companies" and "voluntarily" into one sentence makes me quiver and quake. Don't you see insurance companies kicking people off their insurance once they're diagnosed with cancer, thinking, "Oh, we don't have to cover Patient X because the high risk pool will cover him now." Wouldn't taxpayers end up having to pay for treatment of the sickest and most expensive patient?
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Patents for drugs should require limits on profits. Exceed those limits remove the patent and allow generic to enter market.
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Tax subsidies were the problem with ACA. Mitch McConnell and friends kept the subsidies low, low, low, which meant the premiums ended up being high, high, high.
Had the subsidies been what they should have been, and what the Obama administration intended -- affordable to more working Americans -- more people would have embraced the ACA.
So I'm not placing any trust in Ryan and the high-risk subsidy plan.
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The republicans have in the field of financial aid to the American people added only one piece of legislation. The Medicare drug plan which in reality is a means to giving big pharma obscene profits by requiring Medicare and patients to pay full list price for drugs. Allow Medicare to negotiate prices and costs to Medicare and patients would drop dramatically. The republicans seem to worry more about the profits of pharma then they do about the costs inflicted on the citizens. But big pharma is also a big donater to the members of the congress.