Saturday, June 10, 2017

Sabotaging the Affordable Healthcare Act (Obamacare)

This is the story about the never-ending GOP effort to destroy Obamacare, literally forcing passage of their obviously inadequate AHCA (the GOP-proposed “replacement” American Health Care Act that is deeply punitive for anyone with expensive medical issues from preexisting conditions). Their goal is to subvert the ACA by not enforcing its provisions – particularly funding from both user and government sources – literally forcing the system to fail. By sending mixed messages to insurers, the second vector is to destabilize the overall insurance marketplace, pretty much eliminating the ability of big medical insurance carriers to plan and sustain viable operations within the existing networks of healthcare exchanges.
GOP ACA repeal-advocates faced trending reports that Obamacare was stabilizing, that those massive premium increases in states with limited operating healthcare providers in that exchange network were fading from the headlines. But rather than accepting this as good news, Republican ACA repeal-advocates, with massive assistance from the Trump administration, simply redoubled their efforts to push insurance carriers out of the system. They turned the solid ground of a working healthcare system into a quicksand of unpredictability.
The Chicago Tribune (June 7th) explains, starting with the latest carriers to throw their hands up in frustration: “A major shoe dropped in the battle to preserve the Affordable Care Act on Tuesday [6/6], as Anthem, the nation’s second-largest health insurer, announced it is withdrawing entirely from the individual market in Ohio.
“The move will leave 18 counties without an insurer in the ACA exchanges, leaving an estimated 10,500 Anthem customers high and dry — most of them in Appalachia, among the poorest parts of the state.
“Anthem said in its announcement that the principal causes of its withdrawal are ‘the shrinking individual market as well as continual changes in federal operations, rules and guidance.’… That’s a reference to the uncertainty surrounding President Trump’s vagueness about whether he will approve subsidies for deductibles and co-pays for the poorest Obamacare enrollees and whether his administration will continue enforcing the ACA’s individual mandate in 2018.
“The ‘increasing lack of overall predictability,’ Anthem said, ‘simply does not provide a sustainable path forward to provide affordable plan choices for consumers.’… Anthem’s action in Ohio is its first withdrawal from a state thus far, but bodes ill for customers in the 13 other states where it offers ACA plans, including California.
“More important, it underscores the costs that insurance customers across the country will face unless Trump and the Republican majorities in Congress take action to shore up the individual market. Instead, they’ve been undermining it at every turn… The costs of their action — or inaction — are being documented by insurance executives and regulators in an increasing number of states.
The most detailed look at the impact of government policies under Trump and the Republican Congress comes from Covered California, the state’s ACA exchange… Under normal conditions, Covered California says, it would expect a premium increase of about 9% for next year. That includes 7% based on increased medical costs and a one-time 2% increase reflecting the reimposition of a health insurer premium tax that was suspended through this year. That’s close to the average 7% annual increase for Covered California plans since the exchange’s launch in 2014.
“In that case, Covered California enrollment would remain stable at about 2.4 million people, about half of whom receive premium subsidies… If the cost-sharing reduction payments are eliminated and the administration stops enforcing the individual mandate requiring everyone to carry insurance, however, enrollment would fall and prices would soar.
“Enrollment would drop to about 2.07 million. The average premium increase would be 42%, not 9%. More than half of the additional premium would result from non-enforcement of the mandate, which would leave older and sicker enrollees in the insurance pool while allowing younger and healthier residents to bail out without penalty. The rest of the increase would come from the loss of cost-sharing reduction payments because insurers would be bound to continue offering low-income residents lower deductions and co-pays, but wouldn’t receive money from the government to make up the difference.
“‘The premium increase caused by these policy changes would result in a worse risk mix and higher premiums,’ Covered California says, ‘as healthier, lower-risk consumers are ‘priced out’ of coverage.’ The burden would fall hardest on buyers with household income above 400% of the federal poverty line, or $98,400 for a family of four. The shock would be cushioned for those below that level, as premium subsidies rise in tandem with premiums.
“California’s exchange would remain relatively healthy, however, compared to some other states. That’s because California has been an aggressive supporter of the ACA, keeping enrollment high through marketing and outreach and managing health plan offerings to maintain competition and keep costs low. Eleven insurance companies compete statewide, though not all offer plans in every county. Still, 92% of consumers in the state can choose from at least three insurers, and none has fewer than two choices…
“If the individual mandate is repealed and cost-sharing reduction payments are not made, however, ‘insurers estimate they would seek an increase of 36.3%.’... Although the ACA’s critics assert that such increases are the residue of the original law, indications contradict that. Both the Congressional Budget Office and Standard & Poor’s expect the 2018 markets to be stable under existing policies. The instability reflected in double-digit premium increases is entirely the result of Trump’s failure to ensure that the cost-sharing reductions are paid and the GOP’s inconclusive efforts at repeal. Under those conditions, more shocks in more states are undoubtedly coming.”
The Republicans are hoping that the headline will read, “Failed Obamacare Finally Collapses” and not “Republicans Succeed in Forcing Obamacare to Fail.” They are walking a fine line between succeeding in their repeal and replace mantra and being blamed for undermining our entire healthcare system with millions losing coverage. They are continuing to tell the world what they hope the electorate will actually believe, even if any collapse of Obamacare will only be as a result of GOP sabotage.
The June 7th Washington Post embellishes: “‘The truth is, the American people are struggling under the weight of the failed policies of Obamacare, and it must go,’ Vice President Pence told a group of female entrepreneurs [at a White House meeting], before calling on two of them to share their experiences with the law’s ‘reams of red tape, skyrocketing premium costs’ and what he labeled job-sapping taxes.
“Both the gathering and Pence’s remarks represent officials’ strategy to convince Americans that the collapse of the Affordable Care Act is inevitable and to bolster public and congressional support for a GOP overhaul. Since the day he was inaugurated, President Trump has taken steps to erode the ACA, from instructing his deputies to ease up on ACA regulations to curtailing consumer outreach during the final days of 2017 health plan enrollment.
“‘The best thing politically is to let Obamacare explode,’ Trump told The Washington Post in March… But behind the scenes, the increasing fragility of the law’s insurance marketplaces has created an increasingly difficult dilemma for the president’s top advisers.
“The issue is whether to take any steps to allay the concerns of skittish insurers, some of which are either hiking up rates or pulling out altogether, or let things deteriorate even further — even at the risk of being blamed. The advisers are split, according to several individuals briefed on the deliberations: Pence and Office of Management and Budget Director Mick Mulvaney have argued against intervention, while Health and Human Services Secretary Tom Price backs providing some federal support if a conservative health-care bill fails to pass this summer.
“For the moment, the administration has defaulted to a position of doing little to try to soothe the health insurance industry even as many insurers warn that federal actions — or inaction — could aggravate the situation. Some suggest the White House’s relentless naysaying is not reflecting marketplace problems as much as driving them.”
Do we need reasonable access to healthcare after decades where over 45 million American were not covered? Look at the above mortality rates that we faced at the beginning of the implementation of Obamacare. We had the highest in the developed world. This would suggest that any body of government officials trying to reduce healthcare coverage in the United States are effectively a new incarnation of a death panel.
I’m Peter Dekom, and it is fascinating to watch those who installed a party that holds them in callous disregard continue to cry their support for those seeking to destroy their healthcare system.

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