January 9, 2017, John Hanno
“PPACA, The Patient Protection and Affordable Care Act, Tarbaby”
You would think, after more than a year of congressional hearings, deliberations, debating, speechifying and amendments leading up to the passage of the PPACA, (signed by President Obama on March 23, 2010) and after more than 60 attempts, over more than six years, by Congressional Republicans to overturn the PPACA, and after every single Republican politician grandstanded and ran on repealing and replacing the law during the last 4 national elections, that at least one member of this “ult” right group might have put forth a better, cheaper or creditable alternative. Having described the ACA as the biggest threat to American Democracy in our history, you would think any number of conservative patriots could have devised a plan to save the country from the ominous threat of providing almost 25 million poor folks with affordable, high quality, lifesaving health insurance.
But you would be wrong. Now that these saviors are in charge of the White House and both houses of congress, their plan is simply, to quickly and definitively repeal the Act, but then only think about replacing it two or four years down the road; preferably after the next midterm or presidential election. It’s clear that the entire Republican party has grabbed hold of a particularly sticky Tarbaby. They’ve demonized the PPACA by negatively attaching the Presidents name, to an overwhelmingly Democratic attempt, to Protect Healthcare Patients from abuse by the insurance industry and to slow down the double-digit increases in premiums for policies that were steadily diminishing in quality and scope.
The Act reduced by half the 45 million uninsured Americans, from 16% in 2010 to 8.9 % in June of 2016. That number has been further reduced by the 5 million or more folks who signed up during the recent enrollment period and since the election of Trump, in anticipation of the Republican’s promise to repeal. Of the 23 to 25 million covered by the Act, 12 to 15 million are covered by the exchanges and more than 11 million are covered by the expansion in Medicaid. 75% of those on the exchanges purchased insurance for $75 a month after federal subsidies, a bargain by anyone’s standards. My Medicare premiums are $104 and my hard earned employer supplemental is $146 a month, for a total of $250 a month.
When the Democrats had control of the White House, the Senate and the House in 2009, President Obama and the Democrats in Congress made the tough decision to spend their 2008 presidential election capital and mandate on doing something that Presidents since Teddy Roosevelt have been trying to accomplish for the last 100 years, finally providing affordable health care to the 45 million uninsured Americans. Almost 25 million of those have taken advantage of that decision.
Now that the Republicans have control of the White House and both houses of Congress, they want to repeal that hard won health care and build a wall between neighbors. This is just more clear examples of the difference of the two parties philosophies. Democrats try to use government to solve problems for America’s middle class workers and the Republi-cons can’t wait to undo those efforts, undermine any government intervention unless it benefits them, and compound problems for the working poor.
To all those poor and middle-class folks in the red states, and for that matter those in the blue states that vote without fail, year after year, election after election for Republi-cons; what in God’s name have these politicians ever done for you instead of to you. We know what the Democrats have done to pull folks out of poverty and desperation and to help families stake their claim in America’s middle class neighborhoods. You can check their voting records over the last 75 years. FDR’s New Deal, LBJ’s Great society, etc, etc, etc.
Yes, our healthcare system has problems. Depending on whose figures you use, we spend about $3.5 trillion, almost 20% of our GDP, $10,345 per person, or two to two and one half times what other developed countries spend on health care. America’s healthcare costs have escalated in relationship to it’s waistlines. More than half of American’s are overfed and under active. Stroke, emphysema, diabetes and heart disease in that order, much of which is preventable, are the four most expensive diseases to treat. Diabetes now afflicts 10% of Americans. The price for insulin has skyrocketed; has at least doubled in the last few years. Drugs costs of all types have escalated far more than the cost of living because most Republi-con’s and pharma state Democrats in congress refused to force drug companies to negotiate fairly with Medicare, Medicaid and other health care providers, just like the Veterans Administration has already done.
The $10,345 average per person spending is wildly different throughout the population. I know 70 year-old folks who have never filed a health insurance claim and some in their 50’s who’ve reached their $250,000 to $500,000 lifetime limits long before Obamacare ended those caps. The reality is that just 5% of the population, the oldest and sickest, account for almost half of that spending. 10% of families account for almost 50% of the spending. American’s 55 years and older account for almost 50% of spending. Half the population has very meager health care expenses, accounting for only about 3% of the total. People 35 and under represent 47% of the population but account for only 25% of the health care spending.
America’s healthcare is complicated. We have a lot of questions to sort out. Are we going to take care of the folks who, through no fault of their own, sometimes contract very expensive childhood or premature diseases? Are we going to care for folks who don’t do everything they can to keep themselves healthy; who smoke, take drugs, eat unhealthy foods, refuse to stay fit or engage in risky and dangerous behavior? Are we going to take care of old folks who end up spending astronomical costs trying to eke out a few more years at the end of life or are we going to send them off to the “Soylent Green” factory? Obamacare attempted to address many of these questions, including emphasizing common sense preventative care.
White folks 55 and over and especially 65 and over spend more money on health care than black folks and statistically, significantly more than Hispanic and especially Asian Americans. Do we give a break on premiums to Asian and Hispanic policyholders for spending less? Are we going to honor the long held idea that insurance spreads the liabilities over a wide group of consumers? A lot of folks, especially healthy young people, who work hard at staying that way, don’t want to pay for those who don’t. Of the $3.5 trillion dollars we spend on health care, 32% goes to hospitals, 20% goes to doctors and clinics and about 15% goes for prescription drugs.
Where do we make the cuts? Before Obamacare was passed, I read a story that claimed 85% of hospitals, especially those in the rural red states that voted for Trump and the Republi-con’s in Congress who can’t wait to stamp out the ACA once and for all, were under severe financial duress. Because of generous campaign contributions, we know that most Republi-cons and pharma state Democrats will again refuse to force drug companies to negotiate fairly and ethically. And it’s already hard to find primary physicians willing to treat Medicare and Medicaid patients because of low reimbursement rates.
Healthcare is complicated; that’s why it took decades and more than 2,100 pages for the ACT and I think 10,000 additional pages of rules and regulations to finally get the ACA passed by the skin of it’s chiny-chin-chin. Most of those 2,100 pages are based on erstwhile Conservative Republican ideas, just like those that compose Massachusetts successful Romney-care. Many of those ideas were first proposed during the Eisenhower, Nixon and Regan administrations. But because the Republi-cons attached President Obama’s name to them, they all of a sudden became toxic solutions. Republican members of congress and Governors wanted to make Obama a one term President and did everything they could think of to make that happen, including opposing the expansion of Medicaid at every turn, even if it hurt poor folks in their own states.
In this Robert Pear December 9, 2015 New York Times Article, “Sen. Marco Rubio Quietly Undermines the Affordable Care Act,” he describes how Rubio, along with other Republican Senators “got a little-noticed health care provision slipped into a giant spending law last year (2015) that tangled up the Obama administration, sent tremors through health insurance markets and rattled confidence in the durability of President Obama’s signature health law.”
This legislation drastically cut the reimbursements for insurance companies in the first three years of the ACA.
The article revealed “Mr. Rubio’s efforts against the so-called risk corridor provision of the health law have hardly risen to the forefront of the race for the Republican presidential nomination, but his plan limiting how much the government can spend to protect insurance companies against financial losses has shown the effectiveness of quiet legislative sabotage.”
“The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law. But because of Mr. Rubio’s efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law’s new insurance marketplaces.”
Republi-cons harangue about the escalating costs of Obamacare, but they are as much to blame because of their relentless obstruction and refusal to join with President Obama and the Democrats to improve the Act. Still, in spite of this opposition, the Kaiser Family Foundation reports that: “costs of premiums for employer covered health plans continued to moderate after the ACA was passed. Those plans rose by almost 70% from 2000 to 2005 but only 27% from 2010 to 2015 and slowed to 3% increases from 2015 to 2016.”
And their recent Kaiser Foundation Obamacare poll also found that: “majorities of Republicans, Democrats and independents alike say they favor:
- Allowing young adults to stay on their parents’ insurance plans until age 26 (85% of the public, including 82% of Republicans);
- Eliminating out-of-pocket costs for many preventive services (83% of the public, including 77% of Republicans);
- Providing financial help to low- and moderate-income Americans who don’t get insurance through their jobs to help them purchase coverage (80% of the public, including 67% of Republicans);
- Giving states the option of expanding their existing Medicaid programs to cover more uninsured low-income adults (80% of the public, including 67% of Republicans); and
- Prohibiting insurance companies from denying coverage because of a person’s medical history (69% of the public, including 63% of Republicans).
“In contrast, a third (35%) of the public says they favor the law’s provision requiring that nearly all Americans have health coverage or pay a fine (63% have an unfavorable view). A majority of Democrats (57%) favor this provision but far fewer independents (30%) and Republicans (21%) do.”
“Support for the law’s requirement that employers with at least 50 workers offer health insurance or pay a fine is more mixed, with a majority of the public (60%) supporting it, including majorities of Democrats and independents. In contrast, just 45 percent of Republicans favor this provision.
Overall attitudes towards the Affordable Care Act are largely unchanged following the election: 45 percent of the public has an unfavorable view and 43 percent has a favorable view. In addition, the poll finds health care played a limited role in voters’ 2016 election decisions, with 8 percent of voters saying health care was the biggest factor in their vote.
As many say repeal would worsen their family’s health care costs as say it would improve
Americans are divided on how repeal would affect health care costs for them and their family, with nearly equal shares saying repealing the law would make costs worse (30%) as saying it would make costs better (27%). Another four in 10 say their health care costs would be about the same. Most also say that, under repeal, they would expect their quality of care and access to health insurance to remain about the same.
Importantly, Trump voters are much more likely to say repeal would help them personally. Half (52%) of those who supported Trump say the cost of health care for them and their family will get better under repeal, and many say the quality of their health care (39%) and their ability to get and keep health insurance (35%) would get better.
The poll also probes the public’s views of whether President-elect Trump’s health care policies would be bad or good for different groups of Americans. The public is more likely to predict “bad” results for the uninsured (43%), lower-income Americans (43%) and women (36%), and more likely to predict “good” results for wealthy Americans (39%).
Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the poll was conducted from November 15-21 among a nationally representative random digit dial telephone sample of 1,202 adults. Interviews were conducted in English and Spanish by landline (422) and cell phone (780). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.”
Mr. Trump and the Republic-cons in Congress have painted themselves into a tight, bright corner. After January 20th, all eyes are on them to walk the walk instead of just talking the talk. They promised over and over and over that the ACA will destroy America as we know it and cause the loss of millions of jobs. Well, we’re still here and 25 million or more Americans are making appointments with their health care providers instead of showing up at emergency rooms with desperate health calamities. And instead of losing 800,000 jobs a month when Barack Obama took over, America has created more than 16 million jobs, more than all the G7 countries combined.
I know this is a lot of facts and figures to comprehend, but the most important ones for me are these numbers: After 9-11, we turned the whole world up-side down because of that terrorist attack. We invaded 2 countries, lost more than 6,000 young Americans, will have spent about $5 trillion dollars when the final bill comes due and we finally take care of all the 35,000 military folks injured in those campaigns. A couple of hundred thousand Iraq and Afghanistan people perished in those wars and we destabilized the entire Middle East, attempting to get revenge and justice for those 3,000 Americans killed on 9-11.
But before the ACA was passed, we lost between 22,000 and 25,000 Americans every single year just because they didn’t have health insurance. Just in the few years since President Obama signed that law and since almost 25 million American took advantage of the life saving legislation, 55,000 American lives have been saved. The Republi-cons who are jumping up and down waiting to dismantle Obamacare can’t in good conscience, ignore these numbers.
Before Obamacare, 45 million American had too much in common with poor folks in 3rd world countries and 65% of those filing bankruptcy, did so because of unaffordable medical expenses.
Any elected official who analyzes our health care system based on whats best for all Americans and not just for the special interests who contribute to their campaigns, must come to the conclusion that America, like the rest of the developed world, must transition to a single payer system before we bankrupt the treasury. Our government already pays more than 50% of the $3.5 trillion we spend on health care.
Even Mr. Trump realizes it’s the only viable alternative to this basically conservative Republican compromise called Obamacare. He came to that conclusion more than 15 years ago, probably based on the fact that when he signed the checks for his employees healthcare, he asked himself why he was sending almost 30% of those costs to the insurance companies. I’m sure he tried to figure out some way to pay the providers directly.
President Obama and the Democrats believed a public option was the best chance for the ACA to succeed. But the Republicans and some insurance company state Democrats in congress (probable based on a study that found a public option would have to be fazed in over a period of time), would not support that option. Many members of congress believed that pulling the rug out from under those who invested in the insurance industry and the large number of insurance company employees, some in their own states, could not be done overnight. But five or ten years from now, we will no doubt, have a single payer health care system.
Billionaire Trump and all the millionaires and billionaires he’s chosen for his cabinet have enough money to afford the best health care in the world. And every Republican Senator and Republican member of the House have the best taxpayer paid health care insurance America offers. I just can’t understand how these people can look at themselves in the mirror if they repeal life saving health insurance for 25 million poor folks? When all is said and done, does anyone believe that these Republi-cons in congress will try to provide or emphasize “Patient Protection” as their main legislative objective? If they eventually come up with a plan, I think an appropriate name might be the (IDCPUCA) Insurance and Drug Company Protection and Unaffordable Care Act, or Drumpfcare for short. This sticky Tarbaby will be hard to shake off.
For folks who wish to learn more about the complexities of the PPACA, please check out a book written in 2008 by the architect of Obamacare, Ezekiel Emmanuel, “Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.”
John Hanno, www.tarbabys.com
Repealing Obamacare could be a matter of life or death for many Americans. Here are their voices
Michael Hiltzik Column January 9, 2017
For Julie Ross, the looming repeal of the Affordable Care Act isn’t an abstract political issue. It’s a life-or-death matter for her 4 1/2-year-old daughter, who was born with Down syndrome and a congenital heart condition and spent her first month in the neonatal intensive care unit.
In the pre-Affordable Care Act era, when insurers could impose lifetime limits on benefits, hers was $500,000. “She would have reached that in her first two weeks,” Ross says.
For Colleen Mondor, whose 15-year-old son was diagnosed with Type 1 diabetes at age 3 and controls it today with four visits a year to a pediatric endocrinologist, repeal would mean shutting down the aircraft leasing company that she and her husband started and finding a job with employer-paid insurance. “So instead of building our own company, we’ll be taking jobs away from people who need them.”
Senators say, without health insurance you can just go to the ER for care. For my daughter, that would be too late. She’ll die without these protections. — Julie Ross of Dallas
Pre-Obamacare, every insurer she applied to for coverage asked about her family’s medical histories. When she told them about her son’s diabetes, as she tweeted earlier this month: “That was the end of the conversation, every. single. time.”
Steve Waxman, 59, an independent filmmaker in Miami, had a heart attack before Obamacare was enacted, but he had insurance. If the Affordable Care Act is repealed and protections for those with preexisting conditions are eroded, he’d be red-tagged as a potentially costly repeat patient. “Life is a preexisting medical condition,” he observes. “Only in America can you go bankrupt because of it.”
On Obamacare repeal, GOP ideology is colliding with reality
David Zasloff, 55, of North Hollywood is still recovering from a stroke he suffered in 2015. Without the Affordable Care Act, treatment “would have cost everything I had, including my niece’s college fund,” he says. Now he has a Blue Shield silver plan via Covered California, the state’s Obamacare exchange, and pays $144 a month to cover most of his treatment and medication.
Ross, Mondor, Waxman and Zasloff, and countless more like them, live in abject fear that Republicans will follow through on their determination to repeal the Affordable Care Act, without passing a replacement that will maintain the crucial protections the law has given them. Obamacare’s critics have painted a picture of the law that is wholly negative: that it’s a “disaster,” that it’s in a “death spiral,” that it’s caused a “struggle” for families that use it. To people not directly affected by the Affordable Care Act — the 85% of Americans who get their coverage from their employers or public programs such as Medicare— these assertions seem plausible enough, especially since they’ve been repeated incessantly for more than six years. Repeat a big lie often and loudly enough, and you don’t need evidence.
House Speaker Paul Ryan (R-Wis.) often repeats a mantra that “Obamacare has failed the American people.” But a Ways and Means Committee fact sheet he cites as evidence doesn’t include a single quote from an Obamacare enrollee. Not one.
The people who know the truth — those whose medical histories would make them uninsurable in a non-Obamacare marketplace, who would face bankruptcy if they faced a major medical need, whose condition would go unmanaged, or who would be forced to give up their dream of creating their own business and working for themselves — their voices are seldom heard. So we’re going to present a few.
Some are insurance customers who struggled with coverage — not from Obamacare, but in a pre-Affordable Care Act market in which carriers looked for any reason to reject applicants, limit their benefits or impose costly surcharges. They struggled with high deductibles, with high-risk pools such as those that Ryan says could easily accommodate Americans with chronic conditions. They know he’s wrong. Some took advantage of the freedom the Affordable Care Act brought them to start their own businesses, because now they could give up their employer-paid insurance without fear of going without coverage. And they know the frustration that comes from going unheard on Capitol Hill.
Julie Ross, 41, runs a home business in the Dallas area with her husband Mark, a commercial artist. She home-schools her daughters, 4 1/2-year-old Niko and her 7-year-old sister. Julie suffers from asthma, a condition that relegated her to a high-risk pool before the Affordable Care Act. Before Niko was born, she told me, she and her husband kept separate health plans, so that her own condition wouldn’t affect the cost of his coverage.
Niko’s conditions require constant pro-active management. “I hear senators say, without health insurance you can just go to the ER and get care,” she says. “For my daughter, that would be too late. She’ll die without these protections.”
Ross has reached out to Texas Sens. Ted Cruz and John Cornyn, both Republicans, and her congressman, Rep. Pete Sessions (R-Dallas). The offices of Sessions and Cruz won’t return her calls. Cornyn’s staff met with her, but parroted his idea of giving families such as hers a tax credit to buy insurance, but it wouldn’t be enough.
“When I talk to Republicans, I tell them we’re everything you want us to be,” she says. “We’re self-employed, we’re pro-life.” But if she lost the access to coverage she gets from the Affordable Care Act, to replace it for her daughter, “I would have to get a divorce from my husband and move into Section 8 housing and go onto Medicaid and welfare. We are living in total fear.”
Colleen Mondor, a pilot and writer, is 48 and runs an aircraft leasing firm in Alaska and the Pacific Northwest with her husband, Ward Rosadiuk, 53. The family’s healthcare nightmare started 12 years ago when their toddler came down with a cold and didn’t get better. He was diagnosed with Type 1 diabetes.
“That changed everything,” Mondor recalls. The family got shunted into a high-risk pool, where the deductible was $10,000 per person and the coverage was sharply constrained. “The high-risk pool is a party no one wants to attend,” she says. “It was absolute misery. We had no control over which doctors we could see, and the deductible was ridiculous.”
Frustrated about a debate about Obamacare that seemed utterly irrelevant to her situation, a few days after New Year’s, Mondor posted a tweet about the difficulties facing small business owners post-repeal. What followed was a torrent of retweets and replies. “I thought I was alone, but I discovered it was not just me,” she says.
Mondor’s teenage son has received first-rate care for his incurable disease thanks to the family’s Affordable Care Act-protected health plan. But pondering the GOP proposals to repeal the law has become a dominating distraction. “I’m not thinking about how to grow my business or get new clients,” she told me, “but about what [Vice President-elect] Mike Pence or Paul Ryan are up to.”
Affordable Care Act plans aren’t perfect. They’re often more expensive and less generous than the health plans offered by big employers. But for people without access to such plans, they’re a lifeline. People such as Donald Goudie of Irvine, 68, who was forced into retirement ahead of schedule when his department at IBM was downsized in 2014. IBM gave him six more months of company insurance, but after that, his wife, Sandra, needed coverage for her chronic rheumatoid arthritis.
The Goudies knew from having tested the pre-Obamacare individual market a few years ago that Sandra, now 63, would be uninsurable without the law’s protection for preexisting conditions. So would Donald, who has a cardiac condition. Because of the combination of a premium increase and a reduction of their eligibility for Affordable Care Act subsides, Sandra’s premium will rise to more than $500 a month this year from about $150 last year. “That’s a big jump, but still affordable,” he says. But that’s only if Congressional Republicans don’t tamper with Social Security and Medicare, on which the couple depends and which also are in the GOP’s crosshairs.
“We’ve gone from our retirement with enough money saved and supplemented with Social Security,” he says, “to wondering if we have enough money to pay for the basics.”
Do the Republicans who talk so blithely about how Obamacare has “failed the American people” and how they will provide “relief” — despite not having any “relief” plan in place despite six years of promising one — have any idea what their plans mean to millions of Americans facing the challenge of health coverage in their daily lives? The evidence is that they don’t, because they don’t talk to the targets of their plans.
Those whose lives hang in the balance of the debate over the Affordable Care Act are beginning to speak up. They’re independent business owners. Parents with desperately ill children. Adults with chronic diseases. Workers who have been laid off. Families for whom an uninsured injury or diagnosis would mean bankruptcy. The Affordable Care Act helps them, and could help even more if Republicans in Congress cared enough about them to make it better.
But to know that, they’d have to listen. Michael Hiltzik
Yahoo Health January 7, 2016
75% of Americans don’t want Obamacare repealed without an alternative
President Barack Obama challenged Republicans on Friday to present a feasible alternative to Obamacare instead of blindly adopting the “repeal and delay” strategy.
And it turns out the vast majority of Americans may agree with Obama.
Only one in five Americans supports flat-out repealing Obama’s 2010 Affordable Care Act, according to a new survey conducted by the nonpartisan Kaiser Family Foundation. Of the 1,204 US adults surveyed, 75% either oppose the repeal entirely or want to keep the law until the details of a replacement plan emerge.
Americans, however unhappy they may be with Obamacare, would rather know their alternatives before tossing their coverage — however costly — completely out the window.
This isn’t the only poll to suggest Americans aren’t on board with killing Obamacare now. Republican Congresswoman — and a passionate Obamacare foe — Marsha Blackburn (R-Tenn.) took to Twitter (TWTR) on Wednesday to conduct her own poll on Obamacare, asking whether people supported the repeal of Obamacare, likely anticipating that many would vote to repeal the legislation. Nearly 8,000 people voted and the overwhelming majority — 84% — voted no.
President Obama considers the ACA one of his administration’s hallmark achievements, and has been spending his last days in office urging fellow Democrats not to “rescue” Republicans by helping them pass replacement measures.
Though there have been vocal and vehement opponents to the ACA, including Sen. Mike Enzi (R-Wyo.), House Speaker Paul Ryan (R-Wis.), President-elect Donald Trump and Vice President-elect Mike Pence, the law’s opponents have yet to come up with a replacement.
Apart from its impact on consumers, the act of repealing the ACA without a replacement would also have dire business consequences. The nonpartisan Committee for a Responsible Budget published a report this week warning the full repeal of the ACA would cost up to $350 billion over the next decade and leave 23 million people uninsured.
The report suggests “any changes to the ACA should reduce, not increase, the unsustainable growth in the federal debt. Savings from repealing parts of the ACA must be large enough to not only finance repeal of any of ACA’s offsets, but also to pay for whatever ‘replace’ legislation is put forward.”
Meanwhile, 50 states would suffer job losses and sharp reductions in business output without Obamacare, predicted a separate study conducted by the nonpartisan Commonwealth Fund and GWU’s Milken Institute School of Public Health. In total, scrapping Obamacare could cost 3 million people jobs and trigger economic disruption, according to that study.
The report’s lead author, Leighton Ku, explained to NPR why the ACA is so tied up with the larger economy: “The payments you make to health care then become income for workers and income for other businesses. And this spreads out. Health care is almost a fifth of the US economy, so as you begin to change health care, there are repercussions that go across all sectors.”
Even medical professionals, insurers and hospital groups have been coalescing to argue they need to see a replacement for ACA before it’s repealed. The American Medical Association (AMA) wrote a letter to congressional leaders pointing out that though the health care system has ample room for improvement, “policymakers should lay out for the American people, in reasonable detail, what will replace current policies” so that patients can make informed decisions.
We’ll find out soon enough whether senators are listening to their constituents when the vote hits the floor next week.
Melody Hahm is a writer at Yahoo Finance, covering entrepreneurship, technology and real estate. Read more from Melody here & follow her on Twitter @melodyhahm.
Yahoo Health, January 7, 2017
Obamacare repeal costs: 3 million jobs gone, $1.5 trillion in lost gross state product
Spending less by getting rid of Obamacare could end up costing a whole lot more.
Up to 3 million jobs in the health sector and other areas would be lost if certain key provisions of the Affordable Care Act are repealed by Congress, a new report said Thursday.
At the same time, ending those provisions could lead to a whopping $1.5 trillion reduction in gross state product from 2019 through 2023, according to the study.
“Repealing key parts of the ACA could trigger massive job losses and a slump in consumer and business spending that would affect all sectors of state economies,” said Leighton Ku, director of the Center for Health Policy Research and professor at the Milken Institute School of Public Health at George Washington University.
Ku is the lead author of the report, which was issued by the Milken Institute and the Commonwealth Fund.
The report comes as President-elect Donald Trump and the new Congress are moving toward repealing parts of the ACA through the budget reconciliation process.
“The immediate and most visible effect of ACA repeal would be the loss of coverage and access to care for millions of people who have gained insurance because of the law,” said Sara Collins, vice president for health-care coverage and access at the Commonwealth Fund.
“This study points to even larger potential economic effects that would be detrimental to the health and well-being of millions more,” Collins said.
The estimate of job and state product losses are based on a scenario in which Congress defunds federal subsidies that most Obamacare customers receive to help lower their monthly insurance premium costs, and also gets rid of funding to cover adults who became newly eligible for Medicaid under the ACA.
Repealing both provisions would save the federal government $140 billion in health-care spending, the report found. And as that funding spigot dried up, it would lead to job losses and a drop in gross state product, the report said.
The study notes that most of the federal funding for Obamacare flows to hospitals, health clinics, pharmacies and other medical providers, who in turn hire and pay staff and purchase goods and services.
The biggest job losses would occur in California, with 334,000 lost jobs, Florida, with 181,000 lost jobs, Texas, with 175,000 lost positions, and Pennysylvania, New York and Ohio, each of which would lose more than 125,000 jobs, the report estimates.
One-third of the job losses would be in the health-care sector, according to the report. The remaining two-thirds of job losses are expected to come from construction, real estate, retail, finance and insurance.
As with other reports estimating the effects of Obamacare repeal, the economic downsides could be mitigated, or completely offset by a replacement plan for the ACA.
But so far, Trump and the Republican-led Congress have not committed to such a plan. So researchers have been unable to estimate the ultimate effects of a replacement plan. Dan Mangan
The Daily Kos
Dear Congressional GOP: Don’t Say You Weren’t Warned. (including your own experts)
By Brainwrap, Tuesday January 3, 2017
A definitely-NOT-comprehensive selection of opinions regarding the Republican Party’s imminent “Repeal & Delay” strategy for the Affordable Care Act:
What outside experts are saying about repeal and delay:
American Academy of Actuaries: “Repealing major provisions of the ACA would raise immediate concerns that individual market enrollment would decline, causing the risk pools to deteriorate and premiums to become less affordable. Even if the effective date of a repeal is delayed, the threat of a deterioration of the risk pool could lead additional insurers to reconsider their participation in the individual market.” (Letter to Congress 12/7/16)
Nick Gerhart (Iowa Republican Insurance Commissioner): “If you’re going to repeal this, I hope that there’s a replacement stapled to that bill.” (NPR, 11/21/16)
Governor Jay Inslee and Mike Kreidler (Washington Democratic Governor and Insurance Commissioner): “Decisions to cut funding before developing a replacement puts the health of Washingtonians at great risk through undermining and destabilizing their health care.” (Letter to Congress)
Sabrina Corlette (Georgetown University): “The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy.” (New York Times, 12/3/16)
Michael Cannon (Cato Institute): “What they are planning to do is absolutely insane.” (TPM, 12/18/16)
(Note: Michael Cannon, one of the architects of the infamous King v. Burwell case, by his own admission, hates the ACA more than anyone else on the planet)
Larry Levitt (Kaiser Family Foundation):
- “The individual insurance market could collapse in between a repeal vote and a replacement vote” (TPM, 11/29/16).
- “Any significant delay between repeal of the ACA and clarity over what will replace it would likely lead insurers to exit the marketplaces in droves” (Huffington Post, 12/1/16).
- “Republicans are in a bit of box here, because the individual mandate is an anathema to them, but repealing the individual mandate immediately while keeping the protections for people with pre-existing conditions would likely lead to immediate chaos in the insurance market” (TPM, 11/29/16).
Stuart Butler (formerly Heritage Foundation), Alice Rivlin (former CBO and OMB Director), Loren Adler (Brookings Institution): “If replacing the ACA is truly the goal, though, repealing it first without a replacement in hand is almost certainly a disastrous way to start. First, a reconciliation bill would likely destabilize the individual market and very possibly cause it to collapse in some regions of the country during the interim period before any replacement is designed…If no replacement plan materializes, the hollowed-out individual market – for people without access to employer-provided or public coverage – could be left in shambles.” (Brookings, 12/13/16).
Topher Spiro (Center for American Progress): “Their strategy of repealing now and replacing later was designed to provide false assurance that everything would be okay. Now there’s a growing awareness that in fact this strategy would cause a lot of chaos and perhaps even collapse the market before a replacement plan can be put into place.” (TPM, 11/29/16).
Robert Laszewski (Health Care Consultant and ACA Critic): “Republicans are being awfully naive. They seem to be ignoring the risks in the transition period.” (Vox, 12/1/16).
Former Senator Tom Daschle: “It sends all the wrong messages to the private sector…You gotta have the replacement before you have the repeal.” Politico Pulsecheck Podcast, 12/1/16).
Joshua Blackman (Professor and former Cato Institute Scholar): “Passing it by itself is politically expedient, but would create a series of headaches very quickly for the Republicans.” (TPM, 12/18/16).
Linda Blumberg, Matthew Buettgens, John Holahan (Urban Institute): “If Congress partially repeals the ACA with a reconciliation bill like that vetoed in January 2016…Significant market disruption would occur…Many, if not most, insurers are unlikely to participate in Marketplaces in 2018.” (Urban, 12/7/16).
Judith Solomon (Center for Budget and Policy Priorities): “Many people likely would lose coverage before any Republican health plan was fully implemented.” (CPBB, 12/5/16).