Tag: Health care

Implement and Improve the Affordable Care Act (ACA)

Implement and Improve the Affordable Care Act (ACA)

Posted on by Jack

Now that the election is over and Democrats remain in control of the Senate and President Obama occupies the Whitehouse, it should be clear to everyone that repeal of the Affordable Care Act (ACA) is extremely unlikely and House Republicans can stop wasting their time with this repeal and replace nonsense for at least the next 4 years.

There are many good things about the law. Or at least I think it is good that insurance companies cannot exclude people who they think will be expensive because of preexisting conditions. I think it is good that they cannot cap the benefits someone who gets seriously sick can receive. But I do not believe the law is perfect.

There are also a good number of things that do not seem like great ideas. And people will differ in opinions as to what those are. For example, many oppose the individual mandate to have health insurance. Others may think the free rider provision for employers is not such a great idea.

You can disagree with some provisions of the law without disliking all of it.

But the ACA is law and there is almost no chance of that changing. I see lots of good things but there are also problems, or at least provisions that some people see as problems. Unless you are happy with all of it, actively encourage your Representatives, Senators, and President to improve the ACA.

More disingenuous crap from Mitt Romney on medicare this time

More disingenuous crap from Mitt Romney on medicare this time

Posted on by Jack

I do like the term “disingenuous crap” to describe many of Mitt’s apparent positions. This time he is talking about Medicare.

I suppose it is meant to scare seniors who don’t think it through. Be Scared, very scared. Not so much about Obama’s cuts to Medicare as Mitt would like. But just think about the Medicare cuts in the Ryan/Romney budget.

Read the NPR story on his latest dubious and baffling claim. Is he really that that confused or is he trying to confuse us?

A false savings by repeal of Obamacare

A false savings by repeal of Obamacare

Posted on by Jack

I have many disagreements with Mitt Romney’s tax and budget plans and here is one that may surprise a few people who think his promises are all about saving money. On his website, he lists several savings. Among them-

Repeal Obamacare, which would save $95 billion in 2016

The House recently passed a bill that did just that. Or at least it would do so if it also passed the Senate and was not vetoed. Seems a bit unlikely now but there next year there is sure to be a different Congress and maybe a new President. But my point was that the House did pass this bill, HR 6079, which would repeal Obamacare and the Congressional Budget Office (CBO) looked at the fiscal consequences.

In a “Letter to the Honorable John Boehner providing an estimate for H.R. 6079, the Repeal of Obamacare Act”, the CBO did a 10 year estimate of spending and revenue which would result if that legislation became law.

Sure enough there were big saving there but the government was forgoing even more revenue. The bottom line is a net loss to the government of 109 billion dollars. Since this is just an estimate a reasonable guess is that the average cost is about 10 or 11 billion dollars per year. This could just be added to the deficit or we could just add this to Mitt Romney’s tax plan.

I’m sure this figure does vary from year to year as different parts of Obamacare are implemented but since the average appears to actually be net loss to the government Governor Romney should explain why he thinks this action will save 95 billion dollars in 2016. And he might want to mention what he thinks will happen in all those other years.

Yesterday (August 1, 2012) a date that shall live in infamy

Yesterday (August 1, 2012) a date that shall live in infamy

Posted on by Jack

According to Rep. Mike Kelly (R-Pa.), yesterday (August 1, 2012) was a date that shall live in infamy. What terrible thing happened that made it comparable to the great loss of life on September 11, 2001 and December 7, 1941 ?

Why it was the implementation of a provision of the Affordable Care Act (Obamacare) ? Now most folks won’t think this is as terrible as the terrorist attacks of September 11, 2001 or the attack on Pearl Harbor that got us into World War 2 but at least 1 republican representative thinks so.

What was this dastardly provision that is so terrible? It is the provision of preventive health services to women( avert your eyes for the rest of this sentence if you are squeamish) which includes contraception. Surely a terrible thing and a good reason for this date to live in infamy.

Here is the story of CBS News which includes a video of the Congressman. Here is an annoucement from Kathleen Sebelius, Secretary of Health and Human Services in case you are interested what this provision is actually about.

As I mentioned before this is a complicated issue but “date that shall live in infamy” is a bit over the top.

Do we improve the healthcare law or repeal and replace?

Do we improve the healthcare law or repeal and replace?

Posted on by Jack

Now that the healthcare law or the Affordable Care Act (ACA) has been upheld by the Supreme Court, the ball is once again in the hands of Congress.

Should we improve the law? Many people support aspects of the law but may oppose others. Perhaps they should encourage Congressmen to try for improvements. I will use the term Congressmen to include women just because “Congress persons” sounds awkward and I cannot think of a good inclusive term (Comments to suggest alternatives, anyone?) Maybe even replace those Congressmen who are not interested in improving the current healthcare law.

There are those who like the idea of repeal and replace. They would reject the law because there are parts they disagree with and trust Congress to replace it with something better. Not a very bright idea, in my opinion.

There are those who just want to repeal the law. Are they really happy with the current system? Do they think it is a good idea that many are uninsured, we have the most expensive system in the world, and certainly far from the best results? Not a good value in my opinion but then I don’t own an insurance company.

Conflict between Religious Freedom and Healthcare (Affordable Care Act aka ObamaCare)

Conflict between Religious Freedom and Healthcare (Affordable Care Act aka ObamaCare)

Posted on by Jack

Recently there has been quite a bit in the news about conflict between Religious Freedom and Healthcare. Specifically, the mandate for employers to provide health insurance meeting standards and the freedom of religious organizations to refuse what they feel in morally objectionable. To be even more specific, the administration believes contraceptive services should be included in all health plans but the Catholic Church believes contraception is morally objectionable and that they should be forced to provide such is an issue of religious freedom.

The administration is tasked with outlining minimum standards for health insurance policies under Affordable Care Act (aka ObamaCare). The administration has decided all policies should cover contraception with an exception for religious institutions such as churches and other houses of worship but the Catholic Church does not want to provide such coverage to employees of its many charitable organizations. The Obama administration has proposed a compromise which is still unacceptable to many.

Although it is often presented as a simple fight between religious freedom and a woman’s right to contraception, it is much more than that. Opens up a whole bunch of questions worth thinking about.

Should the exemption to health care requirements be limited to established churches alone?

What about church-related organizations?

Should any employer because of his or her church be exempt for providing some aspects of health insurance to employees?

Does a church need to be of any particular size before its members are allowed to object to the health care law on religious grounds?

How about employer with religious objections not based on any church?

What if the employer objects to more than contraception? Say the objection is to transfusions, surgery, chemotherapy, diseases related to various lifestyle factors, etc.

If an employer has objection to providing insurance or certain parts of insurance should that employer provide the employee with an allowance comparable to what the employer would pay for a policy they are willing to provide?

Since this is so complicated, should we just skip the employer mandate and move toward a single payer system or individual policies?

Huntsman Beats Obama

Huntsman Beats Obama

Posted on by Jack

Jon Huntsman beats Barack Obama in making public a jobs plan. President Obama’s plan should be out in a few days. Gov. Huntsman’s plan has already been available for several days. It covers many aspects of the economy as would be expected as jobs are not an isolated issue and they are but a part of the larger economy. Here is the whole plan as a PDF as well as a blog entry on the candidate’s website that summarizes.

Let us hope more of the candidates come out with plans like this so we can have a debate on some ideas. I was a bit disappointed that parts of Huntsman’s plan were vague but I’m sure these points will be more fully explained in the near future.

do we need to destroy medicare in order to save it

do we need to destroy medicare in order to save it

Posted on by Jack

No doubt Medicare has a problem. We are told the funds available are not enough to pay the benefits promised. So do we need to destroy Medicare (as it is) in order to save it?

Can we reduce costs without impacting benefits? You occasionally read about really big frauds being found. Do we need to do more about preventing those or at least minimizing damage? Private insurers seem less subject to this type of fraud. What is their secret? Can we make the medical system more efficient and less coslty.

If the American people think we should keep Medicare benefits, do we need to find a better funding mechanism? Obviously paying a small percentage of your salary while working and getting heath care benefits for life after 65 is not a viable model in itself. Do we want to supplement this from general revenues or add another dedicated tax. Increasing the taxes on gasoline consumption or adding a carbon tax seems appropriate. We need to decrease our dependence on oil and other carbon producing eneny sources so a tax seems logical to me.

Do we want to decrease benefits? That is the other possible solution. I don’t agree with Rep. Ryan’s plan but at least it has moved us a bit more toward a discussion on this.

House Proposal to Defund Health Reform Would Block Market Reforms, Cost-Containment Measures, and Coverage Improvements — Center on Budget and Policy Priorities

House Proposal to Defund Health Reform Would Block Market Reforms, Cost-Containment Measures, and Coverage Improvements — Center on Budget and Policy Priorities

Posted on by Jack

House Proposal to Defund Health Reform Would Block Market Reforms, Cost-Containment Measures, and Coverage Improvements — Center on Budget and Policy Priorities.

Plan B alternative to the individual mandate for health insurance

Plan B alternative to the individual mandate for health insurance

Posted on by Jack

Last month I wrote about Plan B or finding an alternative to the individual mandate for health insurance . Several have been proposed but I’d like to point out a recent NY Times opinion piece by Ross Douthat which says in part:

The mandate is a harder puzzle, since it works in tandem with the requirement — popular enough to have many Republican supporters — that insurers cease denying coverage to customers with pre-existing conditions. If you repealed the mandate without repealing that requirement, people could simply wait until they were sick to buy insurance, driving everyone’s prices up.

But Republicans could propose dealing with the same problem in a less coercive way. One alternative would establish limited enrollment periods (every two years, for instance) when people with pre-existing conditions could buy into the new exchanges without being denied coverage. Anyone who failed to take advantage wouldn’t be able to get coverage for a pre-existing condition until the next enrollment period arrived. This would reduce the incentive to game the system, without directly penalizing Americans who decline to buy insurance.

Several other ideas for conservative reforms of the health care reform known as ObamaCare are discussed and the article is worth reading but this seemed directly relevant to my thoughts on finding alternatives to the individual mandate for health insurance.

Health care reform: Plan B for individual mandate

Health care reform: Plan B for individual mandate

Posted on by Jack

Yesterday I wrote about Plan B for the individual mandate which could be threatened by court decisions or a future congress. Health care reform ensures that insurance companies must take people with preexisting conditions. The obvious problem is that someone could skip having insurance until they know big medical bills are coming soon and then apply for insurance and companies would be powerless to refuse and so be stuck with pick payouts for relatively little in premiums. The solution in the Affordable Care Act (aka ObamaCare) is the individual mandate .

A few days ago there was a court decision that ruled the individual mandate unconstitutional (see Bloomberg News story). There will be more litigation and the issue may end up in the Supreme Court.

Striking down the individual mandate by the courts or perhaps a repeal of this provision would be bad news for heath care reform but it is good to see that someone is thinking about a Plan B (see Kaiser Health News story)just in case the individual mandate is out of the picture.

The most straight forward idea would just be to raise taxes enough to cover insurance cost for the whole country and then offer a tax rebate to each filer that would cover a reasonable insurance plan and have some sort of mechanism for insuring those who cannot afford to pay full price for a reasonable plan. This approach would probably be a hard sell in an age of “no new taxes”.

But other options are surely possible. I like the one suggest by Paul Starr of Princeton in the article cited above (Kaiser Health News). Perhaps this or some variant of the idea might be useful.

Princeton sociologist Paul Starr, who was a senior health adviser to President Bill Clinton, anticipated the risk of political backlash even before health law was passed. He outlined a more flexible alternative aimed at quelling political fires while still expanding the insurance pool.

Except for the poor (people making less than $9,350 and couples earning less than $18,700 are not subject to the mandate but would be eligible for coverage under Medicaid), people would have three choices, Starr said. They could buy insurance, with subsidies if they qualify. They could pay an annual tax penalty for going uninsured. Or they could opt out with no penalty – but they couldn’t opt back in for five years.

Those who opt out wouldn’t be eligible for any subsidies in the exchanges. And under this scenario, they wouldn’t be covered by one of the most popular protections in the legislation — the ban on insurers excluding people with pre-existing conditions. People who opted out could still shop for insurance, but there would be no guarantee that they could find an insurer to cover them, at a price they could afford.

Then there could be waiting periods or penalties for waiting (as in Medicare Part B). At any rate, if enough people think this is an important issue, I’m sure we can find a reasonable solution.

Note added: You might want to check out FireDogLake which lists 8 alternatives to the individual mandate.

implications of tax compromise to delay Bush tax hike

implications of tax compromise to delay Bush tax hike

Posted on by Jack

There is a very interesting exchange of views about the implications of the tax compromise to delay the Bush tax hike or extend the Bush tax cuts, depending on your point of view.

The HealthBeatBlog hosts a nice discussion of the implications of this tax compromise for Medicare, Social Security and Health Care Reform. The link is to Part 1. So more is coming and probably soon.

Health care debate: preexisting conditions and individual mandate

Health care debate: preexisting conditions and individual mandate

Posted on by Jack

The Affordable Care Act (aka ObamaCare) includes a provision requiring individuals to have a certain level of health insurance or pay a penalty. This is commonly called the individual mandate. And is often thought needed for the health care law’s provisions preventing insurance companies from denying coverage to those with preexisting conditions.

Depending on who you listen to there has been either elation or disappointment over the news lately that a Virginia judge has ruled the individual mandate unconstitutional. Of course this one decision and the next judge could support it or disagree but one thing we do know is there will continue to be litigation on this and the issue may end up in the Supreme Court.

Striking down the individual mandate by the courts or perhaps a repeal of this provision would be bad news indeed for those who believe our health insurance system should cover preexisting conditions. It is possible that the individual mandate will be preserved (and some think it likely) but shouldn’t those who believe we should cover preexisting conditions be thinking about a Plan B just in case the individual mandate is out of the picture.