Thursday, December 22, 2016

A Tragedy Of Shakespearean Proportions

Dana Milbank, opinion writer for the Washington Post, was featured on some of the news shows yesterday to discuss Trump voters who desperately rely on Obamacare (The Patient Protection and Affordable Care Act). His article appeared Tuesday and was creating quite a buzz. I, for one, enjoyed 20 minutes of TV that didn’t feature Putin or the words “Conflict of Interest”. Still, this is a serious issue, and we will treat it with a little more respect than Mr. Milbank.

There are and always will be Americans who vote against their personal interest. This is a link to a Forbes article on the issue. But as this article and many like it point out, it is not necessarily that simple. Poor people in Kentucky didn’t decide on Election Day to screw themselves. The previously uninsured didn’t vote for Donald Trump because he vowed to repeal Obamacare. Interviewing them now, a month after the election and a month before anything has changed is unfair to them. It is bad enough to be poor. We don’t need to make them look stupid.

I have a number of clients who have benefited from the PPACA who still voted for Trump. Let’s take a quick look at some of the possible reasons for their choice.

It Didn’t Matter – There are many people who feel that Obamacare will be repealed loudly and retained quietly. We may end up with Trumpcare, a modification that fixes some issues while creating new problems. The Republicans declare victory and the Democrats cede the next 5 years of glitches and complications to the other side.

The Bright Side – I have at least one client predicting a major economic recovery that will result in more jobs with benefits. If they score better gigs, they won’t need individual coverage and all of this will cease to be relevant to THEM.

A Better Way – There must be a better option and their team’s got it. No matter how many times they have been let down by politicians of both parties in the past, this could be the time they get it right.

There Are Other Issues – Health Insurance is really important to me, but I doubt that there are many single issue Health Insurance voters. Abortion, Pro-Life or Pro-Choice, seems to drive people to the polls. Immigration and jobs, too. People were riled up and voted AGAINST Obamacare, often without understanding its positive impact on them personally, but I think that they saw it as part of a whole, a failure of Washington to properly serve and protect them.

Regardless of why or who voted for Donald Trump, the election is over and about 40% of us have spoken. Donald Trump will be the next president and he has a Republican controlled Congress. He has nominated Tom Price (R-GA) to be the next Secretary of the Department of Health and Human Services. Mr. Price is famously anti-Obama and anti-Obamacare. His solutions are radically different and concerning. Will the Price plan or something like it be implemented? No one knows at this point.

Congress will be very active in January and February. It will be important for all of us to watch them closely and share our thoughts with our elected officials. I don’t think that we will see any major changes in 2017, but that is my guess. I will be in Washington in February, in part to discuss my clients’ needs and how the actions of Congress can help or hurt my people.

Until then, if you need a liver transplant like Mr. Mills of Whitley County, Kentucky, I strongly suggest that you get this scheduled soon. The press may paint you as a victim of your own folly for being in this mess, but if you put it off too long this really could be a tragedy of Shakespearean proportions.


Wednesday, December 7, 2016

Reality What a Concept

Editor’s Note: All articles, blogs, and news reports about Obamacare (The Patient Protection and Affordable Care Act) must, per the edict from the incoming president, begin by stating that Obamacare is a terrible burden on the American public and that it needs to be repealed immediately. If you have benefited by the law because of the subsidies, preexisting conditions, or access to care, please have the good sense to keep that to yourself. You wouldn’t want the most powerful man in the world to tweet about you at 3 AM.

The election was about a month ago. Each day brings new proclamations and trial balloons. The Congress beat at Health Insurance Issues With Dave has been working overtime to monitor all of the pronouncements coming from our elected officials. Today’s post will serve as an update.

Republicans in both the House and Senate are eager to repeal Obamacare. The repeal may even be HB 1, the first bill of the new legislative session. It will be a great moral victory. The newspapers, Facebook, and TV news will talk about it that night. The details are more important. Some in Congress want to have the replacement bill be introduced as soon as the celebration and back-slapping dies down. Others believe that the replacement package is still 1, 2, EVEN 3 years away. This is known as Repeal and Delay.

There are advantages and disadvantages to both strategies.

On June 22, 2016, Speaker of the House Paul Ryan released his health care plan, A Better Way. His proposal begins with the repeal of Obamacare. “…This law cannot be fixed…We need a clean start in order to pursue the patient-centered reforms the American people deserve”. That has been the Republican line of attack since the bill was passed in March 2010. No compromise. No tweaking. No amendments. The Republicans have bludgeoned the Democrats with Obamacare to the point that even those Americans who have benefited the most from the new law might not understand or appreciate it.

If Obamacare is repealed and immediately replaced we, the American people, would be able to quickly identify winners and losers, the before and after of the Republican’s actions. The insurance companies and the medical providers would also know their places in the new market. Unfortunately, that is not going to happen. There is no Republican alternative plan. There never was one. Speaker Ryan’s recent interviews confirm that. Reality: What a Concept.

So we are looking at Repeal and Delay. The concept is simple. As detailed by the Urban Institute, the partial repeal of Obamacare could be done through the process of reconciliation. The Senate Democrats could not stop this since reconciliation only needs a simple majority in the Senate. Congress would starve Obamacare by cutting off the funding for Medicaid, tax credit subsidies, and eliminate the individual and employer mandates. Doing that immediately would be the equivalent of dropping a bomb in Times Square. But it could be phased in over a three year period.

Why three years? For one, Paul Ryan, Mitch McConnell and the entire Republican team want to take a victory lap for killing Obamacare even before it is really gone. The real impact of their actions wouldn’t hit until after the 2018 election, just the press releases. The other reason is that they need several years to come up with a viable option that can be phased in properly. Mr. Ryan doesn’t want to take health insurance away from 20 million Americans. That is not his goal. Plus, some of them vote! And, if they can buy three years they have enough time to find a Democrat or two to sign on to their final legislation which will provide the illusion of bipartisanship. The Democrats tried the same thing in 2009 and 2010. But in the end Senator Chuck Grassley and Senator Olympia Snowe still walked away from the negotiations.

The insurance companies, already losing money in the individual market, and the medical providers aren’t real excited. Eliminating Medicaid expansion will force millions of Americans out of the health care system. No routine care. No access to maintenance prescriptions for diabetes, high blood pressure, and other common easily treated illnesses. The E/R waiting rooms will again be filled with people seeking care for minor ailments better treated in a doctor’s office. Would the Republican controlled Congress reinstate reimbursements for charity care? Who knows?

The insurance side is worse. The law would still require insurers to cover anyone who applied, regardless of preexisting conditions. But healthy people would not be required to retain coverage. Only the unhealthy and the responsible would seek coverage. Insurers would be foolish to offer coverage under those circumstances. Major insurers, now publicly owned, would be forced to leave markets or face the ire of their shareholders.

Other alternatives? Darned if I know. You can’t have health insurance if there isn’t an insurance company to sell it. I am scheduled to go to Washington in February to meet with our members of Congress. I have no idea what I’m going to find when I get there.

Oh, and did I mention that Speaker Ryan would like to change Medicare?