Republican Presidential candidates for 2016 have one thing undeniably in common. They all pledge to repeal the Affordable Care Act (ACA) and replace it with lollipops and rainbows…er, lower premiums and lower costs and more freedom. These candidates have been asked repeatedly for specifics of their plans and sidestep the questions with more general, meaningless statements.
Well Scott Walker, Governor of Wisconsin, has finally put the pedal to the metal and produced an outline of what he proposes to do to replace the ACA.
To preface my introduction to his plan let me just assert that
- The Affordable Care Act is not perfect, and
- There are ways available to address any flaws without tearing the entire law apart, and
- Any fix or replacement must be based on the facts of the current situation
Click to access Day-One-Patient-Freedom-Plan.pdf
Here is the first paragraph of Scott Walker’s plan.
Washington’s failed approach to health care is hurting the American people. Big government created a health care system built around Washington, not hardworking families. This backwards approach drove up health care costs and reduced access to medical care for far too many of our neighbors, friends, and family members.
Each sentence is a lie.
Washington’s failed approach to health care is hurting the American people
On the contrary, the uninsured rate has dropped dramatically and there have been real positive consequences of the law.
http://www.huffingtonpost.com/2015/03/22/obamacare-5-years_n_6918326.html
Big government created a health care system built around Washington, not hardworking families.
Again false, That is the equivalent of the often made claim that the ACA was a “government takeover of health care.” And that, my friends, was the Politifact 2010 Lie Of The Year And do not dismiss Politifact as a source because Walker himself takes advantage of it in support of his ideas, which you will see.
This backwards approach drove up health care costs and reduced access to medical care for far too many of our neighbors, friends, and family members.
To this I can pretty much only respond, HUH?
More lies
The list of ObamaCare failures is long. Democrats have long promised affordability with their big-government health care plans, from HillaryCare to ObamaCare. But instead of lower costs and expanded coverage, ObamaCare has caused insurance premiums across the country to spike as the cost of Washington’s new regulations and taxes are passed to the American people. The Heritage Foundation found from 2014 to 2015, average premiums for young people increased by approximately 14 percent in Iowa and 19 percent in Ohio and Minnesota. Families in Kansas and Louisiana saw increases of almost 14 percent.[1] We will likely see even higher premium increases in 2016 and beyond as ObamaCare’s insurance company bailouts phase out. Probably the most cited ObamaCare failure, and Politifact’s 2013 ‘Lie of the Year,’ was President Obama’s repeated claim that if you liked your existing health care coverage, you could keep it.[2] So while both Obama and Hillary Clinton made promises that their health plans would allow Americans to keep their existing coverage, millions of people were pushed out of their preferred health plans and restricted access to the doctors they wanted to see.[3] ObamaCare has also punished employers with costly mandates and red tape, hurting growth and job creation. Another ObamaCare failure is the way it went about expanding coverage. Where ObamaCare expanded the number of people with coverage who previously were not insured, it did so mostly by pushing people into Medicaid, a program that was already overburdened.[4] And many of the people who received insurance through the ObamaCare exchanges had in fact been previously insured, but got knocked off their private health plans. Others switched coverage because federal subsidies only flowed if they signed up for ObamaCare’s prescriptive plans. As a result, billions of taxpayer dollars have been spent on downgraded health policies.
Let me make some points here.
- The Heritage Foundation can find whatever premium increases it wants, but these increases have been predicted since day one of the law and, guess what, the average actual increase for premiums from 2014 to 2015 was ZERO
Now, of course an average of zero does not mean there were no increases but that there were both increases and reductions. And the article cited notes the reasons behind the relative stability of health care premiums across the board including the benefits derived from the standardization of plans under the ACA. But other factors include geographical differences, the number of insurers in the market and other variations.
Likewise the predictions for hikes in 2016 are based on proposals not actualities. Again look to the Commonwealth Fund for guidance.
http://www.commonwealthfund.org/publications/blog/2015/jul/proposed-premium-rate-increases-for-2016
- “ObamaCare’s prescriptive plans”,
I am not certain what he means. All the ACA does is require health care plans to now contain prescritption drug coverage, though not necessarily for all drugs, whereas previously they did not have to.
http://thinkprogress.org/health/2013/12/10/3042741/drugs-obamacare-coverage/
- Where ObamaCare expanded the number of people with coverage who previously were not insured, it did so mostly by pushing people into Medicaid, a program that was already overburdened.[4] And many of the people who received insurance through the ObamaCare exchanges had in fact been previously insured, but got knocked off their private health plans.
The Department of Health and Human Services reports that 11.7 million Americans signed up for coverage through the exchanges in the 2015 enrollment period ending in March and
As of March 2015 HHS reported a total of 16.4 covered due to the ACA between the Marketplace, Medicaid expansion, young adults staying on their parents plan, and other coverage provisions.
So Medicaid enrollees are nowhere near a majority of the newly insured. Even if that were so, the states that accepted the expansion of Medicaid are saving money.
However, the states that refused to expand that program are experiencing greater costs to care for the uninsured.
Nationwide, the cost of caring for uninsured people in non-expansion states between now and 2024 is projected to reach $266 billion if no new states decide to expand Medicaid, according to a report in April from the Kaiser Family Foundation. If all states decided to expand, that cost would drop by a third.
- millions of people were pushed out of their preferred health plans and restricted access to the doctors they wanted to see.
First of all, the number of people who may have had policies cancelled appears to have been grossly overstated.
http://www.factcheck.org/2014/04/millions-lost-insurance/
But do you know the only group that specifically was mandated to lose their coverage under the ACA? No, you probably don’t, but it was Congress, together with certain staffers who were kicked out of the coverage they had had. And that coverage was simply participation in the same menu of plans available to all federal civilian employees. That is why, when Ted Cruz lost his spousal coverage when his wife left Goldman Sachs, he was forced to purchase coverage from one of the ACA exchanges. Yes, Virginia, there is a mandate for Congresscritters to participate in the exchanges. A mandate, incidentally, I believe to be both totally political and stupid.
Because I find the source, FOX News, to be amusing in this context I’ll present a viewpoint expressed there.
But in an overall sense the ACA is a scapegoat for any cancelled policies. If insurance companies had enough introspection they would paraphrase Cassius
The fault lies not in the ACA, but in ourselves.
You see…and really this is not revelatory, simply a reminder…prior to the Affordable Care Act insurers could cancel policies for any damned reason or none at all. Just peruse this article from 2007 before the ACA was a gleam in Barack Obama’s eye.
http://usatoday30.usatoday.com/money/perfi/insurance/2007-01-28-insurance-1a-usat_x.htm
And private health care plans frequently change the providers they allow access to. See this look at the UPMC–Highmark steel cage match in Pittsburgh.
http://www.wsj.com/articles/SB10001424052702303812904577295901619123904
Now to the essence of Walker’s plan, his five points.
1. Repeal ObamaCare in its entirety.
We heard you already, Scott!
2. Ensure affordable and accessible health insurance for everyone.
A. LOWER HEALTH INSURANCE PREMIUMS
B. PROVIDE TAX CREDITS TO ANYONE WITHOUT EMPLOYER-SPONSORED HEALTH INSURANCE
C. GIVE ALL AMERICANS MORE CHOICES AND MORE ACCESS BY IMPROVING HEALTH SAVINGS ACCOUNTS (HSAs)
D. ALLOW ALL AMERICANS TO SHOP FOR INSURANCE IN ANY STATE
E. PROTECT ALL AMERICANS WITH PRE-EXISTING CONDITIONS
Part A is a pipedream and Walker’s ideas as to how to accomplish this are nebulous and sketchy at best. And it ignores the reality that in this century health care costs and premiums for coverage have seen steady, sometimes very large increases, with and without the ACA, but the rate of growth of both has slowed since the law was enacted.
Part B, A footnote accomopanying a chart showing suggested levels of subsidies states
so there would be no intrusive oversight by the IRS and no accountant needed to determine the credit amount.
Pray tell who administers or tracks these subsidies if not the IRS. And he wants to put honest accountants out of work? I have friends who would be hurt.
Part C Here’s more on health savings accounts and pros and cons.
https://en.wikipedia.org/wiki/Health_savings_account
One note I will add is that in Part B Walker claims his simplification of subsidies will lessen IRS influence, but HSA’s appear to reuire high IRS maintenance to ensure compliance with the law.
Part D This may be the only part that has some merit in that presumably there would be more competition for the health insurance premium dollar. But the same was said about permitting banks to operated across state lines and look at what Dr. Franken-deregulate-Stein has created.
Part E The devil is in the details. And these details have a strong resemblance to Satan. For, instead of simply requiring companies to insure those with pre-existing conditions, he forces them back into high risk pools with limited coverage. No thank you.
3. Make health care more efficient, effective and accountable by empowering the states.
A. RETURN REGULATORY AUTHORITY OVER HEALTH CARE COVERAGE TO THE STATES
B. REFORM MEDICAID
In this part Walker highlights Medicaid and declares it so broken only the states can fix it. Balderdash, Run by the states eligibility reuirements are set so unfairly that many desperately poor people have no chance of becoming insured, and thus will tax resources as noted above.
For instance in the U.S someone is considered to be below poverty level if their income is no more than $11,770 for one person, $15,930 for 2 persons in a hosehold and $20,090 for a family of 3. But states that did not opt for the Medicaid expansion do not allow eligibility for those above a certain percentage of the federal poverty level. In Alabama, it is 13% for parents and 0% for other adults.
Click to access medicaid-and-chip-eligibility-levels-table.pdf
In other words In Alabama a household with 2 parents and a child, earning barely more than $2600 per YEAR means the parents cannot receive Medicaid (though the child may be eligibe for CHIP).
Think about that. Can states be trusted to take care of their own? Or only a small proportion of their own.
As to returning regulatory authority to the states, again this is a fallacy because they still exercise the majority of regulatory authority over insurance companies. Indeed, the differences between state actions in this respect are another reason why premium rates differ so greatly.
Along the way he asks that the current funding means for Medicaid, shared by the state and federal governments, remain in place with some tweaking of the formula with states getting block grants from the Feds. However, in states with no expansion, they are right now tied to the old levels of federal participation which rarely exceed 50% of Medicaid costs, whereas those falling under the Medicaid expansion get 100% paid by the feds until dropping to 90%. A much better deal than now.
4. Increase quality and choice through innovation.
A. EXPAND COVERAGE OPTIONS BY ALLOWING CONSUMERS TO POOL TOGETHER AND PURCHASE INSURANCE AS A GROUP
B. SUPPORT WELLNESS INCENTIVE PROGRAMS
C. REFORM LONG-TERM SERVICES & SUPPORTS (LTSS) PROTECTION
D. LIMIT EXCESSIVE LITIGATION THROUGH INNOVATIVE LAWSUIT REFORM
While at least A B and C have some merit on the surface, Walker’s approach is oversimplistic. As to Part A, group plans, these already are very common for members of groups like unions or fraternal organizations or even members of credit unions or those having other affinity relationships. The one basic limitation is that the persons eligible for such policies have some affiliation with each other besides the mere fact of seeking group insurance. Indeed, besides health coverage one can get auto or life insurance or pretty much any kind of insurance. Since so many Americans belong to affinity groups I would guess the extent of this type of coverage may be reliant on knowledge and desire of groups to pursue such measures.
Wellness incentives are already included in many private insurance policies. Does he want the government to mandate such coverage or merely command people to stay healthy?
Long term care coverage can be very important to individuals or even couples. But from what I can find on the topic, it does not really appear that the practice is over-regulated. In some cases there is next to no regulation. But Tax Qualified policies, because they do not tax benefits, of necessity must follow IRS regulations. Here is a good overview of such policies and practices.
https://en.wikipedia.org/wiki/Long-term_care_insurance
Part D is a complete lie. That is tort litigation is not a prime mover of medical costs. Best estimates that the total cost of the effects of medical malpractice are slightly more than 2% per year.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/
But what does that mean exactly? According to the study cited here perhaps 10% of the total figure is for what is paid out in judgments and settlements, nearly $6 BILLION a year. But that money was paid out because doctors did something wrong.That was not mere generosity on the part of malpractice insurers. In addition defense attorneys cost those insurers almostt 20% of those payouts. But defense lawyers get paid no matter the outcome.
But the major thing wrong with this point is that it is based on myths, which are dispelled here.
http://www.medmalfacts.com/facts-and-myths/
For instance various sources put the number of yearly deaths due to medical mistakes at 100,000 or more. That is close to 4% of all deaths in the country. That’s an awaful lot of malpractice yet only 1 in 8 victims of such treatment files suit. So it is bogus to argue there is excess litigation when the opposite is true.
Now Walker and his cohorts will assert that excessive damages are frequently awarded, especially for pain and suffering, but this, like many opinions, depends on whose ox is getting gored. Rick Santorum has pushed for limits and still advocates the same but when his wife lost a baby and undoubtedly experienced pain and suffering, to which he testified on her behalf, she got an award over the limits he wants for everyone else. (Not being intimately knowledgeable about her case, I believe the award is nowhere near out of bounds.
5. Provide financial stability for families and taxpayers.
Hey! Who can argue with that goal?
As a result, all of our citizens in poverty have gained access to health insurance through our state’s Medicaid plan, BadgerCare – a first in Wisconsin history. And our reforms are providing everyone in the state access to health insurance, according to the non-partisan Kaiser Family Foundation
Never dare The UMOC to check your claims of others’ approval. In fact, not everyone in poverty in Wisconsis has access to coverage but many of the ones who gained coverage through the Medicaid waiver links to BadgerCare must now pay premiums for that coverage (unlike regular Medicaid enrollees) and can lose eligibility for enrollment for a period if they fail to pay these premiums.
In 2012, Wisconsin received approval to apply premium payments to TMA adults above 138%FPL with a 12-month restrictive re-enrollment policy as a penalty for failure to pay premiums. In 2012, the Wisconsin Department of Health Services (DHS) studied the effects of the increased and expanded premiums implemented on TMA individuals above 138% FPL. This study found that between July 2012, when the premium provision was implemented, and December 2012 over two thirds (69%) of the 18,544 individuals between 133% and 150% FPL had left the program. About one in five (21%) of that population lost coverage due to failure to pay within the initial six months.
Now early on in this plan Walker justifies his desire to rid the world of “Obamacare” with this statement.
It should come as no surprise that many pillars of ObamaCare can be traced to “HillaryCare,” Hillary Clinton’s 1993 health care plan. And the proposals in Hillary’s “American Health Choices Plan,” released during her 2008 presidential campaign, provide a useful link between her 1993 plan and her present-day ideas.
I smile at the irony. You can get a glimpse of Hillary’s plan here, in the assessment of the Heritage Foundation, a reliable go-to source for WAlker.
http://www.heritage.org/research/reports/1993/11/a-guide-to-the-clinton-health-plan
The Affordable Care Act does NOT resemble that at all. What it does resemble is a health care plan brewed up by that same Heritage Foundation that was introduced into the Senate in December of 1993 by 21 mostly Republican co-sponsors that also was the basis for the plan Massachusetts adopted when Mitt Romney was Governor. Now, was that 1993 plan, submitted in opposition to the Clinton plan, identical to what became the ACA? Of course not, and truth be told, it never came to a vote and other GOP Senators vehemently opposed it.
The core part of both the Republicans HEART plan and the ACA was the individual mandate which, of course became such a point of contention in debate and in litigation when the law passed. Sure there were significant differences.
This article expounds on the genesis and evolution of the GOP plan.
Have I been harsh on Scott Walker? Or rather on the health care plan he has submitted for public scrutiny? Oh, Geez, I surely hope so. I’m a scrutineer from way back. But this plan is deserving of all the snark and skepticism I can muster because from the get go it fails to honestly and objectively assess what impact the Affordable Care Act has had on health care after 5+ years of implementation.
I stated at the outset that the law is flawed. However, Walker chooses to evade discussion of the real flaws and instead focus his attack on the bogeymen created by Republicans and other opponents of the law, together with the same sound bites, debunked allegations, and outright lies that have characterized this eminently debatable issue since the first inklings of what the law was to be emerged in 2009.
Do I unequivocally support the entire ACA? Hell NO! While it does some great things and millions of people are reaping its benefits, at heart is still does not achieve what its main goal purports to be, and that is ensure every American has access to health care through a system of insurance.
As Bernie Sanders and others remind us to a steady drumbeat. the United States is the only major industrialized nation without universal health care.
We can argue the best means to get to that Nirvana, that paragon, but we still waste far too much time arguing if this is a desirable goal at all.
Disappointingly far too many of our politicians would sooner have us at the mercy of private enterprise…oh, yes, that institution that has never harmed one hair on our collective chinny-chin-chins. perish the thought!
All the more dejecting because a simple solution is right before our eyes.
Once more to the ramparts exclaiming…MEDICARE FOR ALL!
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