Sorry, Republican Congress. Health care is complicated

As the GOP is still learning, healthcare is complicated. It was easy to throw darts at the length and complexity of the Affordable Care Act, but the truth is the law hangs together remarkably well and is long for a reason. Meanwhile, some of the GOP’s main proposals are easy looking, digestible concepts that can be explained at the 5th grade reading level. Unfortunately, they won’t achieve their goals or are counterproductive.

Here are a couple that are swirling around this week:

  1. Get rid of mandatory benefits so that people don’t have to buy more than they want or need. After all why would a man need pregnancy coverage or mammography screening? Sounds good, but it turns out that those mandatory benefits only drive costs to a small degree. The main drivers of premium increases are rising provider reimbursements and higher utilization of people with pre-existing conditions who are now able to get coverage. Sure, if you remove coverage for hospitals, doctors or prescriptions premiums will drop, but what kind of insurance would that be?
  2. President Trump is threatening to withhold subsidies that help low-income Obamacare customers pay their out-of-pocket expenses. Sounds like a hawkish budget move. But it turns out the maneuver would actually increase federal spending. That’s because health plans would end up raising premiums and federal subsidies would automatically increase as a result.

There are more examples. Here are a couple:

  • Selling health insurance across state lines. It’s already allowed but no one wants to do it because it doesn’t make economic sense.
  • Rejecting the Medicaid expansion. Some states say they can’t afford it, which is nonsense since the feds pay the vast majority of the cost. If they stop states could just cancel the expansion.



By healthcare business consultant David E. Williams, president of Health Business Group.

April 26, 2017

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