Tag: affordable care

From "repeal and replace" to "retain and improve"

February 13th, 2014 by
From repeal and replace to retain and improve
From repeal and replace to retain and improve

“Repeal and replace” has been the mantra of Affordable Care Act/ObamaCare opponents almost since ObamaCare.  Although the “repeal” part has been tried many times in the House, very little serious attention has been paid to the “replace” part. The recent proposal by Republican Senators Orrin Hatch, Tom Coburn and Richard Burr is still couched in “repeal and replace” terms, but the actual contents of The Patient Choice, Affordability, Responsibility, and Empowerment Act are best described as an effort to retain much of ObamaCare –including changes to Medicare, bans on insurance coverage caps, coverage for children up to age 26 and so on.

There are all sorts of things in this proposal that I don’t like, but in the interest of spurring constructive dialogue to actually improve the Affordable Care Act I will highlight a couple of provisions that I think are improvements.

The first one  is in Title 2, Section 201, which calls for allowing insurers to charge older people up to 5x what they charge younger people.

The second is Title 6, Section 601, which “caps the tax exclusion for employee’s health coverage at 65 percent of an average plan’s costs.” In other words, it limits the size of the tax deduction for employer-provided health insurance.

To reinforce my “retain and improve” label, keep in mind that both of these provisions are essentially tweaks to the ACA. The ACA limits insurers to charging 3x the premium for older v. younger people and the so-called “Cadillac Tax” also limits the deductibility of expensive plans.

In any case, here why I like these two provisions:

  • Older people already get a very good deal from the government. Medicare represents a significant transfer from the working age population to those who are older. While it’s true that people pay into Medicare while working, the amount they pay comes nowhere near the actual costs of the program. It’s a cruel irony that there are many taxpayers without health insurance who pay taxes that subsidize older people on Medicare. The Affordable Care Act exacerbates the transfer from young to old by effectively making younger people overpay for insurance and giving older people a subsidy. The Republican proposal improves intergenerational equity and also helps stabilize the insurance market by bringing the ratio into line with the actual difference in cost.
  • Providing a tax deduction for health insurance provides an incentive to spend more on health insurance and less on wages. It also represents an unfair advantage for those who get insurance through their work rather than on the individual market. I’m in favor of phasing out the deduction completely over time. This proposal from the GOP does a better job than ObamaCare of reducing the deduction

What do you think? Do you agree with the “retain and improve” label? Are there other things you like about the new proposal? Leave a comment on the blog or Twitter @HealthBizBlog

photo credit: katerkate via photopin cc

By David E. Williams of the Health Business Group

Why repeal and replace is a joke

July 22nd, 2013 by

Republicans started talking about “repeal and replace” soon after the Affordable Care Act was passed in 2010. The 2010 and 2012 elections have come and gone, the Supreme Court has ruled, and implementation is continuing. Yet while opponents continue to rail against the law and the House has voted 39 times to repeal it in whole or part, to date there has been no real attempt to “replace” the law with something else.

That’s despite the fact that “replace” is part of the so-called Pledge to America the GOP put in place when it took over control of the House.

An Associated Press article (After 3 years, House Republicans still voting to repeal ‘Obamacare,’ but have no replacement) describes the situation.

Officially, the effort is “in progress” — and has been since Jan. 19, 2011, according to GOP.gov, a leadership-run website.

But internal divisions, disagreement about political tactics and Obama’s 2012 re-election add up to uncertainty over whether Republicans will vote on a plan of their own before the 2014 elections, or if not by then, perhaps before the president leaves office, more than six years after the original promise.

But the problem for Republicans is more fundamental than internal divisions, tactics or even Obama’s election. The real “problem” is that the GOP believes its own propaganda about the law itself and how it was passed. In this view, the Affordable Care Act is an extreme piece of left-wing legislation that was rammed down the throats of the Congress by Democrats without input from the GOP.

In fact, the law is a moderate one that includes many Republican ideas (such as individual responsibility in the form of mandates, exchanges for insurers to compete for business), is conservative in the sense that it leaves the basic mechanisms of the health care system (employer purchase of health insurance, private employment of providers, Medicare, Medicaid) in place, and excludes more radical ideas such as single payer, global budgets, or nationalization of hospitals and physician practices.

The remaining ideas Republicans discuss publicly for “replace” are frankly a joke. Here’s more or less what it amounts to:

“Giving the tax break for health insurance to the employee instead of the employer, medical liability reform, creating high-risk medical ‘pools’ and allowing insurers to sell their products across state lines.”

In the short-term, thanks to gerrymandering, individual Republican House members have done fine in their own districts by taking a strident anti-Obamacare line. But not only is a repeal-only approach bad policy, I think it’s also likely to be bad politics in the long-term. If Obamacare fails  –either due to obstructionism or its own weaknesses– what do opponents think will happen next?

Doing nothing or tinkering around the edges of the system circa 2010 won’t be an answer. If anything, it may reinforce the case for a single payer system and lay the groundwork for true socialism.


Cartoon version of Obamacare is pretty useful

July 18th, 2013 by

It’s not surprising that the average person is pretty confused about the Affordable Care Act. It’s a complex piece of legislation that gets phased in gradually, and opponents have been attacking the law and intentionally confusing people while proponents have been less effective about getting the word out.

Meanwhile, Kaiser Family Foundation (KFF) and a few others have been good about explaining the law to those who cared enough to look for the information and read through serious articles and analyses on the topic. As the core components of Obamacare kick in over the next few months, KFF is seeking to explain the law to a broader audience.

At close to seven minutes, the YouToons Get Ready for Obamacare animation is a lot longer than the typical 60 second cutesy web video, but there’s a lot of information packed in that will be useful for people who want to know how the Affordable Care Act will affect them. Most of the video is devoted to describing the ways people will get insurance under the law, and there is also information about who will pay for it. There’s a definite pro-Obamacare line but it doesn’t avoid some of the hard truths.