Dave Roberts shared a wealth of information at our monthly club meeting in April. “When I was invited to speak”, he explained, “health care was a hot topic.” But it still is, and thanks to Dave’s presentation we received clear details on both the key elements of the ACA (commonly known as Obamacare) along with explanations of what Trumpcare was attempting to implement. (See his presentation below).
Dave began by revealing the U.S. spends $3.2 TRILLION on health care a year, twice as much as any other country in the world. And yet, costs are so high that medical bills are the number one reason for bankruptcies. In the military health care is their biggest cost! The 2010 ACA was just intended to be the beginning of multiple steps to bring affordable health care to everyone. “The first step is to declare that health care is a right and if you can’t afford it, you can still get it”, Dave explained.
The mandate requiring all to purchase health insurance was necessary to ensure that everyone is part of the solution thereby lowering the cost for all. All plans had to cover a list of essential benefits, many of which the Republicans tried to remove in their first attempt at replacement. These included such essential items as emergency services, preventive care and prescription drugs to name a few.
The ACA had many elements that originated with Republican principles, yet “they would never vote for it if it mandated a gun for everyone” Dave said. It put mental health on parity with physical health and that was a key decision. Many believed Medicaid could be expanded and eventually 31 states chose to expand. And contrary to current talking points it was not passed “in the dark of night”. There were several years of hearings and meetings with all kinds of stakeholders Dave indicated.
The ACA also held up under the Congressional Budget Office’s process of fiscally scoring it. Over 10 years, although it would cost $940 billion, between new incoming taxes associated with the ACA primarily on medical device manufacturers, and additional cost savings, it scored as a net saving of $144 billion.
Hillary Clinton had a vision to build on Obamacare. In addition to prescription drug reform and Medicaid expansion to the remaining 19 states through incentives, she wanted to focus on rural America’s needs and support for women’s reproductive health care.
But instead of this realistic and compassionate vision, we now have to deal potentially with Trumpcare, the first version of which was an abysmal failure. The individual mandate would have been eliminated, discriminatory pricing practices for senior citizens allowed, and age based tax credits provided, rather than income based subsidies. There was still the intent to continue to allow people with pre-existing conditions to enroll, but at what cost? Additionally Trump was also hoping to still expand Medicaid to the 19 states remaining because they are mostly red states and “those folks are feeling lost” Dave said.
The first version of Trumpcare did not score well at the CBO. If this were implemented, 24 million fewer Americans would have been without health insurance. With the 2017 repeal of Obamacare with NO replacement, 23 million fewer would go without. In other words, 1 million more Americans would have health care under FULL REPEAL than would be covered under Trumpcare! “That’s how bad it was” Dave exclaimed.
So what now? Things will remain stable for this year, as plans are already in place and won’t be canceled. But 2018 is still very uncertain and the deadline for health insurance companies to announce their new plans for next year is approaching fast. Yet there is still no real plan announced for how to proceed. This could result in many insurers opting out of the market due to uncertainty leaving many without options.
California is taking action however. Toni Atkins co-introduced SB562 which would establish a single payer system for California. The bill is light on details however so even if it passes it could be several years before anything is implemented. California could be the leader however, as it has been on other fronts. 51% of the country has single payer now between Medicare, Tricare and Medicaid. “Single Payer” would provide for people who don’t have access to another private plan to basically all go on Medicaid. The major issue California will face is having enough health care providers which needs to be addressed. Currently there are rules that limit how large our medical force can be and what services non-MDs can provide. Changes here would help to reduce long wait times.
In summary, Dave said “It’s not about us as a society. It’s about the society we want to leave for our children.”