Improve the ACA, don’t repeal or replace the law

The bills proposed by Republicans outline what they plan to replace Obamacare with. For many Democrats, the bill is alarming because it dismantles some of the key components of ACA.

But it is not yet clear how Republicans will be able to do that without also making everyone buy insurance, which leads to our listener question this week.

While the aims of PPACA were broad and touched on almost every conceivable aspect of health care – including types of health insurance plans; responsibilities of insurers; primary preventive care; supporting and expanding the health care provider workforce; and curbing unbridled costs of pharmaceuticals – the realities have been strikingly different. But there are still a lot of issues that have not been touched, he said.

“What we hear is that the medicine, people will have to take less”.

Three months later, in his inaugural address, Trump’s memorable line – his reference to “American carnage” – specifically referenced “drugs that have stolen too many lives and robbed our country of so much unrealized potential”.

Similarly for health flexible spending accounts (Health FSAs), the $2,500 ($2,600 as adjusted for inflation for 2017) ACA cap on contributions to Health FSAs would be repealed for tax years beginning with 2018.

Many questions about the Republican proposal’s effect on those over age 65 remain unanswered. “This is best exemplified subsequently by the Romney Massachusetts policy (that had the subsidies/mandate pillars) in order to get the preexisting condition exclusions eliminated”, Jennings said. Analysts say that could actually deter healthy people from signing up until they need care.

“It’s just hard for me to believe that the GOP would have an interest in seeking the repeal of that provision because the reality is that most people in that age category, especially if their parents have insurance to cover them, are kind of low risk in any case”, Halabi said.

One of the stickiest points in the PPACA was the individual mandate to have a demonstrable health care plan. Much of the $70 million in charity care that North Mississippi Health Services provided past year went to people without health insurance, Davis said. That would accelerate by almost four years the timetable for depleting the Medicare hospitalization trust fund would begin to run out of money, potentially curtailing benefit payments unless additional taxes were raised.

A report by the Kaiser Family Foundation, a healthcare nonprofit, concluded last week: “Generally, people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive larger tax credits under the ACA than they would under the American Health Care Act replacement”.

After the June 2012 U.S. Supreme Court ruling made participation in Medicaid expansion optional for states, researchers realized they had a flawless control group in the states that chose against expansion.

States who have the Medicaid expansion would continue to get the same federal funding under ACA until the year 2020. Supporters say the change would bring needed fiscal discipline and encourage states to innovate.

But the bill allows for some people who aren’t getting subsidies now to get federal help… Also appreciated is the decision to forgo conversion of Medicaid funding to a block grant program, and the proposed elimination of Medicaid disproportionate share (DSH) funding cuts.

In an even bigger change, the bill would end Medicaid’s open-ended entitlement status, moving to a system of limited federal financing. This was meant to offset the cost of health care. People who get their insurance on the jobs have been protected against discrimination for pre-existing conditions since 1996, when Congress passed the Health Insurance Portability and Accountability Act (HIPAA). But it will be downright devastating to families and individuals who rely on Medicaid in OR, most of whom live in Rep. Greg Walden’s district. “Currently, there is no cost estimate or accounting for how many Americans may lose or gain coverage under AHCA”.

Profit-driven insurance companies will justify exorbitant premiums in the individual market because the overall insurance pool will skew sharply toward those with more serious and expensive health needs. The proposed repeal and replace legislation now keeps some popular elements of the original, like allowing young adults to remain on their parents insurance and guaranteed coverage for pre-existing conditions. The difficulty with the current model, these Republicans argue, is that American health care has always been synonymous with insurance, which separates the consumer from the provider and jacks up prices. Yet, later in provision 36C, the paper states that a refundable tax credit would be available to aid one’s purchase in the individual insurance market.