Payers in Exchanges Don’t Get It

John Rusche, M.D., is a former Board Certified pediatrician, health plan medical executive, and Idaho House minority leader, 2009-2016. I can’t think of many people who were ecstatic about their pre-ACA health insurance benefits or costs, and I fear a return to those times. He advocates a progressive tax system, i.e., the wealthiest households would pay significantly more, through an increased personal income tax and taxes on unearned income, like capital gains and dividends. Under the Republicans’ plan, that mandate – that all plans include things like prescription drug coverage, emergency room services, maternity care and mental health treatment – would have disappeared. I hope that a discussion might start to discuss the underlying drivers of health care costs (insurer administrative costs, paperwork, unregulated pharma pricing, etc.), as that will prove better for everyone.

After Speaker Paul Ryan pulled the GOP health care bill, President Trump indicated that he thought Obamacare would die on its own, saying in a tweet, “ObamaCare will explode and we will all get together and piece together a great health care plan for THE PEOPLE”. But what’s usually forgotten is how the government is involved with the other two-thirds of us.

With that reality, Washington Insurance Commissioner Mike Kreidler recently answered a February call from U.S. Health and Human Services Secretary Tom Price asking states what can be done to strengthen the health law.

The premiums for those policies are tax-exempt. The age of the participants also affects the cost. Working families, older Americans, children, patients with chronic illnesses and low-income Americans living in rural areas would have suffered the heaviest cost.

Without this Medicaid expansion, many people were left in a coverage gap because they make too much for Medicaid but not enough to earn a federal tax credit. Even if you could pay this amount, the deductible is $7,000 – so what good is it? The government can’t continue deficit spending forever! Perhaps, re-emphasizing our moral compass and calling upon our compassion as a people, rather than passing laws declaring a “right” to whatever is the issue of the day, medical care, a college education, housing, food, will lead to lifting more of our fellow men and women out of poverty and helping them receive decent medical care. If not for the tax exemption, health insurance would be considerably more expensive and millions of us would not be able to afford it, but because of the policy, we can.

Results from the 2017 Louisiana Survey show that Louisiana residents approve of the state’s decision to expand its Medicaid program a year ago under the auspices of the federal Affordable Care Act, or ACA, but remain deeply divided over the ACA itself. “Most whites have an unfavorable opinion of the ACA, but most blacks and most residents of other races have a favorable opinion of the law”.

Loss aversion helps to explain the cognitive dissonance on the part of many Americans who jointly hold the incongruent views that on the one hand reject ObamaCare and on the other hand fear the loss of coverage within it.

Second, even with the ACA as the law of the land, 62% of Democrats and Democratic leaners in November said that the healthcare system was either in a state of crisis or had major problems. No insurer can cancel someone’s policy because they have a pre-existing condition or if they become so sick they hit a lifetime cap.

The House bill simply isn’t fixable.

States that chose not to expand their Medicaid programs, however, saw very different results.

What’s interesting is that these are some of the least “free market” aspects of Obamacare.

Editor’s note: Since Republicans withdrew their proposed health care overhaul, the American Health Care Act, on March 24 (after our April issue went to press), we asked Dr. Gewanter for his reaction. It’s because it can’t be done. They passionately believe that a deregulated, privately funded and operated healthcare system can work in contemporary American society.