Major Problems of Repeal without Replacement

Larry Hurwitz Advice, Announcement, Lifestyle

The Senate has taken a major step to unhinge the Affordable Care Act (ACA) through Budget Reconciliation. Budget Reconciliation can be passed by a simple majority and cannot be filibustered; in favor of Republicans who hold 52 of the 100 seats.

On Saturday, January 14th, House Republicans voted 227-198 and instructed committees to draft legislation by January 27th that would repeal the 2010 Affordable Care Act.

Once the repeal legislation is drafted, both chambers will need to approve it, and a presidential signature will be required. With reconciliation, budgetary elements of the ACA, such as insurance subsidies or Advanced Premium Tax Credits (APTC), Medicaid expansion and the individual mandate can be eliminated but not the requirement prohibiting insurance carriers to deny coverage based on pre-exiting conditions. Mission accomplished, the ACA will fall like a deck of cards without the premium assistance. Most people who depend on this assistance will no longer be able to afford insurance and be left out in the cold. To add insult to injury everyone else’s coverage will also be at risk because as the risk pool shrinks only those who have serious health issues will find a way to pay for their coverage, and everyone else will exit. Premiums will skyrocket and more insurance carriers will exit the marketplace.

Will Paul Ryan and the Republicans be able to get 8 Democrats on board to pass a replacement? With the current political divisiveness and rancor, it’s doubtful. Perhaps the Republicans will feel they have no choice but to drive off the cliff of reconciliation to get the Democrats to the table and find common ground. Will the Democrats prevent a crash or would they prefer a crash so they can blame the carnage on the Republicans? The path to true affordability & access to quality healthcare will need to consider most of the following:

  • Eliminate the requirement for minimum essential coverage – let people have a major medical plan.
  • Tort Reform: If your doctor follows reasonable medical protocol limit the damages that can be levied against him or her – defensive medicine is costly.
  • Offer options for those who can’t qualify for standard plans based on one’s health. Block grants for state risk pools can ensure that people will get coverage, perhaps limiting premiums to no more than a percentage of one’s income.
  • Offer positive incentives to procure coverage. The larger the risk pool, especially healthier people, equates to lower premiums for all; tax deductible premiums would go a long way.
  • Expand Medi-Cal provider access. Parents will often take their children to Emergency Rooms because of the wait times to access Medi-Cal doctors. Emergency Rooms are the most expensive way to receive healthcare.
  • Allow insurance carriers to increase premiums based on lifestyles. It’s ironic that California, a state that has the lowest smoking rates in the country, rejected the ACA’s flexibility to charge smokers more. If people want to smoke they have every right to do so, but not charging them more means that their lifestyle choice is being subsidized.
  • Although controversial, a national conversation about Euthanasia would be productive. If people have a written directive that they don’t want to suffer and have extraordinary medical measures to keep them alive, shouldn’t we respect that? Terminal patient’s final days in the hospital are costing millions of dollars and with the aging of America this is only going to get worse.
  • Paying providers based on outcome and quality as opposed to only quantity of services rendered. For example, Anthem Blue Cross was dispersing bonuses to hospitals with low staph infection rates.

Some of the points I mentioned such as Euthanasia probably won’t be brought up in any of the Republicans bills and likewise, Tort reform will probably be bitterly fought by the Democrats. What is most important is that we don’t allow the untangling of the ACA to hurt America’s health. Let’s urge our local politicians to work on rational replacement legislation and not let politics becoming the driving factor which can drive us off the cliff.