Oct 142017

10/14/2017 — Earlier this week, the President of the United States signed an executive order to cut subsidies to insurance companies through the ACA (Obamacare.)  45 said, “[I am instructing the government] to take action to increase competition, increase choice and increase access to lower-priced, high-quality health care options.” 

These payments are subsidies required by law and will affect, according to Slate, more than seven million people in the United States.  Premiums are expected to rise 20 percent by 2018, and 25 percent by 2020, said Slate.

What is so distressing is that many people will buy the snake oil of “lower-priced, high-quality health care options.”

I’m not an economist or an actuarial, but isn’t the point of insurance  to spread risk over a population? If the community is diluted from those without illness or disease, won’t the usage go way up and thus the price?  If the price goes up, won’t people pay the $600 fee penalty for not having insurance, and use the emergency room?

Image result for morton plant hospital clearwater floridaI’ve worked for more than three decades in healthcare.  Whether you agree politically with it or not, the Affordable Care Act has allowed individuals who lacked insurance coverage access to non-emergency health care.  I’ve witnessed many people getting care at my hospital who would not have had the opportunity before this legislation.  I work in a psychiatric and addiction treatment center.  You can hear about the need for these services nationwide by listening to any radio or tv news show for about ten minutes. You’ll hear about the opioid epidemic in our country. If this executive order is allowed to stand, more people will die of drug overdoses, among other things.

In my job, my team and I visit area emergency departments frequently.  Over the past four years, there’s not an emergency room within 100 miles in every direction that I’ve not visited.  We talk with clinical staff about their needs for psychiatric and addiction treatment, as well as educate on and facilitate direct admits.  Most of the time, the emergency rooms are crowded.  Can you imagine the demand for these services when 7 million people find their health insurance unaffordable?  The mother whose child has strep, the Little Leaguer with the broken bone and the asthmatic will jam the emergency rooms because they don’t have access to private practitioners. Those clinics which provide low-income care and struggle for funding with a patchwork quilt of government funding, grants, and philanthropy will also be more overwhelmed.

The premiums for Obamacare have gone up drastically, and in many locations, are non-existent.  In my county, there is only one provider, and the rates are expensive. There are other ways to address this, without throwing the baby out with the bathwater.  The result of the new order is that hundreds of policies that don’t address the real need of insurance, pre-existing conditions, will pull younger, healthier people from the group, thus diluting the risk pool.

And there is no need for this.  Despite all its flaws (which are apparent and have been discussed at length) the ACA provided access to a needed population. Letting the air out of this balloon will only force more people to choose care or food and heat, or sit for hours in overcrowded emergency rooms.

It doesn’t have to be this way. We have an excellent, well-run provider network in Medicare, which is a single-payer using market providers.  Why not lower the eligibility age for Medicare to fifty?  The risk pool for the entire Medicare population will be lessened, with healthier people fifteen years and under the current enrollment age.  The risk pool for people under fifty would also be enhanced with healthier people.

I’m not smart enough to know the answers, but what I do know is that we are the only country in the western world that doesn’t ensure that all citizens are covered.  We think it is a right for every citizen to have unlimited firearms and ammunition, yet we cannot guarantee a flu shot.  And if you don’t think a flu shot is essential, check out our history for one hundred years ago in 1918 when the Spanish flu killed more people than World War I.


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