The Transylvania Times -

Pure Folly


March 13, 2017

Before this country goes to war, one would hope our elected leaders would confer with our Joint Chiefs of Staff, the Department of Defense, the State Department and intelligence agencies to determine if war is the only option, what the cost would be in terms of finances, material and lives, and what the ultimate goal would be and how it would determined if the goal had been achieved or not. This rationale should apply to any major legislation that affects the nation.

Unfortunately, the health care plan revealed last week by House Republicans does none of these things. Those who actually deliver health care services, who know the everyday problems caused by and resolved by the Affordable Health Care Act (Obamacare), not only were apparently excluded in creating this new plan, the American Health Care Act (AHCA), but they strongly oppose it. The American Nurses Association, American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, Association of American Medical Colleges, American Hospital Association, and Children’s Hospital Association, as well as other physician and hospital organizations, along with the American Cancer Society and the March of Dimes, have announced their opposition to the plan. The problems with this plan are multiple, with at least three significant ones: millions will lose coverage, people will pay more for coverage, and health care costs will increase, thus placing a greater burden on the federal budget:

• “As drafted, the AHCA would result in millions of Americans losing coverage and benefits,” said Dr. Andrew Gurman, president of the American Medical Association. “By replacing income-based premiums with age-based tax credits, the AHCA will also make coverage more expensive – if not out of reach – for poor and sick Americans.”

According to the Brookings Institution, “at least 15 million people will lose coverage.”

Avik Roy, a Republican health policy expert, wrote in Forbes magazine, “The flat credit will price many poor and vulnerable people out of the health insurance market.”

• The Kaiser Family Foundation estimated the new tax credits would be an average of 36 percent or $1,700 less than the subsidies received under Obamacare.

Older Americans in the 50-64 age group will pay more for health care insurance. They can be charged five times as much for premiums as younger people. Under the ACA, they could be charged only three times as much. AARP estimates that an unmarried 64-year-old making $15,000 in a state like North Carolina that did not expand Medicaid coverage, could see premiums increase to $8,400 a year.

•The plan to drop the tax penalty for not being insured and replace it with a 30 percent penalty for obtaining insurance could be financially ruinous. Instead of penalizing people for not purchasing insurance, people will be penalized one time for purchasing insurance. Thus, healthy people will stay out of the insurance market as long as possible. Because they cannot be denied coverage due to having a pre-existing condition, they probably would sign up when they contract an illness that is prohibitively expensive to treat. (They could also drop it again once the disease is cured.) This is analogous to buying car insurance after your vehicle is totaled and having the insurance company pick up the tab. This approach also emphasizes medical practice that is reactive, not preventative; and that approach is vastly more expensive.

Those pushing the new House Republican plan are not weighing its costs. They are not waiting on an analysis by the Congressional Budget Office for a non-partisan, unbiased view as to how much the plan will cost and how many people it would serve. That is fiscally irresponsible.

The ultimate goal is unclear. In January President Donald Trump said, “We’re going to have insurance for everybody” and it would be “much less expensive and much better.” Yet, House Republicans have acknowledged that everyone will not have health insurance. And Mick Mulvaney, whom Trump appointed as White House Office and Management Budget Director, said, “insurance is not really the end goal here.”

When elected officials ignore those people who have the most knowledge about a subject – whether it is going to war or expanding and improving health care coverage for all Americans – the result is pure folly.


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