With the death of the current incarnation of the Republican plan, we have to take a minute to consider what will continue to happen if nothing is done to repeal and replace or revise Obamacare.
The good news is that the expansion of Medicaid will continue. This means the federal government will continue to subsidize the states that cover those who got coverage as a result of the Affordable Care Act’s expansion of Medicaid. Expanding Medicaid has had significant benefits. The working poor were finally able to obtain healthcare benefits. In states like West Virginia, workers that are now covered have seen their wages increase, their children’s attendance at school increase, and their use of the emergency rooms for medical treatments has significantly declined.
That is where the good news ends.
In a large number of counties and in some states, there will be no carriers writing policies for coverage in the individual market. That means that people who live in those counties/states will not be able to purchase health insurance of any type; and, the in addition, they will be penalized for not buying insurance that is absolutely unavailable to them in any form.
For those that can purchase health insurance, including businesses, rates are expected to increase at least 20%[1] for coverage next year. Many companies are struggling to pay current premiums. In certain states, including Texas, Connecticut, Maryland and Virginia, carriers have asked for premium increases in excess of than 50%[2]. A business that is struggling will be forced to drop their healthcare coverage. If your business bought coverage and can no longer afford it, your employees may or may not be able to get coverage of their own, depending upon where you live.
Co-pays will no longer be considered part of your co-insurance payments and, as such, may not count toward your deductible. With individual deductibles on the increase from $2500 to as much as $5000, you might be surprised to learn that your co-payment will no longer count against your deductible. This means that only co-insurance payments will apply. Co-pays range from $45 to $115 per visit, depending upon the doctor. Most plans now require a co-payment for all doctor visits and, in addition, you will be responsible for a co-insurance payment. If you are on an 70-30 plan, in addition to your co-payment you will be responsible for paying 30% of the amount billed to your insurance company. This means that after you pay your co-pay, and the doctor bills the insurance company for the visit, if the bill is $100 you will owe another $30 on top of your co-pay. You now have to pay $75 for your visit; but only $30 counts towards your deductible.
The exchanges will continue to be funded by the government. The exchanges duplicate 100% of the functionality provided by insurance company web sites. Since the taxpayers already paid for the cost of developing these insurance company sites, every year we support the exchanges we are paying again for something we already paid for.
The 5 million, plus, illegals that currently get healthcare paid for by the government will continue to receive this healthcare. The amount of subsidies paid will continue to be above and beyond what is really called for. The Obama administration did not implement the electronic verification of citizenship nor did they implement the electronic verification of income. Income and citizenship is input on the honors system. We simply take your word. Because all verifications are essentially done manually, if you claimed you were a citizen and you aren’t or you claimed an income below what you actually earned, you get the benefits you asked for. Too bad for the tax payer!
Networks are going to get narrower. It will get harder and harder to see a doctor. Almost one quarter of doctors are over 64, retirement or frustration will end their medical careers. Since 2013, the year Obamacare went into effect, in addition to the loss of doctors due to changing careers or retiring, approximately 10% of doctors each year opt out and accept only cash. This is especially true in the large cities and applies more specifically to professionals with excellent reputations who are tops in their fields. These guys are so good, they can command any price, and people are willing to pay it. Why should they accept insurance when the reimbursement rates offered don’t cover the cost of doing business.
New doctors are not going into private practice; they are becoming part of large hospital systems and thus only take on patients that their hospital system will treat. If your provider doesn’t have a contract with a big research facility and you have something that requires the sophisticated treatment such facilities can offer, you are out of luck unless you can pay for it.
The bottom line is this, the trends that started with the Affordable Care Act, less access to care, longer wait times to see a doctor, dramatic increases in the cost of insurance and even more dramatic increases in the out of pocket cost of care, will continue unless something is done.
[1]http://www.consumerreports.org/health-insurance/buy-aca-health-insurance-in-2018-what-you-need-to-know: http://www.cleveland.com/nation/index.ssf/2017/06/a_trump_gambit_on_obamacare_ha.html; https://www.americanprogress.org/issues/healthcare/news/2017/06/15/434320/state-state-estimates-ahcas-2018-rate-hikes-age-tax
[2] http://www.modernhealthcare.com/article/20170510/NEWS/170519999
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