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Hullabaloo


Sunday, March 12, 2017

 
Who says you can't go backwards?

by digby

















Those of us who are in the individual health insurance market know this. But perhaps those who get their insurance through their employer, Medicare or the VA don't. So it's worthwhile having some charts.Michael Hiltzik of the LA Times provides them:

Congressional Republicans, evidently hoping that by repeating an untruth they’ll convince American voters, and perhaps themselves, that it’s a truth, on Wednesday said the Affordable Care Act has “failed.”

The undistilled version of this view came from House Speaker Paul Ryan (R-Wis.), who emerged Wednesday from a meeting with Vice President-elect Mike Pence to assert: “This law has failed. Americans are struggling. The law is failing while we speak. … Things are only getting worse under Obamacare. … The healthcare system has been ruined — dismantled — under Obamacare.”

Every one of those statements is demonstrably untrue. How do we know this? We know because every measure of healthcare spending, access and cost has improved since the passage and implementation of the Affordable Care Act. Timothy McBride of Washington University in St. Louis has done the heavy lifting of pulling together the relevant charts and graphs, and posting them online in a series of 12 tweets compiled on Storify. We’ve culled some of the most important, and present them here.

We should add, first, that Ryan also pledged, once the GOP repeals the law, to “make sure that there is a stable transition to a truly patient-centered system. We want every American to have access to quality, affordable health coverage”

This is nothing but fatuous gobbledygook. The GOP has had six years to come up with an alternative plan, and never has done so. Its current strategy is to repeal the Affordable Care Act now, and then cook up a replacement sometime in the next two, three, even four years. (They can’t even agree on a time frame.) What exactly is a “patient-centered system,” anyway?

Here are the charts, courtesy of professor McBride.

First, the overall uninsured rate has come sharply down since the advent of Obamacare:



The decline in uninsured rates was especially pronounced among lower-income Americans, according to the Council of Economic Advisors and other sources:



Although Republicans claim that even if the Affordable Care Act brought down the uninsured rate, its enrollees had trouble seeing a doctor, that isn’t true. Numerous studies debunk claims that doctors shun Affordable Care Act enrollees. This sample by the Council of Economic Advisors shows that the decline in the uninsured rate is closely associated with a reduction in people who were prevented from seeking and finding medical care because of its cost:


Hospitals are major beneficiaries of the Affordable Care Act, as the Department of Health and Human Services and the Council of Economic Advisors report. Hospitals’ uncompensated care costs fell sharply in Medicaidexpansion states, as patients treated as indigent in the past are now covered by Medicaid. Their uncompensated care costs fell from an average 4% of operating costs before the Affordable Care Act to less than 2% afterward, a decline worth tens of billions of dollars nationwide.



Overall national health spending has come down even faster than was predicted, as a share of gross domestic product:



The average growth in per-enrollee spending by private health plans in key categories has slowed materially since the passage of the Affordable Care Act in 2010, from annual growth averaging 5% in 2000-2010, to 1.5% in 2010-2015. Spending growth on hospital services, physician services and prescription drugs all slowed. Medicare, which has instituted numerous cost-control initiatives under the Affordable Care Act, has seen an overall decline in spending per enrollee.



Finally, even though employer-based insurance hasn’t yet been directly affected by the Affordable Care Act, there seems to be a spillover effect from the overall reduction in healthcare spending growth. Premiums rose by an average 5.6% a year in the 10 years prior to passage of the Affordable Care Act, but only 3.1% since, according to Kaiser Family Foundation’s annual survey of employer health benefits.


Republicans have promised to give Americans a health insurance system better than the Affordable Care Act’s and at lower cost. This is almost surely a chimera; no plan that the GOP has considered would expand coverage beyond the Affordable Care Act. To the extent that the plans would reduce costs, they would do so by relieving the federal government of responsibility for paying for coverage and placing it even more heavily on the shoulders of individuals and families. That’s not lowering costs; it’s just shifting them to those least able to pay. The fact that the GOP will have to face is that bringing healthcare to more Americans costs money. Taking it away from millions of Americans will cost money, too.

No one claimed, either before the passage of the Affordable Care Act or afterward, that it was perfect or that it would solve America’s healthcare crisis in one swipe. What became evident in the three years since the individual insurance exchanges opened for business (on Jan. 1, 2014) is that the subsidies for premiums needed to be increased and improved. Because they’re inadequate, especially as households cross the threshold of 400% of the federal poverty line at which subsidies are eliminated — at about $97,200 for a family of four — middle-class families in the individual insurance market feel overburdened. They blame Obamacare for this injustice. The real culprits are Republicans who have refused to consider any approach to the Affordable Care Act except repeal. Now the GOP is “it” on healthcare, and it’s discovering that crafting a solution from scratch may be almost impossible.

What became evident during the most recent open-enrollment period for Obamacare exchanges is that “Obamacare is more popular than ever,” as Kevin Drum of Mother Jones observes. Enrollment grew to 12 million, up by about 1 million from 2015, even in the face of higher premiums. In any case, more than 85% of all enrollees are entitled to subsidies, which limits and in some cases cancels out the higher prices.


Yet the GOP pledges to overturn all that. The question the party never has found an answer to is: If this is what a failure looks like, how would it define a success?


As he says here are some real holes in the system that could be fixed if Republicans weren't malevolent destroyers of worlds. The subsidies don't go high enough and some middle class people are getting hit hard. That could be fixed. The medicaid expansion should be universal. We could add a public option. I'm sure there are million wonky details that could be fixed to make it better.

But there is simply no doubt that it is an improvement over what we had before. And there is also no doubt that repeal is going to take us right back there and their replacement is actually going to make it worse that it was before.

I know it's their holy grail and they want it gone because it's a government subsidized benefit and they are simply opposed to that no matter how many people suffer and die without it. But the reality is that we tried the "free market" approach to health insurance and it did not work. It was killing people and leaving families destitute. This is a hybrid system that incorporates as much "free market" as can be incorporated while making sure that people have affordable insurance and will not go bankrupt if they get sick.

I'd prefer something simpler, universal and comprehensive. Let's call it ... Medicare. It works fine. Expand the program to everyone and let's go home. But we weren't allowed to have that so this was the only option. And it's a hell of a lot better than nothing.

They may succeed in destroying this, they have all the power they need to get it done. And employed people, those on government health care like Medicare and the VA and well-off folks who can afford health insurance won't feel the pinch at first. But all you have to do is look at the overall cost lines in those charts above to see that it's not just us poor self-employers losers or Medicaid beneficiaries who will be impacted when these amateur wonks take a meat ax to the program without knowing what they're doing. The whole health care sector will be hit hard.

Remember, the ACA wasn't just about covering people in the individual market and expanding medicaid. It was an attempt to bring down spiraling costs through a complex set of regulations and requirements. The result of cluelessly reversing all that isn't going to be pretty for anyone.

The horror of the election results just never ends ...

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