Donald Trump is the U.S. President-elect, and everyone who writes and cares about health insurance and health care policy in America is eager to learn what he and his Republican colleagues in the House and Senate will do with the Affordable Care Act (aka, Obamacare). Will they repeal it? Replace it? Both? Neither? We can reasonably expect that over the next four years, Trump will sign off on some policy changes to Obamacare and millions may lose their health insurance.
Still, the larger Obamacare repeal and replace questions remain, will Speaker of the House, Paul Ryan, get to institute his Better Way (to Fix Health Care) outline? Or will professional President Obama hater and Senate Majority Leader, Mitch McConnell, get to declare Obamacare a total failure with no need to replace? It's looking increasingly likely that they may both get what they want although not because of any powers of persuasion they have, but because repealing and replacing Obamacare will help some Trump family members and friends.
Before he won the election, Trump said he would repeal and replace Obamacare with "something much better for everybody." He also called Obamacare, "A complete disaster." But after he won the election, he said that there are parts of Obamacare that he likes and wants to keep: allowing children to stay on their parents' health plan up to age 26 and the one about people with preconditions (he meant pre-existing conditions, but he's careless and uninformed). Then last week it was reported that Trump has family and friendship ties to a health insurance start-up, Oscar Insurance, that isn't doing so well. Continue Reading...
The upper middle class benefits a lot from the current system of access to health insurance. They are more likely to have jobs that provide health insurance that they can easily afford, and they benefit favorably from the tax treatment of these workplace benefits. So, it is fair to assume that the majority of these individuals do not support changes to the health insurance and health care status quo. But the question on many people's minds is whether the unveiled contempt for the professional elite will impact their health care status.
The election of Donald Trump as President of the United States and a majority Republican House and Senate all but ensures changes to health insurance and health care policy in America. What those changes will be is anyone's guess. Does it mean a cap on pre-tax health insurance premiums that most benefit the upper middle class? It could since there is bipartisan support for such a change.
But I'm betting it won't be for several reasons. One, Trump supporters have yet to articulate what health care reform should look like. Two, most Trump supporters don't understand health insurance or the health care industry well enough to suggest any meaningful changes to them. And, three, many middle class people rely as much on workplace health insurance and its favorable tax treatment as the elites they hate.
But what is the point of beating the elites in a national election, if you can't also make them suffer?
Will Hate Trump Logic? Continue Reading...
A Fragmented Health Insurance System Needs The Same Cure As a Fragmented Health Care System—Integration
There is a lot written about the downsides of fragmented health care. Most stories start out with an example of an extremely ill person, whose condition gets worse as they go from one medical specialist to another and one facility to another, taking one drug after another. The result is usually that the person suffers for a very long time until someone mercifully steps in to help coordinate care or the patient dies. No one is to blame for the person's suffering or death because they did what they were supposed to do. It's only after the fact that we find out that things should have gone better.
The good news is that there are solutions to address the horrible consequences of fragmented health care. Before the production of these solutions, a very sick person had to rely on the kindness and fortitude of family and friends to navigate a system where no one person could or would answer all of their questions. Harvard Business Review has an article here on how to improve fragmented health care. The Affordable Care Act (aka, Obamacare) also works to try and improve the delivery of health care through Accountable Care Organizations (ACOs).
What Is An Obamacare ACO?
According to Jenny Gold, writing in Kaiser Health News online, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation, "An ACO is a network of doctors and hospitals that share financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending." Currently, Obamacare ACOs are Medicare-based only.
Addressing the physical and mental suffering and costs of fragmented health care is one of the best components of Obamacare, even if it only addresses a small percentage of the insured. But wouldn't it be great if Obamacare addressed the fragmentation of health insurance programs instead of maintaining or add to them?
A Fragmented Health Insurance System Is A Bad Thing.
I'm not claiming that America's fragmented health insurance programs are as bad as fragmented health care. It's not. Still, fragmented health insurance is a big problem in that it separates us into groups with different levels of coverage, at varying rates and ends up costing us all more than if we were in one group. Instead, we are left with at least six groups—Disabled, Old, Poor, Veterans, Traditionally Employed and Individually Employed—each expected to carry its own financial weight. A difficult and unnecessary standard to meet and maintain... Continue Reading...