alternatives to obamacare – USA Gov Policy

Health care in the U.S. is entering a challenging period. Both Medicare and Obamacare patients will experience serious obstacles

According to a study by The Kaiser Family Foundation (KFF) 21 percent of physicians are not accepting new Medicare patients. This compares to the 14 percent that have decided not to accept new privately insured patients. That is, the proportion not taking new Medicare patients is 1.5 times greater than the proportion not taking new privately insured patients. KFF notes that “Previous studies show that the vast majority of physicians accept Medicare, but the proportion taking new Medicare patients is smaller, particularly among primary care physicians compared with specialists…” This growing limitation of choice will limit choices for those who are aging into the system.

For those using Obamacare, premiums are set to rise. Bloomberg reports that “Premiums for mid-level Obamacare health plans sold on the federal exchanges will see their biggest jump yet next year, another speed bump in the administration’s push for enrollment in the final months of the U.S. president’s term. Monthly premiums for benchmark silver-level plans are going up by an average of 25 percent in the 38 states using the federal HealthCare.gov website, the U.S. Department of Health and Human Services said in a report today. Last year, premiums for the second-lowest-cost silver plans went up by 7.5 percent on average across 37 states. Individuals signing up for plans this year are facing not only rising premiums, but also fewer options to choose from after several big insurers pulled out from some of the markets created under the Affordable Care Act, known as Obamacare.”

A Guardian review found that “ the ACA relies on competition between insurers to provide affordable coverage, and that is dwindling. Under the ACA, health insurance marketplaces, also called health exchanges, were set up to facilitate the purchase of health insurance in each state. Customers are free to choose from a set of standardized healthcare plans from participating insurers, and those policies are eligible for federal subsidies. But insurers have been fleeing the exchanges, arguing that they are loss makers and the types of people attracted to them make the risks too great for the insurers to provide affordable (and profitable) policies.”

A Breitbart analysis concludes that Obamacare’s (ACA) financial unsustainability is causing both insureds and insurers to abandon the system, “leaving President Obama’s takeover of the nation’s healthcare system on the verge of collapse.” Due to the high and rising costs, young, healthy people, whose payments and relatively light use of medical care were expected to prop up the system, are staying away in sufficient numbers to cause major problems.

Realclearpolitics fleshes out the details. “Economic reality is making it increasingly obvious that we are in the midst of Obamacare’s long anticipated death spiral. Most recently, Aetna joined United Health care and Humana as the third of the ‘big five’ insurance firms to announce major cuts to its Obamacare exchange business. For insurers, it’s simple math: Premiums collected must exceed claims paid. If too few healthy, low risk individuals enroll to offset the costs of insuring unhealthy, high risk individuals, the math doesn’t work. This imbalance forces insurers to raise premiums on the low risk individuals who do enroll to cover the costs of insuring high risk individuals. The rising premiums cause even more healthy individuals to drop coverage – resulting in what has been called a death spiral…Aetna, for example, suffered a second-quarter pretax 2016 loss of $200 million and total pretax losses of more than $430 million since January 2014 when the exchanges opened for business. Aetna wasn’t alone…UnitedHealth lost $475 million in the exchanges in 2015 and expects to lose $650 million in 2016.”

The US. House of Representatives Committee on Energy and Commerce recently concluded an investigation which found that lower-than-expected enrollment, higher-than-anticipated costs, and more complicated-than-anticipated technology challenges have caused state based exchanges (SBE) in Oregon, Hawaii, New Mexico and Nevada to fail, ( having wasted hundreds of millions of taxpayer dollars) and Kentucky will be added to that list next year. Only 12 will remain. Washington now appears to be encouraging state exchanges to close and join the federal exchange.

The major findings of the Congressional investigation noted that the state based exchanges will not be sustainable in the long term. As of September 2016, every SBE still relies upon federal establishment grant funds—20 months after SBEs were to be self-sustaining by law. Washington failed to enforce its own rules on Medicaid allocations, and did not recover misspent dollars.

The looming financial collapse of Obamacare may finally clear the path for more viable options, such as:

Tort reform (which would significantly reduce the cost of practicing medicine,)
Allowing nationwide competition between insurance companies (which would lower costs for purchasers of health insurance to be tried)
Tax credits to help make private policies affordable
Allowing the sale of more flexible policies with different types of coverage, a concept that will be far more attractive for healthier, younger people.

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It has become a standard line of those defending Obamacare (the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) that there is no alternative to the deeply flawed program, which has cost the taxpayers so much, and produced so little.

The National Center for Public Policy Research has compiled a list of alternatives that have been proposed, including those presented by the CATO Institute; Senators Hatch, Burr, Coburn, and Upton; the Republican Study Committee; Rep. Tom Price; and Senator Ted Cruz. The continuing statements by the White House, many legislators, and much of the media that no alternatives have been developed is manifestly incorrect.

In addition, many of the concepts to address the escalating costs of health care and health care insurance have yet to be enacted, and remain actively opposed by special interest groups, including lawyers groups and insurance companies. These include innovations such as allowing health care insurance to be sold nationally, instead of state by state to enhance competition and reduce prices; enacting tort reform, to address the skyrocketing cost of malpractice insurance for doctors and medical institutions due to non-substantive nuisance law suits; and permitting policies that more precisely fit the needs of the insured, such as coverage for catastrophic care only.

The need to address Obamacare has been summarized by the Heritage Foundation, which outlined how the legislation detrimentally affects Americans:

“Seniors: The law cuts an estimated $716 billion from Medicare over ten years. However, these “savings” are not set aside to preserve Medicare’s future, instead they are used to fund new spending created by the law. Nearly one-third of all seniors rely on Medicare Advantage, the private health care option in Medicare. Despite the program’s growing enrollment and beneficiary satisfaction, Obamacare makes deep cuts to the program that jeopardize its viability in coming years. In addition to payment cuts, Obamacare imposes new taxes on drug companies and medical device makers, and new regulations that will make health care more costly for seniors.

“Doctors: The United States is facing a severe physician shortage. By 2020, the nation will need an additional 91,500 doctors to meet medical demand. Obamacare exacerbates this problem by further increasing physicians’ workload and worsening their attitudes regarding the health care system.

A 2012 survey found that Obamacare is motivating doctors to change their retirement timeline, with 43 percent of respondents stating that they are considering retiring within the next five years as a result of the law.
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“Business & The Economy: The Congressional Budget Office estimates that the Obamacare subsidies will discourage Americans from working, and cause 2.5 million employees to drop out of the labor force.

Obamacare’s employer mandate will raise the minimum cost of hiring a full-time worker to $10.30/hour in 2015. Congress has already raised the minimum wage from an employer’s point of view, but the money goes to the government instead of the employees.

“States: Obamacare’s Medicaid expansion worsens the already heavy burdens facing states. By 2021, approximately 78 million people are projected to be enrolled in Medicaid—requiring billions of dollars from state budgets and taxpayers. In the individual market, Obamacare’s exchanges have on average decreased insurer competition by an estimated 29 percent nationwide. Furthermore, over half of the counties in the U.S. have only one or two insurers to choose from in their Obamacare exchange.

“Families: Obamacare adds nearly $2 trillion in new health care spending according to the Congressional Budget Office. Over the next 10 years, Obamacare will levy about$771 billion in new taxes and fees.

Obamacare imposes significant financial penalties on the decision to get or remain married – over $10,000 per year for certain couples.

“Uninsured: The Congressional Budget Office estimates that “between 6 and 7 million fewer people will have employment-based coverage each year from 2016 through 2024 than would be the case in the absence of [the new health law].”In 2024, after ten years of full implementation, 31 million people are projected to remain uninsured.”

Quick Analysis

AMERICA’S STRATEGIC POSTURE

The Final Report of the Congressional Commission on the Strategic Posture of the United States As 2023 drew to a close, the dramatically deteriorating national security picture for the United States and its allies prompted a review of “America’s Strategic Posture.” A committee chaired by Madelyn Creedon and Jon Kyl issued a sobering analysis. We present a summary of this vital analysis. The militarily troubling and increasingly aggressive behaviors of Russia and China over the past decade led Congress to direct a review of the strategic posture of the United States, including nuclear weapons policy, strategy, and force structure. China’s rapid military build-up, including the unprecedented growth of its nuclear forces, Russia’s diversification and expansion of its theater-based nuclear systems, the invasion of Ukraine in 2014 and subsequent full-scale invasion in February 2022, have all fundamentally altered the geopolitical landscape. As a result of China’s and Russia’s growing competition with the United States and its Allies and partners, and the increasing risk of military conflict with one or both, as well as concerns about whether the United States would be prepared to deter two nuclear peers, Congress determined it was time for a new look at U.S. strategic policy, strategy, and force structure. The new global environment is fundamentally different than anything experienced in the past, even in the darkest days of the Cold War. Today the United States is on the cusp of having not one, but two nuclear peer adversaries, each with ambitions to change the international status quo, by force, if necessary: a situation which the United States did not anticipate and for which it is not prepared. While the risk of a major nuclear conflict remains low, the risk of military conflict with either or both Russia and China, while not inevitable, has grown, and with it the risk of nuclear use, possibly against the U.S. homeland. The United States faces a strategic challenge requiring urgent action. Given current threat trajectories, our nation will soon encounter a fundamentally different global setting than it has ever experienced: we will face a world where two nations possess nuclear arsenals on par with our own. In addition, the risk of conflict with these two nuclear peers is increasing. It is an existential challenge for which the United States is ill-prepared, unless its leaders make decisions now to adjust the U.S. strategic posture. America’s defense strategy and strategic posture must change in order to properly defend its vital interests and improve strategic stability with China and Russia. Decisions need to be made now in order for the nation to be prepared to address the threats from these two nucleararmed adversaries arising during the 2027-2035 timeframe. Moreover, these threats are such that the United States and its Allies and partners must be ready to deter and defeat both adversaries simultaneously. The evidence demonstrates that the U.S.-led international order and the values it upholds are at risk from the Chinese and Russian authoritarian regimes. The risk of military conflict with those major powers has grown and carries the potential for nuclear war. Therefore, the Commission reached the unanimous, non-partisan conclusion that today’s strategic outlook requires an urgent national focus and a series of concerted actions not currently planned. In sum, we find that the United States lacks a comprehensive strategy to address the looming twonuclear-peer threat environment and lacks the force structure such a strategy will require. In reaching that overall conclusion, we make clear that the fundamentals of America’s deterrence strategy remain sound, but the application of that strategy must change to address the 2027-2035 threat environment. Those changes drive necessary adjustments to the posture of U.S. nuclear capabilities – in size and/or composition. A full spectrum of non-nuclear capabilities is also essential to the nation’s strategic posture. Such adjustments, in turn, drive the need to strengthen and expand the capacity of the infrastructure required to sustain and enhance U.S. strategic capabilities. In addition, Allies and partners are central to our findings regarding strategy and posture. We also emphasize the need for robust risk reduction efforts as fundamental to the U.S. approach in the new threat environment. The Report continues tomorrow Photo: The lead ground-based Interceptor is launched from Vandenberg Air Force Base, Calif., March 25, 2019, in the first salvo engagement test of a threat-representative intercontinental ballistic missile target. The test’s two interceptors successfully intercepted a target launched from the Ronald Reagan Ballistic Missile Defense Test Site on Kwajalein Atoll in the Pacific Ocean. (DoD)