{"id":6766,"date":"2017-06-22T11:31:07","date_gmt":"2017-06-22T17:31:07","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/?p=6766"},"modified":"2017-06-22T11:31:07","modified_gmt":"2017-06-22T17:31:07","slug":"holy-pre-existing-conditions-batman-obamacare-lite","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2017\/06\/holy-pre-existing-conditions-batman-obamacare-lite.html","title":{"rendered":"Holy Pre-existing Conditions, Batman! It’s Obamacare-lite!"},"content":{"rendered":"\n<\/head>

\"https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg;<\/p>\n

The Senate healthcare proposal is finally out, and here\u2019s my first, lunchtime assessment.<\/p>\n

Republicans have promised up and down that they\u2019ll end Obamacare for one reason: \u00a0that it\u2019s not working. \u00a0Does the typical consumer care about the taxes on high earners? \u00a0No, not really. \u00a0They care about how it impacts them, or about how they fear it\u2019ll impact them in the future.<\/p>\n

Why is Obamacare failing?<\/p>\n

The bottom line: \u00a0Insurers are withdrawing from some Obamacare markets, and raising premiums erratically and narrowing networks in others, because they themselves cannot price policies reliably, due to the regulatory conditions in which they must operate. \u00a0In particular, the young and healthy folk that Obamacare policies had relied on to subsidize the old and sick, have done the math, and see that their premiums would be higher than it\u2019s worth to them. \u00a0And the required benefits, while all well and good, increase costs without any apparent pay-off. \u00a0 And the risk corridors and other goodies that were supposed to provide government subsidies to the insurers were a matter of executive order that Congress has eliminated.<\/p>\n

But is the Senate proposal going to fix these problems? \u00a0Not likely. \u00a0At this point I\u2019m going off of the Vox summary<\/a>, which seems credible and without hysteria.<\/p>\n

The biggest impact of the Senate proposal is to pare back Medicaid, or, rather, restructure it from a blank check into a fixed sum of money from the feds, and they pare back the 95% cost-share for the Medicaid expansion population. \u00a0Now, how the Medicaid system should be structured is, as they say, beyond the scope of this blog post. \u00a0Are there efficiency gains to be found, or not? \u00a0To what degree do Medicaid participants abuse the no-cost ER for sniffles? \u00a0What about the fact that American retirees tend to think of Medicaid as\u00a0long-term care insurance, with advisors consulting on how to best shelter assets to meet the asset test? \u00a0How will this impact patients, vs. requiring states to pitch in more?<\/p>\n

The proposal also keeps the fundamental concept of means-tested subsidies; it just reduces the cut-off for those subsidies and reduces the amount of the subsidies by tying them to a bronze rather than a silver plan. \u00a0One plus is that it provides those subsidies to everyone, rather than leaving the below-poverty folk in non-Medicaid expansion states floundering, as is the case now.<\/p>\n

But the proposal keeps the guarantee of coverage for people with pre-existing conditions, and at the same time, eliminates the mandate that was supposed to prevent people from gaming the system. \u00a0All that\u2019s left now is the fear that you\u2019ll be diagnosed with something outside the open enrollment period and be unable to come up with a special exemption to enroll as a status change.<\/p>\n

Now the new bill does have some other tweaks: \u00a0according to a summary in The Hill<\/a>, similar to the House bill, it raises the permitted differential between premiums for young and old (you might think it\u2019s noble and socially-responsible for young people to pay more than their actuarially-fair share, but it doesn\u2019t work in practice), and it eliminates the employer mandate (which had its own set of unintended consequences, as employers cut away at 40 hour jobs). \u00a0And the proposal only indirectly addresses the question of\u00a0Essential Health Benefits, by permitting state waivers. \u00a0Does it address Obamacare\u2019s preventive care mandates? \u00a0I don\u2019t know yet.<\/p>\n

When it comes down to it, there are two basic considerations at play here: \u00a0how much money should individuals, vs. the government, be paying for healthcare? \u00a0And what\u2019s the most effective way to deliver this?<\/p>\n

At first glance, this Obamacare-lite proposal needs a heck of a lot of improvement before it can address these two questions successfully.<\/p>\n

\u00a0<\/p>\n

Image:\u00a0https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg; By Unknown photographer [Public domain], via Wikimedia Commons<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

The Senate healthcare proposal is finally out, and here\u2019s my first, lunchtime assessment. Republicans have promised up and down that they\u2019ll end Obamacare for one reason: \u00a0that it\u2019s not working. \u00a0Does the typical consumer care about the taxes on high earners? \u00a0No, not really. \u00a0They care about how it impacts them, or about how they […]<\/p>\n","protected":false},"author":2209,"featured_media":5217,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[256,658],"class_list":["post-6766","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-obamacare","tag-obamacare-lite"],"yoast_head":"\nHoly Pre-existing Conditions, Batman! It's Obamacare-lite!<\/title>\n<meta name=\"description\" content=\"The Senate healthcare proposal is finally out, and here's my first, lunchtime assessment. 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