Effective But Will It Be Enough to Stop Provider Exits
(Insurance Provider's Bottom Line)
Background: The ACA (Obamacare) was enacted in March 2010 and is still not fully implemented. Its growth has been hampered in part by partisan gridlock that has further undermined the exchanges. The question is why? Some reasons follow:
For example: Gerard Anderson, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health says: “They haven’t changed the law since it was passed, and it was passed in a very convoluted, rushed state. Normally, what you would have had was a whole series of technical changes over the last six years to make the law better, but they haven’t been able to do it.”
Now and ever since the bill was signed into law and the USSC ruling keeping it alive, we have had this from the GOP: “Kill it; Repeal it; Replace it; Scrap it; etc. etc.
Now GOP nominee Donald J. Trump continues that line and says he will scrap it altogether on day one.
But, Hillary Clinton is expected to try and rescue it even as it enters a new and worrying stage in its development.
Some facts: By many measures the program has been a tremendous success. Some 20 million more people now have insurance; those under the age of 26, who often skip insurance, can be covered by their parents’ plans; and, people with existing conditions cannot be discriminated against.
However, 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.
Some insurers have been fleeing the exchanges, arguing that healthy persons vs. sick persons “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.”
David Howard, an associate professor at Emory University’s department of health policy and management, said the ACA included provisions to keep the marketplaces stable, but some of those were watered down in the push to get the deal through Congress, and in other cases the provisions have not been enacted in the way people expected. Then he added: “That means the exchanges are potentially on the cusp of falling apart.”
Why this insurance abandonment? Coverage to millions of young adults, who are reaching the cutoff point, are at risk falling through the gaps. The marketplaces are unstable in part because they are new, and all the parties involved – from insurers to those who need insurance – are trying to figure out where they fit into the equation. Quite simply: The system needs healthy people to enroll to help offset the costs of sicker people, but that is not what is happening – there are fewer enrollees than projected, and they are sicker than anticipated.
On top of that, premiums are expected to rise, which makes insurance from the marketplaces less attractive to the healthy, young people they need. “They’re eventually going to get to the point where premiums go up, healthy people drop out of the market, which causes premiums to go up more, then more healthy people drop out of the market, and eventually the whole thing just falls apart,” said Howard.
Others argue this period of instability, while a problem, is a natural - and temporary – part of the cycle.
As for me, I believe the solution best expressed by more than 2,000 physicians is the easiest and simplest and would solve any long-term problems: They want a single-payer system similar to Canada. They also say the Affordable Care Act didn’t go far enough in that regard.
Continue the story at this link from The Guardian.
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