Local view: Affordable Care Act offers important protections
June 28, 2012 at 7:00 pm in Duluth News Tribune
The Supreme Court support of the Affordable Care Act was even more important for Northlanders than for other Americans.
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Local view: Affordable Care Act offers important protections
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We the US doesn’t have a fabulous health system. As a country we spend the most $$$ compared to other industrialezed nations and still have worse outcomes. We have a dismal infant mortality rate and education and income are only a small reason for that. We have serious access issues as well. The idea is not to hurt but help small business. We Americans should be more upset that the insurance industry and pharmaceutical companies are making enormous profits. If they we less greedy the costs would go down across the board for everyone.
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I disagree, they have factored in our neonatalogy efforts and we still have high rate.
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Part of the reason people “beat down our door” is they can afford it. If you have more money you most certainly can get better care in the US. Unfortunately most of the “worker bee’s” aren’t allowed that luxury to shop around for VIP healthcare services.
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We are the most expensive healthcare in world and only ranked 26th in world in providing proper healthcare and we are are way down list in infant mortality. It’s not a leftist ranking, it’s by the World Health Organization and if we’re so good in neo-natal then why the high mortality rate. You don’t even think about the BS propaganda being fed you.
Conservatives keep parroting…whhaaa, but world leaders all come here for healthcare….Who? I am pretty sure it would be in the news and I don’t recall any.
Every year for over 10 years each and every year has broken a record in the number of bankruptcies and 60% of those are because of medical expenses. Also there are more people that leave this country for medical treatment then come here for medical treatment. It’s a booming new tourist industry.
Republicans just want to be against everything and really want to be against this because is feather in Obama’s hat. In 2005 State of the Union Address Bush demanded that Congress pass healthcare reform that year so stop with the leftist liberal agenda BS also. We are the only industrialized nation in world that doesn’t provide a universal healthcare. Germany has had it since the 1880′s…their reasoning was a healthy people made a healthier nation…what a concept.
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The CBO’s March 2012 revised estimates showed an improved net deficit reduction over their previous estimate. You either misunderstood or are relying on others who misunderstood or attempt to mislead. Read the report here: http://www.cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf
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Rescored last week, it came back a budget buster…again.
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“Federal money”–ah, how sweet the sound. But that money has to come from someone’s pocket. Justice Roberts warned us that it wasn’t the court’s job to protect us from bad political choices. Elections have consequences–always and everywhere.
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In our own personal situation, we have employer provided health insurance where we pay 30% of the premium. Our insurer, the largest in our state (not minnesota), provided this information about the effects of the full implementation of the law. 1) It already meets the standards of the covered services so no change. Copays will not go up. 2) The best estimate of our premium increase by both our insurer as well as our state insurance commissioner for the ACA is less than 4% of the premium we and our employer already pay. 3) An accounting review by the two largest hospital systems in our area showed that the costs of the uninsured account for almost 10% of their balance sheets, that is currently paid for by those of us with insurance. In short, based on the actual facts I have in our particular case, the ACA will have minimal effect for our care and our wallet. The real problem is the rising cost of health care itself. Over 90% of our premium increases are due to costs, not the ACA.
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Yes the insurance companies make billions of PROFITS, if they were a little more humane we may not be in this crisis. Again the current system is designed to pay for illness. There is little effort for preventative care. ACA will finally allow every one to have no co-pays on preventative care. It doesn’t take an economist to realize that is were the savings will be, preventing disease. The high cost is related to treating those with advanced illness and the consequences stemming from disease process. We the people need to stop listening to the Insurance company and big Pharmaceutical industry. They are the enemy. The don’t like ACA because it will effect their bottom line $$$$.
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We already pay over $3000 per year just for our portion of our health insurance as does everyone where I work whether you make 20k or 100k a year.
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I would also point out that the average family policy cost in the US is over $5000 per year.
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I would also like to point out that the average cost of a single surgery for one person out of that average of 4 people in a family likely is very close to the $5000 mark, if not more.
Granted, surgery is not an every year event for most people. But neither is a car accident and they force you to have car insurance in the state of Minnesota.
But nobody is complaining about that mandate.
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We all know that there are certain portions of this law that pretty much everyone can agree on – keeping kids on parent’s policies, elimination of the pre-existing condition restrictions, etc. HOWEVER, read what else is in this law and be informed. Don’t just take the talking points (which are the good things mentioned above) and conclude that this is a good law in its entirety. As recent as today, the insurance industry has said that the ACA will cause our premiums to rise. Small businesses can’t afford the rising costs and will quit providing coverage and then the employees will be forced to get the government insurance. Do you really want government deciding whether it is cost effective for you to have a surgery or a treatment? Remember who is going to be enforcing this law — the IRS. Benefits for seniors are going to be cut by $500 billion, meaning they will be paying more out of their own pockets. The physicians I know do not want the ACA because it puts more people in between the decisions that need to be made when providing healthcare for their patients. If you really think that this is a good thing, take the time to do some digging into it and make the decision yourself. Read up on what else is included in this bill that has nothing to do with healthcare.We can all spout off the talking points on either side — take the time to check into it yourself and be informed.
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You are correct that I did not talk about all of the features of the law — I was sticking to 600 words.
You are confused as to the way in which the ACA will change Medicare to save $500 billion over 10 years.
The program that proposes passing more of the expenses of Medicare on to the recipients is the Ryan-Romney-Cravaack plan to convert Medicare to private insurance. They plan to issue vouchers which will gradually decrease in value relative to medical costs, in the hope that Medicare recipients will be able to shop for insurance that costs less, using the marketplace to achieve savings. In the real world of insurance lower cost means lower actuarial value — that the insurance will pay less, usually by use of higher co-pays and deductibles and other out of pocket expenses for enrollees.
The ACA proposes to save the $50 billion a year on Medicare not by having recipients pay more but by paying less for certain things. The first is for Medicare Advantage, the existing program to allow Medicare recipients to use private insurance programs. Advantage costs the government about 15% more a year for each enrollee than conventional Medicare. The ACA divides Advantage programs into three groups, based on the value of the insurance compared with regular Medicare. Group A is for programs that provide more value than conventional Medicare (about 10% of Advantage programs.) Group B is for programs that provide about the same value as regular Medicare (about 45% of programs.) Group C is for programs that provide less value than regular Medicare (about 35% of programs.) The ACA proposes to stop paying for group C Advantage programs and return the enrollees to regular Medicare, since their insurance is actually worse than regular Medicare. That would save about $7 billion a year, or $70 billion over the ten years, while providing the enrollees with better insurance, saving them money and improving their care in the long run.
The ACA plans to save the remaining $430 billion over ten years by cutting waste and reducing harm to patients through a series of programs to improve care and eliminate ineffective, wasteful, and sometimes harmful care. Paul O’Neill, the former CEA of Alcoa and Secretary of Treasury under George W. Bush, headed a study that estimates that there is about $1 trillion dollars A YEAR of this waste. Other studies have estimated between $400 billion and $800 billion a year. About 45% of the waste — $170 billion to $450 billion a year — is in Medicare and Medicaid. The task of finding about $45 billion a year of this waste and eliminating it from the budget is one that the CBO believes is well within reach, which is why it has found that the ACA will actually reduce the deficit by being able to pay for itself and have extra money left over.
The question of the impact of the ACA on private insurance prices is a good one. The ACA expects that the combination of the financial subsidies for buying private insurance and the potential penalty from the mandate will result in about 15 million new customers for private insurance Although some of those will be people with poor health who are able to enroll because of the guarantees, large numbers will be ordinary people who are in relatively good health. In the experience over the last several years in Massachusetts with the Mitt Romney program which is almost identical to the ACA, private insurance has actually increased in cost less in Massachusetts than in the rest of the country. Since the ACA is almost identical, it is reasonable to assume that it will also reduce growth of costs.
In addition, private insurance will be able to take advantage of the savings located and used by Medicare to save money in their own programs. Since the end of the managed care experiment of the 1990′s, Medicare has been better at controlling costs than private insurance, but private insurance has been quick to adopt cost controls pioneered by Medicare. The cost growth of the latest 2 years is a good example. Two years ago Medicare reduced its cost growth to about 3.5%, while private insurance experienced cost growth of about 7.5% Last year private insurance adopted many of the new Medicare savings and was able to match Medicare cost growth of just over 3%. In the competitive world of private insurance, cost control is often hard to impose, but savings realized by Medicare give the private insurers cover to implement savings. Anyone who has experience in medical billing and collections can verify this experience.
Thanks for your questions.
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CK said:
“Small businesses can’t afford the rising costs and will quit providing coverage and then the employees will be forced to get the government insurance. Do you really want government deciding whether it is cost effective for you to have a surgery or a treatment? Remember who is going to be enforcing this law — the IRS.”
I don’t know where you’ve been doing your “checking” but, you seem to have found some things that don’t exist in the bill/law.
Firstly, there is no “government insurance” that small businesses will be forced to get. There is no public option in the bill that passed into law. In my opinion there should have been but….there wasn’t.
The government will have absolutely ZERO to do with any decisions about your treatment or how it’s administered.
And the only thing the IRS will be involved in is collecting the tax from those that choose not to enroll in a health care plan.
The government’s only role in providing health insurance will be to give subsidies to people and small businesses so that they can afford to purchase insurance in the open market.
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No. The rules may change a bit, but Medicare and Medicaid actually require less “approval” than private insurance, ask anyone. You and your doctor already have your insurance company, the provider system he or she belongs to , the hospital, the state government, and the federal government in the room with you right now, and the ACA will not make that much of a change.
BTW, your notion that most doctors are opposed to the ACA is not true. It is heavily supported by doctors, including endorsements by the AMA, the national organizations for internal medicine, pediatrics, family practice, ER medicine, and others. In general, the closer a doctor is to the front line and seeing patients face the problems of getting insurance and access to care, the more likely they are to support the ACA. In Duluth, there is an organization of over 80 doctors working to support the ACA, and the organization is growing all the time.
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I said that the doctors I know are not supportive. The AMA does not have the numbers that people think they do. There are many physicians that do not want socialized medicine.
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How do you feel about having to pay a sales tax when you sell your house to help fund healthcare? Why is that included in the healthcare plan?
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That is an urban myth. There is no federal sales tax on houses at all, and certainly none in the ACA. Someone said that, someone else believed it, and before long people were repeating it without checking. Just one of a whole raft of confusion/lies surrounding the law.
Please take a look at the AP article published in this edition of the DNT for an accurate explanation of what is actually going to happen with the ACA. It is short, to the point, and makes it clear that there are a lot of very odd things being said that are just not true.
You can easily check up on national opinion on the ACA in multiple polls, just get on Google. New poll today, after the Court decision, says that national opinion on the ACA as of today is 46% oppose, 46% favor, 8% don’t know or don’t care.
I suspect you are right that more people favor it in Duluth, both because of the political environment here and because there are so many people who will clearly benefit by being able to get and afford insurance, many for the first time in their lives.
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And … Duluth is a very democratic area. Get outside the bubble of Duluth and northern Minnesota and you will find many more varied opinions.
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Dr Shoenfleder, What will happen to your reimbursements rates, and thus your income under the ACA and it’s trickle down effect on medicare? If you assert no change, I must challenge the veracity of all your claims.
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and you can theres nothing on this bill requiring you to buy government run insurance you can still pay more for your supposedly better care provided to you buy private insurance.
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CK said:
“I would prefer to be involved in my own health care decisions and not have it decided by someone else.”
I think we all would. And, in a perfect world that would happen.
However, as it stands (with or without the ACA)…no one actually has that luxury, unless they are willing to pay cash.
Everyone that depends on health insurance to cover their treatment has someone in a little insurance company office somewhere figuring out how they can deny payment for that treatment.
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The ideas that you can’t have your same Primary care provider is unfounded. I have not seen any where in ACA that says that. I have however seen commercials on TV paid for by insurance industry saying that. The insurance and drug companies have spent an unprecedented amount of money of money lobbing against ACA, hmmm I wonder why. They have spent million but yet they refuse many people care etc.
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I did a fact check on the sale of homes and the ACA. (The provision is on Page 33 of the reconciliation bill.) Fact check states “Only those with incomes over $200,000 a year ($250,000 for married couples filing jointly) will be subject to it… the tax still won’t apply to the first $250,000 on profits from the sale of a personal residence — or to the first $500,000 in the case of a married couple selling their home” They go on to state that it would most likely affect single executives who sell a vacation home or empty nesters. So it IS in the bill/law. You have to admit also that this is not a popular bill/law as noted by the poll you referred to. You have half of the people not wanting it and yet are being required to participate.
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Still wrong. This is not a home sale tax. It is, as the AP article from the New Tribune says, an added tax of 3.8% on all income over $200,000 for individuals or $250,000 for couples, including capital gains. The reason people get confused about the home sale issue is that the first $500,000 of gains on sale of a primary residence will be excluded from the tax, a feature of the tax laws that has existed since the mid-90′s. It is the mention of that exemption that has gotten people confused, but that is not a change. The change is the small tax increase on all income. The rationale for that tax change is that people in that tax bracket get the highest amount of government help in paying for health insurance now and will continue to get it, saving 35-40% of the cost through tax deductions and above the line consideration of employee insurance.
Here is a clear explanation of the myth from that well known left wing journal, Forbes. Read it, it’s short:
http://www.forbes.com/sites/beltway/2012/04/02/there-is-no-obamacare-tax-on-most-home-sales-really/
The poll popularity of the law is actually up from lows of as far down as 36% just after the Supreme Court arguments. The popularity now more or less reflects the split on everything else in US politics today.
However, the popularity of features like the prohibition of using pre-existing conditions for issue of insurance, prohibition of yearly and lifetime insurance caps, prohibition of cancellation of insurance due to illness, insurance of children up to 26 on parents policies, expansion of Medicaid, and the credits for purchase of insurance for low and middle income people and for small businesses all have always polled in the 65% yo 75% positive range, and continue to do so.
People actually like all the details about the law EXCEPT the mandate and some imaginary features like the home sale tax, the supposed payment for abortions that is specifically banned in the law, the supposed insurance for illegal immigrants that is also specifically banned, the mythical “death panels,” the supposed reduction of Medicare benefits that does not exist, and so on. In addition, in some polls as much as a third of the opposition to the law comes from people who think it does not go far enough, and want things like expansion of Medicare to everyone or a full fledged national system modeled on the VA.
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Directly from the article you directed me to: “So the bottom line is this: If you are a married couple whose AGI exceeds $250,000, and if you make more than a $500,000 profit from the sale of your house, yes, you may owe this tax” Your own article says this home tax is in the ACA. To say it is an urban myth is just not accurate. To say “imaginary features like the home sale tax” is not accurate. This is one just one reason THIS law is not a good one. It includes taxes and restrictions no one even knows are in there. To another one of your points,”The change is the small tax increase on all income.” The President specifically stated that this was not a tax over and over again and would not affect the lower and middle class- NOT true! It is a new tax…(in your words “on all income”)… confirmed by the Supreme Court. It was not sold to us as a new tax. Not one of our representatives during the debates in the house and senate stood up and said that they wanted to vote for “a new tax that will affect everyone”. In regard to your statement that AMA supports this bill. Yes, it does, but according to USA Today, “it’s been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it’s between 20 and 30%. But it seems many physicians have little positive to say about the organization.” It also states in MedPage Today,”the AMA ‘saw another steep drop in its membership in 2010 — this time losing about 12,000 members or 5% of its total membership.’” Many believe that it’s because of the AMA’s support of the ACA. I don’t think it is inaccurate to say that many physicians are not in favor of the ACA. Once again, Duluth is a democratic area. I’m sure your statement that 80 physicians are in favor of this locally is probably true, but not a true representation of the rest of the U.S. As to your polling numbers, directly from Newsweek: “Overall, 50 percent of those polled said they disapprove of the court’s 5–4 decision, while 45 percent said they support it. Consistently, a majority of voters said that they oppose the individual mandate (53 percent); believe taxes will increase (52 percent); believe their personal health-care costs will increase (56 percent); and disapprove of Obama’s handling of health care in general (58 percent). Only 24 percent of those polled said that they believe the ruling will make the country better off.” It is clear that the majority of people are not supportive of the ACA. Yes, we want a change in the healthcare system. No, we do not want THIS change. We want to keep our kids on our insurance, we want the cost to go down, we don’t want to be denied because of pre-existing conditions, but we don’t want all the other intrusive parts of the ACA . Obviously, we will have to agree to disagree.
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As you note, the tax is not a tax on the sales of homes. It is rather a tax on all income and profits. The passage about home profits is not a tax on home sales, it is an exemption of profits on home sales that do not generate a profit of over $500,000, granting a special exemption to home profits between $200,000 and $500,000 that does not apply to other profits. The article, by Forbes’ tax expert, says specifically that the idea of a separate home sale tax is a myth.
You seemed to have missed my point as to the popularity of the law, since the numbers you cite are virtually identical to mine. The mandate is unpopular. The overall law is, since the Court decision, essentially tied between like and dislike. However, almost all the individual aspects of the law other than the mandate, including the tax on high income people we discussed above, are very popular across the board. Article after article has discussed the dilemma this poses for opponents, who want to eliminate the law but fear the repercussions of ending the popular features. Many, including Romney, have been struggling with the notion of how to protect the popular elements while overturning the law as a whole.
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Were I a patient of yours, I would be troubled by your apparent double speak. And while I applaud your interest in the bill, I don’t trust what I’m hearing from you versus what I read directly from the legislation. Something doesn’t jibe here. And as a physician, isn’t trust what it’s all about? Who seeks the medical advice of someone they don’t trust?
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hattie wrote “Right now there are no waiting times for elective surgeries or a panel deciding if someone will get the surgery or just take a pill like the President has said in the past”….you sure wait a long time when they refuse to cover you (not to mention theres no wait for those with money to travel to America because everyone here cant even afford our own surguries). And secondly there already is a death panel (its called the insurance industry cost cutting FOR PROFIT) and id rather have my panel basing them on sound judgment than on basing them on how much profit they can squeeze out of their consumers.
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Mitt should really stop saying he’ll get rid of the ACA when becomes president.
The more he says it, the more people are going to realize just how disingenuous and duplicitous he actually is.
The same guy that told the people of Mass that this was the best thing to happen to the state since sliced bread now saying it’s a bad law?
The only thing that changes faster and more dramatically than the weather in Duluth is, Mitt Romney’s stand on things.
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The only problem with the ACA is that it’s far too conservative. Mandating the citizens to purchase for-profit health insurance was tried before and unabashedly rejected. I see this as a huge win for the Republicans, yet they won’t accept it. It’s like you guys just received a shipment of M120 mortars, but it’s not good enough for you – you’ll send them back in hopes of some new Mark 4 battle tanks instead. Then you can really blow apart the healthcare system!
Also, WW… I think it’s funny how you say, “WHEN Romney wins in November.” That’s 1 of the 2 main things that Republicans do to degrade the political discussion. You speak in terms of the reality you wish to have, rather than the reality as it is. It’s just like Fox News calling itself “fair and balanced”, when it is clearly skewed far right… or how MN for Marriage says that most people agree with them. You’re making up your own reality and treating it as truth. It’s asinine. The #2 thing that Republicans do is fail to listen. Instead of actually analyzing and debating, Republicans just memorize the talking points provided to them by the heavily financed propagandeers of our time.
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You should compare Romneycare to Obamacare.. oh wait.. they are the same..
One exception, Romneycare helped fund abortions. (Or as politifact puts it, Romneycare enables people to purchase plans that include abortion coverage.)
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http://www.nationalmemo.com/states-with-most-obesity-oppose-obamacare-the-most/
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