Medicaid expansion under the ACA raises the income threshold for eligibility for subsidized public health insurance. But Washington Governor Jay Inslee (who’s also running for President to save the planet) just signed a different kind of Medicaid expansion: allowing any resident to buy into the state’s Medicaid coverage as a public option:
A set of tiered public plans will cover standard services and are expected to be up to 10% cheaper than comparable private insurance, thanks in part to savings from a cap on rates paid to providers. But unlike existing government-managed plans, Washington’s public plans are set to be available to all residents regardless of income by 2021.
…the state will dictate the terms of the public option plans but hire private insurance companies to administer them, saving the state from having to create a new bureaucracy — and guaranteeing a role for the insurance industry in managing the new public option [Tom James, “Washington to Offer First ‘Public Option’ Insurance in US,” AP News, 2019.05.12].
Washington’s plan will offer premium subsidies for folks making up to five times the poverty level.
Washington’s plan also offers the same advantage a public option would for Medicare: more premium payers in the pool, providing the state with more money to support all of the people covered. Heck of a deal! There’s one more health care plan we Democrats can offer as a counter to the Republicans’ preferred model of letting people go without any coverage.
On Facebook this week, I said this about Medicare, but the same applies to Medicaid:
I believe there has been a key piece missing from the “Medicare for All” debate – the discrepancy between Medicare reimbursements/payments to providers and private insurance reimbursements/payments to providers. The RAND corporation studied this and has found a 156-311 percent discrepancy (different states have different discrepancies).
If Medicare were the sole, or even primary, reimbursement model, most providers would go out of business at current Medicare reimbursement/payment levels. Who believes that a federal monopoly on healthcare payments would result in *higher* payments to hospitals and other providers? See:
Prices Paid to Hospitals by Private Health Plans Are High Relative to Medicare and Vary Widely —
Findings from an Employer-Led Transparency Initiative
https://www.rand.org/pubs/research_reports/RR3033.html?fbclid=IwAR2PFET_f-M_WknCos2WY7CQDe3b0Z8JQpQfME6MXqQloDKAK51F4P-rAyI
We have seen first hand the problem that is government health insurance. Beginning with the ham-handed roll out of the ACA supervised by Kathleen Sebelius and a lack of Security of personal informstion, the confusion, we saw things go downhill from there. We saw the spiraling out of control co-pays, deductibles, and other cost. We saw rampant fraud and a gapping money pit. While the ACA provides millions with health insurance coverage, others cannot afford to use it. Some of our Democrat Presidential candidates now want to fix the ACA which is an admission of a broken plan.
We see another prime example of failed government health insurance with the Veterans Administration. The last two administrations have tried to fix the VA. Then there is Indian Health Care as another example of failure.
Now…there are many reasons for these failures. Some will blame the Repubs, others will resort to name calling however, when we look for a common link in these failed systems we see they are all ‘government run’.
T. Camp, I see the point that government insurance has not gone as planned; however, you end your analysis where the GOP always does and not with a better option. It is easy to call out the deficiencies of the ACA — to be fair, all legislation has to be tweaked and changed as unexpected eventualities come up, but the GOP refused to help the ACA succeed. They played for the political win over the responsibility to serve constituents — so to what end is your advocacy? Should we just allow the poor to go without insurance and care? Should we allow an even more abject failure, the private health insurance system, to take over completely? Or is the point to wait for the 2020 elections and FINALLY the Trump/GOP plan for health care will be adopted (or written?)?
To answer Mr. Wylands question: Private insurance reimbursements are compared with Medicare reimbursement rates for the same procedures and facilities to determine relative prices. When more people buy into Medicare (via public option) the relative price comparison will absolutely result in higher reimbursements from Medicare to hospitals and other providers.
Cory: Colorado has done the same as Washington to add a public option. If approved by Washington it will begin in 2020.
https://www.denverpost.com/2019/04/23/colorado-public-health-insurance-option/
Well, then Michael, we need to talk about pricing for healthcare. One common complaint about the ACA is that it surrendered to the insurers and providers and declined to implement serious cost controls. If health care can’t stay in business at prices that don’t bankrupt half of its customers, then we have a huge problem to fix.
Is there really no option for providing universal and affordable healthcare?
Camp’s comment falls apart when we look at every other industrialized economy in the world that has gone to some sort of public health insurance and has not experienced anything like the complete failure he falsely paints.
Single-payer covers everyone. Single-payer spends less of the national wealth.
My follow-up comment on Facebook was: “Perhaps [Medicare for All will free up monies currently paid to private insurers], but pressure from taxpayers to limit [healthcare] costs and government’s desire to spend as much as possible on as much as possible would prove too tempting for most legislators.”
I suppose one could posit that increases in taxes on employers (necessary to funding a more robust government-paid healthcare option) could be preferable to employers faced with unpredictable increases in insurance premiums paid on behalf of employees.
However, the provider payment issue remains. Healthcare provider margins are small and already declining, with some hospitals operating at a deficit. Over 100 hospitals have closed since the ACA was passed, and many formerly independent hospitals are now owned by or affiliated with large healthcare systems that are, themselves, dealing with narrowing profit margins and competition for professional and paraprofessional staffs.
One unanticipated consequence of the ACA has been that the vast majority of additional people covered are being covered under Medicaid, both traditional and expansion. Increases in people covered under private insurance, either through the exchanges or elsewhere, have not come close to meeting projections.
Medicaid reimbursements fall significantly below private insurance reimbursements, as noted above. The American Hospital Association, which supported the ACA believing that it would result in more paying patients, is now reassessing that support. The relatively low Medicaid reimbursements, coupled with increased out-of-pocket costs for patients covered under private insurance, have reduced operating margins (net profitability) and increased uncompensated/bad debt) care for many hospitals.
In this environment, providing more patients with a government option doesn’t look like a solution to providers. Less is paid on patients’ behalf, political pressure mounts on government to limit reimbursements to providers. Even large provider networks – already dwarfed by the size of large private insurers – have little or no negotiating leverage with the federal government.
Mr. Wyland’s position on future healthcare options requires a bit of “reading between the lines”. When he tips his hand by saying, “government’s desire to spend as much as possible on as much as possible would prove too tempting for most legislators.” it’s his tell. Republicans in SD view politics as a parlor game with the objective being to stop Democrats from helping people in need. Repub’s used to bring up the cost of aiding the people but Trump’s unbridled spending and massive deficit increases have ended that excuse. Whereas, American Democrats objective is to look for ways to help people as cheaply as possible. We’d have a public option except Joe Lieberman wouldn’t vote for ObamaCare unless it was dropped. We’d have already tweaked the ACA and co-pays would be a tenth of what they are now. Rubio, Cruz et al removed provisions from the ACA and now you all pay out the nose. Why would Republicans want you to pay super high co-payments? Because it’s just a damn parlor game to them. It’s more vital to hurt Democrats than it is to get people on healthcare cheaply.
T.Camp offers up a frequent theme:
The theory seems to be that programs run by “the government” are inherently worse than those run by non-government entities such as corporations, partnerships, or individual entrepreneurs. Of course “government” is only a name we apply to groups of human beings, just as with “corporation” or “partnership.” These terms mean nothing without the humans it takes to make them function.
This necessarily means that it cannot be “government” that causes any failure, rather, it must be the human beings who operate the “government.” Following T.Camp’s reasoning, we must “look for a common link in these” human beings. Are they all male – no. Female – no. One race – no. One nationality – no. One educational level – no. One political party – no.
This inquiry seems fruitless as I have asked many anti-government zealots for their take on what attributes they can identify in these humans who create and work for the organization of human beings that is labeled “government” have in common. To date no one seems to have any meaningful response that might justify blaming anything on the “government.” It seems instead, that every so-called problem with a “government” program has literally nothing to do with the fact that it is a “government” program, rather, it seems the problems originate from one or more individual humans with no discernable connection that can be linked to “government.”
In some cases a particular political party gains control of the government and then does stupid or harmful things with their newly gained power, yet that seems a function of the stupidity of those individuals or the members of their particular group rather than “government” (or the label they use for their political party for that matter). This becomes even more evident upon recognizing that it is just as possible for a caring and wise political party to gain control and accomplish things that benefit, rather than harm, our communities.
So if there is indeed any human characteristic that can be rationally deemed a “government” characteristic that necessarily leads to problems or failure, perhaps T. Camp can tell us what this missing link is that ties all of us humans that choose to undertake government functions, whether creating the particular government, deciding upon the function or carrying out the functions of government, that can justify the assertion that failed systems are the fault of “government.” If not, we are left to recognize that such claims are simply blind prejudice without a rational foundation
I understand where Porter might misunderstand my statement as being partisan in nature. It really isn’t intended that way.
Legislators have every incentive to say “yes” rather than “no” to constituents, donors, and others, regardless of ideology or party affiliation. Re-election is predicated on “bringing home the bacon” to one’s voters and otherwise taking actions presumed to be helpful to their voters’ interests. No single legislator is accountable for overspending or over-committing government resources. “It’s not me, it’s Congress.” In practice, it’s a negotiation where all sides want something and the goal is that everyone gets some portion of the something (not everything) they want.
I’m reminded of CBS correspondent Lesley Stahl’s comment about the Tea Party members elected to Congress in 2010: “No one can figure out how to deal with them. They don’t WANT anything!”
BTW, my observation is hardly original and I don’t claim it to be. Bill Janklow said the same thing as governor, referring to the GOP-dominated SD Legislature.
Regarding Obamacare, Medicaid and Medicare it’s not the case that Mr. Wyland and other Republicans “don’t want anything”. It’s more accurate that they “don’t offer anything “. Repeal and Replace seems to be missing the second half. All your efforts are to find fault with Democrat’s plans while presenting none of your own. Parlor game …
I’m not sure which Republicans Porter Lansing is referring to. I know that Paul Ryan, as Speaker of the House, had an Obamacare alternative posted on his website in 2016 as part of a six-point policy agenda. The unsuccessful Obamacare repeal effort in 2017 included many of Ryan’s ideas as well as several “backstop” features such as hundreds of billions of federal dollars for states to build up high risk coverage pools.
As for me, I was lobbying on behalf of the SD Psychological Association both before and after the ACA was passed. I also remember GOP proposals in the 1980s from people like Sen. Bob Dole (R-KS).
Whether Republican or Democrat, everyone was trying to find a way to “bend the cost curve” (reduce the rate of increase in healthcare costs and health insurance costs), insure more people, and not offend the healthcare lobbies, especially the private health insurance companies.
Large employers, who were key in promoting Hillarycare in 1993-1994, were especially interested in a way to get out from under providing increasingly expensive health insurance to employees. However, the support of large employers wasn’t enough to overcome opposition from the private insurers – remember the “Harry and Louise” ads?
The architects of Obamacare remembered, so their proposed solution had to satisfy private insurers and healthcare providers’ lobbies. Securing the providers’ support required a commitment of $150 billion to make permanent the “doc fix” that was passed by Congress annually as a stopgap to prevent reduced Medicare reimbursements to providers.
Many GOP plans included features such as guaranteed issue regardless of preexisting conditions, subsidies for individual insurance, facilitating association health plans that would cross state lines, encouraging the use of health savings accounts (HSAs) and similar vehicles that allow individuals to couple catastrophic/major medial health insurance with tax-advantaged investment accounts they could use to pay for healthcare expenses, etc.
The media are not known for taking deep dives into complex policy questions, so little of this reached the general public. There are limits to what can be reported in sound bites, and showing talking heads arguing is far more entertaining than an expert explaining the intricacies of a plan.
The GOP shares the blame for the lack of information on a replacement for Obamacare because they played the game of sound bite for sound bite, and being anti-Obamacare was a simple slogan that resonated with the GOP base.
Before Obamacare Democrats weren’t looking for a way to appease health insurance companies. We were forced to by Republican opposition to our solutions. That’s where the great compromise known as the ACA failed. Insurance companies were making windfall profits with little risk. My lawyer hired an expert witness that testified that besides the $2.2 million in assets I lost when my policy was canceled because I contracted a long term illness (which became a preexisting condition) I also lost $26.6 million in future earnings. Obamacare ended that common practice by insurance sellers. Republicans oppose allowing everyone to be allowed to buy a Medicare policy for the same reasons they’ve always had. The campaign donations from insurance companies has bought their allegiance. That sell out is contrary to the greater needs of Americans and just a “we’ll stop the Democratic efforts” parlor game.
Cory and Beatcreekbat: You are making this about me and ignoring the historically accurate evidence of government health insurance failure.
The industrialized countries you mention likely have different populations diversities, physical size, economic foundations and historical and political governance. Gender, race, sex has nothing to do with the issue and is nothing more than fingerpointing.
We agree that the Repubs did not offer any ACA replacement but as Democrats we have no control over them. We did nothing, Zip, nada, neit, to fix our ACA when cost over-runs became apparent. We own the ACA and the serious issues which many of our front runners now want to fix. What took us so long!?
Many love to deflect and point to the other guy but they forget the sage acknowledgedment of our friend, “Pogo”.
Terry Camp or whatever your real name is. That’s the name of your hunting/fishing spot in the Black Hills, isn’t it? Anyway, The historically accurate evidence of government health insurance failure? I believe your argument is going to be disputed by BCB and Cory.
Sorry T. Camp, my comment has nothing to do with you. Rather it addresses the common but unsound argument that you have advanced about the “government.” To predict a failure of the Washington plan simply because in your opinion past efforts by the “government” have not satisfied whatever standards you apply is a fool’s errand. The people putting together the Washington program have developed a program that will work or fail on the merits of the program, not because the program is a “government” program.
Cory said,
“Republicans’ preferred model of letting people go without any coverage.”
They’ve proven that repeatedly. They like to say that it’s just lazy people who ought to get a job. That’s a lie. I’ve worked with many disabled people. Bobby was a fine and healthy little boy till his dad beat him over the head so hard his skull is lumpy now and his brain doesn’t work right. Or Sharon, born with Downs and a most delightful woman, a real pleasure to be around. Sue, with FAS.
So? What about people like them? They don’t have family around to care for them and they have greater health needs than the average citizen. They’ll die without help and I guarantee, Chinless Wonder McTurtle could care less about Bobby, Sharon or Sue. He doesn’t care about us elderly and retired folks either.
Like Porter, I had the misfortune of becoming ill at age 56 and unable to work full time at my profession any longer. Then the Great Recession hit. My savings, pension, life insurance, 401K . . . all used up fast. Chinless Wonder McTurtle doesn’t care.
I think it was Mr. Wyland who said that senators and reps care what their constituents think. Nope. Not all of them.
Chinless Wonder McTurtle has said he doesn’t care what the people of Kentucky think and his ratings in the state he “represents” are in the toilet. But Kentucky just got new, no paper trail, voting machines and the company owner happens to have contributed a pile of $ to Chinless Wonder’s campaign. So no worries.
No. The current GOP leadership doesn’t give a rat’s ass about the well-being of US citizens in 2020. They’ve got voting machines, Pootie and hoodwinked MAGAts to thoroughly rig every election necessary. The only chance for care and a decent life for this country’s people is Democratic control of DC.
A quick off topic. SORRY. Debbo brings up MAGA. If you see a federal worker wearing a MAGA hat at work, it’s against the law. Charges are being drawn up against the Trump Administration for rampant campaigning at work.
The Hatch Act is a federal law that prohibits federal employees from engaging in certain partisan political activities. … Violations of the Hatch Act can result in disciplinary action such as reprimand, suspension, demotion or dismissal.Jun 14, 2018
Enforcing the Hatch Act | Campaign Legal …
https://campaignlegal.org › cases-actions
FTI t.camp–I use the VA, my father used the VA and all my veteran relatives use the VA. I have never heard any of them use derogatory statements against the care received.So, as with most of your posting, you merely pull something out of your arse or repeat disgruntled hearsay from some who think they are entitled special treatment because they served.
The Heath Savings Accounts and before that, the Medical Savings Accounts, were never designed for the worker class of people, they were designed for the white collar worker as another IRA account with mostly employer contributions for their tax purposes. These plans did not do a thing for health care or it’s delivery and were never intended to do so.
High deductible plans only work when all medical expenses go towards the deductible and there is no co-insurance. BTW, a high deductible plan should never exceed $2,500.00 annually in order for them to be affordable to the average consumer. $2,500.00 for a maximum out of pocket on a yearly basis, is a mountain that can be climbed, but $7,900.00 for an individual, and upwards of $15,800.00 for the family is impossible.
Democrats wanted free mental health treatments, dental and vision for the children with reasonable costs. Marco Rubio, republican, put the bullet in the head of the ACA when he eliminated the Risk Corridor. republican’s have vowed to destroy healthcare since there have been doctors. There is no sugar coating for the evil the republican party have done to the American people for the benefit of the wealthy.
We pay 241% more for hospital services than does Medicare for the same services according to the Rand Report.
“On average, case mix-adjusted hospitals were 241 percent of Medicare prices in 2017. Reducing hospital prices to Medicare rates over the 2015-2017 period would have reduced health care spending by about $7.7 billion for the employers included in this study. In 2017, reducing prices from the 75th to the 25th percentile price could reduce spending for those employers by $1.4 billion per year, which is approximately 40 percent of 2017 hospital spending.” Rand Report
“Growing frustrations with employer-based insurance
The rising interest in single-payer health care can be explained by a simple fact: the cost of private, employer-sponsored health insurance keeps going up. The original sin of the American health care system—the exclusion from taxation of employer-sponsored insurance—has created all sorts of incentives for hospitals, drug companies, and other health care industries to keep raising their prices, knowing that patients are several middlemen removed from the cost and value of the care they receive.
Employers have been reluctant to control costs, because workers often get upset if a favored—but costly—hospital or doctor is excluded from the employers’ plan. The end result has been a passive-aggressive approach in which deductibles have tripled over the last decade, and wage growth has been suppressed.” Forbes 05/11/2019
A real fix to the ACA/Obamacare or Medicare for all needs to be. The republican non fix to healthcare must end.