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A plea for law makers to work together

Fri, Feb 14th, 2014
Posted in All Commentary

When local legislators appeared before the Fillmore County Board a few weeks ago to hear the county’s legislative priorities for the 2014 session, commissioners requested that they work together to get needed legislation through. Working with colleagues from both parties and buckling down to create useful bills for a better future takes real effort and work. Politicians who only criticize, finding fault with the work of those they disagree with, without producing anything constructive are not doing their jobs or practicing good governance. They are just taking up space and creating noise.

Affordable Care Act, not yet a work of perfection

Our heath care system was in desperate need of a fix, prior to the Affordable Care Act (ACA), which is better known as Obamacare. No matter where one stands on the politics of ACA, there is agreement that access to our health care system was not as it should be. An inefficient and very expensive way to get routine care is the emergency room. Use of the emergency room drives up costs for all of us. In a moral society, everyone should have access to health care. Many people have been forced to live just an injury or illness away from bankruptcy because of our health care system. More than half of the bankruptcies in this country are due to medical expenses.

We spend at least two times more on health care in this country than is spent in other developed countries or about 18 cents of every dollar spent. Unfortunately, in many ways we get less. Our life expectancy is about a year less. There are only about two-thirds of the doctors and hospital beds compared to other developed countries. Staying in that hospital bed costs about three times as much with similar care. The objective should be to provide better outcomes along with a reduction of unnecessary tests and procedures which are primary drivers of the higher cost.

With the roll out of ACA, several problems have come to light, even disregarding the website deficiencies. Those in a position to make the accessibility of health care better even if they don’t approve of ACA should use their power and energy to improve and fix the program. The reality is there is no going back to the system before ACA. Recently, three Republican senators (Orrin Hatch-Utah, Tim Coburn-Oklahoma, and Richard Burr-North Carolina) pitched an alternative to ACA. Their plan has little chance of getting passed and signed by President Obama, but maybe it is a beginning of a meeting of the minds to make improvements.

Blending the public and the private as they have with ACA is very difficult. Some programs have to be implemented to more clearly recognize the flaws. Making the puzzle pieces including employer provided health care, private insurance companies, health care providers, and a government mandate with subsidies fit together is very complicated. Getting a health care program that allows access to health care in the most efficient and fair way is not a simple problem. It is a problem that has been worked on for several decades.

The recently introduced Republican plan or alternative labeled the “Patient Care Act”, which at this point is just a list of ideas, keeps the popular aspects of ACA. Included are no lifetime limits, allowing dependents to be on their parents policy until age 26, and a more limited pre-existing condition guarantee. There would be no mandate or taxes, the unpopular aspects of ACA. Young people could get policies for less and older people would pay more (insurance companies could charge older people up to five times more than younger people). There would be tax credits for those with incomes up to 300 percent above the poverty line to help them pay for the insurance. ACA provides subsidies for those with incomes up to 400 percent above the poverty line. There would be no minimum requirements on insurance. The minimum requirements in ACA do cause higher premiums, but I believe there has to be some standard to eliminate “junk” policies. A discussion to reduce the minimum requirements to some degree may be useful. Medicaid expansion is to be reduced. Employee coverage contributions for some plans would be taxed. There is no tax on employer contributions in ACA (maybe there should be). The 35 percent tax would go toward the tax credit to be made available for lower income people.

Is it an improvement? There are little sweeteners to make the medicine go down, but in some ways they forget to make us take our medicine. “Continuous coverage” in the Patient Care Act for those with pre-existing conditions means an individual can change policies and not be turned down assuming they have maintained continued enrollment in some health plan. But, young people or other overly optimistic souls who think they are unlikely to get a serious illness or sustain a debilitating injury will not be required to get health insurance. When the worst happens and they haven’t had health insurance, insurance companies will not have to sell them insurance when they need it.

The Patient Care Act would encourage everyone to get insurance, but not mandate it. Many, if not most, at some point in their lives will have a serious health issue and according to this plan they will not be able to buy health insurance when they need it, if they have not been continually insured in some health plan. The only way to insure against being bankrupted by a serious illness or a serious injury is to be constantly insured, even when one is young and less likely to need it. Short of having a “crystal ball” to predict the future, we all need insurance. You have to pay into the system when you are healthy to allow the system to take care of you when you are not.

Mandates should not be made easily, but I don’t see any way around having a mandate in this case. States require every vehicle being operated to have at least a minimum of insurance. If this was not required by state law, many would not buy insurance at all on their vehicles. There is no way of predicting what might happen to you over your lifetime. Not having health insurance is irresponsible. I don’t see how removing the most unpopular aspect of ACA, the mandate, is going to work.

It is a fact that there have been unintended consequences with ACA, causing increased premiums for some or loss of their physician. Some of these problems could be fixed. Providers and insurance companies may have more successful negotiations in time and widen the networks providing better opportunities for health consumers. Big changes, like ACA, cause confusion and are difficult, but may seem worth it a few years down the road. Spinning the Congressional Budget Office (CBO) report on the ACA.

With the recent CBO non-partisan report the political spinning wheel was put into overdrive. Both parties were out there working it their way.

The headline saying ACA will cost 2.5 million jobs over the next 10 years is misleading and dishonest. The report didn’t say ACA will be a “job killer”, but actually said it would create jobs in the near future. People are not expected to lose their jobs, but there is expected to be a smaller increase in those hired because of the availability of affordable health care outside of the work place.

The CBO report did say that overall there will be a reduction in workers, not jobs. It didn’t say businesses would reduce their workforce. Some people are expected to voluntarily leave the labor force to retire, stay home to raise children, pursue some other career, or start their own business because they no longer have to keep their job in order to keep the health insurance provided through their employer. ACA will give people freedom of choice to move on to other opportunities if they want to (the Democrat spin).

Yes, some may choose not to work because it may be financially beneficial for them not to work. Republicans argue that ACA will cause low wage workers to trade jobs for entitlement benefits. Subsidies are withdrawn as income rises. This fact, it is argued, will act as an incentive not to work. Some workers may determine that it would benefit them to reduce their hours so they would be eligible for the federal subsidy. Perhaps, an adjustment to the income level triggering the subsidies will become necessary, when more is learned over time. In the end, some will always abuse the system.

There are about 145 million people in the workforce. Two and one half million is less than 2 percent of workers. This isn’t that big of number especially when it is reduced by those who actually are taking advantage of the opportunity to stay at home with their kids, retire, or start a business.

There will be some abuse by those choosing to live off government benefits (the Republican spin). Any program will invite some abuse. This is what it is, but it doesn’t diminish the program’s potential to be worthwhile and valuable.

The truth is, no one can clearly see 10 years from now the effect ACA will have on the health care system and the economy.


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4:28:54, Feb 18th 2014

Bonita Underbakke says:
Dear Karen,
Thanks again for your thoughtful view, presented clearly.

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