The Simple Reasons Why the GOP is Choking on their Repeal/Replace Healthcare Agenda

The GOP’s attempts at making good on their 7 year campaign promise to repeal and replace the ACA was served a bitter pill of failure last Friday when 3 GOP Senators voted against the proposed bill.

The amazing thing though shouldn’t be that it failed due to 3 GOP dissenting votes, but that 48 Republican Senators were willing to vote for such a flawed and defective bill in the first place that had less that 14% public support.

The GOP seems to be suffering from a severe case of missing-the-point-itis when it comes to trying to make good on their campaign promise. They think that just getting a bill passed no matter how bad it is will make their base happy, when in fact, the Republican base is expecting them to provide a better alternative to the ACA.

The GOP House and Senate are caught in a bind because their campaign promises of a better alternative to the ACA was nothing but hot air and political games. Seven years of continuously passing bills to repeal the ACA and now when faced with the ability to do just that, realize that there are real world negative consequences that can’t be dismissed in some simple campaign slogan that will punish both red and blue states.

The GOP denounced Obama and the ACA for being “rammed” through government under secrecy and no Republican support. In reality, the ACA had several open hearings for ALL the discuss and debate and accepted GOP amendments to their bill, while the GOP monstrosity was crafted by just 13 men in a closed room in secrecy.

The reasons why the GOP is flailing and failing with their repeal attempts are pretty simple:

  1. They aren’t trying to IMPROVE healthcare but just strip the ACA of government financial support. Cutting back on Medicaid and taxes do NOTHING to improve the state of healthcare.
  2. The GOP refuses to acknowledge that the ACA is a CONSERVATIVE plan that has private companies in group exchanges selling health insurance as opposed to a progressive plan of single pay healthcare. This doesn’t give them much leeway in coming up with a decent alternative.
  3. The American public likes this part of the ACA: no preexisting conditions to get insurance, but this can only be done with a mandate that everyone be required to buy insurance. The GOP seeks to kill the mandate rather than address the real problem- cutting the cost of insurance. The majority wouldn’t have a problem with the mandate to buy insurance if it was affordable.
  4. The GOP is making NO attempt to directly reduce prescription or insurance costs, and live in a fantasy world of thinking the free market without government involvement will result in superior and more affordable care. If the “free market” were capable of producing superior solutions, there would have been no momentum for the ACA to be created in the first place as a solution. People who complain about the ACA’s rising costs  seem to forget that prices were spiraling into the sky pre-ACA as well, and at a faster rate to boot.
  5. A good portion of the GOP simply doesn’t believe the government should be involved in healthcare, and that affordable healthcare is a right citizens should be entitled to. If you can’t afford health insurance they think it’s okay to “choose” not to have it even though reality dictates we will all need medical attention at some point in our lives. Most bankruptcies are due to being overwhelmed by medical costs.

 

It would be far easier to fix the problems with the ACA than to just start over from scratch, as seen from the inability to get a unified GOP front on any real or decent plan.

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My Experience and Opinons on Obamacare

health reform

The mere mention of the words “ACA” or “Obamacare” can start a flood of comments. There doesn’t seem to be a big middle ground as people are either in support of it or vehemently against it.

As someone who was already getting private insurance before the onset of Obamacare, I can give you my first hand experience and impressions about it.

I was also one of the privately insured who received a notice that my insurance would be cancelled next year due to changes in the health laws. Like others, I was also surprised and not expecting that. I had assumed that I would have a choice to pick a plan under the ACA or stay with my current plan.

Obama took tons of heat from people angry that their insurance got cancelled despite his promise that folks would be able to keep their plans if they want. The thing is, it seems to me Obamacare isn’t the reason the plans were cancelled, as in they were not “ordered” to close, but the insurance companies are using it as a reason to get rid of them. Here is where we see the law of unintended consequences coming into play.

The new law makes it mandatory for everyone to buy insurance. The insurance companies know this. Therefore, they now have a great incentive to get rid of their cheapest plans knowing that they have a guaranteed market of buyers. Now an argument can be made that the Pres and Co. should have realized this would happen and therefor can still be blamed. This is an unfortunate consequence of creating forced demand.

So my next step is to see what is available on the new ACA health exchange. Fortunately I live in California, one of the states that created their own separate exchange so I didn’t have to deal with those huge problems the Healthcare.gov site had.

I guess I should discuss my thoughts about the Healthcare.gov kick off debacle. They blew it- no excuses. Simple as that. I’ve worked on many IT/software development projects and it’s clear the website development team were sorely lacking in organization and accountability. That said, this is how things work – ideally, the company knows in advance how much time is needed for a project by discussing it with their engineers. In reality, many companies just pick an arbitrary date and expect their team to work overtime or do what it takes to get it done. The “reality way” sucks, and is the reason many people wonder why they choose the engineering/IT profession with all the late nights and weekends spent at work.

The next problem is the “moving target” of scope of work. In the beginning there is a cloud of confusion as to what needs to be done and that chews up time. Then finally a plan is developed , and as more information comes in the plans can change dramatically, negating much of the work that was already done. You can be sure that plans were changing constantly with a project of this scope and size. This also consumes lots of time.

At the congressional hearing on what went wrong, they also mentioned that they only spent about two weeks doing end to end testing. This is a joke as even small projects can require months of full testing and one of this size would need far more than just two weeks.

Those in charge should have delayed the start by a month or two and taken the heat from it. The next alternative was to open it to just a few states at first before making it nationwide. Instead they just let it start as scheduled and “hoped” for the best. Terrible decision. It would have been far better to be embarrassed by a delayed start than a software fiasco that makes everyone involved look like dunces.  It just gives all the opponents that much more ammo to attack with. There clearly needs to be accountability for the decisions made.

Of course it also needs to be said, the web site is itself not “Obamacare” and a problem with the site doesn’t automatically equate with the law being a failure, despite what all the detractors say. We won’t know if it’s on track for success or failure for at least a year or two.

Okay, so I get on “CoveredCalifornia” via the Cali health exchange and see what I have to do to get insurance.

The required information includes entering my social security number and expected salary for 2014 as well as any known deductions. From that they determine whether one is eligible for Medicaid or ACA coverage.  This is a HUGE difference from what was needed for private insurance pre-ACA. The forms I had to fill out before required me to fill out pages and pages of medical history, naming any and every doctor I’ve visited, where they worked, medications taken, procedures done, results of all actions over the last several years. When filling those forms out you were always under the gun to include anything and everything medical because the form also stated that failure to include ALL medical details would be cause for insurance cancellation.

There have been proven cases where someone came down with a serious chronic illness and needed ongoing expensive treatment, and then shortly thereafter, their insurance company researched their past medical records and cancelled their insurance because they failed to write down they had acne when they were a teenager. This is what most people worry about in the world of private insurance – getting cancelled when you need it the most for some spurious reason.

So the easy form to fill out is an immediate plus to me, as well as the fact that I know I can’t be kicked off my insurance or denied as a result of companies trying to cut costs.

Now I get to choose from the insurance packages being offered and compare the new prices to what I’m currently paying under the old private system. My current insurance is known as “catastrophic”, meaning that I will pay for all medical expenses until costs exceed the deductible which is about $5K, then my insurance covers everything else. However, the yearly check up and vaccinations are included and the deductible is waived for those. The high deductible allowed me to get lower cost monthly payments.

I can opt for this since I haven’t required many visits to the doctor and am counting on the trend to continue. Now some who are unfamiliar with insurance might argue why am I willing to pay for insurance when I still have to pay for medical expenses up to five thousand dollars. The answer is risk management – I’m only risking a maximum of $5k in medical expenses per year versus my life savings and assets if I should get seriously ill or injured and require medical treatment exceeding $5k. For those unfamiliar with medical costs, I had to go to the emergency room once, and I saw my insurance (full coverage at the time and not private) paid out $11K to the hospital. That’s just one visit. Extended stays in the hospital and surgery can run into the tens and hundreds of thousands of dollars. By not being insured properly, one is risking their financial livelihoods.

The new private insurance plans now being offered runs more expensive than my current plan, but they also include a lot more coverage. A visit to the doctor now has a fixed lower cost for the first 3 visits, as well as emergency room, urgent care, and other operations like x-rays. My out of pocket expenses now have some cushioning. My total deductible is now higher at over $6K, but the fixed lower costs of visits and procedures more than make up for it. Knowing the costs in advance makes it easier to figure out expenses than the unknown of what the costs would be. In the past, I’d try to call to get prices of doctor visits out of pocket, and no one would know the answer- or at least they kept their lips sealed- so there was always a worry a trip to the doc would be big bucks.

I selected my plan, and the first attempt to finalize failed as the system output an error message. The data was saved, so I tried again, and got the same error message. I was going to call, but I figure I’d try a day later first, since my data was saved with my log on account. When I tried it the next day, success!

So overall, the process of signing up wasn’t that bad at all, and in my opinion, the benefits of the new system are great and much superior to the much more complicated multiple page medical information required under the old system.

Another argument I’ve been seeing online that makes no sense is that doctors will reject insurance under Obamacare. It makes no sense because I’m buying private insurance under the system, so there’s no way any doctor can tell how your insurance is obtained. The argument is really referring to Medicaid, which is different, but folks are conflating the two either by mistake or deliberately as a false attack.

The software glitches will eventually(hopefully) be fully resolved and then the real proof will be if costs are controlled.

As an entrepreneur, I think this new system is great because it finally lets people get decent private insurance at more affordable costs. The biggest fear most people have with leaving the office job and striking out on their own is the loss of insurance benefits from their company. The ACA removes that problem.

Coming down with a preexisiting condition like diabetes or cancer meant you were trapped to the insurance company you were currently with, and if they kicked you out or left your state, you were out of luck. Now you have a full selection of insurance companies to pick with no fear of rejection due to a preexisting condition. This is also a huge plus.