Unaffordable Care Act, Part 1

So I did some research into the Affordable Care Act and the Republican repeal and replace strategy. Boy, talk about com-pli-cat-ed!

After some reading, it boils down to:

1. Is the Affordable Care Act working?
2. How much does it cost America?
3. What's wrong with the Affordable Care Act?
4. What are the benefits of the Affordable Care Act?
5. Will the Republican replacement plan work better than the Affordable Care Act?
6. How much does the Republican replacement plan cost?
7. How do the alternative Republican plans affect me? 
8. How do the alternative Republican plans affect America?
9. Has public opinion about the ASA changed?

It doesn't look like I made it less complicated, but here goes:

1. Is the Affordable Care Act working?

• Yes it is according to a New York Times 2014 article, but its not perfect.  Gallup did a 2016 survey that showed the number of uninsured had decreased, but there are still quality and cost concerns.

2. How much does it cost America?

• When the Congressional Budget Office estimated the cost for the first 10 years (FY2010-FY2019), they calculated a debt reduction of $143 billion.  When they recalculated in 2012 for an 11 year period (FY2012-FY2023), they calculated a debt increase of $1.252 trillion. 

3. What's wrong with the Affordable Care Act?

• It's complicated
• The penalty tax is hard to understand
• Plans were canceled for 1 million people because the health insurance companies didn't comply with ACA's ten essential health benefits
• Medicare reimbursement changed from a fee-for-service to a value-based payment creating a painful transition for the hospitals
• All medical records must be computerized
• Health care costs could increase over the short term as many people receive preventive care for the first time
• Families lose some tax deductions for uninsured medical costs
• Higher income families pay additional Medicare taxes (affects 1 million individuals and 4 million couples who make more than $200,000 and $250,000 respectively)
• Between 3 and 5 million people lost their company-sponsored health care plans.
• Health care and health insurance companies pay additional taxes to help pay for ACA benefits

4. What are the benefits of the Affordable Care Act?

• The ACA lowers cost by making health insurance affordable
• The ACA lowers cost by emphasizing prevention
• The ACA lowers cost by improving how healthcare itself is delivered

5.What does the Republican ACA repeal and replace plan do?

• It keeps some of the changes that Affordable Care Act implemented.  Senator Rand Paul quipped that it sounds like Obamacare Lite based on media reports.
• It does away with individual mandate, which is a requirement that most American obtain and maintain health insurance or pay a tax penalty.  It's a way to help pay for the ACA, providing about $64 billion for the first 10 years. 
• Instead of a individual mandate tax to encourage people to stay insured, insurance companies will be allowed to levy a 30% surcharge for a year on the premiums to people requesting to be re-insured.
• Income-based subsidies would be replaced with age-based tax credits that may be less generous to people with low income. These tax credits could be perceived as entitlements.
• The Medicaid expansion to include additional low-earning Americans would continue until 2020.  After that state adding Medicaid recipients would no longer be federally funded.
• The federal-state Medicaid program would be changed from open-ended federal financing to a limit based on enrollment and costs in each state

6. How much will the Republican replacement plan cost?

• The plan does not include any price tags.  It was released without a Congressional Budget Office score.
• CNN published a Jan 2017 article that provides some financial insight saying that a full repeal will cost $350 billion over the next decade. 

7. How do the alternative Republican plans affect me? 

• The Washington Post published an interactive article on Jan 17, 2017 that let you see how the various Republican plans to replace Obamacare could affect you.  Hopefully they will do a new one to address the plan submitted Mar 6, 2017 and I'll provide a link.

8. How do the alternative Republican plans affect America?

• It keeps some key features of the ACA, like giving more help to lower-income Americans and Medicaid expansion
• It will leave millions uninsured
• It would cut taxes on the wealthy

9. Has public opinion about the ACA changed?

• Yes.  Since the Affordable Care Act was implemented in 2010, public opinion has shifted according to a 2015 survey by CBS News

Bottom line, the Affordable Care Act is working but needs to be improved. The repeal and replace plan that the Republicans presented this week includes many of the ACA's provisions.  The driving force for repealing it seems to be trumped up Republican pride.  The American people cannot afford to pay $350 billion to assuage partisan pride.  Congress and the President need to get their act together and improve the Affordable Care Act.  

REFERENCES:

1. Is the Affordable Care Act Working?,  by Margot Sanger-Katz, Abby Goodnough, Reed Abelson, Anemona Hartocollis, Sabrina Tavernise, and Robert Pear, The New York Times, Oct 26, 2014, 
2. Uninsured Down Since Obamacare; Cost, Quality Still Concerns, by Nader Nekvasil, Gallup, Aug 29, 2016
3. How much Did Obamacare Cost?, by Kimberly Amadeo, the balance, Jan 12, 2017
4. What is Wrong with Obamacare? by Kimberly Amadeo, the balance, Feb 4, 2017
5. House Republicans Release Obamacare Repeal and Replace Plan, by Dan McCue, Courthouse News Service, Mar 6, 2017
6. Republicans unveil bill to repeal and replace Obamacare, by Lauren Fox and Deirdre Walsh, CNN, Mar 7, 2017
7. Fully repealing Obamacare will cost $350 billion, by Tami Luhby, CNN, Jan 4, 2017
8. How the Republican plans to replace Obamacare could affect you, by Kim Soffen and Denise Lu, The Washington Post, Jan 17, 2917
9. Republicans' Obamacare replacement bill: The winners and losers, by Tami Luhby, CNN, Mar 7, 2017
10. The American Health Care Act: The Republicans' bill to replace Obamacare, explained, by Sarah Kliff, Vox, Mar 6, 2017
11. Republicans' Obamacare repeal plan would cut taxes on the wealthy, by Brian Faler, Politico, Mar 6, 2017
12. Poll: Obamacare and the Supreme Court, by Sarah Dutton, Jennifer De Pinto, Anthony Salvanto, and Fred Backus, CBS News, Jun 22, 2015
13. Lawmakers take up Obamacare revision without an independent scorekeeper, by Karen Tumulty and Max Ehrenfreund, The Washington Post, Mar 8, 2017

Is there something we can learn from other countries about how to manage an effective and efficient system?:

• World Health Organization Ranking: The World's Health Systems, The Patient Factor, Mar 12, 2017