President Trump laid out some major points he would like Republican plans to replace the ACA to address. The proposed issues straddle the fence between genuine expansion of health insurance penetrance and caving to Republican desires, and the outlook for the prized reform--Medicaid block grants--for Republicans is not especially rosy. While it does, in a sense, provide more flexibility and control to state Governors in addressing Medicaid funding allocation, the overall funding of Medicaid would potentially have to be slashed by 20% or more in the next ten years.
“The looming specter of automation rendering many more Americans jobless does little to assuage fears that enrollment in Medicaid will skyrocket as reimbursement declines.”
That’s not something to be taken lightly. States would likely have to adjust eligibility criteria to accommodate budget shortfalls, or cut reimbursements, which are already meager compared to normal insurance. Furthermore, the looming specter of automation rendering many more Americans jobless (nevermind the title of the article, even Forbes admits automation is already evaporating low-skill jobs) does little to assuage fears that enrollment in Medicaid will skyrocket as reimbursement declines.
There is no doubt that the ACA is fraught with problems, from the rollout of the website to the exit of key insurers, including Humana, from the exchanges. It was not a perfect piece of legislation; it did not fix all of the problems that face US healthcare--namely controlling costs of healthcare provision; collective bargaining for pharmaceuticals; lack of choice for insurance plans and providers; and the overall health of Americans writ large. There is debate as to whether or not Americans have gotten significantly healthier or longer-lived in the six years since the ACA was put into law, according to Margot Sanger-Katz, and some sources even claim American life expectancy has decreased slightly (note: primary data could not be found for this article). It is well known that American life expectancy has always lagged significantly behind other OECD countries and does not appear to be catching up.
“Repeal and replace without an actionable, transparent plan seems to be throwing the baby out with the bathwater.”
Despite this mixed review of the ACA’s performance, the refrain of repeal and replace without an actionable, transparent plan seems to be throwing the baby out with the bathwater. It is certainly no secret that Republicans would love to deny Barack Obama a critical piece of his legacy, but at what cost to American citizens? There is a widely-held sentiment that the ACA is “failing”, “a disaster”, and of course “socialism”--I actually couldn’t find a source I consider credible for that last one, but the word is bandied about frequently in conservative circles. Yet, gross medical debt or inability to see any provider has decreased, an encouraging sign. And furthermore, the pitfalls of the consortium of Republican replacement plans have a plethora of pitfalls all their own, as outlined by Healthcare Triage, not the least of which is the insanity of poor people to set up health savings accounts, or HSAs, and use tax credits at the state level not based on income to purchase private plans.
That rather undermines the entire point of expanding provision of care to the poor. I rarely appeal to religion, but it seems downright un-Christian to deny poor people comfort and care in their moments of greatest need, especially from someone who claimed to be the world’s foremost bible reader. Just like his bibliophile proclamation, the President’s health policy goals seem to be somewhat flimsy under even cursory examination.
But, then again, healthcare is super complicated, so who am I to judge?