Repeal and replace?

Repeal and replace Obamacare.  We’ve heard it a million times; it has been a rallying cry of Republicans in Congress ever since it was passed.

What is it about this law that makes it so hated?

Probably not the provisions that say you can’t be denied coverage if you have a pre-existing medical condition and you can’t be kicked off your policy if you get sick. New Mexicans really need that protection; for example, almost 10 percent of New Mexico adults have diabetes and another 7 percent are prediabetic. Before Obamacare, under private insurance they would have had to undergo a waiting period before getting coverage for those conditions.

Probably not the provisions that say your lifetime benefit cannot be capped, so if you have a serious and expensive illness you can still be insured. After all, very sick people are the ones most in need of coverage.

Those provisions make the health care system more expensive. They help the people who consume more services than their premiums pay for.

The hated provisions are the individual mandate and employer mandate. The employer mandate requires employers with 50 or more employees to provide coverage to their employees. The individual mandate requires individuals not otherwise covered to buy their own coverage, which for some will be subsidized. We Americans don’t like mandates.

Letting healthy people choose not to buy insurance would be a bit like requiring only accident-prone drivers to buy auto insurance and then expecting the cost to be reasonable.

The insurance is expensive and continues to increase. It can be very costly for people who don’t qualify for subsidies.  There are logical reasons why.

Healthcare itself is becoming more expensive, in part because people use more of it. If you are paying for it anyway through insurance, you tend to want to get your money’s worth by receiving some service.

As the science and technology of medical care have expanded, patients have come to expect longer lives and better outcomes. Not many years ago, cancer was a death sentence; options were limited. Now cancer cures are common, but they are expensive. Instead of limping along with your gimpy leg you can get a knee or hip replacement. You can get a bypass instead of dying of a heart attack.

We’re using many more pharmaceuticals, including drugs to counter the side effects of other drugs.

The New Mexico Retiree Health Care Authority reported recently that 75 percent of its members over age 65 took five or more prescription drugs last year. Congress has repeatedly refused to pass any legislation to control the cost of prescription medications. The pharmaceutical industry spends more on lobbying Congress than any other industry, spending $240 million in 2015, according to A friend of mine told me recently her new medicine costs $95,000 a year.

Obamacare has very high administrative costs, which include both overhead and profit of the numerous private for-profit health plans. A portion of your insurance premium is paying dividends to stockholders.

By contrast, Medicare, administered by government, is extremely efficient, with administrative costs only about 2 percent.

There really are only two ways to make health insurance less expensive:  cut the administrative cost or reduce services. Uh-oh.

Theoretically, we consumers provide the incentive to companies improve efficiency by choosing the health plan that costs the least while promising all the services we want. The problem is, as with any insurance, when you pay in advance, you don’t really know what you’re going to get when you need unexpected services.

The cost of pharmaceuticals is politically untouchable.  Any more reduction in payment to doctors will worsen the severe shortage of doctors, especially here in New Mexico.  Our small community hospitals are financially strained.

We have been waiting for six years to see the replacement part of the “repeal and replace”plan. We’re still waiting.

Triple Spaced Again, © New Mexico News Services 2016



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1 Response to Repeal and replace?

  1. Steve Fischer says:

    The Affordable Care Act is so hated by Republicans because it represents Obama’s legacy. In terms of the mandate provisions, it’s interesting to note that in 1974, Richard Nixon proposed an insurance plan that is very much like today’s ACA. Republican Senator John Chafee introduced a plan containing a universal coverage requirement with a penalty for non-compliance in 1993. It was supported by Orin Hatch, Chuck Grassley, Bob Bennett, and Kit Bond. Newt Gingrich was a big proponent. In 2010, Republicans, including many who previously supported the idea, declared it unconstitutional.

    After bipartisan efforts to draft the ACA and over 90 Congressional hearings over the course of a year, Republicans want you to believe that the Affordable Care Act was drafted behind closed doors and shoved down Congress’s throat in a midnight vote. Nothing could be further from the truth, but truth no longer seems to be valued. Over 160 Republican amendments were accepted in the final bill and then not a single Republican in either the House or the Senate voted for the bill. In fact, the day after passage, Republicans introduced legislation to repeal the bill.

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