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Obamacare Faces An Uncertain Future

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Obamacare Faces An Uncertain Future

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Obamacare faces tough challenge in Republican controlled congress

By Caroline Humer

NEW YORK (Reuters) – Republican President-elect Donald Trump vowed on the campaign trail to repeal Obamacare, but making good on that promise may be easier said than done.

President Barack Obama’s 2010 national healthcare reform law extended medical insurance to 25 million more people by expanding the Medicaid plan for the poor and creating subsidized coverage for individuals.

Republican lawmakers, who have voted more than 50 times to repeal all or part of the law, have begun pressing Trump to deliver. Senate Majority Leader Mitch McConnell said on Wednesday repealing Obamacare is a “pretty high item on our agenda” for the new Congress.

But a complete repeal of Obama’s Affordable Care Act may not be immediately in the cards, as Republican lawmakers now hold 51 seats in the Senate at latest count, well short of the 60 seats required to overturn it.

Instead, health policy experts said, Trump could try to dismantle key elements through a process called budget reconciliation. That would allow him to eliminate funding for the income-based subsidies that make the new insurance plans affordable, or cut the money providing expanded Medicaid benefits in 31 states.

“Some of the policy experts on the Republican side would say tearing it up and starting over would be very disruptive,” said Paul Howard, director of health policy at the conservative Manhattan Institute.

Parts of the law have been weakened through legal challenges. Several of the largest U.S. health insurers have pulled out of the exchanges for individual coverage after losing money on a sicker-than-expected group of patients. Consumers not eligible for government subsidies have seen premiums rise sharply, including a projected average increase of 25 percent for 2017.

Scrapping the law altogether without a clear plan for providing replacement coverage for so many people would be politically risky, experts said.

Trump also would face a tight deadline were he to try to dismantle the insurance exchanges by 2018; many state-based health insurance regulators require insurers to submit plans for the upcoming year by April or May – only a few months into a new administration.

Trump also could seek changes to other provisions of the law, such as a tax on medical device makers, or the so-called “Cadillac tax” that is due to hit rich employer-based healthcare plans in 2020.

However, some elements could not be eliminated by depriving the law of funds. For instance, the law prevents insurers from denying coverage to people based on their health or pricing insurance based on gender. Mandatory coverage of preventive benefits also would be unaffected – short of a complete repeal.

It also is not clear if Trump would try to reverse the individual mandate, which requires people to purchase health insurance or pay a penalty. The goal of the requirement was to broaden the pool of policyholders to include more healthy Americans.

SOWING CONFUSION OVER HEALTHCARE

Trump’s surprise victory over Democratic candidate Hillary Clinton rattled healthcare investors on Wednesday, depressing shares in hospital operators and some insurers.

Medicaid focused health insurer Molina Healthcare Inc. fell nearly 16 percent, and hospital chain Tenet Healthcare Corp dropped 25 percent. Large insurers, who have been losing money on the exchanges, gained, with Anthem Inc. up 1.5 percent.

Enrollment opened on Nov. 1 for 2017 coverage and once those plans are purchased, it would be legally difficult for Trump to cancel them before the one-year contracts run out, said Molina Healthcare Chief Executive Officer Dr. Mario Molina.

“Any changes they make will have to be on a prospective basis to begin in 2018,” Molina said.

It’s not clear what Trump’s plan to replace Obamacare would look like. Options he raised on the campaign trail include replacing the Obamacare individual coverage with high-deductible healthcare plans, and lumping the sickest people together into high-risk pools that are insured separately.

“I think there is going to be a lot of confusion and a lot of anxious people,” Molina said.

Among the worries for some people covered under Obamacare is how long it will last.

Before the law took effect, Marc Dobin, a 57-year old mediator and lawyer in Jupiter, Florida, said his insurer put a surcharge on his premium because he has heart stents. Under Obamacare, insurers are barred from charging more for pre-existing conditions.

“Imagine the disaster if, part way through the year, they cancel it,” Dobin said.

For others, the cost of premiums bolstered their support for Trump.

Crista Simmons, 63, a piano teacher in Kalamazoo, Michigan, spends about a third of her gross income on premiums and medical care.

“There are people who pay more in premiums than their mortgage,” she said.

(Reporting by Caroline Humer, additional reporting by Sue Horton; Editing by Michele Gershberg and Lisa Girion)

IMAGE: Republican presidential nominee Donald Trump arrives for his election night rally at the New York Hilton Midtown in Manhattan, New York, U.S., November 9, 2016.  REUTERS/Andrew Kelly

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29 Comments

  1. dtgraham November 10, 2016

    Crista Simmons, 63, a piano teacher in Kalamazoo, Michigan, spends about a third of her gross income on premiums and medical care.

    “There are people who pay more in premiums than their mortgage,” she said.

    One third of gross income (not net!)? More than their mortgage? That is f’ing crazy. While still some improvement compared to what was, it’s no wonder that the ACA doesn’t have the kind of love and support among Americans that health care reform should have had. That shows up in polls.

    Reply
    1. Keith Garevich November 10, 2016

      Spot on, my friend! And on a personal level, Anthem is raising my premium from $146/mo to $356/mo. Unbelievable. Shame on them. I have to find a similar premium amount or something within reason.

      Reply
      1. itsfun November 10, 2016

        Think about a family of 4 with rates going to over 1000 a month. How can anyone afford that?

        Reply
      2. dtgraham November 11, 2016

        There shouldn’t be an Anthem. At least not for basic healthcare.

        Reply
    2. latebloomingrandma November 10, 2016

      We paid 22% of our income on health insurance and deductibles, before the ACA. We pay far less on Medicare.

      Reply
      1. dtgraham November 11, 2016

        Medicare is the ticket lateblooming.

        Reply
  2. rednekokie November 10, 2016

    The only answer to replacing the Affordable Care Act is to enact Medicare for all, eliminating the insurance companies completely.
    That would solve the medical problems in this country. Anything short of that will fail.

    Reply
    1. itsfun November 10, 2016

      Having the government completely in charge of my health care is the worst and scariest thing that could happen.

      Reply
      1. latebloomingrandma November 10, 2016

        I love my Medicare. I’ll be a real unhappy camper if Paul Ryan wants to voucher it. That will probably pay for diddly squat, with all my problems.

        Reply
        1. itsfun November 10, 2016

          I am happy with it also. I don’t want anyone messing with it. There is a coming problem though. Now they have hired a firm to accept or deny a procedure. My 79 year old uncle had a procedure done on one side of his back before sept 1. After that date he was suppose to have the other side done, The new panel rejected it. Now he has had to appeal and his doctor had to spend 4 hours also writing a appeal. Mean while he is in great pain on that side of his back. He takes pain pills, hot and cold on his back and that doesn’t help him. The doctor is really pissed off because he can’t fix my uncles problem without written approval from medicare. I was there with my uncle and heard everything the doc told him. This is garbage and should not happen to anyone. I guess it is coming to just drug the old folks until they kick the bucket.

          Reply
          1. dtgraham November 11, 2016

            Even if your story is true, how is that different from what doctors had to go through (and still do) with private insurance companies? They determine what the doctor can do if he still wants to get paid, and they determine what hospitals you can go to that fall within their network.

            Reply
          2. itsfun November 11, 2016

            Talk with any doctor and ask them the difference in health care they can provide in a timely manner now. If a procedure that gave my uncle great relief in August was refused. He went through rehab, therapy, pills, etc before the procedure, thought he was going to be done with that in September, but because of our government he is still going through that pain, pills, not being able to even ride a garden tractor to mow his yard. He paid for medicare every payday for good health care to just get broken promises from his government. If you want government accountants in charge of your medical care instead of doctors, be prepared to get no healthcare.

            Reply
          3. dtgraham November 12, 2016

            No health care at all is what too many Americans have had in the past. That’s unique among the richer nations. None of what you say makes any sense. If you were fortunate enough to even have private health insurance company accountants in charge of your medical care, they would routinely deny health care procedures. That was common.

            Reply
          4. itsfun November 13, 2016

            My uncle had blue cross in the past and his procedures were always approved. Medicare is the one that denied his procedures. All policies detail exactly what they will cover and not cover. If
            people bought policies that didn’t cover some procedures, then they
            couldn’t expect insurance companies to pay for them.

            Medicare also covered this procedure until the government hired a company that is just there to deny procedures. We are forced to pay for Medicare every month, then they deny us coverage. We don’t have the option to drop Medicare as we do with private companies. The government just takes my money out of my SS check every month. I have absolutely nothing to say about that.
            I was in the hospital 3 weeks ago. In the lobby and emergency room they have posted a sign that says they are required by law to treat everyone that comes into emergency for medical care. If that is the law, everyone has some kind of health care.

            Reply
          5. dtgraham November 13, 2016

            The problem with your uncle’s medicare lies with private companies. They’re now increasingly being used to contract out insurance. They’re playing a much bigger role and the criticism is that they can skimp on care. That’s medicare part B and C, and advantage. That started with Reagan.

            Private insurance companies outside of medicare used to find loopholes to deny coverage for things that they were supposed to cover. A surprising number of patients have been in the middle of costly treatment for a serious disease only to have their policies canceled, sometimes even retroactively, and found themselves responsible for astronomical bills. It’s called rescission.

            It’s a secret program that if you have a serious illness or are on costly medications, when the insurer gets the bills, they go through your file and look at your application, and get medical records from the last several years. If they find an inconsistency in your application, even if it’s an honest mistake, your policy is rescinded.

            Some insurance companies veto a doctor’s orders if they feel the treatment isn’t necessary or consider it experimental. They do a lot of denial for newer treatments, especially cancer treatments.

            I don’t know to what extent the ACA alleviated this problem with insurers, but it will be gone or gutted now.

            In any event, you shouldn’t have to pay a fortune to cover everything, and then hope the insurer doesn’t play games. Health care should be a human right.

            I did a lot of research on ER’s treating everyone while arguing with a poster named mike one time. They’ll give the uninsured battlefield medic type of medical care where they’ll stabilize you, then out the door you go. They’re not going to provide the necessary care though to someone with a substantial illness or something requiring longer term care.

            Reply
          6. itsfun November 13, 2016

            It was Medicare not a private insurance company.I saw the letter from Medicare denying his treatment. I also spoke with his doctor who had already sent in a rebuttal to Medicare. He told me he spent about 4 hours on the appeal. He also told me that now he will need to hire at least 1 more full time employee just for appeals. Guess who that cost will get passed on to.

            This is one article I read about emergency room care: http://www.alllaw.com/articles/nolo/medical-malpractice/uninsured-patient-denied-emergency-treatment.html

            Reply
          7. dtgraham November 14, 2016

            “Medicare also covered this procedure until the government hired a company that is just there to deny procedures.”

            That’s what you said in your prior reply, so it must have been a proxy private health insurer that denied your uncle’s claim. Medicare was originally designed as a single payer system, and single payer government health care simply doesn’t work that way.

            In single payer they may or may not buy the latest costly pharmaceutical, substituting something else that’s appropriate for treatment. You may also get put on a waiting list to see a specialist, the wait time dependent on the seriousness of your condition taking various factors into account.

            That’s the downside, but that’s not denial of care. There is no denial of care in single payer. Let’s just say that I have extensive experience with this system, as healthy as I’ve always been.

            Reply
          8. itsfun November 14, 2016

            If you know more about the denial by Medicare than my uncle’s doctor, more power to you. I was there and listened to the Doctor as he explained why the procedure was denied. He had to write a appeal and also he can apply to have the procedure done again after 50 days.This doctor is the specialist that performs the procedure and the doctor that has performed the first part of the whole procedure for my uncle’s back.

            Reply
          9. dtgraham November 14, 2016

            The private health insurer that Medicare contracted with is, in effect, Medicare to that doctor.

            Reply
          10. dtgraham November 14, 2016

            As to ER for the uninsured, the consumer watchdog group, Public Citizen claims that despite the law some hospitals continue refusing to provide basic treatment for patients who are unable to pay. “It’s distressing that this law has been in place and hospitals are still flouting it,” says Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “The government needs to do more to force hospitals to comply. People shouldn’t be denied desperately needed emergency medical care when they go to a hospital.”

            From 2002 to 2015, the Centers for Medicare and Medicaid found 2,436 violations, working out to an average of 174 violations a year. Those are just the ones who were caught.

            You can be fined for violating EMTALA but violations still happen all the time. The largest fine of $100,000, according to the Office of Inspector General , was issued to Kaiser Foundation Hospitals in Santa Clara, California. The hospital agreed to pay $100,000 for allegedly violating the Patient Anti-Dumping Statute twice. According to OIG, Kaiser failed to provide appropriate medical screening examinations and stabilizing treatment for a 15-year old child that arrived at the emergency crying and complaining of severe abdominal pain. Kaiser discharged the patient and sent her to a pediatric physician group on the hospital’s campus.

            In the second instance, a 12-year old boy returned to the emergency room after being sent home the night before. He was in pain, had a high fever and was lethargic with swollen eyes and face, but was discharged to the pediatric physician group on the hospital’s campus. More than six hours after he went to the emergency department, he was admitted to Kaiser’s Pediatric Intensive Care Unit where he died the next morning from staphylococcal sepsis, according to OIG.

            The hospital will also require you to make arrangements to pay later, and will have bill collectors harass you forever and financially ruin your life. Despite the guidelines, hospitals massage them and decide what an emergency is. Sure, if you come in unconscious and near death you’ll be treated. You’re not going to get long term cancer treatments though without the ability to pay.

            Reply
    2. Dominick Vila November 11, 2016

      That would make sense, but it is not going to happen. In fact, don’t be surprised if phase II of W’s MEDICARE “reform” takes place for the express purpose of further undermining the effectiveness of MEDICARE.
      The goal is not going to be to expand public healthcare, but to return to the for profit healthcare system that made our medical system the most expensive in the world, and the most exclusive.

      Reply
  3. dbtheonly November 10, 2016

    No uncertain future.

    Obamacare is toast. It won’t last past March. In fact, I’d be surprised if it sees February.

    Reply
  4. itsfun November 10, 2016

    He promised to repeal and REPLACE, not just to repeal. Its this kind of yellow journalism that has destroyed the reputation of journalism.

    Reply
    1. dtgraham November 11, 2016

      When have the Republican party, or Trump, ever said what they would replace it with? What are journalists supposed to report on other than the repeal?

      Reply
      1. itsfun November 11, 2016

        House speaker Ryan has had a plan or a link to a plan on his website for one. Journalist are suppose to report the whole statement, not to pick and choose what they personally like. Reporting half of a statement is no different than lying. Maybe Trump should have said replace and repeal instead of repeal and replace.

        Reply
  5. Dominick Vila November 11, 2016

    The ACA, aka Obamacare, will be replaced by the Trump Care Act (TAA). The new legislation will preserve certain things included in the ACA, such as no discrimination because of pre-existing conditions, allowing dependents to remain in their parents healthcare coverage until age 26, and eliminating the expense cap that resulted in millions of Americans selling everything they had to stay alive. Other than that, the TAA will be focused on a transition to market forces, and limited subsidies.

    Reply
  6. Moderate Black Woman November 11, 2016

    It’s interesting to see Republicans back tracking on their leader’s promise to “Repeal Obamacare on day one!” The ACA won’t be repealed, it will be renamed. I’m reminded of the civil rights icon, Stokely Carmichael, who was often quoted as having said “The white man’s power lies in his ability to define.”

    Reply
  7. michelebenson November 23, 2016

    After 5 yrs I finally resigned from my previous job and I am so happy now… I started doing work at home, over a website I discovered over internet, for several hours a day, and my income now is much bigger then it was on my previous job… Last check i got was for 9k dollars… Amazing thing about this is that now i have more free time for my loved ones… http://chilp.it/8d93f4b

    Reply
  8. jannie.gandhi November 28, 2016

    1 year have passed since I decided to resign from my office work and it changed my life… I started doing a job from home, for a company I found online, for a few hrs daily, and my income now is much bigger then it was on my previous job… Check i got for last month was for 9000 bucks… Awesome thing about it is that now i have more time for my family… http://secure59.com

    Reply

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