Health Care Policy USA

By pjain      Published June 18, 2021, 12:37 a.m. in blog Geo-Politics   

Health beyond Sick Care

2020 Covid Bungling, Massive Stimulus

Universal Health Care, Single Payer, Efficient and KPIs

If the court strikes it down, we expect that it will force Congress to someday enact a single-payer system, which will be legally invincible.

A key lesson of the 2012 SC challenge on state-authority, opt-out request and federalism.

The message to Congress was simple: Don’t involve the states at all. To achieve universal coverage, the federal government needs to do it alone, with a simple federal entitlement, like Medicare.

The 2012 ACA case therefore set a strange precedent. The result is a lopsided reading of constitutional authority. The federal government has a weakened power to work with private businesses and with states to achieve universal coverage. Meanwhile, the federal government has a nearly invincible power to itself tax and spend.

Medicare for All

Medicare for All would leave out insurance companies and instead rely on the federal government as the single insurer.

Healthier Real School Food

France, Moore visits a public school that serves multicourse, high-quality lunches to its students. Shown images of the typical slop served at a public school in the United States, the students recoil.

Proper Regulation of Toxins and Industrial Foods

FDA fails

Europe Bans Thousands of Toxins allowed by FDA

Soda Taxes, banning in School

High Fructose Banning

Health Documentaries and Movies

Sicko Michael Moore Documentaries

  1. All about the fabulous European health care initiatives

  2. Sky High Health Care Costs due to Employer Gold Plated plans. Two-thirds of all American personal bankruptcies after GFC'08 are caused by the cost of health care. Few people can afford an extended illness in this country. Covered also in Sicko.

But while it made some valid points, Sicko didn’t really have much appeal outside the US, where socialism is part of a slippery slope that leads to beer, coke, meth, chicks with dicks and jail.

Health Care Politics Analysis

Pathological Ideology/Fetish against Health Care

Republicans just have a deep, unreasoning hatred of the idea that government policy may help some people get health care. - Krugman NYT

Personal responsibility Ideology - We are NOT Socialist

Conservatives viewed having insurance as a matter of personal responsibility, to avoid passing health care costs on to others.

In the USA we have socialized 100% of police, firefighters, public K-12 education, all Community Colleges, majority of State Colleges and Universities. Local, state and Federal employees are often the largest employers in majority of states.

FUD - Government Takeover to Death Panels

  1. Take my Doctor away from me!

  2. Government takeover of health care - no choice

  3. Many people came to believe incorrectly that the law would create "death panels" to decide the fate of seniors on Medicare, which became PolitiFact's "Lie of the Year" in 2009.

  4. Untrue claims about the law included the idea that it would require people to be microchipped, that it would create a "private army" for President Barack Obama and that it would require hospitals to fire obese employees.

GOP pushes Federalism - Wants Opt-out State-by-State

A GOP/conservative principle is federalism – to retain a central role for the states.

The ACA carved out an important role for the states in expanding the state-administered Medicaid program to provide health care for poor Americans. But in the NFIB case, the Court conservatives insisted that states be allowed to opt out.

2010-2021 ACA scapegoated - blame it for any new and all old shortcomings of Health Care

  1. Political Naming. People on the street expressed a strong preference for the Affordable Care Act over Obamacare — unaware that they were the same thing.

  2. For example, rising prices for prescription drugs have been a problem for years. But the ACA didn't seek to address that, except for one provision that sought to facilitate generic copies of some of the most expensive biologic medications.

  3. Concentration of Providers and Irregularities.

  4. Dumping ACA. Some insurers stopped offering plans in the individual market, while others raised premiums dramatically and often wouldn't cover care at high-cost providers like teaching hospitals.

FUD - lies about ease of care access in Canada and UK

FUD - Political mileage in Scaring 250m Americans with Health Care

They opposed Obamacare because they thought there was political mileage in scaring people about change, and also in denying Obama any successes. Oh, and their donors really hated the taxes on the rich that pay for the ACA’s subsidies. And right up through 2016 they could hope to convince voters that they had a secret plan for something much better than Obamacare.

Ignorance and Lack of knowledge - Not clarified by Government PR

A big part of why people don't like the health law is that they don't understand what it does or how it works. Some of that is because health care is complicated. Even some of the main arguments made by the law's supporters are not well understood. For example, the health law is responsible for some 20 million Americans gaining health insurance. Yet in 2016, when the uninsured rate hit an all-time low, only one-quarter of respondents to the Kaiser tracking poll knew that. A little under half thought the rate had remained unchanged, and 21 percent thought the rate had risen to an all-time high.

Why take away Obamacare from 20m?

The 2020 campaign than taking insurance away from 20 million Americans?

Hurts core Red states

  • In 2016, West Virginia went overwhelmingly for Trump anyway, because he promised not to cut health care, and also promised to bring back those good jobs in coal.
  • In 2020, Trump only added few thousand mining jobs with Trump policies, but 142,000 would have lost if ACA challenge had worked - harming them severely.

Racism - Homeless, Blacks, Illegal Immigrants are the ones without Health Care

Expansion of Medicaid Blocked in Republican States

  1. If Republican-controlled states hadn’t refused to expand Medicaid and generally done as little as possible to support the act, national progress might have tracked progress in, say, California – so another 7 or 8 million people might have coverage.

  2. Ironically bulk of costs would be borne by Washington - so they were hurting their own populations for political pride.

Trump tried to kill or Cripple Obamacare 2017-2020

  1. 2017, Republican attempts to repeal Obamacare made it clear to everyone that their party didn’t have any better ideas, and never did; everything they proposed would have devastated the lives of millions.

    1. Then health care became the top issue in the 2018 midterms, and voters who considered it the most important issue went Democratic by a three to one margin.
  2. 2020 Supreme Court Challenge. Trump administration, having failed to repeal the ACA when Republicans controlled Congress, sued to have the whole thing declared unconstitutional in court.

  3. 2021 Supreme Court rejected case.

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Obamacare In Depth

Obamacare 101, Timeline

  • 2010 signed into law

Popularity of Obamacare

Date For No Partisan Split Source
201711 50% 46% D 80% for,R 80% against Kaiser Poll

BONANZA for some

The goal of the ACA subsidy program is to require you to pay no more than 9.86% of your income for health insurance each year. Those with the lowest incomes in the highest cost areas receive the largest tax credits.

Calculator for Obamacare

For a family of 4 ages 50, 55, with 2 kids under 20, both no smokers.

Income Bronze Plan Silver Plan Note
<27,000 $17,000/yr $23,500/yr No Fin Aid below 100% poverty level - Free if Medicaid for states that allow it
$30,000 $0/yr $0/yr Above poverty limit - AHA pays 100% for SILVER PLAN!
$40k-70k No point ~$0-$2.5k/yr Above poverty limit - AHA pays MOST of $2k/mo costs of SILVER PLAN!
$80k-100k Some point ~$5k-$8k/yr
$110-180k Some point ~$10k-$15k/yr Above poverty limit - AHA pays 100% for SILVER PLAN!
$200-250k Some point ~$17k-$22k/yr Above poverty limit - AHA pays 100% for SILVER PLAN!
$250k+ ~full $23.5k
  • Here Income is household income as filed for income tax. If you are not required to file taxes, then likely eligible!
  • The higher incomes between $30k to $70k basically are subsidized fully with additional payments between $0 to $3000/year
  • SEE: What’s included as income | HealthCare.gov

  • No Fin Aid below 100% poverty level - Free if Medicaid for states that allow it

  • If your children are under the age of 19, they are likely eligible for coverage through the Children's Health Insurance Program (CHIP) or Medicaid, based on application. If your children are eligible for one of these programs, they would not be eligible for financial help through the Marketplace and should instead enroll in CHIP or Medicaid.

  • Bronze plans. For most people,represents the minimum level of coverage required under health reform. Although you would pay less in premiums by enrolling in a bronze plan, you will face higher out-of-pocket costs than if you enrolled in a silver plan. Also Bronze plans usually have HUGE deducible payments of 5,000+ per head and 10,000 family. A silver plan has an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest.

  • Silver Plans. Out of Pocket costs max limited to eg $17,000 for silver plan. A bronze plan has an actuarial value of 60% for all enrollees in a typical population plan will pay 60% of expenses in total for covered benefits, with enrollees responsible for the rest.

  • In Network Care only. Both Bronze, and Silver plans require this - health insurance only protects you when you go to doctors and hospitals that are in your insurer’s network. If you go to a doctor or hospital that is not in the network, you could end up paying much more.

  • Health Insurance Marketplace Calculator | KFF

  • Will You Qualify for Affordable Care Act (ACA) Tax Credits in 2018? | Nolo

Minimal or catastrophic coverage

With a catastrophic plan, you would pay for most health services yourself until you reach the annual limit on cost sharing ($17,100 in 2021). However, preventive services are covered with no cost sharing required.

Generous Plans for free for Poor Homeless, Blacks, Illegal Immigrants

The goal of the ACA subsidy program is to require you to pay no more than 9.86% of your income for health insurance each year. Those with the lowest incomes in the highest cost areas receive the largest tax credits.

HURT Some - $25,000 for family of 4 when minimum wage is $11 or $22,000/yr

20%+ Premium rising for middle-income "suckers" on Health Exchanges

Healthy people who managed to buy individual health insurance before the law’s passage have seen their premiums and out-of-pocket costs soar as insurers have raised prices to accommodate sicker people who had been largely shut out of coverage. Among those hardest hit are people who earn just slightly too much to qualify for federal premium subsidies, particularly early retirees and people in their 50s and early 60s who are self-employed. - KHN

Many of those people hurt by Obamacare would have been helped if Democrats had been able to pass

PUBLIC option, Medicare Buy in for 55+ - Blocked by Republicans

Current 2021 Situation

  1. If Democrats hadn’t managed to pass the Affordable Care Act, around 20 million fewer Americans would have health insurance than currently in 2019-03 do.

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Insurance Economics are Critical

Preexisting conditions is a Fundamental Issue

Today, our society has made another moral commitment that insurers cannot turn away the sick. But the market cannot let people wait until they are sick to buy insurance. That would be like buying homeowners insurance when your house is already on fire. If insurers insured only sick people, premiums would have to be exorbitantly high. Rather, insurers must be able to spread the risk of any of us getting sick over a large base of healthy subscribers.

IRS Enforced Individual Mandate opposition

There has been exaggerated politics on the unhappiness with the ACA's individual mandate.

Late 1980s Individual Mandate idea was originally suggested by Republicans

The GOP had mostly backed away from it over the years

2006 A huge notable exception of Massachusetts Gov. Mitt Romney, who supported that state's health overhaul in 2006 - now amongst the most liberal in the country, and tax returns have pages of enforcement of mandate!

2008 When Barack Obama was elected president, he initially resisted the idea of an individual mandate. But he lacked the votes for a single-payer approach. In the ACA, he settled on a weak mandate with a low monetary penalty for failure to comply, an expansion of Medicaid through the states, and subsidies so everyone could afford coverage on the private market, just as Newt Gingrich proposed so many years ago.

2017 Republicans tried to get court to overturn this key element.

Since 2017 Republicans are working to repeal a key element of the health law in the tax bill Congress is negotiating. The requirement that most Americans have health insurance or pay a tax penalty — the so-called individual mandate — is by far the most unpopular provision of the law, particularly among Republicans.

Mental Health is expensive - Mandated by AHA

CHIP act covers poor children under 19

Children to 26 - Expensive

Health Care Politics Timeline and Futures

1790 Founding Fathers Liked Health Insurance

In 1790 and 1798, George Washington and John Adams each signed laws requiring the purchase of health insurance by ship owners and sailors.

1940s WWII - Kaiser Health Plan covered Insurance Needs of Steel, Ship building

Reagan 1980

Reagan got his start in national politics during the 1960s campaigning against the enactment of Medicare. He claimed it would lead to a socialist dictatorship that would “invade every area of freedom we have known in this country.” So, with single-payer off the table, an individual mandate for private health insurance was the conservative solution.

Ever since republicans have hated and opposed single payer, and Medicare for All systems.

1986 EMTALA - ER Treatment Mandated - Ronald Reagan

In 1986 President Ronald Reagan signed a law called EMTALA – the Emergency Treatment and Active Labor Act – recognizing that uninsured Americans would get sick and would show up at emergency rooms needing health care. Reagan and his Republican Senate majority, led by Bob Dole, agreed with their Democratic colleagues in the House that, as a society, we simply cannot turn away fellow Americans to die on the streets. So, to this day, EMTALA requires hospitals to provide emergency health care.

But it provides no funding mechanism to do it. Hospitals can try to shift those costs to other payers, or try to go after the patients themselves, who often have no alternative but bankruptcy.

1993 Newt Gingrich and Republicans Proposed Health Care Reforms

Newt Gingrich, one of the most conservative speakers of the House, who laid out the blueprint for the Affordable Care Act as early as 1993. In an interview on “Meet the Press,” Gingrich argued for individuals’ being “required to have health insurance” as a matter of social responsibility. Over time, he drew on ideas from the conservative Heritage Foundation and Milton Friedman to suggest “that means finding ways through tax credits and through vouchers so that every American can buy insurance, including, I think, a requirement that if you’re above a certain level of income, you have to either have insurance or post a bond.”

1994 Hillary Clinton proposed - Severe opposition by Republicans bombed to Obama

Obamacare 2010 Signed

2012 Supreme Court mandate Challenge - CJ Roberts saved it

ACA reached the Supreme Court in 2012, NFIB v. Sebelius. The issues were the constitutionality of the mandate that people buy insurance or face a penalty, and congressional expansion of state Medicaid coverage for poorer patients.

Chief Justice Roberts saved the ACA’s mandate, finding it a legitimate exercise of the Constitution’s taxing power; he was joined by the four more liberal justices.

The message to Congress was simple: Don’t involve the states at all. To achieve universal coverage, the federal government needs to do it alone, with a simple federal entitlement, like Medicare. If conservatives keep killing conservative reforms like the individual mandate and expanding Medicaid through the states, the only alternative left will be a single-payer system, like Medicare for All. Ironically, the Supreme Court has made eminently clear that such a simple tax-and-spend approach is constitutionally invincible.

The 2012 ACA case therefore set a strange precedent. The result is a lopsided reading of constitutional authority. The federal government has a weakened power to work with private businesses and with states to achieve universal coverage. Meanwhile, the federal government has a nearly invincible power to itself tax and spend.

2019 Trump and Congress eliminated tax penalty

  1. In 2019, President Donald Trump and congressional Republicans eliminated the tax penalty for going without insurance.

  2. A judge in Texas then held that in doing so, Congress inadvertently repealed the entire ACA, including its subsidies, protections for preexisting conditions and expansion of Medicaid. The judge theorized that a tax of zero is not a legal nullity, but rather an unconstitutional and fatal flaw that brings down the entire bill.

  3. Supreme Court appeal in 2020. The legal arguments are convoluted, depending on whether one part of the Affordable Care Act can be “severed” from the nullified tax.

  4. 2021 SC rejected case. The conservatives who now control the Supreme Court face an odd dilemma. In the short run, they may strike down the ACA, causing chaos that Congress and the president may not be able fix, given the politics.


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