Stanley Feld M.D.,FACP,MACE
I was profoundly disappointed when The American Healthcare Act was introduced last week. There was immediate rejection by Republicans and Democrats in both the House and Senate.
The mainstream media commentators emphasized the Republicans’ rejections and added their own scornful objections. The mainstream media painted the Republican Party as a party is disarray.
The media was presumably giving a boost to the Democratic Party and Obamacare’s failure.
Both Paul Ryan and Dr. Tom Price gave complete explanations of their strategies on how this bill, along with its two other components, will repeal and replace Obamacare.
I was profoundly disappointed in the bill until I was able to hear Dr. Tom Price and Paul Ryan’s explanation of their reasons for the initial reconciliation bill and the plan of the other two components necessary for replacement.
Vice President Pence and President Donald Trump then repeated Ryan ad Price’s strategy in less detail.
I reacted immediately to the bill being a sell-out to the healthcare insurance industry and central government control of healthcare. It looked like Obamacare Lite or Obamacare 2.0. There was no other explanation presented.
It took them 24 to 36 hours to explain the logic of the strategy.
By that time there was so much mainstream media noise and politician noise that It was impossible to hear what Tom Price and Paul Ryan were trying to say.
No one listened to what President Trump was trying to say. They were only listening to the media describing Republican caucus’ members outburst against the bill.
President Trump tweeted “it is a beautiful healthcare bill. Everyone will be happy with the result.”
No one listened. No one heard.
The mistake Ryan and Price made was that in the initial introduction of the bill they were being too cute, cunning and clandestine. In reality they were very prepared. They have been working of this repeal and replacement since 2010.
The plan to repeal and replace Obamacare has three parts.
- Administrative Action
- Additional Action
It would be very helpful to understand their positions if you watch them explain their positions in their entirety.
This lecture by Paul Ryan is an excellent review of the metodology necessary to Repeal and Replace Obamacare
Both videos are a must see in order to understand the Trump administration and congressional leadership strategy.
Obamacare was supposed to provide an opportunity for people in the individual insurance market to buy healthcare insurance at an affordable price. It was not meant to affect the employer provided healthcare insurance market.
This was supposed to be done by State Health Insurance Exchanges that would supply this insurance. Much of the individual market would be subsided by the federal government..
Only 22 states signed up and most have failed after receiving over $200 billion dollar loans to cover startup cost. These state health insurance exchanges are never going to pay back the federal loans.
Additionally, Obamacare extended Medicaid coverage by increasing the poverty levels in states. This increased the eligibility for patients to participate in Medicaid.
President Obama completely ignored the fact that Medicaid was a financially unsustainable subsidy that was failing rapidly.
Thirty-three States signed up for this expanded Medicaid coverage because they were afraid to get stuck with the bill.
All states are supposed to have balanced budgets. Most states have budget deficits.
They share the costs of Medicaid with the federal government to provide free healthcare coverage to the poor.
President Obama said he would pay 90% of the Medicaid bill. He then increased it to 95% and then 100% in the first few years in order to induce states to join.
Remember, President Obama’s ultimate goal was to have the federal government be in total control of healthcare with a single party payer system.
Twelve million new people have signed up for Medicaid under Obamacare. Additionally new immigrants have been added to the Medicaid roles.
Only nine million have signed up for Obamacare through the health insurance exchanges. Most of the enrollees have preexisting illness.
Most of the enrollees cannot afford the premiums even though President Obama provides subsides to 85% of these people.
Additionally, these enrollees cannot afford the deductibles that are up to $6,000 in some states.
Obamacare has affected the employer market. Obamacare does not pay the insurers enough or have a high enough enrollment distribution to give the insurance industry a high enough return on investment.
Insurers compensate by increasing insurance rates in the employer sponsored private market in almost all of the states. The industry increased rates in both individual and employer sponsored private market by as much as 116% in Arizona.
This forces small and large employers to decrease insurance coverage for employees.
If they did not provide healthcare insurance many small businesses had to pay Obamacare’s mandated penalty.
A mandated penalty was avoided if people worked less than 29 hours a week. Therefore, large employers reduced full time jobs to part time.
There are many other reasons that Obamacare has failed. It has inhibited economic growth.
Obamacare must be completely repealed.
The Ryan plan’s process is repealing as much of Obamacare as it can through the reconciliation process. This is only the first stage. does.
Congressional reconciliation only needs 50 votes in the reconciliation process thanks to Harry Reed.
After passage of the American Healthcare Act, Dr. Tom Price will then move on to part two.
He will repeal all the administrative rules and regulations that President Obama and Donald Berwick put in place that hurt Americans and the economy.
He will replace them (one regulation for two eliminated) that will help people obtain affordable healthcare insurance and help our economy grow.
Republicans opposed to the Ryan plan do not seem to get this point.
If Republicans could get total repeal through the House of Representatives with they would not get the 60 votes necessary to get Senate approval.
In stage three Republicans will be able to get the 60 votes necessary for Senate approval.
There are 18 vulnerable Democratic senators up for reelection in 2018.
With Obamacare’s rules and regulations repealed at that time, Democrats’ opposition to things like expanded Health Savings Accounts, malpractice Reform, insurance Reform and insurance across state lines will melt. It will be important for these vulnerable Democrats to vote for these reforms in order to get reelected..
The Ryan plan now looks like an excellent strategy to me. I do not see why the opposition Republicans cannot see it.
Doing it their way with complete repeal a stage one might not work. Then will be stuck with Obamacare and the loss of both Republican controlled of the house and senate in 2018.
There are still refinements necessary to be a consumer driven healthcare plan that is patient-centered.
I hope the Ryan/Price plan is passed by congress.
The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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