Stanley Feld M.D., FACP, MACE
It is apparent that Obamacare is failing. Obamacare was built on a defective business plan designed with the goal to have all medical care controlled by the federal government.
If a stakeholder could potentially develop a plan that would threaten the central government’s takeover of the healthcare system, President Obama and his administration would simply rewrite the rules to destroy the initiative.
A clear example is the new rules to destroy health savings accounts. Medical savings accounts are similar to health savings account. The difference is Medical saving accounts put the money in the consumers’ hands initially. If there is any money left of the deductible it goes into a retirement account that is not directed to healthcare. Health saving account direct the unspent money to healthcare costs in the future.
The states are responsible for Medicaid. States claim that the central government is impinging on states’ rights by directing states to do what the federal government tells them to do with respect to Medicaid.
States have fought and won their argument in the Supreme Court when the federal government was paying 100% of the bill for Medicaid if states extended Medicaid. The Federal government will pay 100% until 2017. Then payment will decrease to 95% until 2020. At that time it will decrease to 90%.
Twenty-two states are not participating. The issue is a states’ rights issue rather that a healthcare issue even though the states need the federal help.
Even with this help many people on Medicaid cannot find a physician or can afford the medical care.
“Many plans are being canceled, and many doctors and hospitals are no longer being covered by the new plans on the health insurance exchanges.”
A Medicaid patient said, “Even though I am now on Medicaid, I cannot use it because I cannot find a doctor. “
Another recently discovered stifling of states innovative ability has come to light.
After much bickering after the Affordable Care Act was written state innovation waivers, also called 1332 waivers, which are to begin in 2017, were written into the law.
The state innovation waivers or 1332 waivers are like a golden parachute to states both participating and not participating in the Medicaid expansion program. They are allowed to dictate the conditions and receive federal money.
The 1332 waiver solves the states’ rights problem.
The 1332 waiver would provide states with block grant funding to provide healthcare insurance to state citizens. It also waives nearly every major component of the Affordable Care Act (Obamacare).
A major provision of the 1332 waiver is that it is deficit neutral.
Two things could happen.
States wanting to experiment with a single party payer system could pursue it.
States that want to experiment with a free market healthcare system could pursue it.
Two prominent examples of innovative experimentation have been proposed.
These private insurance plans would require higher spending for Medicaid. Theoretically the decreased spending in the Obamacare Exchange would offset the increased spending and better service for Medicaid patients. It would remain deficit neutral.
Rhode Island and Hawaii want to pursuit innovative entitlement programs that would cost less than the inefficient bureaucratic central cost.
The Obama administration could not tolerate the thought of the states being independent of federal control. A recent Friday afternoon, at 3 pm, the Department of Health and Human Services announced a rule change.
“These 1332 innovation waivers must still be deficit-neutral. However,
The ruling by non-elected officials now makes these state controlled innovative experiments mostly impossible because the states cannot offset the savings.
Since all medicine is local, common sense dictates that states should be able to do a better job than a bloated federal bureaucracy in serving its local citizens’ healthcare needs.
The present system is a multi-trillion dollar failure. The states are correct in wanting to try something new.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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