If health reform is overturned, 20% of Americans may be without coverage in 2020, yet we’ll be spending 20% of our GDP on health care.
That’s David Blumethal’s prediction in today’s New England Journal of Medicine.
Blumenthal walks thru three potential electoral scenarios: status quo with the Democrats retaining the White House and Senate (ranked as unlikely); the GOP winning the Senate, House, and the Presidency; and what may be the most likely outcome of November’s elections: President Obama re-elected with a GOP-dominated Congress.
If the GOP wins the trifecta, ACA is dead, and at least at this point, there doesn’t look to be any Republican alternative to health reform that would fill the “replace” part of the “repeal and replace” slogan. Blumenthal notes that after blasting health reform for the last several years, a GOP administration and Congress would find it difficult to then legislate a new approach.
Moreover; ” the traditional Republican approach to covering uninsured Americans [is] an individual tax credit subsidizing purchases of private health insurance funded by ending the tax exemption for employers’ contributions to employees’ health insurance. Many employers and employees oppose this idea, and it would be difficult to pass without a major political fight. Historically, Republican presidents have been reluctant to take on the political costs of comprehensive health care reform, and the last thing a new Republican president will want is to fall on the political sword that impaled his predecessor.”
So, what does this all mean?
Repealing health reform will undoubtedly lead to more people without health insurance. My best guess is we’re somewhere in the 52-53 million range now, an all-time high due to the recession and ever-higher employer premiums coupled with an individual market that is essentially closed to all but the most affluent, healthiest Americans. Without limits on medical underwriting, it will become increasingly difficult for those with pre-ex conditions to get coverage in the individual market – and in many states, the small employer market will be severely restricted as well.
Blumenthal predicts as many as 65 million Americans will be without health insurance in 2020 – eight years out. I think he’s optimistic.
As more go without insurance, cost-shifting to those with coverage will increase, driving up their premiums even faster. The vicious cycle will accelerate, and as costs rise, employers and families will drop coverage, dumping more cost onto the ever-smaller population of insureds.
I’ve been predicting family premiums will top $30,000 this decade. If ACA is repealed, that timetable will accelerate, and perhaps then America will wake up.
Then again, probably not.
Thanks To Merrill Goozner for the tip.
Dec
1
If there isn’t any health insurance, the consequences will be far, far worse than Blumenthal could possibly predict. Yes…as premium rise, more and more workers will drop their insurance. I do not think that America will wake up. We will be governed by a faith based political party. All will be lost. The American public, at least some, are still believing in the death panels. What would you expect.
Joe, remember any market is at least a two-way exchange. If premiums keep going up, we have to pay some notice to the natural market force of resistance to the increase; which would mean more uninsured (non-participants in the market). But sooner or later, the business model of ever increasing premiums breaks down when there are not enough takers to create the necessary revenue to support the business.
In every analysis I’ve seen to date, analysts project the ever increasing costs of health insurance (to infinity) without ever paying mind to the other side of the exchange: the consumer. If the projectory is to be believed, sooner or later the insurance companies will price themselves out of business. It cannot continue as projected. There simply won’t be enough people demanding health insurance at such a cost to support the insurance industry.
I’m confused by portions of this post. In one paragraph you state that the Republicans don’t appear to have any alternatives that would cover the “replace” piece of their “repeal and replace” plan. However, in the very next paragraph you go one to state one such Republican plan?
I understand you may not agree with that plan but I’d caution you to be careful not to let your political bias result in a loss of credibility.
Keeping in mind what the “A” stands for in ACA, giving people more power over their own healthcare decisions (which I believe many of the Republican plans would do) would result in more “A”ffordable care and better choices. I’ve seen it first hand over the past two years as my own company moved to high deductible plans that include (among other things) free preventative care and HSA’s.
micmac – thanks for your comment.
I’m not sure why you are confused. The description contained in the paragraph you referenced is not a plan – not even close. The tax credit funded by ending tax exemption has been one of the GOP’s policy ideas for quite a while, but it is far from a “plan”. The sad fact is there is no GOP plan to fix the health care cost and coverage crisis. There’s a bunch of free market blather based on a mis- or non-understanding of the basics of health care and health care funding, but that’s about it.
That’s not surprising; the ACA is really quite similar to the plan advanced by then-GOP-Sen. Bob Dole over a decade ago. Today’s GOP has moved away from what was, a few years back, considered good policy by Republican party leaders
I find it intriguing that you reference your “own company moved to high deductible plans that include (among other things) free preventative care…” – the reason there’s free preventive care is it was mandated by ACA.
I absolutely agree that resolving the health care cost crisis will require more engaged consumers – and more engaged health plans as well. I’d suggest that the “Accountable” also refers to health plans – who must disclose more, report more, and inform more.
Joe – The reason for my initial post was simply that I think its disingenuous to offer that no GOP plans have been or are now being discussed. I suppose if a plan = a bill then I’d have to agree with you but I don’t think this is the case.
Sorry but in my opinion but the comment came across as politically biased. I learn a lot and enjoy reading your posts, I just think they’d be more effective without bringing political preferences into the mix. Partisanship is what’s brought us to the mess we’re in now and it most certainly will not solve the problems.
I’ve got no love for the GOP nor the DNC. Leaders on BOTH sides of the aisle have dropped the ball on this and many other issues. I do agree with your comments regarding accountability. So we agree that consumers and health plans need to be more accountable, I suspect we’d both agree to include congress and the POTUS as well.
One final point – My company plan was changed in 2009, the ACA was not signed into law until until March of 2010. The free preventive care I’m now provided was not bestowed by government mandate, rather it was a decision made within the framework of the free market.
micmac
1. It is not at all disingenuous to say that there is no plan under discussion. THERE IS NO PLAN UNDER DISCUSSION. Blumenthal was discussing a “traditional Republican approach” and why it won’t work. This is not a plan, a bill, a framework, a mechanism, a working paper, a strawman, or anything else remotely close to a “plan”.
2. I make no secret of my political leanings nor my opinions. I also make no secret of my willingness to discuss topics as long as those discussions are fact-based and supported by citations. I manage to piss off people on the left side of the aisle on a rather regular basis – see my discussion of the need to terminate Part D and complaints about ACA. My point in this post is NOT political – it is that the GOP has NO PLAN other than NO. I hear nothing that even comes close to a solution, just a bunch of nonsense about the ability of the free market to cure all ills and wildly uninformed and unworkable “solutions” such as selling health plans across state lines.
3. I’d love to hear the GOP’s plan. I’m not particularly enamored of ACA – again I’ve noted this dozens of times here – but it’s a helluva lot better than nothing – which is what the GOP has to offer. I commend Congress and the President for passing something – and I’d note it was done honestly as opposed to how the GOP passed Part D. The same idiots who passed Part D are the ones now moaning about government intervention in health care and budget-busting bills. Their hypocrisy is beyond disgusting.
If calling out the people that have added over ten trillion dollars to our deficit while lying about a bill that will cost far less and cover thirty million more Americans is partisanship then I’m all over it. Partisanship didn’t create this problem, willful ignorance on the part of most Americans did.
4. Glad you work for a company willing to give something back when it went to an HSA plan. You’re a disappearing breed.
The real truth is that the Republican party has no plan. They never did. I certainly wouldn’t call their out of state purchases of private insurance with the government giving a voucher to compensate for a very small expense, a plan. Terrible.