Monday I opined that the individual mandate will not be overturned. But let’s say it is – and stipulate that the rest of the health reform bill is rejected as well.
Then what?
We’ll leave aside the political implications for the moment, but it’s safe to say that a rejection of the PPACA by the Supreme Court would be bad news indeed for Democrats
Over the near term, what happens to the 49 million Americans currently without coverage? They won’t be able to get coverage under Medicaid.
Their employers – mostly small businesses – who can’t afford the premiums (without subsidies) today certainly won’t be able to find affordable insurance in the future.
In many states, people and families trying to buy coverage on the individual market will find a) their pre-existing conditions won’t be covered, or b) will only be covered after an extended waiting period and with a much higher premium and c) the cost of family coverage – for plans with very high deductibles – will be above $1500 a month in many states.
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. 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.
Okay, back to the political implications.
As David Blumenthal noted in the NEJM article cited above, if the Republicans win big this fall, 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.
PPACA is overturned, the number of uninsured is on a path to 20% of the population, the insurance death spiral accelerates, and the new Congress and President can’t/won’t do anything about it.
Can someone tell me how the free market fixes this problem? What insurance company is going to seek to cover families and small businesses with significant pre-existing conditions? Which, by the way, more and more of us have?
And if you can’t get coverage thru your small employer or on the open market, what are you going to do?
Those folks lucky enough to live in states with rational, sentient state legislatures will be better off than those living in states less fortunate.
But all of us will be facing family premiums north of $30,000 within five years.
Mar
28
The “fix” is that workers without medical insurance file workers’ compensation claims.
My feeling is that ACA is flawed, but can be tweaked and improved. My fear is if it is overturned, the current system will implode in the next 10 years and the only option will be a universal health plan system.
ACA has at least forced health care reform into the national consciousness. If it is overturned, and I personally hope that it is, the President and Congress need to turn to the states for solutions. It would be great if we had 50 laboratories working to find a solution. I have never been convinced that a one-size fits all mandate was the best or most prudent approach. Especially since we really don’t know what will work. It is a complicated system with even more complicated economics. We have seen in the workers’ comp system that heavily regulated reimbursement schedules don’t necessarily control costs. Unfortunately, the way health care and insurance are structured in today’s world, we don’t know if a market based solution will work either because the ultimate consumer isn’t involved in the financial aspect of a health care transaction. Very few people have actually “shopped” for a health care service. There is a market dynamic missing which has created an environment of escalating cost without any constraint or personal responsibility. ACA didn’t change that dynamic, and in fact may ultimately exacerbate it. I believe there are solutions out there, but I don’t believe ACA is the solution and it would inhibit finding the right solutions.
Joe –
The Federal budget for 2013 has been filed and made public. Under the section entitled “Cuts, Consolidations, and Savings” are 11 areas medical spending under the Medicare program are scheduled to decrease next year(pp. 176 – 178). These budgeted cuts were introduced as part of ACA. Are these “savings” areas in jeopardy of going by the wayside as ACA arguments conclude? If so, how do we then go back and address the very real problem of Medicare Trust insolvency in 2017?