Response/Reflection #1
Student Response #1
The two statements made by Donald Trump during his campaign to fix healthcare in the United States that will be discussed are the following:
“... we must stop insurance companies from being able to come in and compete from across state lines.”
“… Obamacare was a disaster”
There are many critics of the idea of selling insurance across state lines. It is a complicated issue that is proving to be impossible to justify or condemn using models and projections. What we are left with is basing our opinions on the opinions of “experts” or simply accepting or denying the idea based on preconceived beliefs about the current administration. Attempting to remain politically unbiased and recognizing the complicated nature of the issue it is tempting, and perhaps appropriate, to rely on the common sense approach. That is to ask, “Does the unregulated sale and transfer of goods across state lines serve to increase or lower costs to the end consumer”?
While there may be specific examples of this not being true, it could be argued that overwhelmingly the answer to this question is yes. That in fact, with regard to other goods sold the increased competition has served to lower costs. Therefore without muddying the waters with opinions and theories that are really just guesses as to what will happen it at least stands to reason that offering insurance across state lines may very well in fact lower the cost of insurance to consumers.
First it is vital to understand how the system is set up. Currently different states have different mandates as to what must be covered (Cauchi, 2017). Why should a man in North Dakota be forced to pay premiums on insurance that mandates his provider provides prenatal care if he can provide insurance more tailored to his personal demographic through a provider in Texas? The federal McCarran-Ferguson Act of 1945 grants states the authority to regulate health plans within their own borders (National Conference of State Legislatures, 2017). Therefore we essentially have 50 different sets of regulations and mandates. To elaborate further on this point, according to Cauchi (2017) the following services are mandated by different states:
Nearly ¼ of states mandate providers cover acupuncture and marriage counseling.
Nearly 60 percent of states mandate insurance companies cover the cost of social workers and contraceptives.
Seven states require all those who buy insurance be covered for hairpieces, while 9 states require all the insurers provide hearing aid coverage.
In total there a greater than 1900 specific mandates across the 50 states and each mandate further increases the cost to the individual (Cauchi, 2017). While many of these mandates cover everyone, there are many that are very specific to only select demographics. There may be reasons that come to light as to why interstate shopping for insurance will not work, but that is yet to be seen. To offer support as to why it will one only needs to consider the vast number of goods in which this model has proven to lower costs.
Again when discussing the ACA or Obamacare, it is important to keep biases and political views separate from determining whether or not the program improved or hurt overall health care in America. Americans both democratic and republican alike, overwhelmingly did not approve. The Chicago Tribune (2017) reports that the reason the program failed was it forced Americans to provide more expensive coverage than they needed. Young Americans did not enroll in the plan and their lack of participation meant the older population’s expenses could not be subsidized. The out of balance cost for the coverage required by younger healthier Americans was viewed as a tax rather than a health care premium. While many Americans benefited from the plan it was at the expense of the majority. In Illinois last year, Blue Cross Blue Shield paid out $1.32 for every dollar they collected providing insurance under Obamacare (National Conference of State Legislatures, 2017). The figures are similar for other insures and in other states. A federal plan that bankrupts the nations insurance companies is disastrous to the overall health care of Americans; therefore repealing Obamacare is vital to “fixing” health care. Even without a replacement plan, Obamacare should be repealed before all insurers are bankrupt.
References
Cauchi, R. (2017, January 3). OUT-OF-STATE HEALTH INSURANCE – ALLOWING
PURCHASES. Retrieved from http://www.ncsl.org/research/health/out-of-state-health-
insurance-purchases.aspx
Chicago Tribune. (2016, September 9). Why Obamacare failed. Retrieved from
http://www.chicagotribune.com/news/opinion/editorials/ct-obamacare-fail-health-
care-insurance-medicine-0911-jm-20160909-story.html
National Conference of State Legislatures . (2017, January 3). Out-of-State Health
Insurance. Retrieved from http://www.ncsl.org/research/health/out-of-state-health-
insurance-purchases.aspx
Student Response #2
The Patient Protection and Affordable Care Act or “Obamacare” was signed into law in 2010. Portions of it were implemented as a process that took years. Repercussions of the Affordable Care Act included consolidation of health insurance which in turn caused increases in patient expenses (Sundwall, 2017). A decrease in competition amongst health insurers is one of the arguments President Trump utilizes against Obamacare. One of his arguments includes opening up competition by abolishing regulations against interstate coverage. If this occurred insurance companies would be forced to lower insurance premiums due to increased competition. One advantage of decreasing this regulation is that it will create several leading insurers that will have a larger pool of customers, allowing it to decrease costs to the customer or patient (Lockwood, 2016). This would be an advantage for the patient, but could cost the providers including hospitals significantly. The larger the insurance companies are, the more power they have over the providers giving rise to lower reimbursement to the providers. I’m not convinced this is any different than the lowered reimbursement that Obamacare has induced, but it is a concern to consider with this change. Reducing provider fees gives little incentive for upcoming college students to enter the medical field. The difficult curriculum combined with high college costs is already a deterrent. Reducing potential pay for new physicians seems counterproductive to me considering the fact that we already have a major deficit of general practitioners in the United States.
President Trump’s plan to allow Medicare to negotiate drug costs and allow patients to purchase international pharmaceuticals has many benefits and issues. Lower medication costs is a huge benefit to this idea, but provider benefits would be decreased (Lockwood, 2016). The decrease in provider benefits is already in place, but this would increase the rate. As a microbiologist I see benefits to the utilization of antimicrobials that are available in other countries, but not in the United States as a result of FDA regulations. This is a small sector of patients that suffer because development of these drugs is too expensive in the United States with very little return. Companies do not have incentive to develop a low usage, life-saving drug over a drug that will be prescribed on a regular basis. Costs associated with trials to validate a pharmaceutical in the United States are astronomical. The FDA has a huge place in validating medical devices, pharmaceuticals, and laboratory testing in the United States for very good reasons, but at a cost. Allowing patients access to pharmaceuticals that are available in other countries could increase our health care system benefits immensely.
One of the reasons the United States is coveted by other countries is that it is very technologically advanced. Without a universal health care system, the United States has progressed quickly, but regulations are slowing that progress. Resources are limited in health care and universal health care for all citizens provides everyone access to healthcare, limiting the availability of resources. It seems as if a combined system similar to Israel’s might be beneficial. Keeping universal healthcare available, but also allowing private practice and insurers to those that can afford it might be the best of both worlds. It seems as if with every move regarding health care also has a counter disadvantage. I believe this is the reason that there really is no great answer regarding health care. Universal healthcare is great in theory, but reduces the availability of health care providers thus lowering quality.
References
Kamerow, D. (2016). What now for obamacare? BMJ : British Medical Journal (Online), 355
doi:http://dx.doi.org.proxy.davenport.edu/10.1136/bmj.i6063
Lockwood, Charles J,M.D., M.H.C.M. (2016). Outlook for healthcare under a president trump.
Contemporary OB/GYN, 61(12), 6-9. Retrieved from http://search.proquest.com.proxy.davenport.edu/docview/1864625009?accountid=40195
McCarthy, M. (2016). Hospital doctors warn of massive job losses if obamacare is repealed.
BMJ : British Medical Journal (Online), 355 doi:http://dx.doi.org.proxy.davenport.edu/10.1136/bmj.i6625
Sundwall, D. N., M.D. (2017). So now what? American Journal of Public Health, 107(1), 26-27.
doi:http://dx.doi.org.proxy.davenport.edu/10.2105/AJPH.2016.303549
Student Response #3
The first statement that Trump made was removing the state lines for health care. By this he means letting people who, for example, live in Michigan, can get insurance from a company in Florida if their rates are cheaper. Currently if you live in Michigan, you only can by health insurance from companies in Michigan. This causes their to be no competition and the prices for health insurance in turn are higher than they should be with interstate health insurance. Under the Patient Protection and Affordable Care Act, "Section 1333 permits states to form health care choice inter-state compacts to allow insurers to sell policies in any state participating in the compact. Two or more states may enter into the compact under which one or more insurance plans may be offered in the such states, subject to laws and regulations of the state in which it was written," (Cauchi, 2017). So if Michigan and Indiana want to enter into the said compact, then insurance companies from both companies can compete for policies sales for people in both states. Turns out this idea is not as easy as President Trump makes it sound.
Many insurance companies have networks of doctors their policy holders are allowed to see in order for the insurance to cover the visit. If this insurance was sold to someone in another state, that policy holder would potentially have to travel to the state that sold the insurance in order to see a doctor in the network. Many are also afraid that insurance companies would relocate to states with the least regulations if this proposal were to go through. This would then allow insurance companies to offer cheaper but less comprehensive insurance coverage. This would then draw the healthy people out of their home state and move to the ones with the cheaper insurance. In doing so the sick would be left behind needing more health coverage and ultimately raising the insurance prices in the home state. This then would totally defeat the whole purpose of allowing interstate insurance.
Trump also mentioned fixing Medicaid and Mediacare. Again, unfortunately if doing so was as easy as it sounds, it probably would have been done. One idea is to raise the age of eligibility for Medicare. The proposal would gradually raise the age to 67 which is said to be Social Security's ideal retirement age. This would reduce Medicare's cost by 5% over the next twenty years. On the other hand, 5% is not a big savings and it would raise total health care spending. It would also put a new burden on seniors who would have to cover the health care Medicare would otherwise cover. It would then also impose new costs on businesses and state governments who would have to cover these seniors longer.
It has also been mentioned to raise the Medicare premiums for those in a higher income bracket. Seniors now pay separately for drug coverage (part D) and doctor visits (part B). Premiums seniors pay for these plans are about 25% of what Medicare spends for these services. If people in higher wage brackets were to pay more for these premiums, it would bring in more revenue for Medicare. Many think though that this proposal would push the higher premiums on the middle class seniors who would then find it harder to afford their health care. It is also thought that many of the high income seniors would find a less expensive health care plan or self pay for doctor visits and prescriptions as needed.
So what is the solution? It is hard to say at this point. We definitely need to start somewhere to help more Americans be able to afford health insurance. It will be interesting to see what happens.
Cauchi, R. Out of state health insurance- allowing purchases. (2017). Retrieved from http://www.ncsl.org/research/health/out-of-state-health-insurance-purchases.aspx.
Rovner, J.Selling health insurance across states sounds good but is it? (2016). Retrieved from http://www.npr.org/sections/health-shots/2016/05/12/477784813/selling-health-insurance-across-state-lines-sounds-good-but-is-it.
The future of Medicare. 15 proposals you should know about. (2016). Retrieved from http://www.aarp.org/content/dam/aarp/health/medicare-and-medicaid/2012-05/The-Future-Of-Medicare.pdf.
Student Response #4
President trump mentioned and promised to repeal, and replace ACA (Affordable Care Act) (Obamacare) throughout his campaign however I feel like President Trump doesn’t have a clear plan how to address the bigger picture. The most important issue is that what he is going to do with the 20 million plus people who are insured under this plan that are chronically ill and will die without it. As a future physician, I was all about repeal, and replace ACA until I start spending more and more time at the hospital and see the struggle some of these patient have to go through day in and day out. Now I don’t completely agree with President Trump regards to repealing and replacing the entire plan without any type of back up plans. I think leaving some of the ACA plan as they are and make some changes would equally benefit to the American people.
The biggest problem with ACA and one of the things that I do agree with president Trump regards to repealing and replacing ACA is that so many people have to pay higher premiums out of pocket and its difficult for average American to come up with type of fund. The reason behind is that insurance companies now provide a wider range of benefits and cover people with pre-existing conditions. Additionally, individuals are coerced to pay fines if they do not have any insurance throughout the year and in my opinion its aggressive for the government to require health insurance by everyone. Most people argued that they are paying the fines that way under ACA everyone is covered that includes the chronically ill and those who like to abuse the system. The other downside of ACA is that the entire process can be very complex for the average Americans and people were complaining the issues with picking the right family and business plan since the entire process was not user friendly. Lastly, a lot of new taxes were introduced to help cover the cost of ACA, such as pharmaceutical and medical device sales which indirectly comes out of the average tax payers (Kim, 2015).
Finally, it is imperative for President Trump, his administration and congress to understand the entire ACA plan and come up with a plan that would help those who are chronically ill and needs the plan to stay alive and allow each individual to decide whether they want to buy into healthcare insurance or pay their own healthcare costs on a cash basis. One of the biggest advantage of repealing and replacing ACA is that patient can shop for coverages with benefits that most closely fit their needs instead of forcing everyone to buy the ACA plan (O’Connell, 2017). According to President Trump the new plan would allow individuals to shop for insurance across state lines, and provides a better individual choice.
Reference
Kim, S. (2010). The Pros and Cons of Obamacare. Retrieved on March 7, 2017 from http://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare?m=2#Overview1.
Connell, J. (2017). The Financial Pros and Cons of Repealing the Affordable Care Act. Retrieved on March 7, 2017 from
https://www.gobankingrates.com/personalfinance/financial-pros-cons-repealing-affordable-care-act/
Student Response #5
Listening to the speeches of President Elect Trump versus the speeches of President Trump differ drastically, especially in regards to the United States Healthcare system. The statements that Donald Trump promised during his campaign were repealing and replacing Obamacare, privatizing all health plans while offering pre-existing conditions, and offering healthcare savings plans. This would benefit the people by saving them money and not being restricted to certain states and counties. “To repeal the bulk of Obamacare, the GOP will have to keep 218 House members and at least 50 senators and majorities of relevant committees together” (Prokop, 2017). Then to actually replace the law with their own full-blown plan, Republicans reportedly believe they will have to go through regular Senate order rather than the special reconciliation process meaning they’ll need 60 votes. That means at least eight Senate Democrats in addition to all the factions described above would have to agree to enact a replacement.
Donald Trump would not being able to repeal Obamacare unless he had a plan that could replace it with, that did not deviate from his promises to the people. The senate would have to vote on the plan to put it into action. There would have to be a transition period so the people would never go without any type of insurance coverage. “An acceptable health care delivery system should have two primary objectives: (1) it must enable all citizens to obtain needed health care services, and (2) the services must be cost effective and meet certain established standards of quality” (Shi & Singh, 2015, p. 37).
Donald Trump talked about eliminating state lines. This would reduce the cost of health care for the people. This would work by privatizing our healthcare plans so they can compete for the coverage of the people. Trump made a promise that people would have pre-existing condition coverage, which private insurances usually do not cover.
The options of a health care savings plan is a great idea if every person had access to it. It usually offered by benefits through a job. People would be able to sign up for a certain dollar amount to be taken out of their bimonthly paycheck that is not taxed. This would save people more money and offer them a benefit that allows better management of their financial spending. They would be able to use this account to pay for copays, medications, and procedures on pre-taxed income. The main issue people have had in the past is not using all of the money in the health care savings plan, therefore people should use their minimum amount that they could spend on healthcare costs for the year. If you don’t use it by the end of the year you lose out on the money that you had put aside for the health care savings plan.
“The market-oriented economy in the United States attracts a variety of private entrepreneurs driven by the pursuit of profits obtained by carrying out the key functions of health care delivery” (Shi & Singh, 2015,p. 37).
In one of President Trump’s speeches he talks about “getting rid of state lines”. What he means by thi,s is allowing insurance companies to compete without being restricted by state lines. This would decrease the cost of health care insurance for the people. As it stands now, insurance companies are able to increase costs to its consumers because of the lack of competition. This also restricts people to only being able to obtain care in certain states. Only emergency situations are covered when you cross state lines, which costs us more money to seek treatment outside our coverage.
The promises might be different than the actions that the new President. If he stands with his promises and ensures good coverage for the people at an affordable cost then I would support these changes. But not only does the President have to push these changes forward but congress as well.
References
Prokop, A. (2017, January 13). Everything Republicans will have to do to
actually repeal and replace Obamacare, explained. Retrieved March 8, 2017,
from Vox website: http://www.vox.com/2017/1/13/14194538/
obamacare-repeal-replace-vote-process
Shi, L., & Singh, D. (2015). Delivering Health Care in America A Systems
Approach (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Student Response #6
President Trump made several statements and promises regarding how he would “fix” healthcare. 1) President Trump wants to repeal Obamacare, “and replace it with a plan that will use “free market principles that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans” (Davidson, 2016). 2) present Trump also made a statement to work with competitive companies to make plan for Medicare which will save money. Both of these statements regarding healthcare reform are doable with a solid plan.
President Trump made changes in Obamacare which now includes: 1) Limiting health savings account. 2) Offering tax incentives that will make individuals to purchase their own health insurance in more affordable manner instead of buying it from their formal employer. 3) There will be limits on employer health care which is offered as tax-free income. 4) Remove all types of limits on buying and selling health insurance across the United States. 5) Offering Medicaid service to citizens. 6) Lastly, offer private Medicare which will help seniors to fund their own health plans (Trump Care, 2017). These are the few changes that is going to be executed in 2017. All these changes are made to help citizens get best care.
Although Obamacare changes are doable, many are unhappy with the changes made with Obamacare. These changes have raised issues and concerns regarding the marketplace after the year of 2017. It is likely to be assumed that deductibles and out-of-pocket costs will be rising for many consumers. The reason being that President Trump cannot close or replaced the Obamacare overnight and it has to be done step by step. President Trump made these changes to have orderly transition out of Obamacare, so people do not lose their current coverage. “This proposal will take steps to stabilize the marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options, (Luhby, 2017). Increase cost for consumers will be seen because insurers would gain greater flexibility in how much their policies would pay for each types of coverage. For example: if an individual plan currently covers approximately 70% of out-of-pocket cost on average then the insurers will allow them to offer a wide range of products with higher deductibles and co-pays. This would most likely lower individual’s premiums especially for the middle class Americans who do not qualify for Obamacare. However; it would also mean that the individual would have to pay more to get care.
In conclusions, changes in Obamacare made by President Trump will drive more people out of the exchanges. The changes mentioned above is not to replace Obamacare overnight however; it is to have a smooth transition so the people do not lose their coverage overnight. Whether these changes will benefit one or the another is a debating questions because some individuals are happy with changes made in Obamacare and some are not. President Trump first wants to stabilize the current individual market and then reform the healthcare for long-term purposes.
Davidson, A. (2016, November 16). With Health-Care Reform, Listen Carefully to Trump's Words. Retrieved March 08, 2017, from http://www.newyorker.com/business/adam-davidson/with-health-care-reform-listen-carefully-to-trumps-words
Luhby, T. (2017, February 15). Trump starts making changes to Obamacare that could mean higher costs for consumers. Retrieved March 08, 2017, from http://money.cnn.com/2017/02/15/news/economy/trump-obamacare/
Trumpcare Facts - President Donald J. Trump Healthcare Reform. (n.d.). Retrieved March 08, 2017, from https://trumpcare.com/
Student Response #7
President Donald Trump, spoke of many things that he was going to be trying to change, once he gets elected. The two things that stood out for me the most were changing the Obama care one his first day and setting up a health care savings. These two things are doable but there must be a plan of action before all this happens. To just eliminate the Obama Care all together without have a replacement of sort will leave more sick people in the world.
We all can agree that there are things that need to be modified with the providers and the type of care given. For the most part it has helped millions of people to prevent the spread and even treat early symptoms of a new found disease, that that person never knew about. Some of the deductibles are outrageous, and the penalty for not having any insurance or making more money than stated for the monthly tax credit, is another thing that needs to be corrected. While somethings do need a makeover within the plan, there are other things that are great for the person receiving the insurance. The one thing that is working the best is the way the healthcare industry shares information thru Electronic Health Record. This is often called the EHR in hospitals and doctor offices. The Electronic Health Record is being used by 72% of hospitals today, which has improved the quality of service and life for many insurance users. “73% of physicians send prescriptions electronically, 67% of the prescriptions filled have electronic warnings about the drugs being subscribed and 50 % have electronic reminders to alert when the drug issued to that person is not in compliance with the drug limits” (Emanuel, 2014).
Where the plan to create a health care savings and comes into play could be doable if all of the kinks really got worked out. There has been talk of this proposed savings form former presidents to develop this savings plan but it never was executed. There were too many challenges that arise then, and the two issues would still be there. The first is the borrowing in order of setting the savings in place, which defeats the purpose of saving money in healthcare. “Second, whatever savings we see in Medicare will be dwarfed by the $70 trillion unfunded liability the program is facing over the long-term” (Gerstein, 2009). This would basically work because people could invest and get a tax credit of up to 35% from Federal government which is money that could be spent back into the economy to continue to make it stronger.
The things that were mentioned are doable with the right plan in place and the agreement of the best interest of the clients in making this country healthy again. To have a plan developed like other countries where they keep you healthy with the pre-screened checkups, before you get so sick it cost the world more money to treat the disease rather than pre-treating the beginning of a symptom.
References:
Gerstein, D. (2009), Forbes. Retrieved on March 7, 2017, from: https://www.forbes.com/2009/05/12/health-care-reform-obama-opinions-columnists-bonds.html
Emanuel, E. J. (2014). Reinventing American health care: How the affordable care act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system. New York, NY: Public Affairs.
Student Response #8
Donald Trump made a lot of statements and promises regarding healthcare during his campaign; and depending on who you ask, all of these promises are either 100 percent doable, 100 percent unrealistic, or somewhere in between. The video posted for this discussion highlights several of the statements made by President Trump, but focuses mainly on his promise to “remove” state lines, or allow insurance companies to sell health insurance across state lines. Instituting this policy would theoretically increase competition among insurers, which would drive down costs. At least, that is what the Republicans claim will happen. Others disagree, and believe that “removing” state lines would instead create problems with negative consequences. Regardless of the potential results, the plan itself is completely doable. In fact, it’s essentially already in place.
That’s right, according to Peter Orszag (2017), “states [already] possess the authority to sanction sales across their borders, and to define the conditions for such sales” (para. 5). A few states-Wyoming, Rhode Island, Georgia, Kentucky, and Maine-already allow/accept insurance plans that cross state lines. In addition to this general authority granted to states, “section 1333 of the roughly 1,000-page Affordable Care Act, allows for states to create ‘health care choice compacts’ permitting insurers to sell policies to consumers in any state participating in the compact, as long as they follow specific rules” (Leonard, 2016, para. 4). In essence, President Trump’s proposed plan already exists. So, why aren’t insurers and the states working together to take advantage of this opportunity? There are several reasons, but one is that the insurance companies and the states would need to agree on regulations, to ensure that insurers are meeting the requirements of multiple states. Additionally, creating a viable pool of insured individuals, and a network of providers is very expensive and a lot of work: it just isn’t worth it for most insurance companies. So, could Donald Trump and the republicans introduce a new variation of the already existing laws to “remove” state lines? Absolutely. The real question is how do you make it work, to produce the desired results?
Another one of Donald Trump’s promises is to apply a block grant system to Medicaid. Like most of Trump’s promises regarding healthcare, block granting for Medicaid is doable, as republicans control the white house, senate, and house of representatives. Should we do it, is another question entirely. Currently, Medicaid is an entitlement, meaning that “everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs” (Luthra, 2017, para. 2). Block granting would instead provide states with a lump sum and the ability to manage Medicaid themselves, thus capping the amount the federal government spends. Proponents of block grants claim that it will likely save the government billions of dollars. Opponents argue that the decreased funding would limit access to healthcare for those who need it, as states would be able to decide who qualifies, what they qualify for, and how many are eligible to qualify. This would be a drastic shift from how Medicaid has traditionally been managed. As mentioned above, though, the republicans control both the senate and the house, as well as the white house, making block grants a real possibility. Especially since these changes focus mainly on spending, which would allow the senate to pass a reconciliation bill with only 51 votes, rather than the usual 60 vote requirement.
References
Leonard, K. (2016, January 6). An Obamacare provision even republicans can love. U.S. News.Retrieved from https://www.usnews.com/news/articles/2016/01/06/an-obamacare-provision-even-republicans-can-love
Luthra, S. (2017, February 2). The skinny on block grants—the heart of the GOP’s Medicaid plan.CNN Money. Retrieved from http://money.cnn.com/2017/02/02/news/economy/medicaid-block-grants-gop/
Orszag, P. (2017, March 6). Selling health insurance across state lines won’t save money. Bloomberg.Retrieved from https://www.bloomberg.com/view/articles/2017-03-06/selling-health-insurance-across-state-lines-won-t-save-money
