Maine Voters Over-Rule Governor on Medicaid Expansion

Sixty percent of Maine voters were successful in making history on Election Day in approving a referendum that expands Medicaid to low-income Maine residents over the staunch opposition of the republican Maine Governor LePage.

LePage has successfully “trumped” the will of the people and vetoed Maine’s Legislative approval of Medicaid expansion five times in the past. In effect, LePage has denied health care to over 70,000 Maine residents.

The Medicaid expansion has been an option of the Affordable Care Act that 31 other states have approved and, as a result, has provided insurance coverage to over 11 million more Americans.

The independent actions of Maine’s citizens in over-ruling Governor LePage sends a strong message that people are tired of autocratic politicians that place their partisan political interests over the needs and desires of citizens.

Advocates of Medicaid expansion in Republican Idaho and Utah (whose Governors have also been opposed expansion) have started similar efforts to place the question on the 2018 ballots in their own states.

photo credit: Robert F. Bukaty/AP

Why Insurance and Health Care is so Expensive in the United States?

And, What Congress Should Do to Increase Access and Lower Costs.

For the past nine years, a group of politicians and talk shows have flooded the media with doom, gloom and blame for the “impending implosion” of Obamacare.

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Ten Facts that your Congressional Representatives Doesn’t Want to Talk About:

1. US health insurance and health care is a $3 trillion-dollar industry with strong economic and political forces that focus on growing larger, increasing profits and having taxpayers assume their financial losses while they maintain control of their industry.

HealthcareSpending

2. The industry is led by special interest groups, that spends over $100 million a year on lobbying and contributions to politicians, healthcare providers and advocacy groups, in exchange for their loyal support.

This comes at the expense of patients, employers, state and local governments who pay for the outrageously higher cost of insurance, health care and prescription drugs than the rest of the world.

3. There are only a handful of large national health insurance companies. These include United Healthcare, Anthem, Aetna, Humana & Cigna.

These insurers are very concentrated in populated areas of the country and this leads to less competition, higher premiums and greater conflicts with health care providers.

4. The major reasons why there are high cost and limited ACA Exchange insurance plans offered in some areas of the country (primarily in rural areas and less populated states) are:

  • (1) there has been no commitment by Congress to maintain the individual insurance mandate and provide ACA funding subsidies to insurers,

  • (2) insurers have no obligation to sell ACA health insurance policies for more than one year at a time and

  • (3) there is no public option insurance (like Medicare) to compete with private insurance for health care and prescription drugs that is available to adults under 65.

ACA.Insurers

5. Individuals, employers, federal, state and local taxpayers pay for the cost of healthcare for people who are uninsured or don’t want to pay for their insurance.

Allowing people to refuse to buy health insurance, without a substantial late enrollment penalty (like Medicare) will result in an increase in medical services bad debts and an increase in the cost to taxpayers and the majority of individuals and employers who buy insurance. There is no free lunch.

6. Nineteen republican governors (primarily from sparsely populated western and southern states) have followed their party’s leadership in refusing to accept  federal funding (since 2014) to expand Medicaid eligibility (with 90% federal funding) for their low-income, uninsured residents.

As a result, these states have substantially higher uninsured residents, higher costs and fewer insurers interested in selling plans in their states.

7. While the overall national uninsured population has been reduced from 20% in 2013 to 10% in 2016, republican governors that have refused to expand Medicaid have experienced substantially higher rates of uninsured residents.

These include; Texas, Oklahoma, Florida, Georgia, Mississippi and Idaho. Blocking people from receiving insurance results in higher premiums, medical expenses and taxes to cover the costs of services to people who are uninsured.

UninsuredRatesMap2017

8. However, the seven republican states that have accepted additional funds for Medicaid expansion have achieved substantially lower uninsured rates including: Iowa, Michigan, New Hampshire, Arkansas, Indiana, Arizona and Montana.

9. The ACA and Medicaid offers flexibility to states that take the initiative to modify ACA and Medicaid regulations with waivers to tailor these programs to their specific states’ needs and preferences.

A small number of large and small, republican and democrat states that have taken advantage of these opportunities and achieved much better-than-average results including: Massachusetts, Vermont, Hawaii, Minnesota, Iowa, Delaware and New York.

10. Over the past decade with the recession and growth of technology that has reduced the need for employees, 40% of workers are now classified as “contingent workers” in order to reduce payroll expenses including paying for a portion of health insurance and other employee benefits.2016-US-Employed-Labor-Force

What Your Federal and State Representatives Should be Doing to Maximize Insurance Coverage, Improve the Nation’s Health and Reduce Taxpayers Costs:

• Approve and enforce, meaningful state and federal ethics legislation that prohibits legislators from: voting on legislation, funding, or seeking preferential treatment for individuals or organizations that they or their family have a real or potential conflict of interest.

• Expand Medicaid Eligibility in the 19 Republican states that have blocked their residents from receiving health care.

• Propose waivers to Medicaid and ACA like other progressive states to better meet the needs and preferences of your local citizens to reduce costs and increase insurance coverage.

Why are New York and Minnesota the only states that have utilized an ACA waiver to establish a very popular Minimum Essential Health insurance plans that has provide coverage to hundreds of thousand citizen who were previously uninsured?

• Approve federal legislation to legalized to importation of prescription drugs from Canada and European counties and reduce the high cost of drugs in half.

• Approve federal legislation that allows Medicare to negotiate prices (on behalf of the 50 million Medicare recipients) with pharmaceutical companies like the VA, Medicaid and every other county in the world does.

• Approve federal legislation to allow all citizens under 65, the option to buy into Medicare.

Medicare is widely accepted across the country and will provide a public option to citizens that live in sparely populated states and regions that experience high costs and few choices, due to the limited interest of private insurers.

• Approve federal legislation to reduce the criteria and length of pharmaceutical & medical device patents like other counties have already done.

These actions will significantly increase competition and reduce the uninsured rate across the country, along with reducing insurance & health care costs for individuals, employers & state and local governments.

Ask your Congressmember, if he/she will support these legislative actions, and if not, why?

Why Insurance and Health Care is so Expensive in the United States?

And, What Congress Should Do to Improve Access and Lower Costs.

For the past nine years, a group of politicians and talk shows have flooded the media with doom, gloom and blame for the “impending implosion” of Obamacare.

unknown-1

Ten Facts that your Congressional Representatives Doesn’t Want to Talk About:

1. US health insurance and health care is a $3 trillion-dollar industry with strong economic and political forces that focus on growing larger, increasing profits and having taxpayers assume their financial losses while they maintain control of their industry.

HealthcareSpending

2. The industry is led by special interest groups, that spends over $100 million a year on lobbying and contributions to politicians, healthcare providers and advocacy groups, in exchange for their loyal support.

This comes at the expense of patients, employers, state and local governments who pay for the outrageously higher cost of insurance, health care and prescription drugs than the rest of the world.

3. There are only a handful of large national health insurance companies. These include United Healthcare, Anthem, Aetna, Humana & Cigna.

These insurers are very concentrated in populated areas of the country and this leads to less competition, higher premiums and greater conflicts with health care providers.

4. The major reasons why there are high cost and limited ACA Exchange insurance plans offered in some areas of the country (primarily in rural areas and less populated states) are:

  • (1) there has been no commitment by Congress to maintain the individual insurance mandate and provide ACA funding subsidies to insurers,

  • (2) insurers have no obligation to sell ACA health insurance policies for more than one year at a time and

  • (3) there is no public option insurance (like Medicare) to compete with private insurance for health care and prescription drugs that is available to adults under 65.

ACA.Insurers

5. Individuals, employers, federal, state and local taxpayers pay for the cost of healthcare for people who are uninsured or don’t want to pay for their insurance.

Allowing people to refuse to buy health insurance, without a substantial late enrollment penalty (like Medicare) will result in an increase in medical services bad debts and an increase in the cost to taxpayers and the majority of individuals and employers who buy insurance. There is no free lunch.

6. Nineteen republican governors (primarily from sparsely populated western and southern states) have followed their party’s leadership in refusing to accept  federal funding (since 2014) to expand Medicaid eligibility (with 90% federal funding) for their low-income, uninsured residents.

As a result, these states have substantially higher uninsured residents, higher costs and fewer insurers interested in selling plans in their states.

7. While the overall national uninsured population has been reduced from 20% in 2013 to 10% in 2016, republican governors that have refused to expand Medicaid have experienced substantially higher rates of uninsured residents.

These include; Texas, Oklahoma, Florida, Georgia, Mississippi and Idaho. Blocking people from receiving insurance results in higher premiums, medical expenses and taxes to cover the costs of services to people who are uninsured.

UninsuredRatesMap2017

8. However, the seven republican states that have accepted additional funds for Medicaid expansion have achieved substantially lower uninsured rates including: Iowa, Michigan, New Hampshire, Arkansas, Indiana, Arizona and Montana.

9. The ACA and Medicaid offers flexibility to states that take the initiative to modify ACA and Medicaid regulations with waivers to tailor these programs to their specific states’ needs and preferences.

A small number of large and small, republican and democrat states that have taken advantage of these opportunities and achieved much better-than-average results including: Massachusetts, Vermont, Hawaii, Minnesota, Iowa, Delaware and New York.

10. Over the past decade with the recession and growth of technology that has reduced the need for employees, 40% of workers are now classified as “contingent workers” in order to reduce payroll expenses including paying for a portion of health insurance and other employee benefits.2016-US-Employed-Labor-Force

What Your Federal and State Representatives Should be Doing to Maximize Insurance Coverage, Improve the Nation’s Health and Reduce Taxpayers Costs:

• Approve and enforce, meaningful state and federal ethics legislation that prohibits legislators from: voting on legislation, funding, or seeking preferential treatment for individuals or organizations that they or their family have a real or potential conflict of interest.

• Expand Medicaid Eligibility in the 19 Republican states that have blocked their residents from receiving health care.

• Propose waivers to Medicaid and ACA like other progressive states to better meet the needs and preferences of your local citizens to reduce costs and increase insurance coverage.

Why are New York and Minnesota the only states that have utilized an ACA waiver to establish a very popular Minimum Essential Health insurance plans that has provide coverage to hundreds of thousand citizen who were previously uninsured?

• Approve federal legislation to legalized to importation of prescription drugs from Canada and European counties and reduce the high cost of drugs in half.

• Approve federal legislation that allows Medicare to negotiate prices (on behalf of the 50 million Medicare recipients) with pharmaceutical companies like the VA, Medicaid and every other county in the world does.

• Approve federal legislation to allow all citizens under 65, the option to buy into Medicare.

Medicare is widely accepted across the country and will provide a public option to citizens that live in sparely populated states and regions that experience high costs and few choices, due to the limited interest of private insurers.

• Approve federal legislation to reduce the criteria and length of pharmaceutical & medical device patents like other counties have already done.

These actions will significantly increase competition and reduce the uninsured rate across the country, along with reducing insurance & health care costs.

Winners and Losers in the Repeal of the Affordable Care Act (aka Obamacare)

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With the election of Donald Trump as president, Congressional Republicans are scrambling to come up with a repeal and replace plan that is acceptable to their various factions and president-elect Trump.

House Republicans have a lot of experience in successfully approving bills to repeal the ACA more than 60 times (without a replacement plan) over the past 6 years knowing that the Senate lacked the necessary votes to approve their bill.

While Republicans have labeled the ACA a disaster since it began 6 years ago, they have opposed every opportunity to work with the President and Democrats to design and improve the health insurance legislation. They have also been successful in arm-twisting Republican members of Congress and Republican governors to oppose the establishing state insurance exchanges, expanding Medicaid and providing tax credit subsidies to eligible low-moderate income uninsured Americans. Their actions have had had a negative impact on the large percent of workers who’s employers do not offer health insurance and the 40% of workers who are treated as “contingent” with no employer commitment to a work schedule or any benefits including health insurance.

However, the ACA has succeeded in enrolling more than 20 million people in exchange plans and another 14 million people have enrolled in expanded Medicaid in 31 states. This includes 16 Republican governors.

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The Trump Wildcard

Now that Trump has been elected after campaigning on repealing and replacing the ACA, the fun really begins. While many people have jumped on the repeal bandwagon, the vast majority of people opposing the ACA don’t know what the impact will be on their ability to buy health insurance and receive services at a reasonable cost in the future.

The repeal and replacement of the ACA will also affect small businesses, state and local governments, health care providers and facilities, insurance companies & brokers, employees of large businesses and national and regional economies. The great uncertainty that remains is what specifically will be lost and gained.

Trump has campaigned as an independent, populist who is the “peoples’ choice” who is not indebted to any special interests. Time will tell.

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Who are the Winners of the ACA Repeal?

Career Republican Politicians

The obvious, big initial winners from the repeal of Obamacare are career Republican politicians who have opposed all forms of tax-supported social supports including Social Security, Medicare, Medicaid and every universal health insurance proposal presented over the past 100+ years, including those proposed by various Republican presidents.

It should be noted that the US spends more than double what every other country spends for health care and prescriptions drugs and has poor health outcomes. Our system is a patchwork of multiple insurers, providers, payers that is costly, inefficient and ineffective that leaves millions uninsured with chronic and costly medical conditions.

From a political standpoint, opponents want to kill, not improve or replace, “Obamacare”. They want to obliterate President Obama’s landmark legislation from the history books.

Higher Income Individuals and Business Owners

Other winners are higher income individuals, who have experienced an increase taxes as a result of the ACA and employers who have experienced increased costs associated with compliance and implementation of the ACA. What is unknown is the cost of repercussions resulting from the repeal of the ACA.

Insurance Companies

Large, national for-profit insurers have to make the most changes to comply with and participate in selling uniform ACA insurance policies in both state and the federal insurance exchanges. Some insurers chose not to participate, others entered the exchange market late after millions were already enrolled and others, such as Aetna, United Healthcare and Humana dropped out of exchanges for 2017 as federal subsidies for catastrophic claims were expiring and their plans for merging with smaller companies were being scrutinized by federal regulators.

With potentially millions of insurance subscribers displaced as a result of the ACA repeal, it will likely cause a “death spiral”, state and federal insurance exchanges and plans for individuals who are not covered by group insurance plans. If it does, insurers will be losers of both subscribers and income. If insurers can negotiate positive changes for them with rate-setting, regulations and federal subsidies for high-need subscribers and regulator support for planned insurer mergers, they will be big winners.

Who are the Losers with the ACA Repeal?

  • The majority of Americans who have indicated in polls, that they only want improvements, not repeal, of the ACA.
  • Individuals who have pre-existing conditions may return to paying between $15,000 (ind.) and $30,000 (fam.) a year for private policies with increased co-pays and deductibles.
  • 14 million low-income individuals may lose their expanded Medicaid eligibility in 31 states
  • Young adults may find their new health insurance costs are unaffordable and chose to go uninsured.
  • Individuals with pre-existing conditions, chronic diseases and those that require costly medical & surgical treatment may find insurance & health care unaffordable and file for a medical bankruptcy.
  • Families with young-adult children, less than 26 years old, who have been covered on their employers’ family plans, may have significant new costs.
  • People who are at risk of serious diseases that may not be able to afford preventative screening tests that have been free.
  • Employees and employers who will require more education and support to understand differences in new  regulations, plans, coverage, benefits and true costs. This will have a negative effect on employee morale and productivity.
  • Insurance companies will lose up to $20 million existing ACA insurance plan subscribers along with up to $16 million in subsidies for low-middle income individuals.
  • Loss of federal tax revenue from select taxes and closed loopholes included in ACA to pay a portion of insurance costs.
  • Loss of brand-name prescription drug discounts and higher out-of-pocket expenses. for seniors.
  • Small employers, who have purchased or directed low-moderate income employees to insurance exchanges for subsidized policies, may face higher health insurance expenses and/or higher employee turnover.
  • Hospitals and health care professionals will likely face loss of insurance income, an increase in bad debts and increased administrative expenses to manage changes.
  • Health care quality and cost containment standards and strategies will be lost.
  • Loss of consumer protections and assistance in navigating a very complex and costly insurance/healthcare system

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CBO Report on the Impact on Repealing the ACA

The non-partisan Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) just released a report on the impact of repealing the ACA on insurance coverage and premiums.

Without any replacement plan in place, the impact will be devastating including:

  • Increasing the number of uninsured by 18 million in the first year and rising to 32 million by 2026.
  • Premiums for individual policies would increase by 20%-25% in the first year and increasing by 100% by 2026
  • Eliminating subsidies to insurers and the individual mandate will destabilize the insurance market and reduce the participation of insurers in selling policies.
  • In the first year after subsidies are repealed, about 50% of the nation’s population lives in areas that would have no access to insurers participating in the individual policy market.

Final Thoughts

The first 100 days of the Trump administration should be very interesting. There will be a major transformation of The White House and management personnel.

And, the repeal and replacement of the ACA is just one of many domestic and foreign promises that Trump has made, but will be implemented by people who have largely not had any similar responsibilities or experience.

The public expects the positive results that Trump has promised and we will soon see the public’s reaction to the new administration’s performance.

With Congressional midterm elections scheduled for 2018, Republicans, who are up for re-election, have their political survival at stake.