Few people lie awake at night worried about the federal debt. So the Republicans’ plan to allow “temporary” COVID-19-era enhanced subsidies for Obamacare to expire because of their exorbitant cost won’t win many votes.
It will save Uncle Sam money. A staggering 93% of premiums are currently paid directly by the federal government to the insurance companies, reports the Paragon Health Institute. But will it win votes in the coming midterm elections? No.
Democrats are gloating that reducing the subsidies will mean higher costs for enrollees and an increase in the number of people who go without insurance. Sen. Chris Murphy (D-Conn.) predicts that Republicans “are going to get their clocks cleaned.”
Democrats cynically insist on continuing to spend huge sums of taxpayers’ money – some $450 billion over the next 10 years – to prop up lousy insurance, defending the indefensible because it’s called Obamacare.
Obamacare is an utter failure. It was supposed to bend the cost curve. But premiums for a family of five can exceed $50,000 a year before subsidies, according to the KFF Health Insurance Marketplace Calculator. Premiums are up 129% since the plans were launched in 2014, rising twice as fast as plans offered by employers and four times as fast as inflation.
Deductibles are outrageous, insurers deny claims 10 times as often as they did before Obamacare, and networks are so skimpy that it can take months to get an appointment with a doctor. Forget seeing a specialist in network.
But Democrats are counting on the simple truth that something is better than nothing.
Politically, they’re right. Republicans who want to stop the skyrocketing subsidies also have to show they care about the quality of care and intend to fix what’s broken.
Armageddon is just weeks away. The enhanced subsidies will expire Jan. 1, 2026, hiking Obamacare enrollees’ costs if no action is taken. Republican lawmakers should offer to extend them, phasing them out over one or two years, in exchange for reforms that will improve the Obamacare experience while Congress considers a broad overhaul.
Republicans finally have a second chance to fix health care. They should seize it.
Here’s the simple truth: If your insurance company routinely denies claims or keeps the network so narrow that you can’t get a doctor’s appointment for months, you’re not really insured. Both these problems should be fixed in the current session of Congress, with Republicans taking the lead.
In 2013, before the Affordable Care Act regulations kicked in, insurers denied roughly 1.5% of claims, according to the American Medical Association. Now, ACA plans refuse to pay 17% of claims, and some nix 30% or more, according to Kaiser Family Foundation research. Those denial rates should be made public for every consumer to see.
Insurers are also increasingly demanding prior authorization, even for routine prescriptions, which can delay care for weeks. Some states are putting time limits on prior authorizations, saying for example, that if the insurer doesn’t respond within 48 hours, you’re good to go. Whatever bill Republicans agree on to extend enhanced subsidies should crack down on these abuses.
Insurers are also gaming the system – deliberately offering narrow networks that exclude specialists and cancer hospitals in order to discourage people with serious health problems from choosing their plans. Why? Because the ACA prohibits insurers from charging sick people more than healthy ones.
Just 5% of the population accounts for more than 50% of health care spending, according to the Agency for Healthcare Research and Quality. It’s a fact of nature. Asking insurers to cover the healthy and those with preexisting conditions at the same price is like trying to feed a Chihuahua and Great Dane for the same price.
Former President Barack Obama bragged about protecting people with preexisting conditions. But now those same people find themselves stuck in ACA plans without access to the specialty care they need.
Yet Congress can fix this problem. Continue allowing consumers to enroll without providing a health history, but once they’re in a plan, their insurer can request the federal government provide an enhanced subsidy to those with preexisting conditions. Call it an actuarially adjusted subsidy — a remedy also proposed by former House Speaker and health care expert Newt Gingrich. It will eliminate the major reason insurers skimp on networks and also bring down premiums for the healthy who are currently being overcharged.
As Armageddon nears, various Republicans are proposing to cap income eligibility for subsidies and curb the massive fraud in the system. All good ways to help Uncle Sam save money. But they also need to improve the patient experience to defuse Democrats’ fearmongering.
Obamacare is an expensive mess. Pouring in a steady stream of taxpayer money without insisting on immediate quality improvements and opening the door to a major health insurance redo in the next Congress would betray taxpayers and consumers. Twelve years of Obamacare is enough.
Betsy McCaughey is a former Lt. Governor of New York State and Chairman & Founder of the Committee to Reduce Infection Deaths. Follow her on Twitter @Betsy_McCaughey.
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It’s just what I thought it was. Obama knew it was going to destroy the healthcare system and he knew that the Republicans would try to fix it. But in the process of trying to fix it some people would lose health Care. There is the genius then they can beat Republicans up about taking away health care and get votes. They don’t care about the individuals at all as a matter of fact they don’t care about this country. All they care about is power. The Democrat party is truly the party of Satan. They’re incapable of telling the truth, they hate God if they even believe in Him, and they deny the existence of one universal truth they think everybody has their own truth. Sounds like a recipe for disaster doesn’t it?
Our do-nothing Congress is going to leap into action in the next two weeks and fix something that has been festering for the past 15 years.
BAHWA HA HA !!
It’s not affordable. It’s not care, but it is an “act”
I like the suggestion about adjusting premiums for the healthy. I am offended when shopping and see people very overweight (trying to be politically correct here), and what they have in their cart. The grocery stores are a breeding ground for destructive lifestyles, with end caps and stand-alone tables loader with junk food. As far as I know, the life insurance industry has a higher premium for smokers, but there is no vetting for that in health insurance. I don’t want to sound draconian, but maybe we should have physical exam for just weight in order to determine premiums or establish a pool for high-risk people. The premium playing field needs to be leveled, so those that take care of themselves aren’t subsidizing those who don’t.
Let’s call it what it is. Unaffordable health care. From the beginning the ACA was unaffordable for many. Small businesses owners can’t afford it for themselves let stand an employee. AARP and United Health pushed this thing through. AARP received 9 billion dollars from United Health recently. What for? AARP is a not for profit organization. Where did this money go to? Undermine any Trump legislation he proposes? Or obstruct ICE and support lawlessness? We don’t know where that money is going but we sure know where it came from. From the poor people who had been mandated to take the ACA insurance or pay a tax penalty. Then when the ACA was in danger of being eliminated the legislature decided to subsidize the premiums by paying it directly to the insurance companies. Wasn’t that a lovely move. We the tax paying, premium paying citizens were still carrying the cost. It just had a different name. Affordable health insurance is possible in America if the powerful insurance industry was ignored. But the politicians need their money for their campaigns which are running into billions of dollars. Let’s start there. Curtail the time they can campaign and the amount of money they are allowed to raise. Now many politicians are reporting to big businesses millionaires no matter what industry we are talking about. Especially under the democrats, they listen to unions and billionaires. Not the people. Remember Pelosi’s who said “we need to pass ACA to know what’s in it”. Trust her or any evil democrat? Well the people did and here we are. High premiums and no doctors or care. Republican should take this moment to come with a comprehensive plan. Dictating to the insurance companies instead of the other way around. Everything the democrats propose falls apart the moment it takes effect. ACA was dead on arrival.
We need an immediate solution to America’s Health Care, especially, on behalf of Senior Citizens. Seniors are a vulnerable populous that seem to take the brunt of others in control. Making America great again would invlove gutting and starting over with Health Care, making it viable for all!
What we have now as health care system resembles the ed. system, endless administration, bureaucratic nightmare, the real reason for being lost in it. Patient and student come last, it’s not for them but for the ones administering it. Nightmare over nightmare.
Whenever the government subsidizes a program or system, the corporations or entities involved in the administration of same seem to raise their costs to significantly higher levels. A prime example is how the cost of a college education skyrocketed when the government guaranteed student loans. Obamacare became a cash cow for insurance companies. An in-depth examination of the entire health care system, similar to what the DOGE group did within the Federal Government, should be conducted. And it should include an audit of the insurance companies that write health insurance policies. Yes, healthcare costs have increased and often dramatically; however, the entire healthcare system needs an in-depth examination and overhaul: Every component of the system needs to be examined, and not by government appointees, but by independent experts in business systems analysis. Experts in the health insurance field should only be used as information sources, when as and if needed, and not as dictators of insurance policy.
I sure hope this health insurance, ACA, can be fixed and I also think that giving the money to the people is so much better than giving it to insurance companies. How to actuate this plan is the rub. We are a free market country still, so why can we not figure out how to do this plan? What we have now, is unsustainable long term
John McCain is why we still have Obama Care!!!!!!!!!
DJT should null and void everything the illegal kenyan did to America. A radical islam muslim born in kenya.
When Betsy McCaughey says that “93% of premiums are currently paid directly by the Federal government” she is really saying that they are paid directly by the tax payer. Why wouldn’t we want to stop this?
The GOP should phase out the “temporary subsidies” since COVID is long gone! Then, as Trump said, send the money directly to the people so they can shop for a policy that fits their needs. And put out plenty of ads of Barry and his crew telling us that premiums would drop by $2500 a year! An FSA or HSA would work much better than these bloated ACA policies!
To End Obamacare:
CUT HHS overhead
Merge programs
Merge Medicare plans
CUT Rx prices
Offer competition
Less bireaucracy
local control
Easier for MDs & patients
Tier pricing
Outsource more
12 years of osambo care is too much.
Great article explaining the flaws in the ACA, that no one wants to face upfront. Sooner rather than later everyone of us are going to have health conditions that will fall under the definition of a “pre-existing condition”, which is why I don’t like the pressure of having to re-evaluate my coverage with the specific insurer to see what changes they have made to the coverage that affects my health needs, How hard is it for them to send me, an itemized list of how the services I need to maintain my wellness care might cost me, because they decided to add higher copayments. That’s a lot easier than making it tedious and forcing me to go line by line/ doctor by doctor/ drug by drug that I already know that I will not be changing because I take maintenance medications, not Mental health controlled medications. And this year, because the healthcare insurer companies figured adding in the GPI-1 medications fr weight loss was a great way to past more cost on to us, even if we don’t use or will use those medications. to me it sounds more like the drugs involved actually cost the drug makers mere pennies to make and are making huge profits because of their popularity. because people think these medications are the fast way to lose weight without having to do any changes to their eating diet.We need a healthcare coverage program, that covers medical needs, regardless of the profit gain for the service, why should people have to use emergency services to get medical treatment and those who have chronic medical conditions should not have to spend an arm and leg to get treatment—get the profit out of healthcare insurance
AS bad as Obamacare has proven to be, if the Republicans cannot get off their duffs and create a bi-partisan proper system that helps the people, manages to promote competition between insurance providers and keep the federal government OUT of the provision of reasonable health care, unless they can do that, nothing will change for the better. Our problem has always been that our political leaders have forgotten their duty and servant hood place. Whatever program, process, proposal or concept they touch will be corrupted from day one (just like Obamacare was at the onset) and we will continue to bury ourselves in debt, deprive people of their needed care and fill the treasuries of insurance and health corporations with tax dollars. A complete and concise program is a must here…otherwise we just change the name and not much else. Common sense has long been ignored. Prudence has completely been obliterated. Fairness and control have lost their influence. That’s my perspective. The same can be said for medicare and medicaid coupled with social security and the whole welfare process that continues to balloon in cost and corruption by fraud. We have lost control.
Congress won’t address these issues properly for the sake of votes and people and companies who abuse the system will continue to do so, while we collapse under the burden of debt. Pessimistic? Certainly! Discouraged? You bet!. Hopeless? Not quite, but we are getting there at warp speed. Cover your eyes….the explosion is coming.
I always thought that it was”obama don’t care”.Someone is making big bucks over this,thats why the democrats are fighting for it.
Take one part brain dead human + offer FREE anything and everything = democrat voter. Maybe we worry too much about trade deficits, and balanced budgets … democrats don’t care, and the only way you will win their vote is to give them free stuff. It’s a vicious circle, never ending, until conservatives loose enough brain cells, or democrats (including some politicians) gain brain cells and grow a few.
MEDICAL INSURANCE COMPANIES ARE A THIRD RAIL THAT DO NOTHING MEDICALLY: THEY JUST TAKE MONEY. IS THERE A WAY TO GET MEDICAL HELP WITHOUT INSURANCE COMPANIES AND WITHOUT THE TAXPAYERS PAYING ALL MEDICAL COSTS?
They can. But will they?
I have not seen anyone propose to increase the product – access to doctors, nurse practitioners and clinics. Supply and demand. I know it takes time to train health care specialists, and if so, a program should be started immediately. Covering education for those workers in exchange for working at clinic/hospitals for a reasonable salary for the same amount of time that your education took, will increase the product. If doctors/nurse practitioners are as numerous as dollar general stores then the cost will come down. Anyone remember the show “Northern Exposure”? Education in exchange for agreement to work for a set contract. You can’t increase the demand and not increase the supply. Each town used to have a accessible family doctor for the more ordinary things. Fevers, cuts, burns, etc.
True, true, true! Thanks Betsy. Republicans, please fix healthcare and put Obamacare in the trash where it belongs. I like what you said about letting everyone who needs the program enroll, then adjusting the rates down for those who don’t use much healthcare while getting the subsidies to help with the 5% who use a lot.
A bigger problem?? What these so called Dr.s charge. If you make $21:00 dollars an hour. No you can’t pay what they charge. Dr might ask what your life worth??? There is limit what patients can pay. You’re either a Dr.or a money grubber. I thought they went to college to be doctors to help patients with illnesses. No it comes down to all about money. Quacks practicing quack quackery..
HOW can my husband get out of Obama Care? We definitely can’t afford regular care for him, but with Obama Care to see what he has (COPD and Emphysema, he has ENOURMOUS BILLS, THAT WE CANNOT PAY! I’m on SS and that is our only income, as he is my FULL TIME CAREGIVER! In the house, I’m relegated to a walker, can’t cook anymore, have to sit in front of the washer and dryer in my walker for well over an hour (legs fall asleep) he is my lifeblood – 3 meals a day, and now he has to give me more fiber in my food… He hates Doctors, and unless he incurs something really debilitating, I doubt if he will ever see another DR!
When Obamacare came in, my husband lost is health insurance because the premium tripled and we couldn’t afford that and mortgage and living expenses. It’s been not good for the people from the beginning and there were too many lies used to make it seem good. Maybe insurance companies have had a lot to do with the problems? Good chance!
The true solution is for the Government to have as little involvement (preferably none) in the Health Care System and let free market capitalism handle it.
Until we charge people according to their health and their commitment to improving it, insurance will continue to skyrocket. Since the populations overwhelming approach to healthcare is to live anyway they want (dangerous lifestyle be dammed), ‘I can always get a pill for that’, means no meaningful change will happen. While unpopular it is the truth.
Congress is betraying taxpayers (especially young taxpayers – who will be force to foot the bill, with interest, for many years to come) every time they kick the can down the road for another year or two (at a cost on the order of a couple of hundred billion a year). If Congress and all their people on capital hill were part of the system and not lavishly protected by taxpayers, they would have resolved this failure years ago. Young people need to rise up and demand balanced budgets and force all of our elected officials to get to work and solve problems. Showboating on TV and Social Media and begging for campaign donations is not the job they were hired to do!
The answer is simple. Get the government out of the health insurance market and let the free market work it’s magic. Doesn’t anyone believe in the free market anymore? Something like 20 million are now getting about $12,000 a year in subsidies. That is insane and worse a large number 20+% of these folks have never even filed a claim (does anyone wonder why)? Allow these people, presumably with pre-existing conditions, be covered by Medicare for a “short period of time” if they are financially eligible. Congress, no doubt, needs to establish an assigned risk pool for these folks and some substantial subsidies will be required. Things can’t change overnight but a 2 year extension is just passing the problem to the next Congress. We will give you 6 months (new programs – everyone has options if they want coverage)!
How long would it take to setup the ground rules for an assigned risk pool, establish appropriate rules, and a funding mechanism (lock them down in the Capital and odds are they would be done before Christmas). The next question is does the government have a system in place to prove these are real citizens who actually need & want the government’s help. Can the government verify income and confirm that the people have pre-existing conditions, in a timely manner?
The hard leftist Democrats and the so-called Socialist Democrats want everything free for the people to get their votes. But somehow, the funds are not going to the people who really need them. There is no accountability for where the funds are going or how they are used. Socialist countries, including China and England, have free healthcare, but at a price. It is based on your income. We see it here in the land of the free as well. You know the level of care older people get, based on their SSA, Medicare, and other supplements. We need a healthcare system that is competitive among insurers to keep costs down.