We already have a doctor shortage. Do other countries? If not, how do they keep doctors employed?
Before the ACA, policy rescissions were no more than 5-6 thousand nationwide each year, so obviously a rare event. Some of those would have been reversed on appeal and some of those would have cases of intentional misrepresentation from the applicant. For people using the exchanges, it’s premature to panic, since at least some provisions of the ACA are likely to stay in place and no one really knows what Trump’s policies are going to be.
However, raising the reimbursement rates would make the cost of the program go up from the already high levels it is. It could try to compensate by being more aggressive at questioning procedures that may not provide medical benefit or which may be fraud, but that could generate resistance from patients (reliable voters) and providers.
Medicare is attempting to move away from the fee for service payment model that may encourage overuse and raise costs through volume of services ordered and reimbursed. The new payment model is called MACRA and is supposed to be somehow quality based.
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
https://www.ama-assn.org/practice-management/understanding-medicare-payment-reform-macra
However, it does not address the medical school debt burden that many US medical school graduates are carrying and which may add pressure to order more services than may be medically useful.
Doctor shortages are also due to reasons other than insurance and medicare reimbursement rates. We only produce x number of doctors per year - a rate that has barely changed over decades despite more demand due to both an increased and an aging population.
The government could also choose to address shortages in different specialties and in primary care by choosing subsidize some of the med school cost for specialties currently deemed less desirable.
My point is there are ways to fix the problems IF it is deemed a priority worth addressing. Based on what just happened in the election, it doesn’t seem to be a priority or voters let other factors distract them from focusing on it. I doubt most voters understand much about the process, not that I claim to be knowledgable. But we see so much disinformation and lack of knowledge here about ACA among educated people, I do wonder how much people really understand.
Many med schools are increasing seats, many are trying to drum up more interest in primary care. More PA programs are opening and PAs will function more independently.
Despite med school debt and the years paying that back, many specialties are far from underpaid and ultimately put doctors among the highest income levels. There is no easy generalization that med school debt is the reason for unneeded services, throughout a career.
But I also question the blanket statements about how rampant these “unneeded” service are. There are anecdotes, sure.
Re: Medicare. I’m on it. I pay an additional amount per month (1/3 of my premium additional) because I’m a “high wage earner”. My husband is still working. I would think that all employed folks would,have this sort of sliding scale in Medicare premiums. Oh…imalso pay an additional $13 to Medicare per month for my part D RX coverage.
The federal law that prohibits insurers from denying policies to people with pre-existing conditions is called the Affordable Care Act, aka Obamacare. The ACA is also the law that allows employed parents to have adult children on their employer-paid policies. Congress has already tried to repeal the entire law, including the pre-existing conditions part and the under-26 part, some sixty times. They promise to do so again under the new President, who has also promised to repeal the ACA.
Before the ACA, insurers could and did deny policies to sick people. Or they would offer policies, but at a higher price. Or they would offer policies that didn’t include the pre-existing condition, so a diabetic could get health insurance that didn’t include diabetes or its complications and a cancer survivor could get insurance for everything but cancer. Or they’d offer family policies for all family members except the sick child.
Here’s a pre-ACA report of a survey done by the Kaiser Family Foundation. They got price quotes for fictitious people with a variety of health conditions.
https://kaiserfamilyfoundation.files.■■■■■■■■■■■■■/2013/01/how-accessible-is-individual-health-insurance-for-consumer-in-less-than-perfect-health-report.pdf
My husband and my son both have pre-existing conditions. In the new order, I worry they will not be able to get insurance.
Doctor shortage? It’s not so simple. From the invaluable Aaron Carroll: http://theincidentaleconomist.com/wordpress/a-doctor-shortage-lets-take-a-closer-look/
Another link to the same story in New York Times, but it’s gated:http://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-lets-take-a-closer-look.html
I have a pre-existing condition, too. If I’m covered under my husband work, can they deny me coverage if it’s repealed?
What can President Trump do on day 1 to the ACA? http://theincidentaleconomist.com/wordpress/what-can-trump-do-on-day-one-to-the-affordable-care-act/
Summary: he can halt the payments to insurers for subsidies. If he does, insurers may be able to terminate subsidized policies mid-year.
Conmama, probably not. Pre-ACA, employers were covering everyone. The employer could decide to stop covering all spouses and dependents, though.
Going to be repealed almost immediately and pre existing conditions will be on the negotiating table as the SOH is very opposed to that provision.
The issue of national health care for all is very, very important to me as I think it’s unconscionable that in the wealthiest nation so many millions couid not get or couid not afford health insurance. I wanted everyone to be able to have insurance like I am afforded through my husband’s employment and after retirement. All I can say is that I, and many more millions of people just like me, tried our hardest. Nothing we can do now, it’s over.
I live in a state that before ACA had guaranteed issue and that law for us will not go anywhere. But, it was unaffordable for most as there was no subsidy. Maybe my state will decide to subsidized (like MA did with RomneyCare,) but it would likely be one of only a handful of states to do that.
If they repeal, which they have promised to do, nothing is on the negotiating table. All will be gone. That is what repeal means.
As of now, no replacement bill has been proposed. Others have already pointed out that allowing people with pre-existing conditions to buy insurance at any time, but getting rid of the individual mandate, is unworkable. Healthy? No insurance for me! Diagnosed with cancer? Time to buy a policy.
My understanding from a careful reading of that article (and another article in Forbes) is that the payments that can be stopped immediately are the Cost Sharing Reduction payments that help lower-middle income folks with copays and high deductibles. I believe the “tax credits” or subsidies that directly lower (and sometimes cover 100%) of the monthly premiums are part of the law and cannot be halted by executive action alone. These subsidies might make it through 2017.
I read this , this morning, and felt a little better…
I’ve been assured by my advisor and department that repeal of the ACA will not affect my coverage… so I’m ok for the next few years. Unfortunately, the next (hopefully several) decades of my life are up in the air.
I’m making appointments to talk with a genetic counselor and a high risk obgyn to talk about my options for maybe having a pregnancy. Kids were not supposed to be on the table for a few years but now I’m afraid of having a high risk pregnancy under a Trump administration for two primary reasons, one of which is insurance. If I’m going to try and have a child, I need to do it all before I lose my university insurance. That gives me about a 3-4 year window.
It’s disgusting that my family planning revolves around the whim of the government rather than between my partner and doctors.
I’m trying so hard not to think about it because the stress is sending me into full flare mode. I woke up today barely able to walk. Guess it’s back to the wheelchair I haven’t used in months.
Yes, I agree (just my statement was badly worded,) They can keep certain provisions as law if they choose to by simply passing a new law requiring insurance covers pre-existing conditions. They just won’t.
They will definitely do a replacement program - it’s just not going to be much of a help to most people who need afforable insurance.
Paul Ryan’s plan kept the most popular provisions of ACA: coverage for pre-existing conditions and keeping those under 26 on their parent’s plans.
^ Wrong.
“U.S. House of Representatives Speaker Paul Ryan called on Wednesday for an end to Obamacare’s financial protections for people with serious medical conditions, saying these consumers should be placed in state high-risk pools.”
http://www.reuters.com/article/us-usa-health-ryan-idUSKCN0XP00C