This is a column I wrote almost exactly a year ago on November 28, 2017. As almost everyone knows the health care dialogue continues without final answers. The only change from November 28, 2017 is the Tax Cuts and Jobs Act passed and the personal mandate was eliminated. Work continues.
“Earlier this year, February 21, 2017, I wrote a column titled “Why Obamacare Is So Hard To Replace.” As most everyone knows, the various attempts of the Republican House of Representative and Senate to pass alternative health care plans to replace Obamacare failed thereafter as every Democrat and some Republicans voted against them.
Now as the year is almost at a close, the Senate version of the Tax Cuts and Jobs Bill, a tax reform or tax cuts bill depending on how it is considered, would, among other things, eliminate the personal mandate to buy health insurance. As one of those measures that can sound great but have unintended consequences, ending the requirement that Americans carry health insurance has results and it may be time to step back for a moment and consider it.
This year as I met with clients, some of them on the edge and undergoing difficult circumstances, I asked people too young for Medicare or not on Social Security Disability and Medicare and either unemployed or employed in low paying jobs, did they have health insurance. Several answered “Obamacare.” There was no distinction made between whether it was under Medicaid expansion or under the ACA with subsidies. Honestly when I tried myself to list the various types of health insurance in America today I came up with 16 or 17 possibilities ranging from various employer provided health insurances to uninsured. To name a few, we have individual insurance plans that are not Obamacare including HMO’s and PPO’s and a new never-before seen EPO which appears to be a hybrid between an HMO and PPO. We have, for Veterans, Tricare and Tricare for Life. We have employer plans that could be HMO’s or PPO’s. We have Point of Service (POS) and HSA Accounts. We have high deductibles joined with HSA’s. We have Medicare, Medicare Supplements, Medicare Advantage plans. We have traditional Medicaid that is primarily for very low income aged, blind and disabled and for young families under TANF (Temporary Assistance to Needy Families). We have CHIP.
Then we have Medicaid expansion and Obamacare with subsidies dropped into this mix. For people who have it, Medicaid expansion and Obamacare are life rafts in the middle of an ocean of health care choices where they do not necessarily fit anywhere.
There is no question that the American health insurance system is a mess. I speak from personal experience having spent hours and days recently reviewing the provisions of multiple plans both for my office and family. Who knew it was so complicated? Pretty much everyone who needs to deal with it.
As I stated in my prior article, the ACA was not a substitute for an otherwise finely tuned machine of health insurance coverage in the U.S. If it had been, you would just discontinue Obamacare and go back to what existed before. Instead, Obamacare, because it could not start over with a beautifully crafted American system of healthcare, had to be grafted onto an already flawed and extremely complicated health care system with lots of moving parts. Some people had then, and still have now, multiple layers of insurance – Medicare, Tricare, coverage through an employer or prior employer. Others previously had or still have no coverage at all.
What happens if we just say forget about getting health insurance? For one thing we can expect hospital emergency rooms to be overloaded. Going back to the Reagan administration, hospitals have been obliged at least to patch up newly injured visitors to their emergency rooms before releasing them. However, from a personal perspective, an uninsured previously healthy person newly diagnosed with cancer could wonder whether he was going to receive chemotherapy and, if so, how would it be paid. If Medicaid is also being substantially reduced, what would be the source of payment? Is bankruptcy the alternative and would that work?
The idea of eliminating the mandate is that the government would save enough by not providing the life raft to begin to offset the Tax Cuts and Jobs Act extremely large tax cuts for corporations and mostly wealthy individuals with some cuts for the middle class that would later expire. Estimates by the Congressional Budget Office state it would likely increase the number of uninsured Americans by 13 million by 2027.
It depends on what we want. Open and reasonable discussion is needed to arrive at answers that can work.”
By the way, vote.
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.