Julie Hagenbuch: Improve, rather than undermine, ACA

Healthcare is now in the hands of the Republican-led government. The Affordable Care Act is not exploding, imploding or self-destructing. This government and insurance companies are attempting to undermine it.

The attempt to undermine the ACA began in 2015, when U.S. Sen. Ted Cruz took on the “risk corridors.” According to the New York Times, “The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law. But, because of Mr. Rubio’s efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law’s new insurance marketplaces.”

This caused several insurance companies to leave the exchanges for 2017 and caused the massive premium increase. Fortunately, subsidies similarly increased.

One of the main challenges to ACA stability is acceptance. I was hoping we had that when House Speaker Paul Ryan declared that ACA would be the law of the land for the foreseeable future. But, when our current president threatens not to remit the tax credit payments to the insurance companies, it causes fear in the marketplace. Even if withholding payment is not within presidential power, just the threat of nonpayment causes fear for my neighbors, my family and me.

In addition, the insurance executives have massive incentives to merge with other insurance companies. When a $131 million enticement is dangled in front of a CEO, the CEO will quit the ACA exchanges, even if it is not in the best interest of the company, let alone the patients.

From CNN money: “U.S. District Judge John Bates concluded this week that Aetna's real motivation for dropping Obamacare coverage in several states was ‘specifically to evade judicial scrutiny’ over its merger with Humana. But Bates said this week the DOJ presented "persuasive support" — including internal Aetna emails — for the conclusion that Aetna withdrew from the Obamacare exchanges in those counties ‘to improve its litigation position.’”

"The court does not credit the minimal efforts of Aetna executives to claim otherwise," Bates wrote in a ruling following a trial over the merger.

He added that Aetna's decision regarding participation in the 2017 exchanges in these counties was "in fact manipulated."”

Another fear is that the tax credits will not be part of the budget allocations. If this occurs, many will truly not be able to buy insurance. We will again see a rise in emergency room costs and, for many people, this visit will be too late to save them. We want our policies to have some substance and cover the 10 essential benefits, which include seeing a doctor, maternity/baby care, mental health, hospitalization, prescription drugs, lab tests, pediatrics, emergency, therapy and preventive services.

There now are places where there is no option for affordable insurance. Routt County could be next. This legislature has shown it is unable to repeal the ACA but knows how to inflict damage upon it. I continue to hope for a kinder more empathetic leadership, but it is difficult to be optimistic when U.S. Rep. Scott Tipton and U.S. Sen. Cory Gardner will not hold Town Halls.

The solution is to be able to cover more people by improving the ACA. Call Tipton at 970-241-2499, Gardner at 970-245-9553, and U.S. Sen. Michael Bennet at 970-241-6631, and let them know you want them to work within the structure of ACA and improve it rather than undermine it.

Julie Hagenbuch

Steamboat Springs

Community comments

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(Nancy Spillane) NSpillane says...

Julie, thank you for pointing out why the ACA should be kept and worked upon to make it better. So many of our Routt County citizens are depending on it.

Posted 21 April 2017, 6:22 a.m. Suggest removal

(Brian Kotowski) Sep says...

"Lack of transparency is a huge political advantage. And basically call it the stupidity of the American voter, or whatever, but basically that was really, really critical in getting the thing to pass, and, you know, it's the second best argument."
~ Obamacare architect Jonathan Gruber

There appears to be an inexhaustible supply of stupidity, if the continued fawning over this boondoggle is any indication.

"If you like your health care plan, you can keep it. Period."
~ Politifact's 2013 Lie Of The Year, compliments of Preezy Pinnochio Boy

"We will start by reducing premiums by as much as $2,500 per family.”

My premiums *and* deductibles have virtually tripled under Obamacare, and for inferior coverage. I was *not* permitted to keep my plan. **Period**. Preezy Pinocchio Boy strikes again! On the other hand, I do have some truly wondrous coverage for pre-natal care and drug counseling. All I need now is a uterus and an addiction, and I'll be in like Flynn. Thanks Obamacare!

Obamacare is a lame horse. Put a bullet in its head already.

Posted 21 April 2017, 9:42 a.m. Suggest removal

(Lock McShane) Lock_McShane says...

Brian, do you believe that the death of the ACA will restore your health insurance to what it was before the law passed? The private insurance industry succeeded in the past because they could deny coverage to high-cost customers. Switzerland, the only other OECD country with a major private-insurance participation, has the 2nd-highest per-capita costs in the OECD, with US the highest. OECD average = 3463. US = 8713. Switzerland = 6325. Private insurance raises per-capita costs, PERIOD.

Posted 21 April 2017, 10:48 a.m. Suggest removal

(Lock McShane) Lock_McShane says...

Also, the problems you had with the ACA were caused by the Republicans and the insurance companies. The GOP wouldn't fund the subsidies to the insurance companies that were supposed to shield the companies from the increases in costs as the ACA ramped up, resulting in higher premiums. And the insurance companies abandoned the policies that were supposed to be grandfathered in.

Posted 21 April 2017, 11:01 a.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

Brian probably is right that ACA cost him higher premiums if he doesn't have any preexisting conditions. Healthy people pay more so that people with existing conditions can get coverage.

Though, the challenge with repealing the ACA is that a lot people with existing conditions consider health insurance to now be life saving and many other people fear getting an existing condition. Trump promised a replacement that is much better. So far what has been proposed by Republicans has no had hospitals, profit or nonprofit, or health insurance companies support as being better for healthcare.

Posted 21 April 2017, 12:04 p.m. Suggest removal

(j mcginnis) JMcGinnis says...

In a January interview President Elect Trump said.
"We're going to have insurance for everybody," Trump told The Washington Post. "There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us."
"[They] can expect to have great health care. It will be in a much simplified form. Much less expensive and much better," he said.

If he can do these things it would be great. He said he had a plan he was not ready to reveal until his cabinet was confirmed. Now would be the time to reveal this secret plan that is better and cheaper than the ACA. I would love to learn more.

Posted 21 April 2017, 12:57 p.m. Suggest removal

(Michael Bird) stmb77 says...

To improve ACA, all agree costs must be lowered. Julie, Nancy, anyone - Since 80% of healthcare is medical and not administrative, how do you specifically propose reducing what is paid to MDs, RNs, hospitals, pharma, and all other medical providers? Please do no go back to administrative ( ins cos or office staff) which comprise the vast minority of healthcare costs. For the moment, let us all agree that a single payer system or ACA is best. I cannot get any proponent of these plans to answer the above question with specific answers. For example, Canada's MDs make much less than US MDs. Do you propose US MDs make what Canada, UK, France MDs make ? Buy pharma as Canada pays ? To lower healthcare costs, these costs must be lowered. Julie, most insurance companies left exchanges because they lost a lot of money. Like all companies, if more money is paid out than earned, the losses have to be stopped. Insurance companies are in business to make a profit but their rates (premiums) are State regulated so is their profit which is 7% compared to the S&P 500 10% and they are part of the minority costs - the administrative (20%) If one magically deleted all administrative costs leaving only medical costs, we'd still be higher than Canada etc. So again, does any single payer/ACA proponent have a specific answer to how medical providers will be reduced to what single payer systems now pay in other countries ? And answers such as a single payer system will produce savings is not specific nor does it answer the above questions. Changes are needed. If ACA is to be improved, specifically how and what ? Need a timeline, costs, estimates, and much more. You bring up good points. Perhaps we can receive comments with specific suggestions showing how we can lower MEDICAL costs - the majority of healthcare costs. My thoughts are to repeal the anti-bidding of ACA, Medicare, and Medicaid pharma, restrict equipment so all hospitals do not have the same as all others leaving each to specialize and be more efficient, vastly increase use of PAs which has already started. Perhaps reduce the number of urban hospitals. What do you think ?

Posted 21 April 2017, 2:27 p.m. Suggest removal

(Julie Hagenbuch) jhagen says...

Repeal of ACA will not lower insurance costs. One of the main drivers of the increased premium costs is addressed by Lock, the insurance risk corridors. As far as lowering costs I think there are a lot of unnecessary tests run for starters. Michael you are correct that negotiating drug prices for ACA, medicare, Medicaid for starters. As far as specific ideas to improve ACA, the tax credits need to expand to higher incomes by spreading them out more equitably. Getting and keeping more people insured has already helped by having people get diagnosed earlier where the cost of care is lower. I am all for moving forward and consider myself open minded; whether that means single payer, universal insurance, or ACA. I am not for moving backwards. I am not for degrading insurance policies to lower costs as those policies will be of no use.

Posted 24 April 2017, 9:29 a.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

ACA health insurance could have limitations such as limited ability to sue for malpractice or having to go to certain hospitals in cities instead of offering local care. In essence, ACA insurance could be more like VA medical care which government has run at lower costs. Not that government should run ACA insurance, but, for example, Kaiser Permanente is generally 10-15% less, but is only allowed to sell health insurance in certain parts of Colorado. If Kaiser was allowed to sell to rural areas where they don't have a local presence, just as VA works, then rural areas could get best costs available in cities.

Posted 24 April 2017, 9:48 a.m. Suggest removal

(Ken Mauldin) KenM says...

The ACA has been an unmitigated, complete disaster that has caused a tremendous amount of harm to America and should be repealed ASAP.<BR><br>The same government that gave black soldiers syphilis on purpose, that ignores the Fourth Amendment with secret FISA Courts and civil forfeiture, that provided Iran (a State sponsor of terror) $1.7 BILLION in cash for hostages and allows rampant fraud in Medicare and HUD programs should never be trusted with the healthcare of Americans. In fact, recent revelations should demonstrate clearly that the government can't be trusted with medical records, much less control over medical services.<bR><br>It's also ironic and a bit dumb that the same people that presumably want to fight against fascism are working as hard as they can to impose one-party-fascism-rule in America. A single-payer, government controlled healthcare system that compels participation is a fascists dream come true. Forced compliance, violence and the heckler's veto are the tools of fascists (see: Berkeley, California) and a compelled single-payer healthcare system is but one of the many intended fruits of their labor.

Posted 24 April 2017, 10:53 a.m. Suggest removal

(Lock McShane) Lock_McShane says...

And the for-profit health insurance has the best interests of the citizenry at heart? All they care about is making money. Who they hurt in that pursuit is irrelevant to them.

Are all the developed countries that have a version of single-payer, Fascist? I don't think any of them are.

Posted 24 April 2017, 2:44 p.m. Suggest removal

(Ken Mauldin) KenM says...

Hi Lock - Yes, the idea that everyone must be forced to comply with a single, government-managed monopoly that controls access to life-saving healthcare is a great example of fascism. I appreciate the opportunity to clarify that point. I believe that profit is a more honest and better motive than presuming to know what's best for other people and forcing them to do what you believe is better for them. The typical liberal 'I'm-smarter-and/or-more compassionate-than-you and may therefore dictate how you live' is the hallmark of fascists everywhere throughout the dustbin of history. "It will be different this time" the modern day fascists claim as they promote the same failed policies over and over again. See: Venezuela. A developed, western nation flush with natural resources that ignored history and economics and had a whole generation of gullible citizens fall for the siren song of free healthcare and free college. Look at them now. I have friends there that are suffering terribly.

Posted 24 April 2017, 3:06 p.m. Suggest removal

(Jim Kelley) jksparky says...

Hi Ken,
Just wondering, Are you or your parents, or you aunts and uncles on social security? How about medicaid?

Apparently, we may already in the grips of fascism!!

Posted 28 April 2017, 9:25 a.m. Suggest removal

(Ken Mauldin) KenM says...

Hi Jim, Both of my parents are deceased, as are most of my aunts and uncles. I'm confident that you don't care about my family and only ask in an attempt to score cheap political points.<br><Br>Setting your feigned concern for my family aside, SS and medicaid are not fascists programs. Because there are free-market alternatives to both Social Security and Medicaid, neither of these fraud-ridden, bankrupt programs are good example of fascism. They are, however, great examples of the inefficiencies of central planning and should serve as examples why an even larger, truly fascist boondoogle like single-payer healthcare would be a predictable, unsustainable failure that will cause a lot of suffering.

Posted 28 April 2017, 9:42 a.m. Suggest removal

(Lock McShane) Lock_McShane says...

Fascism:
a political philosophy, movement, or regime (as that of the Fascisti) that exalts nation and often race above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition.

an authoritarian and nationalistic right-wing system of government and social organization

Ken, your definition of fascism is extremely broad. Developed nations with universal health care come nowhere close to that definition.

Venezuela failed because they bet everything on the high price of oil.

Posted 25 April 2017, 1:04 p.m. Suggest removal

(Jeff Kibler) JeffKibler says...

Your definition of fascism sounds remarkably like communism under Stalin. Stalin wanted to differentiate communism from fascism and started the whole "fascism is right-wing" propaganda.

Posted 25 April 2017, 1:33 p.m. Suggest removal

(Dan Kuechenmeister) dannyk says...

Lock, regards Venezuela. You might want to read the attached. Cheers, Dan
https://www.washingtonpost.com/news/w...

Posted 25 April 2017, 4:37 p.m. Suggest removal

(Lock McShane) Lock_McShane says...

Yes, I know that Venezuela screwed up. So we can learn from their mistakes and also learn from countries that succeed.

Posted 25 April 2017, 5:44 p.m. Suggest removal

(Michael Bird) stmb77 says...

Julie, insurance doesn't increase or reduce medical costs:only medical costs increase or reduce medical costs. Insurance is a medium to pay these costs to medical providers just as the medicare staff does. It is the lowest cost area of healthcare and medical is, by far, the highest. Should single men have to pay for maternity coverage in their individual health insurance policies ? Some say yes. Some say no. Deleting maternity for these would degrade them but of what - coverages they cannot use. Should we be allowed to buy policies that do not include some coverages, such as mental health, chiropractic, etc. at lower premiums ? Should we continue to subsidize health insurance policies when there is no reduction in medical costs paid by these policies ? I ask you should US MDs, RNs, hospitals, and all other medical providers be paid on or close to the Canadian schedule? This makes single payer systems cost less. Tough questions and complicated problems.

Posted 25 April 2017, 3:05 p.m. Suggest removal

(Lock McShane) Lock_McShane says...

Michael, the problem with a la carte policies is that it reduces the pool covered, therefore, increases premiums. The lowest premiums for the greatest number occurs with the largest pool, i.e. everyone in the country.

Plus, isn't it better to cover all conditions, because you never know exactly what you will need? If you have a magic crystal ball, that will tell you exactly what your future ills will be, then you can go a la carte. Women pay for men's issues too, like prostate cancer and Viagra.

Posted 25 April 2017, 4:37 p.m. Suggest removal

(Michael Bird) stmb77 says...

Lock, a pool that covers everyone with coverage that covers all conditions will still have high costs unless medical costs are lowered so my question remains unanswered - should we lower our payments to medical providers to a level that Canada or similar countries pay, which is much less than is paid to US medical providers ? Please give me your opinion and thoughts . Single payer systems can be good but not with uncontrolled medical costs. Notice I didn't take a position on the questions I posed. Yes,women pay for prostate cancer and, in some cases, Viagra and men pay for ovarian cancer and birth control pills and abortions so maybe it's a wash. To me the problem remains the absence of anyone talking extensively and specifically about medical cost reductions. It seems that the conversations always revert back to the minority costs (administrative). Without significant reductions in medical providers' costs, no system can cost less.

Posted 25 April 2017, 5:30 p.m. Suggest removal

(Lock McShane) Lock_McShane says...

I have stated before that we need to control medical costs and if that means paying our providers less, then we should. Canadian doctors still make a good living.

Posted 26 April 2017, 6:50 a.m. Suggest removal

(Chris Hadlock) chadlock says...

Why is the insurance in Denver so much cheaper than the insurance in Steamboat Springs? The actual doctors would tell you that they make less money by living here than they could on the Front Range yet insurance there is cheaper. Hmmmmmm.

Why can I not commit to a Front Range based insurance policy that requires me to use Front Range Doctors. I would gladly make that choice to save $400-500 every month.

When we allow the insurance companies to carve us into ever smaller groups the insurance premium skyrockets for the smaller groups.

One rule change could bring down insurance costs for everyone. No more Groups. Every single citizen goes to the marketplace to purchase health insurance and the insurance company is required to treat all 45-55 year old individuals the same regardless of where they live/work.

If you truly want a free market for health insurance the first thing that has to be done is to break the tie between employment and insurance.

Posted 26 April 2017, 1:07 p.m. Suggest removal

(George Hresko) GeorgeHresko says...

Chris--You say the first thing that must be done is to break the tie between employment and insurance. What problem does that specifically solve in the health care arena? And if that tie is 'broken' what are the economic consequences?

Posted 26 April 2017, 6:01 p.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

Chris,

From your reasoning then the more obvious solution is to allow population from rural areas to join health insurance offered in high population areas. Why did you reject that and instead make the far greater leap to ban groups?

Posted 26 April 2017, 6:48 p.m. Suggest removal

(Chris Hadlock) chadlock says...

George, in the days of a 30 year career tying healthcare to employment made sense. With current employment averaging 5-7 years it just does not make sense. A better plan would be to have all individuals purchase their healthcare and remove all the regulation involved with Corporate requirements and taxes. That one thing saves billions of dollars in overhead costs for corporations.

Specifically requiring insurance companies to treat their entire population of customers as one big risk calculation would drive down premiums even if costs stayed the same. (Actuarial science proves this contention.)

Driving down actual health care costs is a separate conversation. This one is about insurance and how the current system is actually driving those costs higher.

Posted 26 April 2017, 6:22 p.m. Suggest removal

(Ken Mauldin) KenM says...

Lock - Are there any other professionals that should have their earnings determined by the whims of the masses? While we're dreaming of using the will of the majority to limit people's earnings in order to impose our preferences, don't lawyers make too much money? How about professional athletes and actors?<br><br>Should we also limit the income of private medical providers like Lasik? That would seem "fair." Besides, if Lasik providers could earn more than government-compelled providers, there would be a Lasik clinic on every corner and Lasik procedures would be even more available and even more cost-efficient. What would you propose to remedy this terrible injustice of availability and efficiency? Outlaw private practice of medicine? That's what HillaryCare wanted to do.<br><br>What's so wrong with just letting people live how they want to live? Be a doctor. Work for the government or don't work for the government. For that matter, be a professional athlete and make even more money. Be an A-list actor and make tons more money than a doctor. Develop one of the world's most successful software programs or become one of the world's most successful commercial real-estate developers and you'll earn more money than you could hardly ever spend in your lifetime. Passing laws that effectively make doctors, of all people, conscripted/indentured servants of the State is a terrible idea.

Posted 26 April 2017, 6:50 p.m. Suggest removal

(Lock McShane) Lock_McShane says...

Medical procedures are different than any other commercial enterprise. There is no transparency in pricing; it is impossible to know beforehand what your bill will be when you go into the emergency room. And most people will not choose to die if they can't afford the life-saving treatment.

Lasik is an entirely different situation because it is completely elective; no one will die if they don't get their eyes fixed. Plus, you can get an exact quote before the operation, unlike most medical procedures.

I have to laugh at the hyperbole of "conscripted/indentured servants of the State". Are all medical providers today servants/employees of the insurance companies? No, they are not.

We spend almost twice as much with worse outcomes than the rest of the developed world. Are you happy with that, Ken?

Posted 29 April 2017, 9:38 a.m. Suggest removal

(Chris Hadlock) chadlock says...

Scott, because larger groups = smaller premiums and smaller groups = larger premiums due to the actuarial risk calculations. One of the biggest problems that the individual market suffers from is that when the insurance company runs a risk calculation for 1 person the cost is astronomical due to the possibility of a $500,000+ hospitalization cost on any given day. Run that same risk calculation for 10 people and the premium goes down. Run that risk analysis with a group size of more than 1 million people and the large group size reduces the risk calculation and premiums drop even when expenses stay roughly the same.

This is the reason that IBM, GM, General Dynamics FEHB etc get such affordable premiums for their employees while the small business and individual gets priced out of the market. Drop the groups and require the insurance companies to treat their entire pool of insured customers as one big group and premiums will drop for everyone.

Posted 27 April 2017, 9:45 a.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

Chris,

Though, GM etc get lower prices because they offer a random group that mirrors the overall population. Individuals selecting a provider include people with preexisting conditions with the incentive to select the insurance that best covers those conditions.

If an insurance company were to consider all of their customers as their pool then every time someone joins with expensive preexisting conditions then they'd have to raise the rates of all of their customers. So then the insurance company best able to exclude or discourage those with preexisting conditions would be able to offer lower insurance premiums to the rest of their customers.

Posted 27 April 2017, 12:16 p.m. Suggest removal

(Chris Hadlock) chadlock says...

I suppose an alternate solution would be to say that every citizen that is not covered by a group employee plan automatically gets access to the FEHB plans. Obviously the Gov't is not going to subsidize those citizens (separate conversation) but having access to the plans and rates available on the FEHB could cut costs for the small business/Individual and have the side effect of eliminating all of the exchanges.

Posted 27 April 2017, 9:48 a.m. Suggest removal

(Ken Mauldin) KenM says...

Hi Chris - I agree with your assertion that using the force of government to require private companies to operate a certain way would have some benefits. Forcing private companies to act as a defacto-arm of a paternalistic government would probably reduce rates in the short-term. In terms of actuarial science, I think that's a pretty safe assumption to make.<br><br>In my mind, this is similar however to suggesting that if we repealed the Fourth Amendment we could solve the opioid overdose problem sweeping our nation much faster and save many lives. Like high insurance costs are an issue for many Americans, so is the scourge of opioids and heroin that may not legally be discovered and seized in light of Fourth Amendment protections.<br><br>Just as I accept the existence of heroin in our community over the repeal of the Fourth Amendment, I also prefer free people addressing their own needs over a paternalistic government that has the power to force people into contracts. This debate has never been about healthcare or health insurance - it has always been about control. Vladimir Lenin wanted the Soviet government in charge of healthcare as a means to control the population. While many among us may be well-meaning and acting out of concern for others and the country as a whole, the term "useful fools" was used by the Soviets to describe those that were happily advocating for the plan that would eventually enslave them all.

Posted 27 April 2017, 11:36 a.m. Suggest removal

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