80% of Americans AGREE: Obamacare needs major fixing or replacing

November 29, 2016

The latest GALLUP Pole shows that 8 out of 10 Americans want the Affordable Care Act (ACA law/Obamacare law) changed or replaced. Specifically, Gallup found that 43 percent of people want to see the law change significantly, but not repealed. 37% want it repealed and replaced.. Only 14 percent approve of the law and want to keep it intact. Read more: http://www.mcclatchydc.com/news/politics-government/article117514193.html

Frankly, this is not surprising. With 40-100% rate increases passed on to Insureds In Illinois, both on the 'Get Covered IL' website and OFF the 'exchange', it's no wonder people are unhappy. Illinois and states around the country have seen a mass-exodus of major players in the individual health market including Unitedhealthcare, Aetna, Humana, and others. Even the Co Op companies that were given money by the Federal Government to start up and be 'new competition', have all gone by the way side; the state of IL department of Insurance effectively shut down operations of Land of Lincoln Heath this summer.

Some ask the question: how can the remaining insurance carriers get approval for such large increases and why are so many carriers leaving? ANSWER: Insurance companies are LOSING MONEY! For every dollar collected, $1.15 to $1.30 is paid out by insurers across the company. (See former blog post with article from NYTimes on this very subject.) Why are they losing money? BECAUSE THE COST OF HEALTHCARE IS OUT OF CONTROL! And specifically in the area of prescriptions, which happens to be one of the 10 Essential Health Benefits covered under the law - which means after your maximum out of pocket, they are FREE to insureds! (but cost the insurance companies a fortune!)

So what have Pharmaceutical companies done with this info: Cha-ching! Cha-Ching! Since 2014 - drugs that we might have considered expensive (for example Humira was just under $900/month now costs $1500 per week for a treatment), have double, tripled, and quadrupled the price of the drugs. Why? Because they can! And insurance companies have to pay - it is an ESSENTIAL HEALTH BENEFIT under the law, and must be paid at 100% by insurance companies after the insured reaches their annual out of pocket maximum, with NO ANNUAL LIMITS or Lifetime maximums imposed. We now have maintenance meds that cost $60k, $70k or $90k. per year, that were no where near this cost pre-2014. Everyone has heard the stories of the Epi-pen, but there are dozens and dozens more examples of drugs from every major pharmaceutical company that have tripled or quadrupled the cost. I have a client whose wife is taking a medication. to fight cancer and the retail cost is $16,000/month!!!!!!!!!!!!!!!!!

Most people agree that there are a small handful of redeeming qualifies of the ACA law, and the most important is guaranteed-issue coverage for people with pre-existing conditions. But I must remind everyone I talk to - WE HAD GUARANTEED INSURANCE IN EVERY STATE BEFORE THE LAW WAS PASSED. It was the CHIP program and later modified to extend to people leaving their Employer Group plans, called HIPAA-Chip plan. It was a federal law and available in every state. Problem: the insurance was very expensive and not great coverage. So instead of fixing this 'pool' and making this insurance better, these 'uninsured' were dumped into the same pool with everyone else.

Whether you think this pool should be separate or with the 'healthy' risks, I think everyone agrees we cannot go back to denying coverage to people with health problems. However, the problem today is that the vast majority of people have health problems! If we go back to 'underwriting' individual policies, I would venture to guess that the vast majority of people would not be deemed 'insurable'. So we need a different fix. While this is a big, complex problem with many, many layers (including tens of millions of people still not insured and going to ER to be treated, undocumented people getting 'free' care, and cost shifting by providers to make up for losing money on free or low-paying insurance, including Medicaid, and physicians passing along increases to patents for increase liability insurance because of the lack of tort reform), we have lots of really smart people around this country, and I am hopeful for the first time in a long time that we can come up with a solution that will make insurance more affordable.

...but that is not going to happen with the current ACA law. So let's roll up our sleeves and see if we can make this law into something that has outcomes in line with the original intentions of the law, namely affordable healthcare with access to providers of your choice, across the country, and without discrimination.