April 7, 2013 in Opinion

Obamacare’s host of issues

Roger Stark M.D.
 

The Spokesman-Review recently published a series on the new federal Affordable Care Act. We now have three years’ experience with implementing the ACA or, as it is widely known, Obamacare.

During the debate in 2009, proponents said the ACA would reduce health care costs and lower the country’s level of debt. The nonpartisan Congressional Budget Office estimated the cost of the legislation would be $940 billion and that it would decrease the national debt by $100 billion over the first 10 years. These estimates were based on the president’s plan to collect 10 years of taxes while providing only six years of benefits, starting in 2014.

The CBO updated its figures. For the 10 years starting in 2012, the cost has jumped to $2 trillion. The nonpartisan Government Accountability Office now estimates the ACA will add $6.2 trillion to the national debt over the next 75 years.

Unfortunately, these new numbers are based on increasing the president’s Medicare cut from $450 billion to $716 billion. These reductions in Medicare payments are virtually all directed against providers. Medicare already pays doctors and hospitals only 70 percent of what private insurance pays. As a result, providers are reducing the number of Medicare patients they can treat simply because they can’t pay their overhead with these low reimbursements. As the ACA kicks in, it will make access to health care still more difficult for people on Medicare.

A further tax increase composes the remainder of the funding of the ACA. Taxes on all taxpayers are set to increase from the original $490 billion to over $1 trillion in the next 10 years. These taxes are in addition to the new taxes being debated in the current federal budget negotiations.

The ACA allows states to expand their Medicaid programs with supposedly “free” federal taxpayer dollars. Yet our existing Medicaid patients are trapped in a heavily bureaucratic insurance program that pays hospitals and doctors only 40 percent of what private insurance pays. Just seeing a doctor is a serious problem for our current Medicaid patients. Adding 16 million more people to Medicaid will only make the access problem worse.

The recently retired chief Medicare actuary, Richard Foster, now estimates that, once the ACA is in place, the cost of health care will rise from 18 percent of our economy to 21 percent by 2020. Insurance premiums for families with private insurance will increase by thousands of dollars to compensate for the poor provider reimbursements in the expanded Medicaid program. In no way will the law reduce the cost of health care for the country.

The president told Americans we could keep our health insurance if we liked it. It turns out that’s untrue. A recent national survey finds that 50 percent of small businesses and 30 percent of large employers will either drop or consider dropping employee health benefits once the ACA takes hold. The CBO now estimates at least 14 million Americans will lose their current employer-provided health insurance under the law.

And because of the draconian cuts to Medicare, it is now estimated that 7.5 million seniors will lose their Medicare Advantage Plan and be forced into traditional Medicare Parts A and B.

Proponents of the ACA promised the law would cover health insurance for every American. In spite of passage of the ACA, estimates now predict that at least 20 million people will remain uninsured.

We were told that the law would improve the quality of our health care. Decreasing access for our seniors in Medicare and adding 16 million more people to the bankrupt Medicaid program will in no way improve the quality of health care for these patients.

The Spokesman-Review cited the young man who lost his mother to pulmonary hypertension because she did not have health insurance. Tragically, his mother probably qualified for the existing Medicaid program and for one reason or another didn’t sign up for the safety-net program designed for people like her.

Everyone agrees our health care system needs reform. The Affordable Care Act has become increasingly unpopular since it passed three years ago. Experience with the law and concerns about the future make this growing unpopularity warranted.

Dr. Roger Stark is a retired cardiac surgeon andthe health care policy analyst at the Washington Policy Center, which has offices in Seattle, Spokane and Olympia.


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