HEALTH CARE CONSUMER’S CONCERNS ABOUT THE AFFORDABLE CARE ACT — THE LAW OF THE LAND (Part C)

In my two previous posts, I wrote about the Affordable Care Act (ACA) and about the three components of that major driver of consumer concern. In this blog we will continue to discuss the tectonic plates which remain and discuss the potential for dying due to the lack of health care coverage.

health care concerns chart

TAX PROVISIONS [1]

The ACA levies hefty taxes on pharmaceutical manufacturers, medical device manufacturers, health insurers, and wealthy citizens. These taxes have been helping to pay for the law’s coverage expansions and such expenses as the Center for Medicare and Medicaid Innovation (CMMI). Similarly, the ACA reduced payments to Medicare Advantage plans, managed care plans for beneficiaries that were thought to be overpaid. And it cut Medicare Disproportionate Share Hospital payments, which compensate hospitals for providing care to low-income patients.

 

TAX PROVISIONS

  • Enacted as part of Tax Reform Bill in 2017
  • Removal of the ACA Taxes
    • Medical Devices
    • Cadillac Plans
    • Health Insurance Industry

New Tectonic Plates: wealthy earners will also get a tax cut as would segments of the medical and drug manufacturing industry as part of the 2017 Tax Bill. As of this writing, the tectonic plates are at it again. The House voted to repeal a 2.3 percent excise tax on medical devices. This tectonic plate was bipartisan in nature.[2]

REPUBLICANS TRY A ‘PATCH’ FOR THE ACA

“Republicans opposed to the Affordable Care Act are showing interest in proposals to shore up the health law and lower premiums. This is Driven partly by their concerns that escalating insurance costs may hurt them in the midterm elections. State and federal GOP lawmakers are backing or considering reinsurance proposals that aim to curb premiums by offsetting insurers’ costlier claims.

“That stance is a reversal from last year, when Republicans almost uniformly opposed measures to aid the health law they tried to repeal. CBO has estimated that as many as 200,000 people previously enrolled in the ACA Health Plan Exchange would buy these ‘ACA Patch’ plans which would cause premiums to rise for the high-risk pool of patients who have no other option. This comes with an estimated cost of $168 million per year in tax credits” [3]

REPUBLICANS TRY A PATCH FOR THE ACA.

  • $200 Million Reinsurance
  • ’We continue to look for state partners that want to be innovative.’
  • And the States have ideas of their own

aca by states chart

And is there a pattern if we look for one?  Can you see an impact?

uninsured-death rate chart

A GOP Congressman said: “Nobody Dies” because they don’t have access to healthcare.”

Having said those words, he immediately had to duck and cover due to “the intense criticism” and feedback from his constituents. This gentleman, a Congressman who voted for the GOP’s repeal and replacement of the ACA made the comments at a town hall in his home district. While taking questions and comments such as “you are mandating [that] people on Medicaid accept dying.” He replied:

“No one wants anybody to die,’ the Congressman responded, adding a moment later: ‘Nobody dies because they don’t have access to healthcare.” [4]

LITERATURE REVIEW:

In 2002, the Institute of Medicine estimated that the “death rate of the uninsured is 25 percent higher than for otherwise similar people who have health insurance. According to the study, 18,000 excess deaths occurred each year because 40 million Americans lacked insurance” [5]

In January 2008, the Urban Institute updated that study. “Subsequent research has continued to confirm the link between insurance and mortality risk.  The true number of deaths resulting from un-insurance will be “significant.”[6]

health insurance and mortaltiy rate chart

But a 2009 rebuttal study by the Health Research and Education Trust found that “when adjusted for health status and other factors, the risk of subsequent mortality is no different for people who lack insurance than for those who are covered by employer-sponsored plans.”

There was a second conclusion from this work: “With health status excluded, the uninsured have a 10 percent higher mortality rate than similar insured persons” [7]

 The Harvard researchers compared 2001- 2005 death rates in Massachusetts to the four-year period after a new health care law was enacted and found that “mortality rate decreased by 3 percent between 2006 and 2010 when greater access to health care may have prevented as many as 320 deaths per year. Providing health coverage to 830 uninsured adults prevented one death per year.” [8] [9]

INDIAN HEALTH SERVICE  [10]

An Indian Health Service (IHS) indicated that it that some deaths have occurred as a result of the care they are not receiving, as well as the care they are receiving.

THE VETERANS ADMINISTRATION[11]

307,000 veterans may have died awaiting Veterans Affairs health care. With 21,882,153 total veterans of which the VA hospitals served 5.69 million of them as patients in 2013. There are 8.92 million people enrolled in VA health care system.  My putting pen to paper indicated that three percent of the VA eligible patients may have died due to some impediment to receiving health care.

EXTRAPOLATE [12]

Now let us extrapolate some data based on the impediments placed on getting health care by the American Health Care Act.  The Congressional Budget Office or CBO originally predicted that 22-24 million Americans would lose healthcare. If three percent of these Americans died presumably because of this impediment to receiving health care, then 720,000 Americans might have died because of that lack of health care.

COMPLIANCE[13]  

But that may be only part of the story. What about the well documented fact that only “50% of patients suffering from chronic diseases in developed countries follow treatment recommendations(?)” That would also be considered an impediment to having health care. This becomes another potential at risk population for death of an additional 375,000.  And that is only the NON-COMPLIANT population.

MEDICAID STUDIES

The New England Journal of Medicine in 2012 published a study which analyzed the effects of Medicaid expansion on adult mortality in several states. They found a connection between access to Medicaid and reduced mortality-exact figure was a 6.1% reduction in mortality. [14]

The Center for American Progress projected what would happen if the NEJM results were applied to the states which had not expanded Medicaid. “In these states alone more than 12,000 lives per year could potentially be saved if state governments agree to expand their Medicaid programs.”[15] Let us not lose sight of what is really at stake in the battle over Medicaid.

medicaid expansion by state

OCED DATA (ORGANIZATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT): [16]

MY RESEARCH[17]

The impact on lives lost without health care coverage is significant. And what is the potential bottom line relating to this tectonic plate projecting actual causes of death in the vulnerable populations?

Using literature reported figures for risk of death due to lack of healthcare and Congressional Budget Office Analysis of the various health care reform bills and then applying them to the National Vital Statistics Report for 2014,[18] the following projected yearly avoidable deaths from lack of health care insurance is suggested:

death rate chart

SO, THE CONGRESSMAN WAS WRONG:

About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. “A growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American “[19]  In 2002, an Institute of Medicine (IOM) was the first to link the lack of insurance with mortality. The evidence strengthens confidence in the Institute of Medicine’s conclusion that health insurance saves lives: “The odds of dying among the insured relative to the uninsured is 0.71 to 0.97 [20]

CRYSTAL BALL PLEASE [21]

That said, we can’t provide much in the way of guidance for the action of tectonic plates which are yet to come. On July 27, 2017, one potential earthquake fault was quieted for the moment due to the vote of the Senate. Will the subject of healthcare reform come up again? Most certainly! Healthcare Reform has already been impacted through Executive decisions and under the guise of Tax reform at the end of 2017.

Both the President and certain Republican members of Congress are intending to address health care again in 2018 and beyond.  How will the Democrats respond? “Republicans have often won support in recent elections by promising to repeal the Affordable Care Act. This year, Democrats hope to turn the tables by pushing the opposite goal—not just keeping the health law but expanding government’s role in health care.”[22]

The Republicans all already blaming the ACA on rising premiums (something the political activity regarding healthcare has actually contributed to as we have seen). Democratic candidates are responding to a push from party activists to move beyond the ACA and expand coverage further. They believe the law has flaws which should be fixed, not discarded.”

Expect to see more uninsured and underinsured. Even those folks with good seats in the ballpark may be impacted by changes in the depth of coverage. This case study was a discussion of the potential seismic impact. For now, let us concentrate on the more mundane and predictable tectonic plates which have already raised their ugly lithospheres and caused measurable ground movement.

So, which one of our metaphors are associated with these last topics for discussion? [23]

oliphant & donkey

TAX PROVISIONS

A-Oliphant

B-Donkey

REPUBLICANS TRY A ‘PATCH’ FOR THE ACA

A-Oliphant

  • And the States Have Ideas of Their Own Ideas

A-Oliphant

B-Donkey

A GOP Congressman said: “Nobody Dies” because they don’t have access to healthcare.”

A-Oliphant

CRYSTAL BALL PLEASE

A-Oliphant

B-Donkey

YOU THE INFORMED CONSUMER OF HEALTHCARE

FOOTNOTES:

[1] Republican Bet Health-Care Funds Shuffle Will Help Get Spending Bill Passed. By Stephanie Armour. The Wall Street Journal January 17, 2018

[2] https://www.wsj.com/articles/house-votes-to-repeal-tax-on-medical-devices-1532467519

[3] Wall Street Journal-Republicans Who Opposed Obama’s Health Law Now Work to Keep premiums Down. By Stephanie Armour Friday, February 16, 2018

[4] https://www.buzzfeed.com/jimdalrympleii/republican-congressman-nobody-dies-because-they-dont-have?utm_term=.mp8m9lKld#.buAnaAgAD

[5] http://www.ihi.org/resources/Pages/OtherWebsites/InstituteofMedicine.aspx -The IOM’s 2002 report, Care Without Coverage: Too Little, Too Late

[6] https://www.urban.org/sites/default/files/publication/31386/411588-Uninsured-and-Dying-Because-of-It.PDF

[7] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739025

[8] http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2014/05/12/health-insurance-and-death-rates

[9] http://www.hsph.harvard.edu/news/press-releases/massachusetts-health-reform-contributes-to-decline-in-deaths/

[10] http://us.pressfrom.com/news/us/-66559-people-are-dying-here-federal-hospitals-fail-native-americans/

[11] https://www.va.gov/

[12] https://www.cbo.gov/publication/52849- CONGRESSIONAL BUDGET OFFICE COST

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525884/

[14] “Mortality and Access to Care among Adults after State Medicaid Expansions”—published in the New England Journal of Medicine July 25, 2012, at NEJM.org

[15] https://www.americanprogress.org/issues/healthcare/news/2013/04/01/57839/access-to-medicaid-reduces-mortality-rates/

[16] https://data.oecd.org/healthstat/potential-years-of-life-lost.htm

[17] This Can Kill You-American Healthcare in Transition, Brian H. Casull MD, MPA, March 2017.

[18] National Vital Statistics Reports Volume 65, Number 4 June 30, 2016 Deaths: Final Data for 2014 by Kenneth D. Kochanek, M.A., Sherry L. Murphy, B.S., JJiaquan Xu, M.D., and Betzaida Tejada-Vera, M.S., Division of Vital Statistics

[19] https://hrs.isr.umich.edu/publications/biblio/9175

[20] http://annals.org/pdfaccess.ashx?url=/data/journals/aim/0/ on 06/27/2017

[21] The Wall Street Journal GOP in New Push to Repeal ACA by S. Armour and S. Hughes. May 25, 2018.

[22] https://www.wsj.com/articles/democrats-campaign-on-health-care-expansion-in-wake-of-gops-failed-aca-repeal-1526040001

[23] ELEPHANT- www.dreamstime.com DONKEY http://natmonitor.com/2017/03/01/whos-in-charge-here-dems-get-gut-punched-again

By | 2018-11-20T09:13:55+00:00 October 31st, 2018|Categories: Uncategorized|0 Comments

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