It’s a good time to talk about the saga of health care reform
It seems a good time to talk about the saga of health care reform and the move afoot to allegedly repeal/replace/rename/tinker with the Affordable Care Act.
Getting rid of this deceased seagull hung around the neck of the American health care system has been a priority and talking point for Republicans since 2009 but now that they control all levers of power, discovering a solution to the problems piling up from the ACA are still in the theoretical stage.
That’s partly due to the fact that many entrenched legislative potentates expected Hillary Clinton to win the election and they could continue to complain without offering much in the way of solutions.
The health-care system, after all, is an extremely complicated and challenging topic that forces individuals to confront their mortality and inevitably superimposes some sort of cost-benefit analysis on providing and paying for medical services, a practice which exists in every health-care system the world over where third parties are compensated.
I’m naturally skeptical of all large systems that attempt to provide individualized services. This is especially true with the health-care industry since I’ve discovered some of my friends who are providers refuse to acknowledge that beef jerky is the perfect food or that donut holes and Red Bull are the foundation of the morning meal.
On the practical front however, no matter how we arrived at this point, the more health care becomes centralized in administration, the less efficient it becomes in delivery.
This is apparent in the removal of health insurers nationwide from various markets where costs continue to exceed revenue as was the case of the recently absorbed Rocky Mountain Health Plans, which could no longer meet expenses, even with rapidly escalating premiums.
Despite the complexity of the Affordable Care Act, its anticipated result seems easy to ascertain — a collapse of the present system under a blitzkrieg of regulation and rulemaking that is at times at odds even with its own stated goals.
For instance, simplifying access to medical records through electronic record retention. This might seem like a good idea until one realizes the time and difficulty of placing records into an accessible system or assigning a staggering increase in diagnostic codes for medical practices. This attempt to make compensation more mechanical actually created a torturous and expensive process for providers because they have to sift through the myriad codes to unearth the most accurate match of procedure and compensation.
I suspect the goal was to push this bedraggled system to a breaking point at which time there would be little choice than to lurched toward a taxpayer supported single-payer system administered directly or indirectly by the federal government.
The beginning of this was the contortion of Medicaid, originally intended for the neediest that were unable to participate in the workforce, to a default program for otherwise healthy and non-disabled individuals. Colorado was one of the states that expanded Medicaid financial eligibility to roughly 138 percent of the poverty level to meet ACA requirements.
This resulted in a surge of covered parties far beyond estimates. As former state treasurer Mark Hillman has pointed out, there was a 196-percent increase in the number of residents of the state participating in Medicaid between 2009 and 2016 which means the number of residents in the program went from 1 in 12 in 2008 to 1 in 4 in 2016 and the department which administers Medicaid now consumes more than 26 percent of the state budget.
While the federal government wrestles with trying to unwind the Gordian knot of Obamacare, Colorado should adopt a more workable solution as a stopgap measure to prevent the unbalancing of the state budget.
The best solution to head back from the brink seems to be that which has been adopted by the state of Arkansas in the form of a program called “Arkansas Works,” which has adopted a hybrid public-private program that does not continuously expand Medicaid but instead uses federal Medicaid dollars to buy private insurance for qualifying individuals. Make no mistake, this program carries troubling exercises of state power by requiring persons over the age of 21 to enroll in some type of insurance if it is provided by their employer with the program picking up the tab for premiums and co-pays at qualifying income levels.
The program seems to be having better results than the pure Medicaid expansion used in Colorado and has a private component. We should consider trying it until a better solution is hammered out.