OpenPlacement Community > OpenPlacement Blog > Health Care Reform has More Negatives than Positives

Health Care Reform has More Negatives than Positives Christy Rakoczy

June 18th, 2013

ObamacareMany have their opinions regarding health care reform in the United States, officially called the Affordable Care Act, and unofficially called Obamacare. There are some enthusiastic supporters of the bill, but many are not pleased with the passage of the legislation and its intended (or unintended) consequences.  A look at the positives and negatives can uncover why so many seem disenchanted with this reform.

First, the top two reasons why the Affordable Healthcare Act is made out to be good, and why they are fallacies:

The Affordable Care Act states that states will receive more funds from the federal government in order to add more low income individuals to Medicaid.

Again this seems like a positive, yet the truth remains that that many doctors do not accept Medicaid. The constraints of the program are difficult for doctors to manage and often doctors wind up not getting paid for services because of the program. So, it does not do a lot of people much good to have Medicaid if they still struggle to find doctors who will accept it.

Additionally, there are a variety of other negatives about the Affordable Healthcare Act:

  • Half of those on Medicare Advantage will lose coverage as a result of rate increases
  • Health care costs will increase exponentially as a result of massive taxes on drug companies and those who manufacture medical devices
  • Excruciatingly high penalties and taxes will hurt small businesses, thereby hurting the economy
  • Many doctors are possibly not going to accept any government sponsored health plan
  • With a tremendous influx of previously uninsured Americans into the system the time to see a specialist or primary care physician could increase dramatically
  • In addition to aforementioned taxes, fees, and penalties, those who do not get what the government mandates as minimal coverage are also taxed

While there are some positives such as the removal of pre-existing conditions clauses and the creation of insurance exchanges which will improve accessibility to shopping for private health insurance, overall the Affordable Healthcare Act seems to have far more negatives than positives.

Comments

  1. John Mills June 18, 2013

    Articles like this make me crazy. I have a deep background in health policy – 20 + yrs in the field including over 8 yrs on Capitol Hill – and the countless factual inaccuracies do a disservice to the write and reader. I feel the need to set the record straight on many of them.

    1 – Doctors Won’t Accept Medicaid – This was a huge problem prior to the advent of Medicaid Managed Care in the late 1990s but today 66% of Medicaid beneficiaries get their care through a managed care plan provided by a Commercial Insurer according to the Kaiser Family Foundation. Most states have network adequacy standards for insurers participating in Medicaid programs and because the card presented at doctor’s offices are Insurance Cards instead of Medicaid cards the offices are far less likely to know if the person is on Medicaid or another insurance plan. While there are downsides to Medicaid managed care, for most Medicaid beneficiaries access to physician services has never been better. There is no reason to expect this to change since the interest in private insurers participating in Medicaid is increasing not decreasing (it was a major reason Aetna bought Coventry Health Plans earlier this year).

    2 – 50% of Medicare Advantage Recipients Will Lose Their Coverage Due to the ACA – What is the source for this info? Medicare Advantage payment rates to health plans have been going down since 2011 but Medicare Advantage enrollment is continuing to increase having risen 10% or more each of the last 3 yrs according to the Congressional Budget Office. The CBO projections of decreased Medicare Advantage enrollment have not come to pass. This is not surprisingly since this is an incredibly profitable product for most insurers and a growing market due to the aging of the baby boomers. I am sure we will see some benefit changes/reductions in the coming years but insurers will work hard to keep this important revenue/profit center.

    3 – Health care costs will increase exponentially. The data is showing otherwise. PWC just released a report showing that healthcare spending is actually stabilizing and increasing at a much slower rate than it has in year. Part of the reason is the systemic changes being brought by the ACA including Accountable Care Organizations and the advent of integrated delivery models. See this article from today’s Washington Post. http://wapo.st/17gXxYo

    4. Excruciatingly high penalties and taxes will hurt small businesses. Please identify what these are. The law exempts small businesses from the requirement to offer health insurance to their employees and the taxes and fees in the law apply to all insurance products (individual, small group, large group and self-insured) not only those offered to small businesses.

    I also think it is important to note that the switch from experienced rating to community rating will create new winners and losers in the Individual and Small Group markets. In an experience rated world, young, health males tend to do very well while women of child bearing age and older adults regardless of health status do not. The winners tend to be reversed in a Community Rated world. More than a dozen states have switched to Community Rating in the last 20 yrs so while this change will be disruptive in 2014-15 it is unlikely this will have much of long last impact on the market.

    The law is not without its flaws but the misinformation being provided to people is very frustrating. As the late Sen Pat Moynihan used to say – you are entitled to your own opinions not your own facts. Unfortunately facts have been severely lacking the debate over the Affordable Care Act.

    Reply
    1. Ron Mills June 20, 2013

      Hear, hear, John Mills. If we’re not related we share the same views and frustrations about such misinformation and ulterior agendas concerning ACA and American healthcare in general.

      Reply
    2. Devon Osborne June 24, 2013

      THANK YOU for clarifying this and making these points! You should have written the blog rather than Ms. Rakoczy. Her use of hyperbole and total lack of fact to support it was almost embarrassing. The only good thing about her “article” was your response.

      Reply
  2. Alisa Hughley June 26, 2013

    Christy, Thank you for sharing your concerns but do follow-up on the resources and the arguments that John has so eloquently and accurately put forward. It is very important to understand that most of the problems that plague our US health care system are because we are married to a feed-for-service model. That is one of the reasons why Medicare Advantage has been a profitable market for the private insurance sector.

    “Many doctors are possibly not going to accept any government sponsored health plan.” You may want to visit the CMS Center for Innovation http://innovation.cms.gov/initiatives/index.html to learn more about these newer generation integrated health care delivery models that John referenced. Fortunately these CMS demonstration projects in bundled payments and payment for outcomes are the small undercurrent for the second reform in health care. Patient centered medical homes and Accountable Care Organizations are designed around payment structures that manage health outcomes (with the assistance of Stage 3 Meaningful Use Health Information Technology systems). These policies necessitate delivery care in the best setting rather than necessitating patients cross the threshhold of the medical practice for each health care encounter.

    “In addition to aforementioned taxes, fees, and penalties, those who do not get what the government mandates as minimal coverage are also taxed.” HHS issued rules around a standard minimum health insurance benefit, so if you have health coverage it will meet this minimal coverage mandate. If you opt out of health insurance you should be taxed because the uninsured cripple the system for all. Over a lifetime the tax penalty paid by an individual is far less than the cost of health coverage.

    “Excruciatingly high penalties and taxes will hurt small businesses, thereby hurting the economy.” Actually, there is a greater chance that small business owners will calculate the penalty per employee as cheaper than their contribution to a group health plan leading them to drop insurance altogether betting that the employee will be able to secure insurance through the health insurance exchange and/or Medicaid expansion.

    The first challenge was primarily to get everyone coverage. It’s the overwhelming number of uninsured that are breaking the system today and no other piece of health legislation in the last 10 years proposed to do anything to combat this challenge. I really think it’s time to stop propagating fallacies or bemoaning the imperfections of the law and get about the work of educating people of how best to take advantage of the new benefits available because of its implementation.

    Reply
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