Everyone wants a number to predict their future, especially when it comes to their health. We want to believe health insurance is a buffer against illness and death — but as a practicing physician, I can tell you that this concept is abstract sometimes, rather than real.
This week, the health care world was rocked by two numbers with opposite impact. The first was that, according to the Department of Health and Human Services, average ObamaCare premiums have increased a whopping 105 percent (from $232 in 2013 to $476 in 2017) in the 39 states using the federal exchange. Combine this with the fact that Aetna has dropped out of all ObamaCare exchanges, UnitedHealthcare is down from 34 exchanges to a handful and Blue Cross this week dropped out of exchanges in Kansas and Missouri, and you don’t have to be a health policy expert to realize that the Affordable Care Act is unaffordable for patients and unprofitable for insurers.
It’s in big trouble. As HHS Secretary Price tweeted Thursday morning, #Obamacare = Higher costs and fewer choices.
The second number was 23 million, the number of people the Congressional Budget Office on Wednesday predicted will lose their health insurance by 2026 if the American Health Care Act, the bill the House passed to replace ObamaCare, is passed in the Senate and signed by President Trump. This number is concerning — until you look at it and the CBO’s handling of the health care bills more closely.
First, the CBO was wildly inaccurate when it came to ObamaCare, predicting that 23 million people would be getting policies via the exchanges by 2016. The actual number ended up being only 10.4 million, according to the Center for Medicare and Medicaid Services. Forty-five percent of those who chose to pay the tax penalty rather than the soaring premiums for policies that covered many services they didn’t need were under the age of 35.
Second, many who chose to buy insurance on the exchanges did so only because they wanted to avoid paying the penalty, not because they needed or wanted the insurance. Many didn’t buy insurance until they got sick. In fact, one of the reasons Aetna gave for dropping out of the exchanges last year was that 55 percent of its customers were new and most were sick or high-risk. So, many who choose to drop out now never wanted this insurance in the first place.
Third, a high percentage of those the CBO predicts will lose their insurance are Medicaid patients. As of last year, over 14 million adults have enrolled in Medicaid as a result of the ACA. It is unlikely that Medicaid reform will remain in the new bill after it is transformed in the more centrist Senate, especially when you consider that 20 Republican senators are from the 32 states that have chosen the Medicaid expansion under ObamaCare. It is more likely Medicaid will be reformed and made more efficient, with bridge-to-jobs programs and premium buy-ins added for more extensive services. If the Medicaid expansion (and its 14 million plus patients) is kept, the CBO prediction would likely be much lower, less than 10 million.
It’s easy to use numbers to define health realities, but life is far different in the doctor’s office. What patients really want is access to basic health care, delivered by a doctor they can trust at an affordable price. Patients want choices, not narrow networks of providers and services and deductibles so high they never reach them. They don’t want to be forced to buy an insurance plan that promises them services that we doctors just can’t deliver.
Patients want a chance to purchase affordable insurance that covers actual problems they may have. A new health law can deliver that and cover most, if not all, of the population if it offers as an option the kind of scaled-down coverage that patients would have chosen to buy under ObamaCare even if they weren’t forced to.