The United States voters elected a new president, Donald Trump, and a new legislature in 2016, both Republican. Analysts expect major changes in policy and law after 8 years of Democratic control, especially regarding the ACA, Affordable Care Act (often dubbed ObamaCare)
Since his election, President-elect Trump says there are two features of the ACA he would like to see preserved-(in an interview with Leslie Stahl on November 13, 2016)
Prohibition of insurance denial for pre-existing conditions
Covering young adults age 18-26 years old on their parents’ insurance plan
the Republican party’s platform on health care.
While similar to the President-elect’s plan, it is broader in scope and more specific.
The Republican Platform includes:
Repeal of the Affordable Care Act
Protect insurance discrimination for preexisting conditions as long as continuous coverage is maintained
Allow people to buy insurance across state lines
Make individually purchased health insurance tax deductible
Limit federal spending on Medicaid, allowing the states more leeway in administering the program through block grants
Changes to Medicare- providing people under 55 years with a traditional Medicare option or a premium support system of competing plans; raising the age of eligibility for Medicare.
the Democratic Party supports
Continue building on the ACA to achieve universal health care
Provide a “public option” plan and allow people over age 55 years to buy-in to Medicare
Make premiums more affordable and reduce out-of-pocket costs to patients
Cap out-of-pocket monthly drug costs
Permit importation of lower-priced drugs from other countries
Allow Medicare to negotiate drug prices directly with manufacturers
Expand funding for community health centers
Mr. Levitt is Senior Vice President for Special Initiatives at the Kaiser Family Foundation and Co-Executive Director of the Kaiser Initiative on Health Reform and Private Insurance. He summarizes his review this way-
“The ACA has increased insurance coverage by 20 million people and is now the status quo in our health care system. Fully repealing it would be very disruptive.
At the same time, the public remains divided on the law, so building on it will also be controversial.”
Tuesday November 8th, we in the United States will elect a new president. It’s been a contentious , bitter campaign and we are all glad it’s almost over. But we should also be glad that we have the privilege of open discussion and disagreement and settling our differences by voting for our leaders.
I hope you will review my previous post about the presidential candidates’ views and proposals concerning health care. Here I am repeating a previous post that outlines the U.S. healthcare system.
I believe we have one of the best healthcare systems in the world because of the people who work in healthcare- the people who devote years to education and training and who work tirelessly 365 days a year, 24 hours a day to make and keep us well. Their commitment, compassion, dedication and competence benefits all of us and deserves our gratitude.
Lady Liberty lifting her torch in New York harbor
Even though the United States does not officially have “socialized” health care, a large proportion of our medical care is funded by the federal government. Even though I know that, I was still surprised by statistics in a recent article, which stated that the federal government accounts for
40% of healthcare spending
$1.3 trillion /year
Covering 100 million individuals
Through 4 federal agencies
Department of Health and Human Services
Department of Defense
Veterans Administration
Department of Homeland Security
(JAMA (Journal of the American Medical Association), June 21, 2016)
The United States Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens. People who oppose the ACA ,aka Obama Care, dislike or even fear government involvement in medical care; they consider it interference, control, or even nationalization of the United States healthcare system.
I think many people, even physicians, don’t realize or forget, how involved the government already is in healthcare. As far back as the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.
a Veterans Administration clinic (photo by blogger)
American soldiers serving in Afghanistan
This year marked the 50th anniversary of two other government healthcare programs- Medicare and Medicaid.
Medicaid provides insurance coverage for adults and children who are unemployed or low income.
Medicare covers disabled children and adults and persons 65 years and older.
The numbers are rather staggering.
Together these programs cover at least 30% of Americans.
Together they comprise 25% of all federal spending.
Together they pay 40% of total U.S. health care spending.
Disabled children and adults may qualify for Medicare.
Children may be eligible for Medicaid if their families cannot obtain health insurance for them.
You may not be eligible for either of these programs now, but chances are eventually you or someone close to you will.
Anyone can become disabled from a serious illness or freak accident.
You or your spouse may lose your job and your employer sponsored health insurance.
Your child may have a disability that will prevent them from working when they grow up.
We may all live long enough to qualify for Medicare on the basis of age alone. Your parents or grandparents are near or already at Medicare age.
Senior adults age 65 and older use Medicare.
It’s important to understand how Medicare works, since it’s not automatic; even if you qualify, you need to sign up to be covered (with a few exceptions). The rules are summarized here. Or consider an easy to understand book here.
Several government agencies regulate, monitor, promote and/or support both public and private healthcare including-
EMTALA requires all hospitals to offer emergency treatment to any patient who arrives, regardless of ability to pay for that care
In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths” of “Life ,Liberty, and the pursuit of Happiness” as well as to promote “Safety and Happiness” .
In the Constitution they vowed to “promote the general Welfare” .
I wonder if they envisioned that would eventually include so much effort and money providing and regulating health care, most of which was not available or even imagined at that time?
Comments welcome and encouraged!
Before you vote, you may want to review this related post.
watercress words by Dr Aletha 