Whitesburg KY

‘Obamacare’ repeal is coming in 2017. How will you fare?

Predicting what the rest of 2017 will bring is a very interesting exercise, and to be truthful, I suspect that I have about a 75% chance of being correct — not a bad percentage when looking into the future.

When I attempt to do my civic duty of staying informed as a private citizen, I get my national news from multiple sources. I get my news not only from FOX, which offers a conservative viewpoint, but also from MSNBC’s liberal viewpoint, from BBC’s worldview, from CNN for its breaking news, and from PBS, for a neutral extended view. I hope, of course, that somewhere in the middle of these various sources and viewpoints lies the truth that allows me to predict the future.

The truth is that for the first time since 1928, the American people have decided the Republicans will control both houses of Congress, the Presidency, and the Supreme Court. Many people argued that Donald Trump was unfit by temperament to be president because of the threat he posed to democratic values that have held our country together since the Civil War. Others decided for various reasons they wanted a change regardless of the uncertainty of what that change would bring. Those who voted against Trump are free to call attention to Trump’s defects while those who voted for him are free to express their support.

Regardless of how each voted, Mr. Trump won the votes in the Electoral College, he will be our next president, and all citizens must accept that. Yet while accepting that decision each of us needs to evaluate both Trump and Congress as they lead us into the future. This evaluation should be based on accountability and not a vindication of our difference or our support, as we must now all wish our nation to succeed and prosper.

With faith in our nation’s future, it is my attempt over the next couple of issues of the paper to evaluate and predict the future that awaits all of us in 2017. We will begin with a look at the future of healthcare.

Obamacare will be repealed – Chaos will reign! The first order of business for Trump and the Republican Congress will be to repeal the Affordable Healthcare Act (ACA), better known as Obamacare. In the GOP repeal of Obamacare there are two problems. First, there is no replacement plan and, second, Obamacare is so embedded in the nation’s health industry and economy that to unravel it completely will mean depriving 20 million people of health coverage and creating healthcare carnage.

Fortunately, the GOP and Trump will want to lessen or eliminate the resulting carnage and that cannot be done with one fatal thrust of the dagger. I suspect what they will do is to repeal Obamacare by February/March but delay the implementation of that repeal for about one to two years or at least until after the 2018 midterm elections. During that period of delay they will attempt to develop a replacement plan.

What everyone must understand about the GOP healthcare replacement is the underlying philosophical difference between the Republicans and the Democrats as it pertains to Obamacare (or any healthcare system).

The Democrats believe health insurance is a right and that it should be available to everyone at an affordable cost and the only way to do that is through some sort of government subsidy. The GOP feels the government should not be involved in health care regardless of the human and financial cost. Healthcare for the GOP is an individual responsibility and whatever system they develop will reflect that philosophy.

I suspect their plan will be to attack Obamacare piecemeal by deleting what they see as the most egregious parts, such as the individual mandate, while keeping the best parts, such as a ban on preexisting conditions and a requirement that insurers cover children under 26 on their parents’ plans.

In addition, I suspect they will eliminate the Independent Payment Advisory Board, a body created under Obamacare with the power to recommend cuts in the level of government’s payments to providers who participate in Medicare. This will be done while revising both Medicaid and Medicare to cut back on health expenses.

There are currently about 12 million people on Medicaid. I suspect the GOP will turn Medicaid into a block grant, eliminate many of the federal rules on who must be covered and give states more latitude to determine eligibility. I believe this will result in two to three million people being eliminated from Medicaid.

There are about nine million people who get substantial subsidies to buy health coverage; otherwise they could not afford it. In order to reduce the cost of healthcare I would expect the GOP to make available to those individuals receiving subsidies a bare-bones catastrophic plan that will not cover routine medical needs but will help if an expensive illness or accident should occur.

If Obamacare is repealed then the Medicare “donut hole” comes back. If you do not recall, this donut hole meant your benefits disappeared for a while then began again after your medication expense exceeded a certain level. This proved a tremendous burden on seniors and by 2020 would be completely phased out by Obamacare. This is not good news for seniors.

The biggest impact will be felt by hospitals. Before the ACA, hospitals had to spend billions of dollars treating people who had no insurance and showed up at the emergency rooms with much of that cost being borne by the states. The ACA provided people insurance, therefore, the hospital industry was willing to accept some cuts to their reimbursements which helped make the ACA more affordable. The GOP healthcare plan could decimate hospitals’ ability to provide services. This would weaken local economies supported by hospitals and result in healthcare job losses.

One study group, the non-profit Urban Institute, found that by 2019, the number of uninsured in Kentucky would rise by 200 percent, or to around 486,000 people. Right now the uninsured rate for people under 65 in Letcher County is around 10 percent, or about 2,300 people. I would fully expect this to rise by at least 20 percent, or to around 4,600 people.

One simply has to extrapolate these figures across America to see the devastating effect of repealing Obamacare through the GOP’s planned budget reconciliation process. Even those who will have health coverage can expect to have reduced coverage.

In my opinion, repealing Obamacare without a replacement through the budget reconciliation process will result in nothing but chaos, yet I fully expect this action to be taken in 2017 and its effect to fall disproportionately upon the people of eastern Kentucky.

Medicare Transformation. Will it be privatized? From a GOP perspective, Medicare is too expensive, causes financial hardship on the federal and state government, and will need to be restrained if it is to remain solvent. The Medicare program trustees, however, say the “Part A” trust fund (the costliest component of Medicare which covers hospital visits) is set to become insolvent in 2028.

The latest projections from the nonpartisan Congressional Budget Office show that Medicare spending is set to rise from the current level of about three percent of gross domestic product to more than five percent of GDP in 2040. Because of this belief in rising Medicare costs, the GOP will attack Medicare at the same time it repeals Obamacare.

I believe Medicare will be attacked through a three-phased approach. The first phase will be to cut the program for the poor; the second phase will be a block grant to the states who, since the majority of the states are Republican controlled, will further reduce Medicare by making it less comprehensive. The third phase will be to privatize Medicare. That is, Medicare will be transformed from a single-payer federal program to a private model where seniors would be given federal subsidies to buy private insurance.

This would be similar to the subsidies available to younger Americans who can now buy insurance on the Obamacare state marketplaces. I suspect this will be attempted concurrent with the changes to Obamacare. However, privatizing Medicare in 2017 will be a bridge too far for the GOP, but I expect that initiative to continue into 2018.

Again, unfortunately, the Medicare changes will fall disproportionately on the people of eastern Kentucky.

Medicaid Transformation – Expect less! I think the GOP will change Medicaid, the federal health program for the poor, from an open-ended, formula-based system with strict rules on benefits to a lump-sum model in which states would have great leeway to reduce or supplement benefits. This will be done by block grants to the states. However, don’t look for any increase in Medicaid benefits, but rather expect a reduction in benefits since most states are now Republicancontrolled and, in order to reduce state costs, I would expect those states to provide less comprehensive care. I also fully expect this initiative to begin in 2017 but not be completed until 2018. Again, unfortunately,

I suspect the Medicaid changes will fall disproportionately on the people of eastern Kentucky.

J.T. Oney is an Adjunct Professor at Southeast Kentucky Community and Technical College.

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