There’s been a lot of talk since the AHCA bill was pulled by Paul Ryan last Friday, March 24th.
Only 17% of Americans liked the bill in a poll taken at that time. Some believe that the bill needs to be modified and resubmitted while President Trump appears to be refocusing his attention to other national issues due to the lack of support for this bill. Looks like Republicans are beginning to work through some of the issues the ACHA bill brought to the surface. Some moderate Democrats are seemingly willing to work with Republicans to come up with a more bi-partisan plan or are at least talking about it. Keep an eye on this—more to come, I’m sure!
The ACA Survey Results from Our Feb. 23rd DMSG Meeting Share An Interesting Perspective on the ACA!
Meanwhile, as they say “meanwhile back at the Ranch” here in Colorado, Bob Smoldt, Associate Director of Arizona State University’s Healthcare Delivery and Policy Program and CAO Emeritus, Mayo Clinic, spoke to the DMSG on Feb. 23rd about “The ACA at 6+ Years—Now What?” Bob shared aspects of the ACA that have worked and haven’t worked as well as talked about other options that the Republicans were considering in an effort to “replace and repeal” the ACA.
After the presentation, Bob gave us a survey to complete at the meeting regarding 12 questions about the ACA . The survey’s results are below but the first question really tells the story about the vision that our group has. The question was “Choose one of the overriding approaches for the ACA—(a) keep the ACA as it is, (b) repeal and not replace it and (c) do an ACA replacement/revision. 90% of the group selected (c) “do an ACA replacement/revision”.
ACA Survey Results of 2.23.17 DMSG Meeting Attendees
I. Overall desire for ACA:
- Keep ACA as it is = 5%
- Repeal ACA, no replacement = 5%
- Do an ACA revision/replacement = 90%
II. With regard to specifics of what an ACA revision/replacement might entail, here are the group’s major suggestions in order of magnitude of agreement.
1. 92% would replace the ACA mandatory benefits list with a more flexible benefit approach.
2. 89% would keep the ACA, move for Medicare to Pay for Value (P4V), AND the vast majority of those favoring this approach would speed up the broad implementation beyond demonstration programs.
3. 80% would allow states the option of expanding Medicaid eligibility (but a majority of those favoring this approach felt that the federal funding should be at the traditional federal funding share of this joint federal/state program (50 – 75% depending on a state’s poverty rate) rather than the ACA’s 90% for expanded beneficiaries).
4. 67% would keep the individual mandate, BUT nearly all of this group would significantly increase the size of the fine that uninsured people would pay.
5. 66% would repeal the ACA Medicare payment update cuts and replace that health reform funding with a limit on the tax free nature of employer provided health benefits.
6. 60% would keep subsidies for lower income individuals to purchase private health insurance (but a slight majority of those favoring this approach would reduce the subsidies to 300% of poverty level rather than the ACA’s 400%). It should also be noted that 37% favored moving to a refundable tax credit to all individuals (regardless of income) who do not get insurance from an employer, Medicaid, Medicare or other government program. There were 3% who felt there should be no subsidies provided.
7. 57% would switch Medicaid to a per-beneficiary government payment to the states (a slight majority of the group favoring this approach felt all states should have a common beneficiary counting method while a slight minority of this group felt that states that expanded Medicaid under the ACA should have a higher beneficiary count).
8. 56% would repeal the ACA provision allowing individuals under age 26 to stay on their parents health insurance (thus increasing the number of young, healthy people who would be in the regular private health insurance pools).
III. In addition there was a question about what type of US health system the individuals would desire regardless of whether the ACA existed. These results were as follows:
- 43% would like a system similar to a revised ACA as shown above.
- 33% would favor a system where everyone in the USA would be on private health insurance coordinated by a government designated body; no exclusions for pre-existing conditions; subsidies for low income; penalty for no insurance equal to the annual cost of least expensive plan. No separate program for Medicare, Medicaid. Basically put all on what Members of Congress get.
- 17% would favor a single government payer with private delivery of care similar to what Canada has.
- 2% would favor a single government payer and government delivery of care similar to the United Kingdom and VA.
- 5% outlined a separate approach of their own ranging from Health Savings Accounts for all to a system concentrating on healthy living rather than delivery of care.
What are Your Thoughts? Email us or reply below!
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