Another Biden executive order was on strengthening Medicaid and the Affordable Care Act (ACA). “Trump holds no affection for the ACA but killing this would have negative public relations [consequences],” Abrams said.
Instead, he thinks the president-elect will just let expire the enhanced premium subsidies, which will be in effect until the end of next year unless Congress renews them.
The subsidies’ expiration “will make the ACA much less attractive, which is probably the goal he’s got … He doesn’t have to take any more heat for killing this thing.” Source Medpagetoday
In his previous run for president Trump promised a great new health care plan to replace the ACA … we are still waiting.
QUINNSCOMMENTARY 
Consider:
https://www.kff.org/interactive/how-much-more-would-people-pay-in-premiums-if-the-acas-enhanced-subsidies-expired/?utm_medium=email&_hsenc=p2ANqtz-9sSL0nC8YLHXUM5LVamboT1j81a1F_b7cP7dfNQsumOlcslCHXq4dQ2ZDYBaQKLc5M5EVxQ0tdF84AUlNhOYYxoUccpQ&_hsmi=335026435&utm_content=335026435&utm_source=hs_email
So, here in Ohio, if you are age 50, and you earn 400% of the federal poverty level, $60,240 a year, your “subsidy” for single coverage will decline $8 a month, $90+ per year – if the Biden subsidy dollop is not extended.
If you are like me, you are probably asking why is there any taxpayer subsidy for someone age 50 earning $60,000 a year!?
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Since health insurance is outside my wheelhouse, I ask Mr. Quinn to respond to the informative comments by BenefitJack. Something other than posting another anti Trump missive would be nice.
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Benefit Jack views this from the current state, not with any creativity and he makes assumptions based on what does not work, but can be changed. Of course a single payer can be crafted to deal with the issues he raised. M 4 all does not mean taking all of the existing system as is and apply it. Not only that Medicare now operates within all the other systems in place, that would change.
Bottom line, let’s hear a better idea that provides universal coverage, a fair distribution of cost sharing and no cost shifting from one group to another and paying on ability to pay. It would be funded by payroll taxes, employer tax, premiums and cost sharing. Keep in mind these are not added costs, but the transfer and consolidation of existing costs we all pay one way or another. And admin costs for providers would decline.
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Sorry, putting the federal government in charge (via Medicare, the Medicare Modernization Act of 2003, Medicaid/Patient Protection and Affordable Care Act of 2010, and other legislation) has placed us where we are today. So long as you cede authority to Congress and allow them to buy votes with new legislation and authorize agency regulations, you will continue to get what you currently got – even if it is disguised as “single payer”.
True reform requires a proper allocation of risks – as I have pointed out in the past. That would leave to society those risks that cannot be shouldered by workers and their employers. My guess is that an attachment point of perhaps $25,000 a year per person is a good starting point or attachment point for reinsurance. Expenses would be limited to covered charges per Medicare or Medicaid allowable expenses. That concept doesn’t come from the idiot President Trump, nor the fool President Obama, but from former Senators Ted Kennedy (D-MA) and Bill Frist (R-TN). The cost of such reinsurance is likely to be something less than $100 a month/person, generating maybe a third of a trillion a year.
Then, individuals are responsible for expenses up to that dollar limit, either by working for an employer who sponsors a plan or by purchasing coverage in the public exchange. There would be a public exchange default, which the individual could opt out by showing employer-sponsored coverage. When the liability for “high claims” or “catastrophic claims” is removed, you would be amazed at just how affordable coverage is for that first $25k per year of liability.
And, yes, I would have an individual mandate where the “premiums” for the reinsurance and those covered in the public exchange are taxes – and just like today, where taxes are not paid, they accumulate, with interest, just like any other unpaid tax.
Voila, universal coverage.
Clearly, universal coverage won’t work without giveaways to all the different constituent groups. Dick knows that. He knows that once upon a time, Americans paid 30+% of the cost of health services out of pocket. He knows that preventive services were not covered under Hospital/Major Medical plans.
So, the reason it failed in Vermont was simply because it was too expensive – because of meeting everyone’s expectation.
The reason Bernie would never accept my proposal, perhaps as an initial step, is that it isn’t a giveaway – something that he can use to buy votes.
When Hillary Clinton, President Obama and John McCain showed up here in Westerville Ohio to campaign for my vote, I handed out a single page summary (front and back) on how it would work, generate universal coverage, and lower spend without burdening providers. And, no surprise, I got turned away. What I found is that every one of the then-candidates had their own preference, and this was not it. Remember Hillary’s proposal? McCain wanted to do away with employer-sponsored coverage – few thought that was so brilliant to vote for him. Obama walked away from single payer early on in the debate. What I found was that each of them preferred the then-status quo (in 2008) if they could not get their own way.
You might ask why I haven’t continued to pursue this. For example, I would be happy to go and talk to Ohio’s Republican governor and Ohio’s very red Legislature and pitch this concept as soon as the Trump Administration takes office – no legislation needed, only need an innovative application of the same Health Reform statutory provisions Vermont and Arkansas and other states have used (once the D’s leave HHS leadership positions). Oh wait, I did just that during Trump’s first term and got turned away.
You know who didn’t support universal coverage? No surprise, it was the medical providers, and those currently on the taxpayer teet, here in Ohio, courtesy of former Ohio governor John Kasich.
The last thing we need is to put more people on the medical “dole”. Almost 50% of Americans are now covered by a plan where the government sets prices – shifting the true cost of services to others with employer sponsored coverage, and taxpayers.
My 45+ years of corporate benefits planning experience confirms that a majority of Americans STILL want the best medical coverage YOUR money will buy!
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To make changes they need to be simple to understand and use, and most important consider human nature which includes the fact nobody wants to use their money for health care so it must be buried in insurance, taxes and/or premiums. That may not be ideal, but it is reality. Plus there cannot be a choice to not take or not pay for coverage.
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You want Medicare for all.
First, amend existing Medicare, Medicaid and VA coverage, so that the providers can charge fees based on actual costs, a margin for recovery of capital investment and a margin for profit – so that Medicare, Medicaid and VA pay the true cost of the services rendered. Let’s see what that costs taxpayers.
Second, assuming taxpayers are willing to pick up that increase in costs to cover other individuals, let’s see how willing they are to raise taxes further to expand Medicare to everyone else.
Did you know that despite Congress’ decision to fix reimbursement rates at levels dramatically less than cost, that the 2025 premium equivalent per Medicare beneficiary with Medicare Supplement is $18,876 per year, calculated as:
Medicare Part A premium: $6,216, $518 per month * 12 (mostly funded by workers paying FICA-Med)
Medicare Part B premium: $8,880, $185 per month * 4* 12 (75% paid by taxpayers via general revenues)
Medicare Part D premium: $2,232, $46.50 per month * 4 * 12 (75% paid by taxpayers via general revenues)
Medicare Supplement (Ohio, option G): $1,548 (mostly funded 100% by retirees).
Total: $18,876 per person, per year (on average)!
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Sorry, there was credible data in 2008-2009, which you and I both heard while at the American Benefits Council, that confirmed:
Preexisting conditions were not a substantial bar to health insurance (as later proved by the anemic enrollment of an average of < 100,000 Americans in the pre-existing condition insurance program over the three year period 2011 – 2013, and
75+% of Americans who lacked health insurance had incomes more than sufficient to pay for health insurance (well in excess of levels qualifying for Medicaid under PPACA today), they just didn’t have health coverage as a priority – as confirmed by the fact that since 2014, 90+% of all enrolled in exchange coverage receive taxpayer subsidies.
For comparison, according to the Insurance Research Council (IRC), 14 percent of drivers (1 of every 7 cars you pass on the road today) are uninsured. Based on AAA’s 2022 American Driving Survey, there are about 255 million drivers, which means around 35.7 million people are driving without insurance! It is why YOU have to pay for uninsured and underinsured motorists coverage – even though every one of the 50 states have a mandate that you have car insurance.
Keep in mind that despite adding $25+ Trillion to national debt since Health Reform took was approved in 2010, significantly as the result of all the unfunded taxpayer-subsidized coverage (for example, Medicaid enrollment went from 54MM in 2010 to 91+MM in 2022, a 68% increase, and despite clear access to taxpayer subsidized coverage for individuals earning up to 400% of the federal poverty level ($124,800 of income per year for a family of four!), the number of Americans without health insurance has only declined by half, from 48MM in 2010 to 25+MM today.
Why would you want to continue the failed status quo that keeps adding to our national debt?
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