The Purpose of This Bl;og

By and large, liberals are very decent, kind, and compassionate people who genuinely want what is best. This should be kept in mind as we explore the Law of Unintended Negative Consequences near invariably resulting from Leftist big-hearted solutions to societal problems.

Wednesday, November 6, 2013

Obamacare - Expanded Coverage?

Obamacare has been promoted under the general promise of "expanded coverage." (See HERE and HERE)

This promise entails four parts: 1) everyone will be covered, 2) more health conditions will be covered, 3) people with pre-existing conditions will be covered, and 4) people will continue coverage from job to job.

Since I have already addressed the LUNCs of "everyone will be covered," this article will examine the LUNCs resulting from the three other parts.

More Health Conditions will be Covered?

The so-called Patient Protection and Affordable Care Act (i.e. "Obamacare") contains several mandates requiring or encouraging insurance companies to: a) insure mental health issues at parity with physical health issues (see HERE), and b) insure various women's health issues, including: domestic and interpersonal violence screening and counseling, FDA-approved contraceptive methods (including in some cases abortion--see HERE), contraceptive education and counseling, breastfeeding support, supplies, and counseling, HPV DNA testing, for women 30 or older, sexually transmitted infections counseling for sexually-active women, HIV screening and counseling for sexually-active women,  mammograms and colonoscopies, etc. (See HERE)

While this expansion of coverage may seem good in one respect, there are a number of reasons insurance companies haven't previously covered all of these conditions, not the least of which is the matter of increased costs (which are passed on to the consumer in the form of higher premiums), moral and religious objections (insurance companies prefer not to offer plans requiring their customers to pay for things they deem morally objectionable), dubious viability (some health treatments are experimental and have yet to demonstrate sufficient effectiveness--this is particularly true with certain mental health issues), personal responsibility and preference (there have been a host of health products and services, like tooth paste, flu shots, hand sanitizers and other disinfectants, shampoo, exercise and dietary regimes, vitamins, aroma therapy, etc., that insurers haven't covered because they are of highly personalized nature), and because certain health treatments and products were thought to fall outside the scope of the traditional understanding of insurance (insurance was long consider as a means of protecting against extreme or catastrophic medical conditions, but has increasingly, particularly in light of Obamacare, become a funding source for general health services).

To a great extent, Obamacare changed this, which in part has unavoidably caused premiums to spike (contrary to what was promised--see HERE), and insurance companies to fold or drop some of their plans (see HERE), and it has also forced the restructuring of certain plans so as to keep them compliant with Obamacare regulations and still remain somewhat affordable.

Thus far, the restructuring of insurance plans have taken at least two key forms. First, certain types of treatments that may have once been covered by insurance have been dropped in lieu of coverage fore newly mandated treatments. For example, many insurance plans have dropped coverage for eye and hearing and foot care while adding coverage for abortions and the like. (See HERE and HERE and HERE and HERE and HERE)

Second, many plans have greatly increased deductibles and co-pays and out-of-pocket expenses (see HERE). What this effectively means is that less costly medical treatments won't be paid for by insurance, but rather by the patient. In other words, by raising deductibles and the like, coverage is shifted from insurance companies to personal savings, thereby decreasing rather than expanding insurance coverage.

Furthermore, because Obamacare will take billions of dollars from Medicare (see HERE and HERE and HERE and HERE and HERE and HERE), this puts millions of seniors at risk of losing their Medicare Advantage plans (see HERE and HERE and HERE and HERE), forcing them into regular Medicare with its inferior coverage.

So, the LUNCs here are that while Obamacare may have expanded coverage for mental and women's health issues, it also caused coverage to decrease for eye and ear and foot treatment as well as Advantage plans, and it effectively decreased coverage for less expensive medical procedures. In short, people are now caused to pay for new coverage they tend to not want, and are losing old coverage that they did want.

People with Pre-existing Conditions will be Covered?

In 2008, Obama said: "And as someone who watched his own mother spend the final months of her life arguing with insurance companies because they claimed her cancer was a pre-existing condition and didn't want to pay for treatment, I will stop insurance companies from discriminating against those who are sick and need care most." (See HERE)

As compassionate as this may seem, and regardless of the questionable nature of the story (see HERE and HERE and HERE and HERE), this provision of Obamacare puts unsustainable upward pressure on premiums, turns the traditional concept of insurance on its head, and inadvertently creates an incentive to game the system. When consumers calculate the cost of insurance premiums, deductibles, and other expenses, and weigh this against the lower cost of tax penalties, and assume they can get insurance at any time regardless of pre-existing conditions, they may figure that it is far more economical for them to drop insurance and wait until they have serious medical problems before signing up, and then drop the coverage again after being treated. In other words, ironically the very government program intended to expand insurance coverage contains a provision encouraging dropping coverage until it is needed.

Granted, some gaming of the system may be prevented by restricting enrollment to several months of the year. (See HERE) However, with all the problems experienced with signups through the Obamacare web site, and with delays in individual mandates (see HERE), it is anyone's guess how effective the restriction will be.

Besides, while Obamacare giveth coverage to the chronically sick by way of eliminating restrictions for  pre-existing conditions, it taketh away coverage from the chronically sick by way of Medicare re-admission penalties (which may force non-profit hospitals to drop Medicare patients) as well as rising medical costs due to a number of economic factors.

The WSJ indicates: "Under the Affordable Care Act's Hospital Re-admissions Reduction Program, hospitals that readmit 'excessive' numbers of Medicare patients within 30 days of discharge now face significant penalties. The maximum penalty is 1% of a hospital's Medicare reimbursement, but that will increase to 3% in 2015. That may not sound like a lot, but for hospitals already struggling financially—especially those serving the poor—losing 1%-3% of their Medicare reimbursements could put them out of business." (See HERE and HERE and HERE)

An article at indicates: "According to a study, 'about two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year.' This provision was inserted into Obamacare as a cost-cutting measure, but it will force hospitals to give the poor, elderly, and chronically ill substandard care. In addition, critics also note that 'large teaching hospitals that are affiliated with universities' could be negatively impacted the most because these hospitals are often on the front lines in dealing with the elderly and the poor in addition to people who have mysterious illnesses who constantly need to be re-admitted to the hospital for urgent care." (See HERE)

Portability--Coverage will Follow the Insured from Job to Job?

In 2007, Obama promised: "If you change jobs, your insurance will go with you." (See HERE)

In some ways, this would be nice.

However, as best I can tell, there isn't anything in the Obamacare legislation which directly requires or facilitates insurance portability between jobs--suggestions to the contrary notwithstanding. (See HERE)

In fact, the NCPA reports: "Although it is rarely discussed by the national health media, a quiet revolution in how health insurance is purchased has been underway for several years now. Specifically, employers have been using Health Reimbursement Arrangements (HRAs) to allow their employees to purchase individually owned health insurance. A number of states, including Colorado, have expressly passed legislation sanctioning this procedure. Absent the HRA, most states have made it illegal for employers to help their employees obtain individual insurance with pre-tax dollars. With certain exceptions (Taft Hartley unions, pro football players, etc.), the only kind of insurance that is portable is individually owned insurance. Now Louise Norris tells us that an IRS ruling last week concludes that this practice must be discontinued, apparently because of the Affordable Care Act." (See HERE)

Furthermore, COBRA, a federal law which "mandates an insurance program giving some employees the ability to continue health insurance coverage after leaving employment" (see HERE), will be losing subsidies because of Obamacare, which in turn will result in less coverage for the unemployed. (See HERE)

And, while the Obamacare insurance exchanges may provide some indirect form of portability within states (see HERE), it doesn't for people changing jobs from state to state.

Furthermore, the employer mandates have been delayed a year, and so what little indirect portability that may be provided by the exchanges, has been put on hold for awhile, and potentially indefinitely.


The Leftist LUNC here is that while we were promised that Obamacare would increase insurance coverage, in reality, we will lose coverage for treatments that most of us want, and will be forced to pay for treatments most of us dont want. And, what Obamacare gives in terms of preexisting conditions, it takes away in terms of chronic illnesses. Lastly, Obamacare does very little in making insurance portable from job to job within states, and does nothing for job changes from state to state.

Sadly, these LUNCs will negatively affect more so the poor and elderly the sick, particularly the chronically sick, for whom Obamacare was allegedly designed to protect.

For an explanation as to why these Leftist LUNCs occur, please see: Gov: Wrong Tool for the Right Job - Introduction and Cold Nanny as well as The Politics of Compassion, Emotions, Ignorance, Denial, Blame-Shifting, and Victimization
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