President Donald Trump deserves his due for delivering a poignant and presidential speech with human moments that will resonate and soon be filed under “history.”
Save for a few moments, I liked the demeanor of the guy who unpacked a vision and an invitation to follow him to a new and better place. Trouble is, magical moments win the day but not the war we’re in with policies that are broken and need fixing.
I watched closely Trump’s comments on health care –– not those critical of the present Patient Protection and Affordable Care Act, but the “replace” ideas. There is no doubt the Obamacare many know and loathe is going to get an overhaul.
What happens next could make or break the way health care and health insurance function in Idaho. We’ve already got an estimated 78,000 people living in “the gap” –– working people making around $16,000 a year who are too poor to afford to buy in the Your Health Idaho exchange, but who make too much money to qualify for care under Medicaid.
We need something that has options to cover every Idahoan. Here are Trump’s comments and my concerns:
▪ “The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we will do.” I don’t know how you can lower the cost of health insurance until we change over from a fee-for-service model to paying for outcomes, and getting everybody on board.
▪ “One-third of counties have only one insurer on the exchanges — leaving many Americans with no choice at all.” Not true in Idaho. Our exchange is working well and offers more than five providers. Why fix what isn’t broken?
▪ “First, we should ensure that Americans with pre-existing conditions have access to coverage, and that we have a stable transition for Americans currently enrolled in the health care exchanges.” Great idea, but to some extent this works because of the mandate to purchase insurance today. How will this work and be paid for in a new policy?
▪ “Secondly, we should help Americans purchase their own coverage, through the use of tax credits and expanded Health Savings Accounts –– but it must be the plan they want, not the plan forced on them by the government.” Explain the difference between tax credits and the present subsidies under Obamacare. To make some of these plans more affordable, they won’t offer the broad basic coverages that Obamacare has. You will get only what you pay for.
▪ “Thirdly, we should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.” The states need money and level playing fields more than “flexibility.” States such as Idaho should be rewarded for running a tight ship with its exchange.
▪ “Fourthly, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance, and work to bring down the artificially high price of drugs and bring them down immediately.” Tort reform that would limit settlements on malpractice suits would bring down costs, but I’ll be waiting to see what other legal reforms will erase “unnecessary costs.”
▪ “Finally, the time has come to give Americans the freedom to purchase health insurance across state lines — creating a truly competitive national marketplace that will bring cost way down and provide far better care.” This is a myth that the anti-Obamacare folks have been trotting out for a decade. Idaho’s directors of the Department of Insurance and the Department of Health & Welfare point out that there is little if any incentive for Idahoans to buy insurance from another state, where they may find themselves outside their network of care providers — and even less incentive for insurers to make the risk numbers that work in one state also work in another state.
I want to see a better health insurance/health care system arrive in Idaho. I’ll hold my powder until I see what the GOP comes up with. I just hope it’s something different than what Trump outlined Tuesday.
Idaho health director weighs in on TrumpCare
After listening to President Donald Trump’s speech to the joint session of Congress on Tuesday, Idaho Health & Welfare Director Dick Armstrong addressed some of my questions.
What should Idahoans expect?
“The ability to continue with tax-subsidized private insurance will exist and Idahoans should continue to purchase that coverage just as they do today, because it is necessary for them and their households. The federal mandate will go away, but we expect Idahoans will participate at the same level because the mandate was not their motivation to purchase coverage — the health and safety of their family was the driving force.”
As a replace plan takes shape, how might it affect our Idaho “gap” population — the 78,000 without health insurance?
“The gap will be addressed — as we read between the lines. We are uncertain how the funding formula will work, but it appears Medicaid will play a role. ... We in Idaho need to be prepared with an effort for whatever funding formula it is going to be.”