Puzzled about the ACA – take this quick quiz

Now that the AHCA effort by the President and Republican majority has fizzled, it would be appropriate to step away from the rhetoric and ask a few questions about the Affordable Care Act (ACA). I would also suggest you may not want to listen only to politicians on this as I have learned the health care awareness of politicians is not as high as we need it to be and some are more interested in optics than impact.

The questions and answers have been provided by a retired benefits actuary, consultant and manager for a Fortune 500 company.

Question 1: The ACA is: (a) undergoing a death spiral, (b) a disaster and will implode, (c) doing well in a number of places, but needs help in a few others.

Question 2: The reasons for rising costs under the ACA are: (a) adverse selection where more bad risks are signing up than good risks, (b) Congress refusing to fully fund insurers as promised for this adverse selection, (c) increased demand of services due to our aging and more obese country and pent-up demand, (d) over-prescribed medicine and tests due to profit-induced incentives, (e) all of the above.

Question 3: In its report of the initial and refined draft of the ill-fated AHCA bill, the Congressional Budget Office noted the number of un-insureds under this bill if passed would: (a) increase by 14 million in 2018, (b) increase by 24 million by 2026, (c) both (a) and (b).

Question 4: Medicaid expansion to cover individuals who earn less than 138% of the poverty level is a key part of the ACA. What do we know about the Medicaid expansion effort: (a) 31 states elected to do so, (b) states that did so received federal funding that started at 100% and will phase down to 90%, (c) per a study by George Washington University, the states that expanded Medicaid have more insureds, better performing economies and more secure hospitals, especially rural ones who had a high percentage of indigent (unpaid for) care, (d) the states who expanded Medicaid are witnessing a decline in personal bankruptcy rates and an increase in hospital accounts receivable rates (e) all of the above.

Question 5: The ACA added which of the following improvements to insurance coverage under the employer and the ACA marketplaces (a) guaranteed issue and renewability of insurance, (b) eliminated life time limits on coverage, (c) extended eligibility to adult children not going to college up to age 26 on their parent plans, (d) provided subsidies to purchase coverage up to 4 times the poverty level based on family size and income, (e) all of the above.

Question 6: What are reasonable considerations to improve the ACA? (a) better fund the promised adverse selection protection to stabilize premiums for insurers, (b) offer to reimburse insurers who left the marketplace for unpaid adverse selection protection as promised under the law to woo them back, (c) offer a public option (such as Medicare) in some places with no competition, (d) encourage the expansion of Medicaid in the remaining 19 states, (e) stop the unproductive naysaying and think of the impact on people not the politics, (f) all of the above.

In my view as a benefits professional who follows these issues, the answers to each of these questions is the last choice provided. I have grown weary of politicians playing with people’s lives. We are owed the truth. Overall, this law is working reasonably well, but needs improvements, especially where insurers have left markets leaving one choice. The framework is there, but the improvements noted in Question 6 are reasonable changes.

One final thought I learned this weekend. To some there is a stigma of being on Medicaid. One man said he was embarrassed to show his card. Under the Medicaid expansion with the ACA, the card does not reference Medicaid, so it removes some of the stigma. The man began seeing a doctor and that has made a huge difference.




37 thoughts on “Puzzled about the ACA – take this quick quiz

  1. We need to take a look at what improvements can be made to the health care act in place. Working together would benefit us all. Regarding Medicaid, Florida ‘s governor Scott refused federal funding for Medicaid. Such an ass.

    • Holly, Scott has made a number of poor decisions. A non-politician who participates under the ACA said the following so succinctly about the ACA – when the roof is leaking, you don’t burn down the house to fix it. Keith

      • They are determined to throw the baby out with the bath water because it is “Obama”care. Hopefully they won’t deliberately cause a melt down. I don’t put that past them.

      • Holly, it would not be the first time. In fact, the GOP led Senate behind Senator Marco Rubio purposely defunded the adverse selection payments with a motive to to make premiums go up. Let me say this plainly – the GOP screwed Americans with intent so the ACA premiums would go up more. Why this malfeasance is not highlighted is beyond me, as it is both sensational and true.

      • There are many things the general population is unaware of…how else can we explain Trump. thank you Keith.

  2. Thank you Keith for this insight into what for a brit is an overwhelmingly complex arrangement for the health of a nation.
    This is a very upsetting state of affairs where folk of independent wealth far beyond the hopes and dreams of many choose to play games with the health of the many.

    • Roger, it is complex. But, the national health care naysayers tend to overwhelm what should be a healthy debate.

      What many don’t realize is our economy tends to flourish when the middle class flourishes. Having health care insurance is accretive to the economy. If the AHCA became law, we would like fall into a malaise or a recession next year. Keith

      • Very wise words Keith, a breath of fresh air amongst the toxicity of Cliché and repetition.

      • Many thanks. Oxford Economics is one of several econometric firms who predicted Trump’s policies would cause from a malaise to a recession. Ironically, the defeat of the AHCA will help the economy under DT’s tenure.

  3. Great breakdown via question asking. There is no doubt that the ACA needs some revamping and tweaking but I personally am still far better off with it than when I was without it. Because it is profit driven only, the whole medical system is slow, laborious, and painful and most decisions are still largely based on money but it is a system in which I can now partake of and the help I’ve been given has been an enormous relief. It needs fixing but not trashing. ~~dru~~

  4. Dear Keith,

    The demand for affordable heath-care insurance should become obvious as it has managed to survive all their attempts to kill it.

    But the republicans will not give up. The WH may choose not to offer a real defense against the King v. Burwell,which is a lawsuit designed by conservative advocates to destroy Obamacare. If the plaintiffs prevail, about 8 million people could lose their health insurance. Premiums are estimated to spike by 35 percent or more, cutting coverage for millions of others. Health policy experts have estimated that nearly 10,000 people a year could die prematurely if they lose their coverage. Obamacare itself could collapse.There is not yet much coverage on this but it adds real meaning to DT’s words, that ACA is doomed for failure.

    Ciao, Gronda

    • Gronda, what frustrates me is the lack of focus on the patient and the absence of data. Price also could use subtle and not so subtle sabotage. What Trump, Ryan and Price forget is the ACA has saved many lives. There must be concerted effort to shore this thing up. I saw yet one more report that failed to mention the risk corridor strangulation as a one cause for increases. Keith

  5. Thank you, Keith, for this excellent post! I scored 100% on the quiz, but I learned something from one of your comments that I was not aware of … about Rubio and his cronies ‘purposely defunded the adverse selection payments with a motive to to make premiums go up.’ Not that I am at all surprised, but I just wasn’t aware of it. It seems there are two sides on the healthcare issue, and neither one of them are focused on We The People! In fact, I read part of a debate earlier this evening, and the word ‘patient’ or ‘voter’, ‘citizen’, ‘taxpayer’ … not a one of these were even mentioned! Thanks again for some excellent information!

    • Jill, our friend Gronda has done some excellent reporting on Marco Rubio’s efforts to strangle the ACA. Yet, it is too much detail for a news network to cover. With that said it should be noted how we Americans are pawns in political games. On the flip side, Democrats need to work with the GOP to improve the ACA. If they get too prideful, they are doing the same thing. Keith

  6. Reblogged this on Filosofa's Word and commented:
    There is so much misunderstanding surrounding ACA (Obamacare), most of which is a result of politicians feeding the electorate misinformation and people not taking the initiative to look up answers for themselves. We have all heard the one about the guy that said he hated Obamacare, but was happy to have his ACA! I have personally spoken with friends whose knowledge about ACA is limited to what they have heard from other friends or from politicians. What has happened here … do people no longer know how to read? Anyway … to the point … blogger-friend Keith has written a post with some highly valuable information about ACA, about the fact that it is working quite well, for the most part, despite some problems here and there. And the fact is that, despite rants from Trump & Co., it is not likely to either implode or explode unless forced to do so by the Republican-dominated Congress! Please take a couple of minutes to read Keith’s post … and be sure to peruse the comments also, as I actually learned quite a bit from them. Keith, being a professional benefits analyst, is my go-to person for these issues. Thank you, Keith, for an excellent post and implied permission to share!

  7. Reblogged this on hughcurtler and commented:
    This man is one of the few among us who truly understands the ramifications of the Affordable Care Act which has been the target of the far Right for so many years and which is helping so many people. It’s worth read.

  8. Note to Readers: A couple of other changes introduced by the Affordable Care Act that should be mentioned:
    – access to preventive care visits sans deductibles
    – limitations on profit margins of insurers requiring refunds of excessive profits to policy owners
    – filling in of the Medicare Part D doughnut hole in benefits

    One of the benefits of having access to coverage is seeing a doctor before big problems arise. So, while the adverse selection has increased cost, getting care now has a dampening effect in the future.

    A financial tidbit to think of is 15% of the people drive 85% of the claims, The key to managing health and cost is to help the 15% get effective care, but prevent the remaining 85% of the people from becoming members of the 15% who drive claims. Routine check-ups on weight, blood pressure, blood sugars, immunizations, etc can make a huge difference. As suggested check-ups such as mammograms and colonoscopies will pay huge dividends and save lives.

    Absent care which would have happened under the proposed AHCA and these routine visits would not occur as needed.

  9. Note to Readers: The Kansas legislature approved a bill to expand Medicaid. Unfortunately, the Governor vetoed it as he did not want to support Planned Parenthood. So, hundreds of thousands of Kansans will continue to be denied health care. As an independent voter who helps homeless families, increased family size is highly correlated with increased poverty potential. Health care coverage is essential to helping people in need.

    Planned Parenthood does a world of good for women and families in poverty, including reducing the frequency of abortions. Family planning, education and birth control reduce the number of abortions, plus they reduce the rate of poverty and reduce the health care costs. Yes, a small part of what they do is abortions, but that receives no federal funding. So, my question to Governor Brownback is why don’t you like Planned Parenthood?

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