Yesterday I posted/linked
two stories about the trainwreck (their word, not mine) AKA ObamaCare AKA the All-But-Affordable Care Act (ABACA).
Today, in The Boston Globe, the editors -- or least an op-ed -- opine that the model for ABACA, Romneycare, is another trainwreck, though they did not use that exact word. The headline:
the misguided and costly evolution of Romneycare -- yes, that is in
The Boston Globe, Romneycare was the blueprint for Obamacare. A few excerpts:
The Affordable Care Act is now six years old. Perhaps more important
for Massachusetts, this month marks the 10th anniversary of
“Romneycare,” making it a good time to review that law’s impact.
Governor
Mitt Romney’s original proposal was simple: Stop subsidizing hospital
care and redirect the money to ensure that all residents have “minimum
coverage” — in his mind, catastrophic insurance. Individuals could
choose and pay for anything beyond that. The premise was that taxpayers
should not have to cover the cost of care for those unwilling to pay for
it.
Today the Connector’s few offerings are over-standardized, with
little variety or innovation in plan design. The exchange has attracted
principally subsidized enrollees, and the remaining private market is
very expensive.
Obamacare further altered Romneycare. Massachusetts’ troubled
implementation of the ACA — including creation of a new exchange that
became an IT disaster and triggered an ongoing FBI investigation —
should disabuse anyone of the notion that these were parallel laws.
Consider Massachusetts’ half dozen waiver requests from the federal law
(one citing the fear of “extreme premium increases”); the introduction
of Accountable Care Organizations; $10 billion in new taxes on medical
devices, insurance, payroll for Medicare and Medicaid over 10 years; and
a $14 billion reduction in Medicare Advantage payments.
Survey results show variations in the uninsured population, but the rate
appears to have dropped from around 9 percent to 3 or 4 percent. The
rise in the number insured has plateaued, with a tenth of the population
lacking coverage at some point during any given year.
The increased coverage was achieved almost exclusively through
taxpayer-funded Medicaid (MassHealth). In fiscal year 2007 MassHealth
served just over a million enrollees at a cost of $7 billion. The
governor’s 2017 budget projects it will serve almost 1.9 million
individuals, 30 percent of the state population, for $15 billion, or $8,000/person. [And it's going to get worse.]
Spending
billions on higher Medicaid enrollments and generous exchange subsidies
is a fiscally irresponsible way to increase coverage, especially
without offsetting savings from reform of the costly Health Safety Net
pool and with continuing billion-dollar “supplemental payments” to
hospitals.
For individuals, access remains an issue. Fewer report a routine
source of care, doctor’s office wait times are long, and in some regions
even insured patients struggle to locate doctors with availability in
their practices. Over half of low-income individuals, many enrolled in
free or heavily subsidized coverage, went without needed care last year,
largely due to costs and access issues. Residents report difficulty
paying their medical bills at virtually the same rate as in 2006.
Ten
years into Massachusetts’ experiment with an “exchange,” the results
demonstrate that it is time to re-think [Romneycare].
And so it goes.
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