By Daliah Wachs, MD, FAAFP
Premiums continue to spike, with increases this year of 25%. Despite who wins the election, Obamacare’s extinction is inevitable.
Open enrollment for those states who offer plans through the federal healthcare.gov marketplace begins November 1 and ends January 31. The Department of Health and Human Services reported an average premium increase of 22%, but assured us that subsidies would increase to offset the rising costs. For those of us who don’t qualify for subsidies and who could preview the plans available for purchase, the sticker shock was confirmed. Rates heftily rose, as did deductibles and copays.
Our choices appear to be slim pickings as well as major insurers, such as Aetna, UnitedHealthcare and Humana have left many state exchanges. HMO options appear to dominate many of the plans with very little PPO choices available.
Since its roll out in 2013, issues with Obamacare continue to prevail. Can Obamacare recover, or is this the beginning of its end? I predict it will near extinction in the coming years. Here’s why……
- Big money is needed to keep it going. When huge insurers such as Aetna pull out, citing $430 million in losses due to policyholders who were sickly and therefore costlier, how are smaller, less funded insurers supposed to carry the weight? Moreover when policy holders look at rising premiums with less product, more are reluctant, and less are able to pay the sticker price.
- By year three, Obamacare should be strengthening, not weakening. Although the computer glitches of 2013 for the most part resolved, the growth and development of Obamacare should start being apparent. Yet rather than growth, we are seeing a shrinking of options and policyholders. At this rate, in a few years, the exchanges may be unable to recoup.
- Less individual healthcare dollars are being spent. While some rejoice in this news, this is a negative economic predictor for a sector that’s 17.5% of our GDP.
- Being “Insured” doesn’t equate to being “healthy”. When policyholders clutch onto an insurance card that allows them to see a provider, but that said card fails to pay until a $12,000 deductible is met, the policyholder hesitates on using his insurance. Many put off visits and prescription refills due to cost. So they have insurance, but are not using it. Moreover, if the number of available providers decrease, a three week wait turns into a three month wait for some. Proponents of the ACA said ER visits would decrease as a result of the rollout, but many of us anticipated the opposite. Oregon, when they expanded Medicaid, reported the following: “Medicaid coverage resulted in significantly more outpatient visits, hospitalizations, prescription medications, and emergency department visits. Coverage significantly lowered medical debt, and virtually eliminated the likelihood of having a catastrophic medical expenditure. Medicaid substantially reduced the prevalence of depression, but had no statistically significant effects on blood pressure, cholesterol, or cardiovascular risk.” In short, having an insurance card does not equal having healthcare.
- Another recession is on its way and rising unemployment will lead to less employer dollars going into the healthcare system. Its a trifecta of the following: employees displaced by automation, baby boomers aging out of their single family residences causing a housing glut, commercial real estate glutting as well as many prefer to shop online and channel their dollars to smaller retailers than the huge anchors supporting strip malls. Another economic roller coaster is the last thing a faltering healthcare system needs.
- Federal spending will have to slow down. The HHS’ promises of increasing subsidies to offset the rising premium costs can’t continue for long. Subsidies of $1000/person/month…..not realistic.
- Both Presidential candidates want to “fix” our healthcare system. Hillary Clinton and Donald Trump are both individuals who want to leave a legacy. Rather than mending a faltering healthcare law, both candidates will want to use this opportunity to overhaul it and stamp their name onto the finished piece. Despite what the former Secretary of State promises, “Hillarycare’ will look nothing like Obamacare and Trump promises to repeal it. The ACA’s days are numbered.
We don’t know what will happen in the coming years. Whether its a single payer system or a back-to-the-cash basics, I don’t see Obamacare in our future. I just wish I could forsee a glimpse of something that’s structurally sound. I need a hysterectomy soon……
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network and Board Certified Family Physician