Affordable Care Act


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Higher premiums for younger, healthier people helped fuel opposition to the Affordable Care Act early on. (Credit: Repeal ObamaCare/ Wikimedia Commons)

Democrats are howling about the health care bill passed by the House of Representatives, but it’s likely to resonate with the GOP’s core supporters.

The Affordable Care Act changed the structure of health insurance, mandating that insurers couldn’t charge more for pre-existing conditions, and only three times more for older patients compared to younger ones. That artificially increased premiums for young, healthy people, including those who supported Donald Trump’s candidacy.

You might think, in order to create a better society, that people would be willing to pay for services even though they themselves don’t use them. Childless couples, for example, pay for public education. But somehow, the discussion on health care has become ask not what you can do for your country but ask what you can for me.

Men are complaining about having to purchase policies that include maternity care.

In December, the Kaiser Foundation conducted focus groups among Trump voters to find out what kind of health care plan they wanted. Members of the groups were “unmoved by the principle of risk sharing,” the New York Times reported on Jan. 5.

Although support for the ACA has edged up since the election, a sizeable minority continues to oppose it — a Real Clear Politics polling average puts opposition to the ACA at more than 42 percent, about the same level as President Trump’s approval ratings.

If the new American Health Care Act brings down premiums for younger and healthier Americans, don’t expect a great rush to oust Republicans who voted for it in 2018. They’re just giving their constituents what they want.

In the Kaiser focus groups, participants said they liked the pre-ACA days because they could purchase low-cost plans, “even if it meant that less healthy people had to pay more.”

This is exactly what the new Republican health care system may be about to deliver.

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TRUTH ABOUT DEDUCTIBLES: We keep hearing about how, with deductibles over $5,000 per person under the ACA, the health care plans are expensive and virtually useless. It’s seldom if ever mentioned that benefits kick in well before deductibles are met.

For one thing, plans include a wellness visit, so at least you can get a checkup to find out where you stand.

But let’s say your doctor decides that something needs to be checked out further, and orders an MRI. If you are uninsured, you will pay the full cash rate for that service — which could be up to $3,000. But if you are covered under a policy, even though you are paying for the procedure out-of-pocket, you’re paying much-reduced network negotiated rate.

Instead of the $3,000, you might owe $800. True, you haven’t satisfied your deductible, but you’ve saved $2,200.

The idea that a family of three has to pay a hefty premium of $1,000 a month — and gets no benefit until they fork out $15,000 out-of-pocket — is just dead-wrong.

But hey, if it fits into the anti-ACA argument, let’s keep using it!

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WATER WOES: There’s a lot of talk about how “poor lifestyle choices” contribute to chronic disease.

But there are many environmental risk factors that are clearly beyond our control.

A recent study by the Natural Resources Defense Council (NRDC) said contamination of community drinking water is widespread, and provisions of the Safe Drinking Water Act (SDWA) of 1974 have not been adequately enforced by the federal Environmental Protection Agency.

“Our research shows that in 2015 alone, nearly 77 million people were served by more than 18,000 community water systems that violated at least one SDWA rule, and there were more than 80,000 violations of SDWA rules that year,” the NRDC said in its May 2 report, Threats on Tap: Widespread Violations Highlight Need for Investment in Water Infrastructure and Protections.

“These violations included exceeding health-based standards, failing to properly test water for contaminants, and failing to report contamination to state authorities or the public.”

Sixty percent of Americans take at least one prescription drug, according to the Washington Post. Yet only 27 percent have a pre-existing medical condition, a recent Kaiser Family Foundation analysis concluded.

One seems to be in conflict with the other — If you’re taking a prescription drug, aren’t you taking it for an existing condition?

It’s a hot topic now that the repeal of the Affordable Care Act is being pit-bulled through Congress by the new crew in D.C.

prescription_drugsHealth insurance companies can’t reject applicants for pre-existing conditions under the ACA, and President Trump and some Congressional Republicans have suggested that that’s a good provision to keep in whatever plan they come up with.

But on the other hand they are talking about reviving high-risk pools, which were the half-baked solution to the uninsured crisis prior to the ACA’s passage in 2010. High risk pools were expensive and limited, and many states had to put people on a waiting list for coverage.

The one thing high risk pools do is allow cheaper premiums for younger people. The ACA has a spread-the-risk policy that requires younger, healthier people to sign up for insurance so that older, sicker people can access policies that aren’t off-the-charts expensive.

Here’s the thinking: Take care of numero uno, and don’t worry that maybe one day you yourself may need a more accommodative policy.

The real question is, how many people actually have a pre-existing condition? If 60 percent of Americans are taking a prescription drug — and estimates are as high as 70 percent — the problem is a lot more widespread than the Kaiser analysis claims.

It also depends on how a pre-existing condition is defined. The New York Times reported Monday that a woman diagnosed with a mild form of gastritis — basically an upset stomach — was offered an insurance policy that excluded coverage for anything related to the digestive tract.

If that’s how insurers will determine the scope of coverage once the ACA is repealed, there are going to be a lot of very unhappy Americans under President Trump’s “terrific” new health plan.

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Eat your heart out, Mary Shelley.

Scientists have frozen roundworms — solid — and brought them back to life, possibly paving the way for people to be frozen and brought back.

The Antarctic nematode, known commonly as the roundworm, was the first living organism to be frozen and revived by researchers from the University of Otago in New Zealand. The worm survives the freezing process because it has a mechanism that allows it to eliminate all of its water content, a process known as cryoprotective dehydration.

maryshelley“No other organism that we know of is able to withstand freezing in its cells with as good a survival rate,” said biologist, Michael Thorne, lead author of the study. “Once thawed from such a state it is able to produce offspring.

“To date no work has been carried out at the molecular level on any organism able to survive total freezing, and the insights provide a great starting point for a fascinating biological phenomenon.”

The paper, Molecular Snapshot of an Intracellular Freezing Event in an Antarctic Nematode, was published in the professional journal Cryobiology.

In fact, people have been frozen since 1967 in the hopes they can be revived later, when a cure is found for the disease that caused their death. The process, known as cryonics, is controversial within the scientific community.

At a cost of between $10,000 and $12,000, the blood is removed from the body and replaced with a special solution before the person is stored at -196 degrees Celsius.

Several U.S. companies do the work but cryonics is also a growing industry in Russia, according to the UK’s Financial Times, which published a profile in December 2015 about a company outside Moscow that hopes to take a global leadership role in the business.

The writer said of the company’s founder: “He has worked at an investment bank, hosted his own television show and helps run an anti-human-trafficking organization, but his day job is freezing people.”

There is actually a new “cold war” brewing between the two countries over cryonics, according to the newspaper.

What proponents have been waiting for is some proof, or at least some hint, that the process can work — that people can be reanimated after freezing and live again another day.

Is the roundworm study the first step in that direction?

Will people wake up 50 years from now to find that world peace has finally been achieved? Or will they step out of the cryonics storage building and into a brutal, raging war between humans and robots?

Stay tuned ….

Image credits: Prescription drugs, National Cancer Institute; Mary Shelley via Wikimedia Commons

Just two weeks from inauguration day, the debate over the Affordable Care Act remains chaotic, with no clear consensus emerging.

Although Republicans seemed in December to be coalescing around a plan to immediately repeal the law — and then delay its implementation for a year or more — some party higher-ups have been contradicting that, insisting that a replacement law accompany the repeal.

House Speaker Paul Ryan, for example, has said a replacement law could be passed this year. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, says it will take “several years” and a consensus with Democrats to come up with a workable alternative.

And now evidence is emerging that Americans don’t want outright repeal of the law. A Kaiser Family Foundation Health Tracking Poll released Friday revealed that 75 percent of the public does not want to see repeal and delay, the option most often discussed by incoming officials.

Forty-seven percent don’t want repeal at all, and another 28 percent say the ACA shouldn’t be repealed until details of the replacement plan are announced.

“Views split not only on partisan lines but also within the Republican Party, where nearly four in 10 think that the government should guarantee health care is available to the elderly and to low-income people, even if it means more federal involvement,” reported Kaiser Health News.

On Thursday, Tennessee Republican U.S. Rep. Marsha Blackburn asked in a poll on Twitter: “Do you support the repeal of Obamacare?” Eighty-four percent said no and only 16 percent said yes. (As any attorney will tell you, never ask a question you don’ t know the answer to.)

A focus group comprised of Trump voters expressed concern that a gap between repeal of the ACA and a replacement would lead to health care chaos. But one member of the group said she didn’t think “a smart businessman like Trump would let that happen.”

Interestingly, The New York Times said members of the group were “unmoved by the principle of risk-sharing,” a cornerstone of the ACA and in fact the insurance business in general. The insurance industry is built around the idea of combining low-risk customers with high-risk customers to create a profitable pool that can bail people out if a problem occurs.

But members of the focus group didn’t like the ACA’s insurance mandate, even though they want coverage for people with pre-existing conditions.

Overall, members of the focus group want health care to be affordable and understandable with adequate access to networks of care providers.

So what would the GOP alternative look like? The bill passed by Congress in 2015 — which was vetoed by President Obama — would remove the mandate, eliminate premium subsidies for low and middle-income Americans, and drop taxes on high income households.

The problem is if you remove the mandate but still require insurers to cover everyone with pre-existing conditions, those people would likely face sky-high premiums.

The two sides in this debate — the public’s demand for affordable premiums and simplified access to health care providers, and Republicans’ preference for market-based solutions — appear to be on a collision course.

An uneasy public can only sit back and wait to see what happens next.