MAY 6, 2017



Trump’s American Health Care...(cont.)

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For Americans who voted for Trump because they wanted to see Obamacare repealed, the missed opportunity this time around comes as a surprise since Republicans have voted to overturn Obamacare more than a dozen times since the GOP took control of the House in 2011 and Senate in 2014. Now that Obama is no longer in office to reject the GOP’s vote, and when Republican lawmakers votes really mattered for the first time in 8 years, the party failed to get anything adopted. It turns out simply repealing has been much easier

than coming up with a viable system, Obamacare supporters point out.

“There have been recent reports that members of Congress are working behind closed doors to revive AHCA. AARP is fighting to stop any backroom deal in Congress that would make you pay even more for health care,” said Arre.

One of the features that AARP will be monitoring is any changes that would allow big insurance companies to deny health coverage based on pre-existing conditions. “This would deny coverage up to 25 million Americans, including 93,366 people in Hawaii,” said Arre.

Trump said: “Now, I have to tell you, it’s (healthcare) is an unbelievably complex subject. Nobody knew health care could be so complicated.”

Dr. Charlie Sonido, who has one of the most well established clinics in Hawaii, said: “Healthcare is very complex. I don’t know that anyone knows the exact formula yet. Something has to be done to make it affordable for every stakeholder.

On Obamacare, Dr. Sonido realizes its shortcoming. “It has been very expensive for the insurers, medical device companies and others, even for the government.” At the same time, he recommends that it should be improved on, not repealed and replaced.

Unlike in the U.S. mainland, Dr. Sonido points out that Hawaii’s employer insurance mandate buffers the need for Obamacare in the state. “Personally, Obamacare has not affected me because I only have about less than 10 patients on it. But this has been true for the state of Hawaii in general. The state does not need Obamacare. The insurance mandate for employees working more than 20 hours/week and other safety nets (private-public health centers) provide good health coverage for Hawaii residents. For the rest of the nation, however, Obamacare has been a blessing. About 20 million people now have some type of medical coverage because of it. That is why I generally favor Obamacare. It provides a safety net for the poor and even the middle class in some states with no insurance mandates.”

Perie Danao, executive director of the Philippine Nurses Association of America, Hawaii Chapter (PNAH) also doesn’t support replacing Obamacare. If it does, she hopes the new system should include key elements of Obamacare such as tax credits for small businesses that offer health benefits, coverage for dependents up to 26 years old, and that people with pre-existing health conditions are not denied health coverage.

Essential Health Benefits or EHBs -- a core package of benefits offered by all insurers -- is something Danao and others are closely keeping an eye on. She says “Trumpcare will only require private insurers to offer all essential benefits, but Medicaid plans will not offer all.”

Obamacare currently requires insurers to cover in full or parts of 10 EHBs: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health, prescription drugs, rehabilitative services, laboratory services, preventative and chronic disease management, pediatric services, and oral and vision care.

Ultra conservative Republicans of the Freedom Caucus in the House supported cutting back on Obamacare’s EHB requirements.

Hawaii State Sen. Josh Green, MD, chair of the Senate Committee on Human Services, said “it is important to keep the essential benefits and the prohibition on discriminating against people with preexisting conditions. He added “Trump’s plan would be a disaster for our country. It would put in peril all rural healthcare facilities and would destroy the safety net for people in the middle class.”

Dr. Josephine Waite-Ansdell, President of the Philippine Medical Association of Hawaii (PMAH), believes Obamacare means well but it needs to be fixed. “I don’t know if Trump’s (AHCA) would be any better. It might be worse. It’s very complicated and frustrating.”

Time to try a new healthcare model?

Some experts studying the American health care system for decades say that we’ve tried everything to fix health care and have come up short. What hasn’t been tried is a single payer system, universal health care coverage.

Pro-single payer system advocates say that even with Obamacare -- the closest model the U.S. has ever had to universal health care -- millions of citizens will still be uninsured and health care rationing (not seeing a doctor because it is too expensive) will still be a common practice. While health care spending per person has grown less rapidly in the six years since Obamacare was enacted than in any period in the last four decades, experts say the cost of healthcare still is rising at a much faster pace than inflation that eventually translates to more people dropping their insurance, even under Obamacare. U.S. companies are also still struggling to stay in business under the weight of health care premiums. Americans fortunate enough to have health insurance through their employers are still paying more, getting less, and living under the constant threat that should they lose their jobs while getting sick or hospitalized, they face economic disaster. On top of all this, the government via the federal or state, is already covering about 70 percent of health care costs.

Some pro-single payer advocates say that if AHCA eventually passes, it will be such a colossal disaster that it will move the country politically closer to Medicare for all, or universal health care.

Under a single-payer system, all Americans would be covered similar to the Medicare model for elderly citizens. Employers would no longer be burdened with providing health care for their workers. The idea is that the vast “risk pool” reduces the price of medicine and medical care. Administrative costs would also be reduced tremendously by about 15 percent or $500 billion annually. Already there is evidence that administrative costs for regular insurance cost about 12 percent; while administrative costs of Medicare consume less than 4 percent.

Dr. Sonido said a single payer system could be good for the U.S. and benefit the majority of Americans. But he doubts that it will ever pass Congress. “Most doctors are opposed to it,” he said.

Sen. Green, MD, agrees that a single payer system would benefit the U.S. “I would propose a modified single payer system with options to buy additional insurance if people wanted it over core coverage.”

Danao opposes this system: “One insurer can monopolize the market that can lead to much higher cost of health coverage.”

The current political climate rules out a single payer system in the immediate future. Americans just have to wait and see what the president and GOP come up with.

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