Jim Clark: Is Obamacare in a death spiral?
June 25, 2014
Last week was an Obamacare Redux — "three years into the law." The Republican Men's Club of Reno on June 17 assembled a panel of local experts on the subject, each of whom gave a short analysis. The following day, Nevada Policy Research Institute hosted CATO Institute Senior Fellow Michael Tanner speaking on the same subject.
At the GOP meeting, NPRI President Andy Matthews recited some fiscal implications of Obamacare as it impacts Nevada.
Originally, federal health officials assumed 118,000 Nevadans would obtain conventional insurance and 70,000 new Medicaid patients would sign up during the first period (October 2013 to March 2014).
The actual results were 35,000 conventional insurance sign ups (25,000 of whom had had their previous policies cancelled) and a whopping 183,000 new Medicaid patients.
Another Obamacare assumption was that 40 percent of conventional signups would be those in the 18 to 35 year old age group whose premiums would subsidize older insureds.
In fact, only 25 percent of the initial Nevada pool was in that age bracket. Mathews added that the federal government will only subsidize Nevada's Medicaid costs for three years. After that, he estimates, the burden on Nevada's general fund will be $5.4 billion over 10 years.
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Reno Internist Ron Smith, MD, gave a physician's view of the law. He explained that Obamacare's mandate that all patient health records be in electronic form cost each doctor about $50,000.
The law requires conversion of the data or all reimbursements for services would be reduced. The biggest problems with the law's insurance exchanges has been the proliferation of errors and lack of any means of patients finding a physician who will accept the policy the exchange produces.
He predicts a trend of doctors leaving private practice and working on salary for hospitals which have the technical staff to navigate Obamacare's intricacies. He also predicts an influx of foreign physicians.
Local cardiologist Costa Arger, MD, expressed concern about the fact that Nevada will be getting stuck with the bill for the expansion in Medicaid patients; that all of the electronically maintained health records are being sent to the federal government which will ultimately decide what kind of health care each patient receives; and that President Obama's medical adviser, Ezekiel Emanuel, remarked that "older patients have been receiving too lavish medical care."
Jim Annis, president of Applied Companies, a temporary hire firm, offered some observations from his perspective. Most younger workers are foregoing health insurance and planning to pay the $95.00 fine. Few of them are aware that the fine is actually $95.00 or 1 percent of annual wages, whichever is greater. This will not hit home until after 2014 tax returns are filed.
Dan Crampton of Senator Dean Heller's staff said that to date the GOP House has passed 28 bills to amend Obamacare and 12 bills to defund it. None got any traction in the US Senate.
He predicts that unless the Republicans take control of the Senate in this year's midterm Election that no changes will be made. He added that even if the GOP recaptures a Senate majority, any changes would have to be negotiated with the President (who has veto power) and would be relatively minor.
Next evening, CATO Fellow Michael Tanner told his audience that Obamacare's fundamental premise that young, healthy people will overpay for insurance in order to subsidize older and sicker patients has turned out to be a false premise.
In fact, nationwide, only about 27 percent of the younger demographic has signed up; this will result in increased premiums for all participants. He described the law as "being in a death spiral."
The question is how do we mere humans survive this travesty?
Jim Clark is president of Republican Advocates. He has served on the Washoe County and Nevada GOP Central Committees. He can be reached at firstname.lastname@example.org.