A blueprint for post-Obamacare health care

Donald Trump tweeted something ridiculous overnight, which is a pretty good sign that there’s a real story that isn’t getting as much media attention.

The president-elect tweeted about burning the American flag, and not about the possibility of eliminating health care coverage for many Americans.

Trump is appointing Rep. Tom Price, R-Ga., as the new secretary of health and human services, the perfect person, Vox says, to roll back health care coverage, an issue many Democrats were too afraid to defend in their recent election.

“Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy, making him the ideal choice to serve in this capacity,” Trump said in a statement today. “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American. I am proud to nominate him as Secretary of Health and Human Services.”

Price is one of the few Republicans in Congress who actually has proposed health care legislation in the post-Obamacare world.

Among his Empowering Patients First Act tenets is higher insurance prices for some sick people and the full repeal of the Medicaid expansion.

It’s geared to be more attractive to young people.

Empowering Patients makes the individual market more advantageous for healthier people. It eliminates the essential health benefits package, which mandated that all insurers cover a set of 10 different types of care including maternity services and pediatric care.

Empowering Patients would allow insurers to cut whatever benefits they no longer want to cover — they could stop covering maternity benefits, for example, to make their plans less attractive to women who plan to become pregnant. This would likely benefit healthy people, who generally want less robust coverage at a cheaper price.

But it’ll send the cost of more comprehensive plans — the plans sicker people need — skyrocketing. And it could leave someone who wants, say, health insurance to cover her maternity costs completely out of luck.

There are other ways Empowering Patients makes insurance better for young people too: by letting insurance plans charge them lower rates.

It does this by allowing insurers to charge their oldest enrollees as much as they want. Right now, insurers can only charge the oldest enrollees three times as much as the youngest — that constrains prices for patients in their 50s and 60s.

The New York Times says Price’s knowledge of Medicare — Price is a physician — could serve him well in reshaping health care in the United States.

The secretary of health and human services sets Medicare payment policies for doctors, updates the physician fee schedule each year and issues rules that can have a huge influence on the practice of medicine.

The government is carrying out a law that changes how doctors are paid under Medicare, and Medicare often serves as a model for private insurers.

On the other hand, as secretary, Mr. Price would need a broader perspective. He would have to consider not only the interests of doctors, but also the needs of Medicare beneficiaries, Medicaid patients and taxpayers who finance those programs.

This is the sort of thing that would have made a great debate in the last election had the Fourth Estate been at all interested in something other than what outrageous thing Trump said or tweeted.

In its editorial today, the Star Tribune appeared to urge journalists not to take the Twitter bait by taking the Twitter bait.

It should be clear by now that Trump’s outbursts will require an adjustment by the news media, which need to bring a double-helping of skepticism to coverage of a fact-averse president-elect.

Too many initially posted headlines that simply repeated — without qualification — Trump’s baseless illegal voting assertion did his work for him.

Those headlines rocket around the internet, further solidifying the notion in the minds of those who won’t go deeper, that Trump is some kind of plain-spoken truth teller, instead of a Twitter troll who needs to get off social media and get back to work.

The future of health care, and almost every other major issue facing the nation, is going to be far too complex to debate on Twitter.

Related: How women’s health insurance costs could rise under TrumpCare (PBS NewsHour)

  • wjc

    Dickens had the answer for the upcoming health care crisis:

    “If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”

  • KariBemidji

    This terrifies me. I’m 41 and I am never going to be able to retire. Not because I didn’t save enough but because I won’t be able to afford the insurance.

    • There are many in this same boat.

      We need a universal plan divorced from employment constraints…

      • KariBemidji

        Exactly. My husband is a teacher. He told me last night at the lunch table one of his co-workers who reaches the rule of 90 in three years said: “I don’t think I can retire then. I can’t afford the insurance.”

        Who wants to drain their retirement to pay for insurance? And good luck younger generation. If we all have to work until we die those jobs won’t be available.

        • I used to work in a school district and saw a ton of older workers just working to have their insurance.

          Imagine how many jobs would be freed up for people who actually WANT to work those jobs instead of those working them because they HAVE to.

          Imagine how many would try their hand at running a small business but don’t because they are beholden to the insurance industry.

        • Kassie

          Because of this, we now have to put a percentage of our income into a health savings account available only after separation from my employer. Also, all of our severance goes into it. While this is great for people retiring in the next 10 years, I’m looking at 25 years before I retire. I will have so much money in it, I’ll likely never be able to spend it.

        • Rob

          Those jobs will not be available even when the current holders retire or die in harness, as the positions will either be eliminated, or will likely end up being performed by robots/AI…

          • KariBemidji

            I hope we don’t have robots teaching 2nd graders.

          • Rob

            Teaching may be one of the few areas that’s relatively immune to robotification.

      • Rob

        But that would make too much sense…

    • Mike Worcester

      I’m about a decade away from being able — in theory — to retire and the same thought bothers me also. I used to resist the idea of a Canadian-style single payer plan for our health coverage. Now? I’m beginning to think those crazy pals of our north of the border are onto something.

      (And cue the “Canadians come to America for health care” rants in 3…2…1…. 🙂 )

      • Rob

        I’d be curious to know what your resistance was based on.

        • Mike Worcester

          Fair question. Mostly on the idea that government in a nation as large and as complex as ours was not capable of managing a health care payment system. Canada may be large geographically, but population-wise it’s only 35 million people — less than the population of California. I’d be more than happy to be proven wrong on this matter.

          • Tim

            Well, Germany has universal health care, and they have about a quarter of our population. Still smaller than the US, of course, but not by nearly as much.

          • rallysocks

            I’ve been wanting single payer for forever. And your reason is exactly what I always heard. I always wondered why people were okay with large bureaucratic corporation dictating your health care rather than government.

            Now, with health care costs spiraling for some, I’m hearing more and more willingness to go single payer.

          • Rob

            I share your hope, but you know what they say: You can count on the American government to do the right thing — after it has exhausted every other option.

          • rallysocks

            Right? Why, oh why do we have to go through another iteration of a health care fix, when we could just as well go to single payer and be done with it.

          • Mike Worcester

            I’ve often wondered that also and it has to do, I think, with the idea the corporations are not the government. That government cannot be trusted, and the companies can be. Is that logical? Nope. But is it the reason cited? Yup.

            And I concur that perhaps the cost issues will finally drive folks to at least examine how single payer would work. Lots of numbers will be needed though to show how it would impact a monthly tax bill vs what is paid out in premiums either by employers or individuals or a combination.

          • rallysocks

            Funny, I’m listening to Jane Mayer right now talking about the Koch Brothers and how they were able to manipulate large swathes of the populace that Government=bad, Corporations=good. Oy.

          • Anna

            You’re on to something there, Mike W. Canada has a parliamentary government with a prime minister and 1/10 the population of the U.S.

            Great Britain has about double the population (64,000,000) but still 1/5 the size of the United States.

            It would not be impossible to implement a Medicare-style, single payer system here but I don’t think any of the current players would be willing to give up even a sliver of the healthcare pie.

            Surely you don’t expect the CEO’s of BCBS, UHG, etc. to give up all their golden parachutes do you?

            The same goes for our illustrious members of the U.S. Congress.

            The only thing certain in life are death and taxes.

            Anytime some legislature wants to cut the budget they do it on the backs of the poor, the mentally ill, the very young, the medically fragile and the elderly.

            They’ve been doing it for more than a century and I don’t expect that to change with the recently elected pseudo-adult.

    • tboom

      I’m 63, my wife can no longer work full time, I work a somewhat physical job and my body is starting to give out. If you’re terrified at 41, well I’m living the dream (and I’m STILL better off than many).

      And another thing to worry about, friends a few years older than me are telling me Medicare isn’t much better than our private plans. I hope they’re exaggerating.

      • Angry Jonny

        Once you go on Medicare, you NEED a supplemental. Make sure you start looking now.

        • tboom

          Is it really needed? I heard or read just a couple days ago that many retired drop their supplemental plans as they get older.

          • Angry Jonny

            Well, I guess it depends on how much health care service you consume in a year. Medicare A B and D cover about 80%, so you’re on the hook for about 20% of whatever you do. If you’re generally healthy, you could probably get away without it. But if you are taking care of ongoing conditions, it couldn’t hurt to take a look at your options.

  • John O.

    Mr. Trump released his Thanksgiving message via YouTube. I suspect being a member of the White House Press Corps after January 20 isn’t going to have the same luster it once had.

  • MikeB

    Do not trust a journalist, or a President-Elect, who is bated by a tweet. It’s used for distraction.

    Medicare payments set by a doctor? What could go wrong?

  • Rob

    With T.Rump’s continued Twitter diarrhea and the selection of Price as HHS Sec, the kakistocracy rolls on. And nobody does Orwell-speak better than the Republicans; calling higher insurance prices for some sick people and the full repeal of the Medicaid expansion the “Empowering Patients First Act” is classic double-speak that will end up being a clusterf*!k for the American people.

  • Ralphy

    Empowering Patients

    “You Keep Using That Word, I Do Not Think It Means What You Think It Means” – Inigo Montoya

    • Jeff


  • chris

    If the health care cost problem could be solved by the private markets it would have been a long time ago. We need medicare for all with cost controls. Anyone who says we need to repeal the ACA first needs to explain why as a nation we spend so much more for so much less than many other countries.

    • Rob

      I think it has something to do with American Exceptionalism…

    • wjc

      There is no free market in health care.

  • tboom

    >>”It’s geared to be more attractive to young people.”<<

    And we all know how easy it is to get young people to the polls. Old people, on the other hand, vote. It will be interesting to see how this develops over the next two years, four years and further down the road.

  • Angry Jonny

    I work as a MNsure Navigator, and I probably have more people ecstatic that they can finally afford insurance than people who are distraught that they can’t. But both populations exist, and the insurance carriers have created this crisis. For a household of two in their fifties earning $65000, with no offer of employer sponsored health insurance, the lowest price plan would cost them $1646 per month, with a $13,500 deductible. If they earned $64000, that same plan would cost them $313 per month. But while you’re in St. Paul, be sure to check out the lovely marble foyer at the BCBS corporate offices.

    • The income threshold is based on gross income levels?

      /Sorry to be ignorant about that…

      • Angry Jonny

        The level of insurance assistance one might qualify for depends on a formula called the Modified Gross Adjusted Income (MAGI). It takes line 37 from your 1040 (adjusted gross), adds in the difference between line 20a and 20b (social security minus taxable social security), adds in line 8b (tax exempt dividends), and then anything reported on schedule 2555 (foreign earned income). 8 times out of 10, it’s a person’s or family’s adjusted gross. For a household of 1, the upper threshold on MA (medical assistance) is $15,800. MA is zero premium, zero annual deductible insurance. For MinnesotaCare, the threshold is $23,670. MinnesotaCare is basically MA with a sliding premium based on household number and income. It is also the state basic health care plan. Once you’re north of $23,670 you’re looking at advance premium tax credits (APTC) towards the purchase of a private plan (QHP). Your premium tax credit depends on your income, but the deductibles and out of pocket maximums are static.

        • Thanks for the information. This will come in handy as my daughter will be needing this in about 18 months, but then again, who knows what will be in place by then.

        • Rob

          It’s good to know that the level of insurance a person qualifies for is based on concise, simple to understand precepts and is jargon-free.

          • Angry Jonny

            Well, every industry has its jargon. You just need to brush up on your TLA’s.

  • jane

    I hate trmp more each day. (And all who voted for him, or did not vote, which allowed the twitter troll to get in.)

  • MrE85

    I’m not sure what is going to happen next, but I fear that won’t be good news for many, regardless of what type of health insurance you have — or don’t have. Keeping some sort of health insurance coverage is my greatest concern as I near retirement.

  • rallysocks

    //they could stop covering maternity benefits, for example, to make their plans less attractive to women who plan to become pregnant. This would likely benefit healthy people, who generally want less robust coverage at a cheaper price.


    • KariBemidji

      Birth Control – not covered
      Abortions – not covered
      Maternal Health – not covered

      What are we Shakers?

      • rallysocks

        and when did pregnancy fall under “not healthy”?

        • Rob

          See above comment.

      • Rob

        Hmmm. Sounds suspiciously like a health care plan written by clueless, conservative old white guys…

        • 212944

          Fixed it for you ….

          “Hmmm. Sounds suspiciously like a health care plan written by clueless, corrupt, conservative old white guys…”

          The insurance and pharma companies pay them well for this, just the Wall Street does. We’re not a country, we’re a subsidiary of big business … same as it ever was.

          • Rob

            Yes, it’s called a corpocracy.

      • Angry Jonny

        I wonder if it applies to boner pills for old white men.

  • jon

    Remember when we more or less gutted pensions plans in the 70’s and replaced them with IRAs?

    Seems like a fitting analogy for gutting insurance companies and replacing them with HSAs… (which is happening anyhow without the GOPs help).

    Now we’ll all live in the same utopia where everyone who is sick can get treatment with the money they saved up tax free…. just like every baby boomer who wants to retire can retire. unless they are one of the 2/3rds of them who can’t even come close to a livable income from their savings….

    Clearly this is a solution we need to emulate else where…. retirement, health care, childcare, education, military, infrastructure… We should each have personal tax free savings accounts for these things… then when we need to buy a gun, or a text book, we purchase it, with money we don’t really have…. then we get reimbursed from one of our savings accounts… and in that way we can get rid of government all together!