A major sticking point in reopening the government is the extension of expiring Affordable Care Act (ACA) subsidies. Without these subsidies, insurance premiums will double for those receiving them. Because of this, Rep. Marjorie Taylor Greene (R-Ga.) is breaking ranks with the Republican Party.
It should be obvious that government benefits, once granted, are virtually impossible to take away, and a subsidy “cliff” will be politically disastrous. The subsidies were necessary to mask the fact that affordable options were being taken away, and extremely expensive coverage mandates were being imposed. The cliff was needed to mask the long-term cost of the bill.
So, what can be done now? One suggestion is a conditional extension of the subsidies combined with measures to reduce costs, based on an understanding of why costs are outrageous. The graph below shows the enormous increase in administrators, and the legislation associated with it.
All that administration is supposed to decrease “unnecessary” care. It is time to ask how many tests could be bought for the price of the staff used to deny them. For the price of a $1 million administrator, 2,000 CT scans @ $500 (possible in independent facilities) could be obtained, or 82 spine surgeries (lumbar laminectomies @ $12,230 at Surgery Center of Oklahoma).
We don’t know how much time is wasted by physicians and nurses in documentation that serves no purpose except to justify billing—but it may eat half their time.
Republicans reneged on their promises to repeal ACA. So, how about promising that “if you like your ACA plan you can keep your ACA plan,” but the following changes will be made to allow affordable alternatives to arise:
- all federal insurance mandates are repealed, so you can buy an affordable catastrophes-only plan;
- the ban on physician-owned hospitals is repealed;
- payments are site-neutral;
- all medical payments including individually owned insurance (not just employer-owned insurance) are payable with pre-tax dollars; and
- other freedom-expanding measures are actively explored.
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