The Republican alternative to Obamacare looks different but not better. There is just a new set of winners and losers.

 

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Ironically, many of the losers would be Trump voters, low-income adults who don’t qualify for Medicare.

Lower subsidies mean that some working class adults would be priced out of the insurance market.

“We just had an election about the working class,” said conservative columnist David Brooks of The New York Times on “Meet the Press. “

“We learned that a lot of people are out of the job market, the social fabric is frayed, so the lesson is pay attention and help these people.

“The Republican Party could help these people with market-based mechanisms, which I support. Do they do that? No. They have huge tax cuts for the rich … meanwhile they’re throwing 8, 10, 15 million people off the rolls. It’s declaring war on their own voters.”

By going after Medicaid, those suffering with mental health issues and the building opioid crisis would be hard hit. This is especially true in Florida.

The American Medical Association stated that the GOP alternative would “result in millions of Americans losing coverage and benefits.”

The American Hospital Association predicted instability of the market, a loss of Medicaid coverage leading to more non-paying patients turning to hospitals.

The potential impact on safety net hospitals like UF Health Jacksonville could be devastating.

Unfortunately, there is not an estimate from the nonpartisan Congressional Budget Office on the cost and the coverage of the GOP plan. That’s ironic given the criticism that Obamacare was rammed through Congress.

Under Obamacare, older Americans were being subsidized by younger Americans. Under Obamacare’s rules, insurers can’t charge older people more than three times the rate of young people. The GOP alternative would return to a more realistic 5 to 1 range.

But without subsidies to compensate, older Americans will be priced out of all but catastrophic policies.

Robert Laszewski, the health industry analyst who advises health insurance plans, wrote on his blog that “Obamacare is so poorly constructed it is literally an anti-selection machine. The Republican proposal is worse.”

As he added, “Half the country will hate it, just a different half.”

RIGHT WAY

Republican options are limited by trying to avoid the 60-vote threshold needed in the Senate to override a filibuster.

But a bipartisan approach is needed for any bill that affects one-sixth of the economy.

How can we deal with the costs and affordability of health care?

Any proposal will have to make some compromises. You can’t have low cost, high quality and universal coverage. Something has to give.

One proposal was found on these pages from a physician-financial planner from Jacksonville, Carolyn McClanahan.

She would take the same funding used for Medicaid and put it in federal health clinics. Her proposal would remove much of the bureaucracy and paperwork involved in Medicaid where reimbursements are so stingy in Florida that many physicians refuse to participate.

Good primary care is needed to deal with the minority of patients with chronic disease who are so costly to treat.

FLORIDA’S MEDICAID FRAUD

Medicaid fraud is a major problem, reported the Office of Inspector General, which coordinated investigations that recovered $1.8 billion last year.

Much of it came from home health care services, which have been easily exploited by criminal enterprises.

Florida seems to be a haven for fraud of all kinds. Last year, Florida led the nation in recovering more than $100 million in Medicaid fraud.

Florida spent just $17 million on enforcement, so the cost-benefit ratio was favorable for taxpayers.

One example of fraud was an assisted living facility that received kickbacks for referring patients to a specific pharmacy. The pharmacy owner was sentenced to federal prison and ordered to pay back more than $1 million to Florida Medicaid.

Because Medicaid is run differently in each state, coordinating fraud investigations is difficult.

As the saying goes, if you’ve seen one Medicaid program, you’ve seen one Medicaid program.

BUSINESSES STEP UP

Many Americans still receive their health insurance through their employers.

As analyst Brian Klepper of Atlantic Beach has often said, only American business has the clout to break through the power of the health industry lobby.

After all, one person’s waste is another’s profit.

One hopeful sign comes from a U.S. alliance of more than 35 companies designed to lower health care spending.

The group will use its clout to purchase prescription drugs, create specialized physician networks and use the Watson software from IBM to analyze health spending data, The Wall Street Journal reported.

Companies would gain more access to cost data on prescription drugs along with guaranteed rebates.

Computers could even predict which employees are likely to develop diseases like diabetes and recommend preventative action.

The businesses are not waiting for government to get its act together. But that sort of action is needed so that everyone can benefit from these efficiencies.

Frankly there is enough data about cost and quality to improve both in health care. It probably will take business to show the way.

The Kaiser Family Foundation listed the winners and losers, reported in The New York Times.

Winners: Young, those with higher incomes and those living in areas with low health insurance costs.

Losers: Older Americans with low incomes who live in high-cost areas.