What should a revised ObamaCare include?

Since the introduction of ObamaCare, officially known as the Affordable Care Act (ACA), there were calls to repeal and replace it. This became a central theme of the 2016 presidential campaign.

Now a unified Republican government controls two of the three branches of government and the Judiciary will soon come under Republican control with the appointment to the Supreme Court. It would seem that the end of ObamaCare should be imminent, but the dialog has changed.

{mosads}In an interview for the Wall Street Journal after the election, Donald Trump said some provisions of ObamaCare are likely to stay. He specifically mentioned two provisions that he would like to retain in a revised ObamaCare:

• The prohibition against insurers denying coverage due to pre-existing conditions

• Allowing parents to keep their children on their own insurance policies for an extended period

From the viewpoint of healthcare providers and insurers, any major changes are expected to gradually take effect over the next three years. Here are some observations on what the new system should cover.

What any new health insurance policy should include

The non-partisan Congressional Budget Office (CBO) has already prepared to respond to proposed changes to ObamaCare for one very good reason. They stated that eliminating all provisions of ObamaCare and cutting the associated taxes would add $6.2 trillion to the deficit over the next ten years.

The CBO said they will evaluate proposed changes to medical insurance and “would not count those people with limited health benefits as having coverage.” That’s an essential point because both sides of the political aisle have assured Americans that any revision or replacement would continue to cover at least as many people as ObamaCare did.

Here are the most important provisions under discussion:

1. Some of ObamaCare’s strengths are likely to remain in any revised version. Those include the provisions on pre-existing conditions and extended coverage for children mentioned above. Another provision likely to remain is a ban on caps for the most expensive patients. The White House pointed out that healthcare premiums have grown at the slowest rate in 50 years under ObamaCare.

2. The CBO defined coverage by saying, “An important function of insurance is to provide financial protection against high-cost, low-probability events.” Obamacare did not consider a person covered if they had “mini-med” plans with very limited benefits or “dread disease” plans that only covered one illness like cancer.

3. Supplemental plans that only pay the portion of the bill not covered by other plans do not count as coverage. Also, fixed-dollar plans that only pay a target dollar amount per day for hospitalization do not count as coverage. Finally, dental, vision or other single-service plans do not count as coverage.

4. The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act, a proposal in the Senate to revise ObamaCare, suggests changes like lower subsidies to individuals and families and tighter caps on Medicaid payments.

5. In the House of Representatives, Speaker Paul Ryan’s proposal, A Better Way, suggests creating Medicare exchanges similar to private insurance exchanges created under ObamaCare. He said that preventing Medicare from going broke is a prerequisite to making any changes to ObamaCare.

The single largest contributor to cost

Despite all the debate, there is a consensus that hospitalization is the largest contributor to rising healthcare costs. The CDC reported that in 2014, the national healthcare expenditure was $3 trillion or 17.5 percent of the GDP. Of that number, 32 percent came from hospitalizations, which dwarfed every other component of cost. Any revisions to ObamaCare must make reductions in hospitalizations a priority through incentives for healthy lifestyles and funding in support of preventative care. Not all accidents have to happen, and prevention is far better option both financially and ethically.

Dr. Anita Gupta is an anesthesiologist, pharmacist and currently Associate Professor and Vice Chair of Pain Medicine in at Drexel University College of Medicine in Philadelphia. She is also an advisor to the FDA, and currently Co-Chair of the American Society of Anesthesiology Committee on Prescription Opioid Abuse. 

The views expressed by contributors are their own and not the views of The Hill.