As someone that believes in healthcare for all Americans, even I know Obamacare fell short. It turns out the Affordable Care Act isn’t so affordable. But there are a couple popular aspects of the ACA that will make it exceedingly difficult to repeal all of Obamacare. Some aspects will have to stay and if you’re not careful, your replacement plan will put you right back where you started – Obamacare!

 

Repeal all of Obamacare? What about the parts people like?

Obamacare is easy to dislike. It didn’t transform healthcare or lower costs. The plan essentially just gave more people Medicaid which was never the right answer. Medicaid is State-Federal insurance for the poor that reimburses facilities and doctors so poorly that it’s difficult to find a doctor that accepts it. Sure you can blame the money grubbing doctors but if any business doesn’t bring in enough money to cover costs, that’s a problem. And contrary to what everyone thinks, doctors aren’t as rich as you’d like to think.

 

But Obamacare did two things that were well received. First they allowed young adults to stay on their parents insurance until the age of 26. Who wouldn’t like that? The other aspect of Obamacare that everyone liked was the inability for an insurance company to deny coverage based on a pre-existing condition. All very noble. There’s only one problem. That’s a very expensive mandate for insurance companies.

 

Obviously I’m not losing sleep over the insurance companies’ well-being but there is a very real economic impact of allowing everyone to get coverage, regardless of a pre-existing condition. It’s expensive. Keep in mind that not only can you not be denied coverage, but the insurance company can’t charge you an exorbitant amount for that coverage. What that means is that it costs more to cover a sick person with a pre-existing condition than what they will pay in insurance premiums. Therefore, the money to cover that person comes from other healthier folks in America. In essence you have healthy people paying more for coverage that they’re not using to help out the sicker people in the insurance pool.

 

Why the government will have to stay involved

To help people afford their more expensive coverage that supported sicker individuals, the government subsidized the people buying insurance on the exchanges. Are you following me here? You hate what the ACA and want to repeal all of Obamacare. That means kids aren’t covered til their 26. It also means you can deny people coverage because of a pre-existing condition. Oh, you like those parts and want to keep them? Ok, no problem, then we just need the government to subsidize individuals purchasing insurance so they can afford the more expensive insurance that covers the sicker Americans with a pre-existing condition. Does this “new” legislation you just wrote sound familiar? Yes, it’s Obamacare 2.0…same thing, different name.

 

Subjecting healthcare to market forces to bring down healthcare costs will help (i.e. price transparency), but ensuring coverage for everyone will lead you back to some aspect of Obamacare. I hope Congress understands that.

 

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.