Tag Archive: Clinton administration

GOP shuts out doctors, experts, Democrats — pretty much everybody — as they work on Obamacare repeal – LA Times

President Trump and House Republicans, in their rush to resuscitate a bill rolling back the Affordable Care Act, are increasingly isolating themselves from outside input and rejecting entreaties to work collaboratively, according to multiple healthcare officials who have tried to engage GOP leaders. The White House and its House GOP allies are hoping to reschedule a vote on their overhaul plan in the coming days, following last month’s embarrassing retreat when the bill was pulled shortly before a vote. But they continue to refuse to reach out to Democrats. Even Senate Republicans have been largely sidelined, though their support will be crucial to putting a measure on Trump’s desk. And senior House Republicans and White House officials have almost completely shut out doctors, hospitals, patient advocates and others who work in the healthcare system, industry officials say, despite pleas from many healthcare leaders to seek an alternative path that doesn’t threaten protections for tens of millions of Americans.

Source: GOP shuts out doctors, experts, Democrats — pretty much everybody — as they work on Obamacare repeal – LA Times

Politicians are naturally inclined to craft these reforms behind closed doors given the fact that medical care in the United States — and particularly who pays for it — is a textbook example of a wicked problem. Soliciting input from stakeholder groups is likely to lead back to square one: everyone agrees there’s a problem, but no one can agree on how to solve it and there’s little common ground. So policymakers say to themselves, “OK, we’ll decide for them.”

Given the nature of the challenge when it comes to health care reform, Hillary Clinton went behind closed doors in 1993, convening an assortment of 100 policy wonks and experts as the Task Force on National Health Care Reform to forge the Clinton administration’s ill fated Health Security Act. However meritorious the legislation was, it was dead on arrival in Congress due to the perception it was drafted in secret without sufficient stakeholder input and strong opposition from health plans and small business.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Health benefit exchanges, community rating could reinforce, boost self employment trend

Like the Clinton administration’s comprehensive health care reform proposal of the 1990s, a key goal of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) is having all Americans medically insured though public or private health plans.  Since coverage gaps largely occur with private coverage, private market reform is central to the reforms of both administrations.

Since most working age Americans have employer-paid coverage, the Clinton administration’s reforms would have required all employers to cover their employees so that none had to obtain their own coverage in the individual market or be medically uninsured.  Rather than the Clinton administration’s employer mandate, the Obama administration instead placed the mandate on individuals, requiring all Americans to have medical coverage by 2014.  Key to the individual mandate in the PPACA is the law’s state health benefit exchanges to provide an insurance marketplace for small employers and individuals.

If the U.S. Supreme Court upholds the constitutionality of the individual mandate later this year, it could mesh well what some observers believe is a trend toward more temporary and self-employment.  This trend has seen a significant boost in recent years as employers hire fewer people to do the same work or adopt processes that require fewer permanent staff.  This in turn has led to growing numbers of temporary and self-employed people.

Since these workers aren’t covered by employer-provided plans and must obtain health coverage on their own, they will benefit from the exchanges where participating insurers will be required to offer coverage with minimum coverages and premiums determined using modified community-based rating versus medical underwriting.  As 2014 draws closer, the exchanges could in turn encourage more to deliberately choose temporary and self-employment.  Many who might otherwise work for themselves balk at the prospect of having to find health coverage in the existing individual market where they can be declined for pre-existing medical conditions and don’t benefit from group purchasing power the exchanges would provide.  The exchanges and the PPACA’s mandates that all individuals have coverage and health plans and insurers accept all applicants regardless of medical history would significantly mitigate this disincentive for those considering self-employment.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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