Health Reform as Seen from Non-DC and OB (Outside Beltway) America

As the final countdown for the November 2 mid-terms begins, people are asking: What triggered this potential GOP wave election and why do people favor repeal of the health reform law?

Multiple reasons exist,of course. The leading ones are slow economic growth, high joblessness, and unsustainable debts at the personal, state, and national levels. On health reform the fears are runaway costs and fear of losing coverage for those with existing plans.

For physicians, chief complaints are – failure to address malpractice reform, Congressional SGR uncertainties , and the feeling that the profession, who deliver the care, has been ignored and has had zero input into the reform process. Who will take care of 34 millions of newly insured patients, with more to surely follow, at reimbursement rates at which they cannot sustain their practices?

For me, reactions to the health reform bill reflects ideological differences. A Gallup poll indicated this ideological split among Americans: conservative 42%, moderate 35%, liberal 20%. Eighty percent, in other words, are non-liberal. Another 35% say they favor the Tea Party, which favors repeal of health reform, and 46% say reform is a bad idea while 36% say it is a good idea.

Should it be any surprise, then, that Americans are skeptical of the reform law, passed under questionable circumstances, that opens entitlement floodgates for millions of Americans while raising costs and causing millions more to lose existing policies? Should it be a surprise, given the following, that the health reform law is threatening to unravel?

The following list giving the reasons for the troubles of Obamacare is based on an article published by Grace Marie Turner in the Galen Institute newsletter.

1. Revolt among the States: At least 10 states have said they will unite to oppose the law’s mandates. And more will follow. Up to 25 new governors will be elected, and 30 will be Republicans. Many of those elected campaigned against reform, and given huge budget deficits, are likely to resist reform mandates.

2. Voter rejection: Three states -- Oklahoma, Arizona, and Colorado -- have ballot initiatives before the voters in November, repudiating the health law. Proponents of repeal, following the 71% vote against the law in Missouri in August, are likely to be emboldened.

3. Lawsuits: There are at least 15 lawsuits against the law. The two largest moved forward last week. The issue of the constitutionality of the individual mandate may be decided by the Supreme Court at the end of the year.

4. Rising costs: Health insurance costs already are rising as a result of the law, and the pressures will intensify. Boeing is the latest company to tell its 90,000 employees that it will increase the price of employee health insurance in response to rapidly rising insurance costs due to the health law.

5. Towering deficits: Gov. Philip Bredesen, Democrat of Tennessee, warned in a Wall Street Journal Op-Ed on October 21 that the health overhaul law creates strong incentives for employers to drop health coverage.

6. Seniors hit hard: Medicare Actuary Rick Foster has said the health overhaul law will gut the popular Medicare Advantage program and that the coverage will cost seniors more. Foster estimates seniors' costs will go up by $346 in 2011 and as much as $923 by 2017.

7. Millions losing coverage: The Principal Group announced it plans to drop health coverage for 840,000 policyholders; 11 million seniors will lose Medicare Advantage plans; child-only policies already are vanishing from the market ; retirees are losing supplemental coverage; and major employers are considering dropping health benefits.

8. Job-killing mandates: The U.S. Chamber of Commerce said that nearly eight in 10 small business leaders expect their costs to increase as a result of the new law. The majority say they will be less likely to hire new employees and more likely to reduce current benefits.

9. Searching for the exits: The McDonald's waiver shows that companies have to be protected against the law to avoid its damage; dozens more waivers have been granted so a million people didn't lose their mini-med coverage just before the election.

10. Lower Quality, higher costs: A Wall Street Journal poll last week found most voters believe the new law will cause them to get lower quality care, pay more in insurance premiums or taxes, or both.