break down and go to pieces if when challenges confront them which they fail to
Toynbee (1889-1975), Civilizations on
frontier of which I speak in not a set of promises – it is a set of challenges.
Fitzgerald Kennedy (1917-1963), Speech accepting Democratic Presidential
Despite the 7 million health exchange enrollment figures,
challenges loom. or perhaps I should say "lurk," ahead for ObamaCare.
- The principle challenge is figuring out what, if anything, the 7 million numbers mean. The government has been tight lipped about
the mix – how many paid, how many were previously uninsured, how many were young, how many were healthy or sick, and how these numbers affect adverse
selection and premium levels, and what the numbers were in key states.
A second challenge will be how to
respond if the premiums and deductible announced in May engender an
angry public reaction.
A third challenge will be what to do if the
enrollment figures fail to lower the number of uninsured – the original goal of
A fourth challenge will be simplifying the online
enrollment process and taking the mystery out of it for the next enrollment
period on November 15, 2014.
A fifth challenge will be how to deal with significant increases in Medicaid numbers. Who will care for them? Less than 50% of
physicians now accept Medicaid patients, primary care physician shortages mount
by the day, 10% of primary care doctors are abandoning independent practice and
entering 3rd party-free,
cash-only practices, and more than 50% are already working for hospitals, where
they have shorter hours.. Is the
answer more community clinics, more mid
level practitioners, or higher pay for
primary care practitioner.
A sixth challenge will be what to do if
Republicans take on the Senate of November 4. 2014. The current odds are they have a 60% to 80%
chance of capturing the Senate.
If a GOP Senate victory should occur, President Obama will
be a health reform lame duck. He will
have veto power, of course, but he and Democrats will have to decide between
stalemate, salvaging ObamaCare, and
compromising. For example what will
they do about proposed cuts for Medicare Advantage plans, to which 30% of seniors belong. Seniors will
bean indispensable and reliable voting bloc in the 2016 Presidential
Republicans, on the other hand, if they are
to win over the independents, the young, women,
and Hispanics, must decide how to
proceed with repeal or replacement, and offer must, in my opinion, offer a positive, attractive, and clearly
understandable alternative health plan to attract support for their candidate. Among other things, the plan should probably
include malpractice reform, more health savings accounts, shopping across state lines, tax credits for individuals as well as
employers, risk pools for the sick to keep premiums low, discounts for seniors
falling into the donut hole, limits of
lifetime spending, and coverage for those with pre-existing illness and for
young adults on their parents plans.
challenge, for Democrats and Republicans
alike, will be what to do if the Republicans take the Senate on November 4. If that should occur, President Obama will be a health reform lame
duck, if not a dead duck, and Democrats will have to decide how to salvage
ObamaCare and what compromises to make. For example,
what will they do about proposed cuts for Medical Advantage plans, cuts
that will anger seniors, the most reliable voting bloc.
on the other hand, will have decide how
to proceed on repeal or replacement, or what alternative reform plan to
offer. The GOP will need to present a united , positive, clean, and
attractive alternative plan to attract
public support. That plan might include
malpractice reform, more health savings
accounts, unbundling of primary care from specialty care, universal tax credits to include those in
individual markets, risk pools to keep premiums low for those with
pre-existing disease. and retention
of popular ObamaCare features, coverage of those with pre-existing
conditions, young adults under their parents
plans, and discounts for seniors falling
into the donut whole.
Tweet: Significant political challenges are ahead
for Democrats and Republicans as
midterm elections approach.
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