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Expect more fragmentation of our dysfunctional health care system

A Big Divergence Is Coming in Health Care Among States

By Margot Sanger-Katz
The New York Times, February 28, 2018

Little by little, the Trump administration is dismantling elements of the Affordable Care Act and creating a health care system that looks more like the one that preceded it. But some states don’t want to go back and are working to build it back up.

Taken together, experts say, the administration’s actions will tend to increase the price of health insurance that follows all the Affordable Care Act’s rules and increase the popularity of health plans that cover fewer services. The result could be divided markets, where healthier people buy lightly regulated plans that don’t cover much health care, lower earners get highly subsidized Obamacare — and sicker middle-class people  face escalating costs for insurance with comprehensive benefits.  

But not everywhere. Several states are considering whether to adopt their own versions of the individual mandate, Obamacare’s rule that people who can afford insurance should pay a fine if they don’t obtain it. A few are looking to tighten rules for short-term health plans. Some states are investing heavily on Obamacare outreach and marketing, even as the federal government cuts back.

The result is likely to be big differences in health insurance options and coverage, depending on where you live. States that lean into the changes might have more health insurance offerings with small price tags, but ones that are inaccessible to people with health problems and don’t cover major health services, like prescription drugs. States pushing back may see more robust Obamacare markets of highly regulated plans, but the price of those plans is likely to remain higher.

The Affordable Care Act was drafted with room for state customization, but one of its primary goals was to make health insurance around the country more uniform. Thanks to state resistance to the health law, varying local conditions and a Supreme Court decision that made the Medicaid expansion optional, results have been much more uneven. Some states have seen much bigger reductions in the share of the uninsured than others. Only some states have seen insurance premiums stabilize.

“Without question I think we’re going to see a natural experiment in the states and a growing divergence in outcomes,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute.

https://www.nytimes.com...

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Finally, a universal healthcare proposal that would work for everyone

By Michael Hiltzik
Los Angeles Times, February 27, 2018

But now take a look at "Medicare Extra for All."

It's not single-payer, exactly, but only single-payer dead-enders could object to its payer provisions. It's the best solution to the realities, politics and drawbacks of the U.S. health insurance system yet to appear, and the time to start pushing it is now.

http://www.latimes.com...

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Comment:

By Don McCanne, M.D.

We should have learned something from the history of health care reform in this nation since we now have by far the most expensive system but the least efficient considering our deficiencies in coverage, access, equity and affordability. So where are we headed?

With the states assuming greater leadership in reform, we can anticipate more of the same with variations - more fragmentation, more administrative excesses, more financial barriers to care, more restrictions in choice of health care professionals, more destabilization of health care coverage - this and more with a failure to control health care spending.

The article by Margot Sanger-Katz describes well the divergence in approaches by the various states, with the best states falling miserably short on application of optimal health policy, whereas other states will perpetuate and possibly expand disastrous policies which can negatively impact the personal finances and health of their residents.

Although there has been an increase in public support for single payer reform, attention is being diverted to proposals such as CAP's Medicare Extra for All - a proposal that has stolen the single payer rhetoric in order to sell a "politically feasible" public option that protects the private insurance industry. The media have totally bought into the rhetoric. Even highly-respected, progressive Los Angeles Times columnist Michael Hiltzik says that "the time to start pushing it is now," as he dismisses us as "single-payer dead-enders." Ouch!

Again, we have to change the politics, but we can't sell out on policy on our way to health care nirvana.

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