Wednesday, July 29, 2015

Congress Continues Playing With the ACA While Costs Increase

Republican leaders opposing the ACA

Senate Republicans remain committed to repealing the Affordable Care Act (ACA/Obamacare). They plan to use budget reconciliation to pass a bill inserting language into the federal budget that repeals the ACA.

You remember reconciliation, don’t you? It’s how the ACA was passed in the first place.

They only needs 51 votes in the Senate to pass budget reconciliation.

The problem is that reconciliation is supposed to reduce the deficit, as measured by a Congressional Budget Office (CBO) score. The Democrats included taxes and student debt legislation so that the ACA reduced the deficit.

Funny thing is that as scored by the CBO, repealing the ACA would increase the deficit. The only thing that Republicans hate more than the ACA is the deficit.

Isn't the ACA still working well?

While it could be argued the ACA had stymied the increase in health costs, costs are rising again.

This is not good.

Given, part of the reason costs are increasing is that new drugs are being invented that save lives.

But a significant part of the problem is that the cost of prescription drugs was not really addressed by the ACA. The government isn’t even allowed to negotiate with pharma for buying drugs in bulk for Medicare patients. Few mechanisms were put in place to address costs.

Doesn’t the ACA address costs at all?

The ACA did set up the Patient-Centered Outcomes Research Institute (PCORI) which is designed to identify which treatments are the most effective and ideally cheaper.

In addition, the ACA instituted Accountable Care Organizations (ACOs) to coordinate care among doctors, and hospitals to improve care for Medicare patients.

Medicare is a government health insurance program for senior citizens, FYI. For my young readers, you’ll learn about Medicare in a history book, like learning about feudalism or pirates (More on that in another post).

Many say that PCORI and ACO are flawed both in design and in funding which prevents them from effectively addressing costs.

In addition, the Stimulus bill in 2009 allocated money to digitize patient records to improve care.

But these are just a few long-term solutions that take time to find savings.

Part of the problem is that some have been claiming that the ACA was responsible for the decrease in heath costs. Others have said it was a correlation of the Great Recession when people had less money to spend.

What was that bit about the pharmaceutical industry?

The pharmaceutical industry (or just pharma) is a very profitable industry that provides many middle class jobs in a struggling post-industrial economy. For example, Johnson and Johnson is the main economic pillar of the city of New Brunswick, NJ.

Due to its success, the pharmaceutical industry has an influential lobbying group aptly named PhRMA.

Instead of opposing the ACA, PhRMA saw that with if more people received health insurance, they’d be able to sell more drugs. So they were involved in negotiations with the White House where they conceded a few pints and won some concessions, like the bit about negotiating drug costs.

The fact that PhRMA ended up supporting the ACA along with other established interests is one of the reasons the ACA didn’t ultimately fail.

Pharma justifies the high expense of drugs by saying that it’s necessity for covering the overhead of their life-saving drugs. But John Oliver doesn’t agree.

How does this affect anyone?

I’ve had problems maintaining my ADD prescription. I take the generic for Concerta, the long-lasting version of the popular drug Adderall. Concerta can’t be chopped up and snorted like Adderall. Both are controlled substances that are heavily regulated by the government. Due to the amount of Adderall abuse going on, this is somewhat justified

But I’ve never abused Concerta since being on the pill nearly every day since October 2002. Without it, I would never have been able to get the good grades to attend Syracuse University or George Washington University.

Given inconsistent health coverage I’ve had to pay for Concerta without insurance where it costs $7 a pill when buying 30 pills. In addition, the state of New Jersey mandates that you see the doctor and pay that co-pay every 30 days for a new script. So it’s not cheap.