Thursday, June 29, 2017


Re-Doing Affordable Care Act: A Quicksand or A Quagmire? After suffering a defeat earlier, the Trump Administration's attempt to repeal Affordable Care Act, ACA (a.k.a. Obamacare), is now back on the legislative agenda by a victory of very few votes in the U.S. House of Representative. Given the fact that Mr. Trump has thus far been using Executive Orders as a means of doing administrative businesses, this victory is indeed no small feat. However, at this moment, this ACA's repeal or replacement legislation is still in limbo as the Senate chamber was and is unable to garner enough votes to pass it through to Mr. Trump for signing. The purpose of this article is not to criticize Mr. Trump per se, but rather to point out that there might be a better way to skin the cat. From my short research on the Internet, added by old knowledge left over from lessons learned in university, the U.S.A. has four forms of health care insurance services for the needs of her population. The first one is private medical care insurance that anyone can buy to provide the services for his/her needs. The second is Medicare which provides medical services for retired elderly people who had pre-paid for it in the form of tax deduction from their paychecks. The third is Veteran healthcare services for those who had served in the military. The fourth is Medicaid which provides services for people who live below the poverty lines, including the elderly who are not eligible for Medicare, the disable, and single mothers with dependent children. The last three of these medical care services are government-run programs. Based on these existing programs, the only group of people who need ACA are those whose incomes are too high to qualified for Medicaid and whose employers are not obliged to provide or subsidize for their medical care insurance. Without employer's subsidy for their medical care insurance, many (if not most) of these people are left with two options in life: buying medical care insurance to maintain good health or buying foods to maintain livelihood. Needless to say, most choose the latter. The fact that people don't buy medical care insurance is not really a problem. Problem occurs when uninsured people start using emergency care services at hospitals to fix their ailments. Because the law requires hospitals to treat people in an emergency regardless if they have medical insurance or the ability to pay the bills, the influx of medically uninsured people seeking treatments via emergency procedure put heavy burden on hospital's financial resources. So, to address the problem, many U.S. Presidents started to find a way to introduce legislation to fix the dilemma once and for all. People may recall that the ACA took about two decades to come into existence. The sole purpose of this law is to fill the gap of health care for the U.S. population who are left without medical care coverage. Starting in the early 1990s, immediately after taking office, President Bill Clinton assigned his wife, Hillary Clinton, to campaign for a legislation to provide affordable medical care coverage for the uninsured. However, the initiative failed to gather enough supports in Congress, so it stayed dormant as a concept for 16 years until President Barack Obama took office in 2008 that he was able to revive it and made it become the law of the land. Now that it has been repealed, one could only hope that the ACA won't take another 20 years to return to existence. Without repeating Mr. Trump's fusses, the ACA is no magic wand as far as affordable medical insurance is concerned. It has many flaws. One of the biggest flaws is having private healthcare insurance companies manage the program. The main goal of private healthcare insurance companies is to make profits, not providing affordable healthcare insurance. One way to correct this oxymoronic flaw is to expand Medicaid program in the form of pay for services. The Federal Government could transfer the whole program to each state to run it based on what the local people needs not based on what politicians in Washington think they needs. We could call it Medicaid Plus (Part A, B, and C) and have people paid for it based on what they needs for their individual care. Those who need more pay more, and those who need less could pay less. This streamline approach could save a lot of money and headaches for many people. Some people might point out that not many doctors or private clinics accept Medicaid insurance because it takes too long to get the claims paid. This problem could be resolved easily as the states regulate the licensing of both doctors and clinics. The states could do both, expedite the payment to doctors and make issuance of license to practice medicine contingent upon acceptance of Medicaid insurance program. This approach might be simplistic; but, if the goal of the legislation is to provide affordable healthcare insurance to the uninsured, expanded Medicaid insurance program is probably the best option.

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