I was curious how to answer those who question how the ACA will be paid for.

[flying rabbit]

I came across this: (written in 2010) http://www.larkinhoffman.com/news/article_detail.cfm?ARTICLE_ID=636
Seems fairly lucid. Anyone have any comments?

[PoliticAverse]

1. Yes those are all projected numbers, we won't really know for a while how the reality meshes with

the projected.

[kelliekat44]

2. Summer interns are great analysts. nt

[kelliekat44]

3. How about no more wars and a huge cut in military expenditures on waste, fraud, and abuse by

MIC contractors?

[flying rabbit]

4. Sure that would be great too.

I was just looking to explain to someone how it would get paid for(without your wishlist). The article seemed to lay out a sensible funding stream. I was wondering if other DUers more knowledgeable on the subject would weigh in on the accuracy of what was written.

[Recursion]

5. The funding is in the law

At least, a lot of it is. There are some new taxes, the Medicare levy cap was lifted and Medicare is levied on some new types of income now.

[Sarah Ibarruri]

6. Yes. Here's a comment: Larkin Hoffman is a law firm of lobbyists. nt

[flying rabbit]

7. OK good to know

The article itself seemed fairly neutral.

[Sarah Ibarruri]

8. Nope. They're lobbyists. Google them. nt

[flying rabbit]

9. I see that,

did you read the article?

[Sarah Ibarruri]

10. Yes. An article written for the purpose of lobbying nt

[pnwmom]

11. The article leaves out a major source of funding. During the Reagan administration,

a law was passed requiring hospitals to provide free care for people who turned up in their emergency rooms and couldn't afford it. Hospitals couldn't manage this on their own, so the government has been reimbursing them for some of this cost, and other costs have been passed on to their paying customers -- including Medicare patients -- in the form of higher bills.

ER's are extremely expensive places and a very inefficient way to provide care, but that's where a lot of people have been ending up because it was the only option available to them. The ACA expanded the Medicaid program and subsidized other people, so there would be many fewer people turning up in expensive emergency rooms for basic care. At the same time, it CUT BACK on the payments to hospitals for uninsured patients, because there were supposed to be fewer of them now. This should be a net savings because it's cheaper to take care of most things in clinics instead of E.R.'s.

Unfortunately for the states that chose not to expand Medicaid, their hospitals will still be losing some of the funding they've been getting to reimburse them for uninsured care. That's how the ACA was written because no one expected 36 states to turn down the free Medicaid funds.

The hospitals in 36 states will be feeling the effects. And not in a good way.

[flying rabbit]

12. Okay

That's The kind of stuff I am looking for. Easy stuff to explain. Thanks for your post!
And it makes more sense towards the lobbying claim up above.

[pnwmom]

15. Here's a more detailed article.

Even it doesn't include one of the savings - at last at a quick glance. I didn't see it mention that the government will save in costs for its Medicare and Medicaid patients, because the hospitals won't have to raise their prices so much to cover the uninsured in the E.R.s

http://tcf.org/assets/downloads/tcf-bettercare.pdf

[flying rabbit]

16. Thanks again. nt

[DebJ]

20. Also there are long-term cost-cutting measures. My area is using one of them already.

Part of the high cost of health care is the extremely high readmission rates of elderly patients.
After surgery or illness, often they misunderstand or forget the regimens and medicines they are
to follow, resulting in the sad necessity of a readmission. To prevent that, saving pain and money,
our hospital now sends out a nurse to these patients' homes after they leave the hospital, to insure
that regimens are understood and are properly followed. This is much more cost-effective than
readmission, not to mention, more humane.

My parents are in their 80s now, and they have difficulty even remembering what the doctor told
them to do just the day before from a regular visit, so I can see how very necessary this is.
And compassionate.

I just love it when compassion is the most cost-effective choice!

[pnwmom]

22. That's a great idea. I hope they'll all be moving toward this now. n/t

[Recursion]

17. The problem with that being that the uninsured don't use ERs at a higher rate than the insured

Now, it's possible (likely, even) that they cost more per visit than the insured, but unfortunately we don't have those data. They would be good to have. But barring that, we can't honestly make the basic claim we're making, that broadening access to insurance pays for itself in the long run.

[DebJ]

19. Since the pricing for uninsured was easily triple that of negotiated insurance payments,

it's hard too tell. The entire system is just capitalist greed gone completely insane.

What do they bill? Whatever they can.

[Recursion]

21. Definitely, that's yet another problem there

That is actually one good idea Republicans do have, more transparency and uniformity in provider pricing. The ACA pushes a little in that direction, but not enough.

[pnwmom]

23. The ACA IS reducing the payments made to hospitals with lots of uninsured patients

through the "disproportionate share" law. This will be happening, even to the states that rejected Medicaid expansion. So the Medicaid expansion WILL be paid for in part by reducing those payments to hospitals. If the hospitals are screwed, that will be a matter for the states to take care of -- the states that refused the money for Medicaid expansion.

But the other issue is that this isn't about uninsured people using the ER's at a higher rate. It's that the same care -- say, for a urinary tract infection -- is much cheaper when delivered at a setting other than an Emergency Room. They might not use the ER more than other people, but it might be their only choice, even for medical conditions that otherwise wouldn't require an E.R.

[Recursion]

24. Good point, sorry, I was misreading your post

Yes, that change is "working", though like you point out it's about to smack hospitals in non-expansion states in the face. Which hopefully will put some pressure on their legislatures to do something about it.

[JaneyVee]

13. Didn't we also raise taxes on the rich

[pnwmom]

14. That was included in the article -- a surcharge on investment income over $200K. nt

[Recursion]

18. Somewhat. We levied investment income, which is a huge Rubicon to cross

That wasn't as much of the funding as most of us would like, but it's the first time we did it as an explicit surcharge, which is a good step.