Pub. 14 2017 Issue 2

O V E R A C E N T U R Y : B U I L D I N G B E T T E R B A N K S - H E L P I N G N E W M E X I C O R E A L I Z E D R E A M S Issue 2 • 2017 17 considered low-income, as the House bill does, the Senate bill slowly phases out the enhanced funding. But seven states, in- cluding NewMexico, have “trigger laws” tied into any change in federal support for Medicaid, meaning this change would cause NewMexico to voidMedicaid expansion. It is thought that many other states would follow suit and end their expansions in the face of rising costs. The CBO’s estimate of the Senate Version, titled the Better Care Reconciliation Act, estimates the cuts to Medicaid would be less than the House version through 2026 ($772 billion). According to the CBO, under the Senate draft, 22 million more people would be uninsured in 2026 than are currently uninsured. Many people take issue with the massive tax cuts to the wealthy that would result from the AHCA. The ACA included tax increases on the wealthiest Americans in order to pay for coverage expansion, but the AHCA would eliminate those taxes and install tax cuts that would add up to $883 billion, most of thembenefiting the very wealthy, according to the Congressional Budget Office (CBO). Also, the CBO estimates that in 2018, 14 million more people would be uninsured under the AHCA than under current law. That number is estimated to be 19 million by 2020 and 23 million by 2026. One positive aspect of the draft, however, is that it would reduce the deficit by an estimated $119 billion, mostly through a huge reduction in direct spending. It is crucial to understand how this proposed change in healthcare would affect New Mexico, a state highly dependent on Medicaid. According to an analysis from the American Hospital Association, New Mexico’s hospitals will be subject to a $60 million increase in uncompensated care for treating newly uninsured payments in the fiscal year 2018. According to the analysis, “the cumulative cost of uncompensated care to New Mexico hospitals would be $678 million.” This would be, simply put, a disaster for New Mexico. Martin Hickey, CEO of New Mexico Health Connections, is concerned that major cuts toMedicaid could lead to a “collapse” in the state’s nursing home industry, according to an article in the Albuquerque Journal. Two-thirds of the residents in the state’s nursing home industry fund their care through both Medicaid and Medicare. According to the CBO report, premiums would increase by an average of 20 percent by 2018. However, according to the report, “Starting in 2020, average premiums would depend in part on any waivers granted to states and on how those waivers were implemented.” The report outlines three scenarios regarding the waivers. In the first, “About half the population resides in states that would not request waivers. In those states, average premiums in the nongroup market would be about 4 percent lower in 2026 than under current law, mainly because a younger and healthier population would be purchasing the insurance. The changes in premiums would vary for people of different ages. A change in the rules governing how much more insurers can charge older people than younger people, effective in 2019, would directly alter the premiums faced by different age groups, substantially reducing premiums for young adults and raising premiums for older people.” The second scenario: “About one-third of the population resides in states that would make moderate changes to market regulations. In these states, average premiums in the nongroup market would be roughly 20 percent lower in 2026 than under current law, primarily because, on average, insurance policies would provide fewer benefits. Although the changes to regula - tions affecting community rating would be limited, the extent of the changes in the EHBs (10 categories of service health insurance plans must cover under the ACA) would vary widely; the estimated reductions in average premiums range from 10 percent to 30 percent in different areas of the country. The re - ductions for younger people would be substantially larger and those for older people substantially smaller.” The third scenario: “Finally, about one-sixth of the popula- tion resides in states that would obtain waivers that would allow premiums to be set on the basis of an individual’s health status. Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums. Over time, it would becomemore difficult for less healthy people (including people with preexist - ing medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly.” So, given this information regarding the AHCA, it’s clearly targeted to benefit the wealthiest Americans and be detrimental to both the elderly and the poor. To go further into Americans’ unhappiness regarding healthcare, the Commonwealth Fund, a long-standing foundation dedicated to promoting a high-func- tioning healthcare system, has ranked the American healthcare system the worst in the developed world in five consecutive stud - ies. The study examines factors such as quality of care, access to doctors, and equity throughout the country. The U.S. has the most expensive health care system in the world, but ranks the lowest in “efficiency, equity and outcomes.” The most damning indictment of the American healthcare system in the report is that the high rate of expenditure “is not commensurate to the satisfaction of patients or quality of service.” Factors such as high out-of-pocket costs and gaps in coverage hinder the ability of the U.S. to improve healthcare. The study stresses that the lack of equity in American healthcare is a huge problem. The study says, “Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home.” The main differ - ence between America and the other 10 nations in the survey (France, Australia, Germany, Canada, Sweden, New Zealand, Norway, Switzerland, the Netherlands, and the U.K.) is a lack of universal healthcare. Since Americans pay more than any other modern nation in healthcare costs, but the system still ranks last in terms of efficiency, it’s clear why so many are unhappy with the system. The concept of universal health care has been floated by many experts and politicians, but has been met with a great deal of resistance. Universal health care, as the name implies, is a sys- tem that provides health care to all of the citizens of a country. It is funded primarily by tax revenue, but in some countries it includes the option of private payments. Most European uni- versal health care systems are funded by a mix of private and public payments. In countries such as Germany, Japan, and France, the private payments are made in the form of required donations to non-profit sickness funds. So, the question lingers, why does America not have universal healthcare? What are the causes for this conundrum? The most obvious answer is private health insurance companies, who clearly have a vested interest in not turning to universal health care. They have made enormous amounts of money by keeping health insurance for profit. They will continue to spend a lot of money to make sure the system stays as is. Also, if an individual has his or her insurance paid for through an employer or if a person can simply afford high healthcare costs, then that person n The Great Healthcare Debate  continued on page 18