Kevin Drum interprets the latest Congressional Budget Office (CBO) report on the financial results if Trump does, in fact, trash the Cost Sharing Reductions (CSRs) in an effort to discredit the ACA:
This comes from a new CBO report on the likely effects of eliminating Obamacare’s CSR subsidies. Basically, the federal government would save money by not paying the CSR subsidies but lose money by paying more in tax credits to poor families. The net result would be more spending on Obamacare.
There’s a couple of fascinating facets to this. First of all, the CBO constitutes an expert agency, a thing to which President Trump has become quite allergic over the last year. After all, sometimes experts bring unwanted results, and we can’t have that damaging the fragile Presidential ego, now can we?
So perhaps he’ll disregard this report, trash the CSRs, and then we’ll find out – are the experts worth their pay?
The other fascinating part is how the the more regular care facilitated by the ACA leads to a national cost-savings. I mean, we shouldn’t be surprised at this, it was, no doubt, even predicted, but still the decline in the growth of spending rates has outpaced even that predicted by the CBO.
In a bit of related news, The New York Times is reporting another prediction is not coming true – a shortage of GPs:
Studies published just before the 2014 coverage expansion predicted a demand for millions more annual primary care appointments, requiring thousands of new primary care providers just to keep up. But a more recent study suggests primary care appointment availability may not have suffered as much as expected.
The study, published in April in JAMA Internal Medicine, found that across 10 states, primary care appointment availability for Medicaid enrollees increased since the Affordable Care Act’s coverage expansions went into effect. For privately insured patients, appointment availability held steady. All of the gains in access to care for Medicaid enrollees were concentrated in states that expanded Medicaid coverage. For instance, in Illinois 20 percent more primary care physicians accepted Medicaid after expansion than before it. Gains in Iowa and Pennsylvania were lower, but still substantial: 8 percent and 7 percent.
Though these findings are consistent with other research, including a study of Medicaid expansion in Michigan, they are contrary to intuition. In places where coverage gains were larger — in Medicaid expansion states — primary care appointment availability grew more.
Clouds on the horizon if you don’t take care of yourself.
Intuition is simply short-cut thinking, reasoning without considering nearly any hidden factors. So – keeping in mind this is quite the limited study, since it only covers 10 states – what might be some of these factors? The article cites better compensation rates for Medicaid patients. In fact, I wonder if, as more patients sport the Medicaid badge, they become a desirable patient, especially with the rise in compensation – so more docs decided to accept Medicaid.
But I’d like to pursue the benefits of regular checkups a little further. Think of a car – if you get the oil changed on the manufacturers schedule, you have a better than even chance that you’ll never encounter a serious problem with the engine for at least a decade. Neglect changing the oil for five years, on the other hand, results in an expensive engine rebuild or replacement, as a friend of mine found out a while back.
Same goes for people. Regular checkups means the doc can move quickly through his checklist of things, but if you haven’t been in for a decade, then he or she must be more thorough, maybe prescribe more vaccines, etc etc.
All this and no Sarah Palin death panels, either. Imagine that.
