David Edelman is co-founder and CEO of Diabetes Daily, a leading diabetes online community. His goal: “I strive to help everyone touched by diabetes achieve a healthier, happier and more hope-filled life.” DiabeticLifestyle's Editor Maureen Connolly chatted with Edelman about the impact repealing the Affordable Care Act could have on the millions of people with diabetes who are currently insured by the ACA.
1. Provide coverage to everyone regardless of pre-existing conditions.
2. Because of #1, you need a mandate requiring insurance coverage, or healthy people would be incentivized to wait until they are sick in order to sign up.
3. Because you require coverage, you need subsidies.
This is basically the only way to make it work in a market-based system. (Which is why the conservative think-tank the Heritage Foundation developed the idea as a conservative alternative to a single-payer system like the NHS in the United Kingdom.)
Do you see any problems with how the ACA currently functions? Absolutely. There are many problems with the ACA. For example, subsidies are phased out too early, making out-of-pocket costs expensive for the middle class. Also, many states have still chosen not to expand Medicaid, which means that the working poor are unable to afford insurance because they don’t qualify for subsidies.
There are many ways the law could be fixed through tweaks. However, those tweaks have been politically toxic and intentionally prevented in order to hamstring the law.
Do you think the ACA has succeeded in some way? In its main goals, the ACA succeeded: it has slowed the growth in the cost of health care while simultaneously expanding coverage. Though some individuals have seen rate increases, the amount of spending on health care has dramatically slowed from double digits to single digits.
Before the ACA, there were millions who were uninsurable due to a pre-existing condition like diabetes. Health care spending was predicted to eat up an increasing share of our national spending over the next two to three decades. This is no longer true and a major accomplishment.
What do you think will happen if the ACA is repealed? If the ACA is repealed, there are two things likley to happen. It will be replaced by something that is the same, but called something different. We would likely get a plan that covers millions fewer people by shifting the cost of health care from the society level to the individual level.
The conservative alternative to the ACA that is most frequently proposed is Health Saving Accounts combined with high deductible plans. Basically, your health expenses are tax-deductible and a typical plan might require that the individual is responsible for the first $10,000 payments each year.
What about the proposal to "repeal and replace"? That’s one of the issues. There is no “replace.” The reason there has been no "replace" in "repeal and replace" is that the alternatives are worse than the current system. The strongest arguments for health care coverage are a market-based solution like we have or a single payer system that covers everyone using tax revenue.
Because a repeal of the ACA or moving to health-savings accounts would increase the out-of-pocket cost of insurance for tens of millions of people, I would be surprised if it happened. I think the most likely change is a series of cosmetic changes and a name change to resolve the political need.
Trump has asserted that there’s a better solution to the ACA where everyone would be covered and it’ll cost less. What do you think about this? The idea that there is some better magical solution where we cover everyone and provide more services for less money is preposterous. The political leaders who have been promising this are either ignorant or lying for political gain.
There are trade-offs to every system. If we as a society decide that we want to cover everyone, even if they have diabetes and little ability to pay for the full cost of their care, then we end up with a system like what we have or a single payer.
To reduce the cost of care, your choices are: (1) pay doctors and hospitals less, (2) remove the insurance middle man, (3) spread the cost across more healthy people, or (4) restrict access to unproven and expensive procedures. There are downsides to each approach.
Where do you personally stand on this issue? Health care is very much a political topic, but I don't come at this from a political viewpoint. I'm not a liberal or a conservative on this. I am supportive of any system that covers everyone, provides reasonable levels of health care, and doesn't financially break individuals. Personally, I think a look around the world shows that this is best achieved through a single payer system. However, given the realities of American political inclinations and skepticism of government, something like the conservative plan developed by Republicans and passed under Obama (called the ACA), is a reasonable market-based approach. We must come together as a community to make sure everyone with chronic illnesses receive quality health care. If we don't fight for this, we may lose. Sitting quietly on the sidelines is unacceptable. We need to be loud, organized, and merciless to our political representatives.
Edelman is the author of Thriving with Diabetes, a step-by-step guide to lifelong health and happiness.