Editor’s Note: Ideas Lab asked the Democratic and Republican representatives in the US Senate to submit 5,000 comments on how they will fix health care, an issue that Wisconsinites surveyed as part of the Main Street Agenda Project said is the third most important issue they face. November 5 election.
The Affordable Care Act made many promises to slow the rise in health care costs and improve access to care. In addition, President Obama said you will be able to keep your family doctor. The truth is that health care costs have only risen as quickly as its establishment and access to care has declined in the community as a whole. The family doctor has a sad case but has disappeared. The law sounded good in theory and included a reasonable provision, which made it possible for people with pre-existing conditions to have access to health care, but everything else made health care more expensive and expensive.
Tammy Baldwin’s article:We have defeated Big Pharma, but I am not done fighting for your health
Throughout my life and professional career, I have been forced to delve into the complexities and complexities of our healthcare system to find solutions. In 1991, I was diagnosed with multiple sclerosis at the age of 27, which changed my life forever. As an entrepreneur, I have started thousands of businesses, buying health insurance for thousands of employees throughout my career.
Over 10 years ago, the continued increase in medical expenses began to affect my businesses and my employees. In the end, I had to move to my employer while trying to keep our health care costs intact.
The ACA has played a major role in increasing costs and the breakdown of care
It allowed mass participation in the health system, creating oligarchies and monopolies. As a result, large health care systems do not need to be efficient and are not forced to provide value to patients.
I saw this myself in my hometown of Madison. Madison’s largest health care provider, UW Health, has been approved to purchase the second largest provider, Meriter Health Services. Estimates show that the corporation now controls about 60 percent of the market for hospital services in Madison County. Health care providers have led to inefficiencies, rising costs, and declining access.
This mass integration has also led to a rapid decline in the number of family doctors. The ACA imposed many regulations on the family physician, and integrated health systems made it difficult for family physicians to remain in broad insurance pools, which forced many physicians to retire or sell to larger physician practices. Large health systems will buy independent, medical practices, further increasing their pricing power.
Another major flaw in the AACA is the health loss rate. The MLR is a de-facto cap on profits that requires health insurers to spend a small percentage of their income on treatment. While this sounds good in theory, in reality the law only made medical costs rise faster.
The reason is that if you are doubling what health insurance can do per dollar of premiums, they have no incentive to push back medical expenses to increase their profits. In fact, the only way health insurance companies can grow their profits is to let medical costs go up.
Vertical integration has clearly decreased, increased costs
This has also encouraged tighter integration with health care providers including health insurers and even pharmaceutical benefit managers, decreasing transparency and increasing costs. Cigna, United Health, and CVS Aetna all either own or partner with PBMs, which has allowed them to increase medical costs for their partners, passing on higher costs to patients. Health care premiums have risen 20% faster since MLR went into effect under the AACA than in the previous five years.
Rising health care costs under the AACA have put individuals and families in financial trouble. In 2010, according to KFF, the average household income was $13,770. In 2023 the cost of covering a family rose to $23,980 – a 74% increase over 13 years. More than 60% of Americans are living paycheck to paycheck, meaning they are just one more medical bill away from a financial crisis.
Since 1980, the two sectors with the highest rate of inflation in our economy have been health care and higher education. The relationship between the two industries is that the federal government has increased its involvement and increased funding. A lot of money sounds exciting at first, but in reality it only allowed these two industries to keep raising prices for consumers. Especially in health care, from 1980 to 2023, the Medical Care CPI has increased by approximately 445%. That is amazing.
While rising costs are a major problem, an equally important problem is declining access to aid.
While costs have risen, access to care has fallen in Wisconsin
Rural communities across the country and here in Wisconsin are struggling to provide care. Last summer, two hospitals in Eau Claire and Chippewa Falls, as well as 19 clinics in western Wisconsin, were forced to close due to a number of factors including rising costs, staff shortages and strict regulations.
Smaller hospital systems are struggling to deal with more regulations by the federal government and changes in reimbursement rates. The choice of Sen. Baldwin was making things worse because of other restrictions and laws. We need to address the factors that are forcing these closures and limiting access to care.
Our health system is broken, and it is important that we choose people with real life experience in the area of ​​providing solutions. As your senator, I will fight for increased cost transparency within the health care system, empowering patients and employees to purchase costs and make informed decisions. I will fight to get health insurers and PBMs to release their negotiated rates and discounts, reflecting the true cost of drugs. I will fight to support Community Health Centers to support the opportunity to care for patients in rural and urban areas who are underserved. And I will fight to fix the doctor shortage and expand programs to train new doctors.
The ACA sounded good in theory, but in practice it has many flaws. The result is the issue and Wisconsinites are struggling because of the broken health care system. We need fundamental reforms that put patients first and value market solutions to lower costs, increase access and increase transparency.
Mr. Eric Hovde is the Republican representative in the United States Senate in Wisconsin. He is the CEO of Hovde Properties, a Madison-based real estate development company.
The full text of the US Senate’s health care inquiry
Question: Last spring, two hospitals (in Eau Claire and Chippewa Falls) and 19 clinics closed in western Wisconsin. The Marshfield Clinic Healthcare System started hiring employees earlier this year. In the Milwaukee area, some providers are cutting back on services. Health care systems cite staffing problems, insufficient Medicare and Medicaid reimbursement, high costs and low costs for privately insured patients. How would you consider solving this problem?
Question: Health insurance premiums continue to rise by 2 percent. Meanwhile, the number of people in Wisconsin signing up for health insurance through the Affordable Care Act hit a record earlier this year. What can be done to make health care more affordable for Wisconsin families? From your point of view, what role does the ACA play in this? Would you, for example, recommend repealing, replacing or amending the ACA?
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