Editor’s Notes: The Ideas Lab asked Democratic and Republican candidates for the US Senate to submit 1,000-word essays on how to deal with health care, an issue Wisconsinites polled as part of the Main Street Agenda project said is the third most pressing issue. the Nov. election. 5.
The Affordable Care Act made many promises to reduce rising health care costs and improve access to care. In addition, President Obama said you can keep your family doctor. The reality is that health care costs have only increased at a faster rate as implementation and access to care has decreased in all areas. The family doctor has just disappeared. The law was clear in concept and included one reasonable provision, which ensured that people with pre-existing conditions could get health care, but everything else made health care more expensive and worse.
Tammy Baldwin’s story:We beat Big Pharma, but I couldn’t fight for your health care
In both my personal life and my professional work, I have been forced to delve into the problems and challenges 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 several businesses, and purchased health insurance for thousands of employees throughout my career.
More than 10 years ago, the increase in medical expenses began to affect my businesses and my employees. Eventually, I had to move to work on my insurance so I wouldn’t have to pay for medical bills.
The ACA played a major role in increasing costs and decreasing care
It allowed greater integration between health systems, creating oligarchies and monopolies. As a result, major medical procedures are not required to be effective and are not required to provide the necessary recommendations to patients.
I saw this in my hometown of Madison. Madison’s largest health provider, UW Health, has been approved to purchase a second largest provider, Meriter Health Services. Estimates show that the combined group now controls about 60% of the hospital services market in Madison County. The standardization of health care has led to inefficiencies, high costs, and limited access.
This extensive merger has also led to a rapid decline in the number of family physicians. The ACA imposed many regulations on family physicians, and integrated medical practices made it difficult for family physicians to remain in insurance pools, which forced many physicians to resign or sell to general practitioners. Large health care systems buy independent, physician-managed systems, which increases their pricing power.
Another major flaw in the ACA is the hospital mortality rate. MLR is an acronym for the benefit that requires health insurers to spend a minimum of their income on medical expenses. Although this seems good in theory, in reality this law only increases the cost of medical care so that it can go up faster.
The reason is that if you are calculating what health insurance can do in terms of premiums, they no longer have an incentive to reimburse medical expenses to maximize their profits. In fact, the only way health insurance can increase its profits is to allow medical costs to rise.
Direct integration has reduced transparency, liquidity
This also encouraged vertical integration with healthcare providers including health insurers and pharmacy benefit managers, reducing exposure and increasing costs. Cigna, United Health, and CVS Aetna all own PBMs or partner with PBMs, which has allowed them to increase their medical costs to their partners, providing higher value to patients. Health care premiums have risen 20% faster since the MLR went into effect under the ACA than in the previous five years.
The increase in health care costs under the ACA has put individuals and families in financial trouble. In 2010, according to KFF, family coverage cost $13,770. In 2023 household spending will rise to $23,968 – a 74% increase over 13 years. More than 60% of Americans have copayments, meaning only one medical bill is a financial burden.
Since 1980, the two sectors with the highest costs in our economy are health care and higher education. The commonality between the two industries is that the federal government has been very concerned about the amount of money. More money sounds attractive at first, but reality has allowed the two companies to continue raising prices for consumers. Especially in health care, from 1980 to 2023, the Medical Care CPI increased by about 445%. That is amazing.
While the increase in prices is a major problem, an equally important problem is the lack of access to care.
While costs are up, access to care is down in Wisconsin
Rural communities across the country and right here in Wisconsin are struggling to get help. Last year, two hospitals in Eau Claire and Chippewa Falls, along with 19 hospitals in western Wisconsin, were forced to close due to a number of factors including rising costs, staff shortages and legal challenges.
Smaller hospital systems are being hit hard by federal government regulations and changes in reimbursement rates. The response of Sen. Baldwin was making things worse by demanding more restrictions and regulations. We need to address the root causes of this closure and reduce access to care.
Our health care system is broken, and it is important that we elect people with real experience instead of providing solutions. As your senator, I will fight for price transparency in health care, empowering patients and staff to shop around for prices and make informed choices. I will fight to require health insurers and PBMs to disclose their drug reimbursements and deductibles, and disclose the true cost of prescription drugs. I will fight to support Community Health Centers to strengthen the access to services for underserved rural and urban patients. And I will combat the shortage of doctors by increasing training programs for new doctors.
The ACA sounded good in theory, but in practice it has many flaws. The consequences are dire and Wisconsinites are suffering because of our broken health care system. We need a radical reform that puts patients first and prioritizes market-based solutions to reduce costs, increase access and increase transparency.
Eric Hovde is a Republican candidate for the US Senate from Wisconsin. He is the CEO of Hovde Properties, a real estate company based in Madison.
Full text of the US Senate health care question
Question: Last year, two hospitals (in Eau Claire and Chippewa Falls) and 19 hospitals were closed in western Wisconsin. Marshfield Clinic Healthcare System launched the hiring process earlier this year. In the Milwaukee area, some providers are cutting back. Health care systems cite staffing challenges, inadequate Medicare and Medicaid reimbursement, high costs and a low number of patients with private insurance. What can you do to overcome this problem?
Question: Health insurance premiums continue to rise at 2 percent. Meanwhile, the number of people in Wisconsin signing up for health insurance through the Affordable Care Act spiked earlier this year. What can be done to make health care more affordable for Wisconsin families? In your opinion, what role does the ACA play in this? Would you like, for example, to repeal, replace or replace the ACA?
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