Explaining the issues

Healthcare: Who calls the shots, from Philly to D.C.

A no-frills explainer about policy related to your body.

Molly Adams / Flickr

The federal government has ushered in massive changes to the nation’s healthcare system in recent years.

With the adoption of the Affordable Care Act in 2010 came a sweeping raft of federally regulated health coverage options, insurance market standards, and consumer protections — but the fate of the law is very much up in the air. Any changes will affect millions of Americans in the years to come.

Where do Pennsylvania and Philadelphia stand in this mess? There isn’t a whole lot to do while D.C. untangles the future of medical coverage. However, state governments have been able to effect some positively-received reforms.

The biggest debates

  • The fate of the Affordable Care Act: Will President Trump try to repeal and replace Obamacare again — and will he succeed? That battle will be decided on Capitol Hill.
  • Preexisting conditions: Under the ACA, insurance companies can not deny or raise your insurance coverage premiums for preexisting conditions, i.e. anything from asthma to cancer.
  • Universal healthcare covers: Medicare for All, single-payer — you’ve probably heard of these policy proposals. Do they have a shot?

How national policy can address healthcare

Despite some acknowledged flaws in the Affordable Care Act, Americans on both sides of the political spectrum overwhelmingly want to preserve these protections afforded under the former president’s landmark healthcare bill.

President Donald Trump’s repeal-and-replace bill — which failed to pass last year — would have allowed insurance companies to deny coverage for preexisting conditions, or else charge exorbitant premiums. Congressional Republicans have come under fire on the 2018 campaign trail for their role in that fiasco. (See: Lou Barletta.)

That’s because the fate of the U.S. healthcare system currently sits in Congress’ lap.

Alternate single-payer systems, where the government controls and regulates all payments to insurers, have gained traction in recent years. Chief among them? Sen. Bernie Sanders Medicare-for-All bill has the highest approval rating: 62 percent of Americans said they liked the idea of expanding the government-run plan provides insurance coverage to everyone. Here’s a visualization of how a single-payer healthcare system works, courtesy of Vox:

How state policy can address healthcare

State lawmakers do have ways to regulate their own insurance markets under the Affordable Care Act.

In fact, the Trump administration is now actively guiding states to deviate away from Obamacare requirements and provide a lower standard of coverage not previously allowed, according to the Commonwealth Fund, a privately endowed foundation that focusses on healthcare reform.

Half of Pennsylvanians struggle with the affordability of healthcare, new studies show. Federal overhauls to the system aside, state governments have some options that could impact how much you pay — and how you pay — for care.

Arkansas established a statewide payment reform that bundles all payments from private and public insurers, which seeks to reduce massive fluctuations in healthcare costs. In Maryland, state lawmakers ended fee-for-service payments to hospitals and rolled out something called global budgeting for all hospitals in the state, which saved hundreds of millions in Medicare costs and improved health outcomes for patients.

How city policy can address healthcare

Cities have relatively few options to control costs here. However, the city’s Health Department is involved with providing quality of care to residents through public and private insurance companies.

Philadelphia is one of the few cities in the country with government-operated health clinics, which accept Medicare, Medicaid, HMO plans, and most other insurance options.

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