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Speakers offered solutions Monday night to combat rising health care costs in Missouri and told people about differences between the Affordable Care Act and a proposed Senate bill attempt to repeal the ACA.
About 100 people gathered on the Lincoln University campus to hear doctors and nonprofit leaders tell the audience how the Affordable Care Act may change under the proposed Senate bill. They explained why premiums rose so much after the bill's implementation and advocated for changes to Medicare that they said would save the country money.
Before diving into what may change under the Senate bill, Ryan Barker wanted attendees to understand the original goals of the ACA. He is vice president of the Missouri Foundation for Health, a St. Louis-based health care advocacy nonprofit.
Missouri spends $35 billion per year on health care. Before President Barack Obama signed ACA in 2010, 50 million Americans were uninsured. Today, Barker told the crowd, just 26 million people are uninsured. While most people get insurance through their employer, Barker said the goal of the ACA was to give individuals more buying power.
"What the marketplace was meant to do, was to provide individuals and families with the buying power of a large employer," Barker said. "The hope was there would be a lot of different insurance companies competing in this marketplace, and it would keep prices down."
Attendees wondered why premium prices rose sharply after the ACA took effect.
Barker said the ACA put sick people and healthy people in the same pool instead of different coverage pools as before. The ACA also put people in pools that included services they didn't need. Barker and others said this raised premiums for some, including young and healthy people, but lowered premium costs overall.
"Some of this is the loss of community as a nation, about looking out for your brothers and sisters," Barker said. "The way insurance works best is if we're all in it together, if it's a community benefit."
Jay Agoff, a Washington attorney who oversaw the implementation of the ACA in Missouri, said having more people in insurance companies allows insurance companies to price accurately.
"Over the long run, that's going to keep rates the lowest for everyone," Agoff said. "The more data an insurance company has, the more accurate its rates can be."
Barker told the crowd the proposed Senate bill included several changes to the ACA, but did not intend to fully repeal the ACA because it was a budget bill. As panel spoke, however, the Senate bill appeared to fall apart in Washington after two Republican senators announced they would not support the proposed bill, effectively killing the legislation.
Barker told the crowd the ACA allowed insurers to charge older people three times as much as young people, but the Senate bill allowed companies to charge older Americans five times as much. Under the Senate bill, companies could also offer cheaper "bare bones" plans as long as they offered one plan that included 10 required benefits under the ACA, Barker said.
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In May, Blue Cross and Blue Shield of Kansas City announced plans to pull out of the ACA health insurance exchanges. The move left a part of northwestern Missouri without an insurance provider in the ACA marketplace. It was just one of several insurers to pull out of marketplaces this year. Barker said it was always expected to take decade for the marketplaces to stabilize, but Congress and other healthcare leaders seem eager to scrap the ACA instead of fix it.
"Part of exactly what we knew was going to happen happened, and now some folks are screaming about it," Barker said. "That takes time."
Dr. Ed Weisbart, former chief medical officer at Express Scripts, advocated for a program similar to a single-payer health care system he calls "Medicare for all." Weisbart said taxes actually pay for about two-thirds of U.S. health care costs.
While doctors would be privatized under this system, taxes would fund a national version of health insurance. This would allow patients to still pick their doctors and hospitals. The savings would come from saving money on redundant bureaucracies currently handled by different insurance companies, he said.