Internist and cardiologist Dr. Tiffany Di Pietro explains why Aetna's exit from ACA exchanges signals a death spiral for the marketplace. She describes how healthy young adults opting out while sick individuals enter creates risk-pool deterioration that costs insurers hundreds of millions. From her Fort Lauderdale practice, she admits 20 uninsured patients daily and argues the ACA omitted key reforms like tort reform and health-savings accounts.
Well, Obamacare officially flatlining. The nation's third largest insurer, Aetna, has announced they are pulling out of the Affordable Care Act's exchange program. The president taking to Twitter saying, "The death spiral with the disastrous Obamacare continues." So what needs to happen to make it truly affordable and workable for the average American with the Republican healthcare plan? Let's talk to internist, board-certified cardiologist, and women's health expert, Dr. Tiffany Di Pietro. Tiffany Di Pietro. Good morning to you.
Thank you. Good morning.
All right. You know, we've heard about this death spiral. We've heard that big insurance companies were getting out, and now we've got evidence that they can't afford to be in it, which says if they can't make money, the system was not obviously built for American healthcare consumption.
Right. The problem is, is there's a risk pool deterioration, meaning that people who get insurance through their employers, it's not really a big issue. But when you're trying to get your own insurance through the government, through the Affordable Care Act, for instance, last year, what's happening is the young people are not in the pool. The young people are opting out.
And all this because they think, I'm healthy, I don't need—
correct. And then what's happening is all the sick people who could not get insurance before or who didn't have insurance but then got sick are now jumping into the pool. And these insurance companies are losing hundreds of millions of dollars.
And so let's explain to folks what the risk pools are. If you are older or you are not healthy, your premiums are going to be higher. And so the government subsidizes you. They put you in a risk pool and then they help you out financially, right?
I mean, a way of thinking about it It's like a car insurance company, for instance. It's like, I'm not going to carry car insurance. I'm going to wait until I get in a car accident and then call a car insurance company to try and get them to get me a new car. Right? Sure.
The Secretary of Health and Human Services, Dr. Tom Price, had this to say regarding Aetna pulling out. He said, Aetna's decision to completely withdraw from the Obamacare exchanges adds to the evidence— the mountain of evidence, that is to say— that Obamacare has failed the American people. Repealing and replacing it is the only solution. You know, I think the average person doesn't care about the politics, they just want to think that if they have to buy their own insurance through something like Obamacare, it's going to be good insurance and it doesn't cost them an arm and a leg.
Correct. I mean, there's a few things— I think as a physician, one of the points that was not covered in the Affordable Care Act and was not taken into consideration is medical liability and tort reform. Because what I know for a fact is a lot of physicians are doing kind of what we say CYA medicine, where you're covering, you know what, and you're ordering tests that might not necessarily need to be ordered because you're afraid of getting sued. So tort reform is a big important factor that was never brought up. Expanding Medicaid, which is done at a state level, is very, very, very important as well because you have some people who cannot afford these Affordable Care programs. And another thing that really needs to be established and addressed is healthcare savings accounts. Healthcare savings accounts is a very good and viable option for a lot of people, pre-tax money that are going in, and then they can afford these higher deductible plans.
You are a doctor down in along the east coast of Florida, down in the Fort Lauderdale area. What do your peers say regarding, you know, what is being done in Congress and trying to fix the healthcare system?
It's— I mean, it's— it really is kind of a broken system. And I think my peers— we're all physicians, right? And we feel like that our voice is not being heard. I mean, come down, look at what's going on. I take call at a hospital where I admit 20 patients a day that have no insurance. So I know it's not working great. And they're saying all these people have insurance. Well, I'm admitting 20 patients a day at a level 1 trauma center that are otherwise young and healthy and maybe get a urinary tract infection or something, and they're getting admitted to the hospital with no insurance.
Well, let's just hope whatever they come up with, uh, there is bipartisan support, which suggests the Democrats are invested in it as well.
And it's something that everyone needs to be invested in it. Absolutely. This is the healthcare of our country. Forget it.
You know what? They need to print that on a card because a lot of people forget about that. They make it a political hot potato.
Yeah.
All right, Dr. Seidman, thank you very much.
Thanks for having me.
