ObamaCare: the Default Option

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This week’s health policy news roundup, curated by Jane M. Orient, MD

As Memorial Day approaches, action on the promised repeal/replace of the Affordable Care Act (ACA or “ObamaCare”) seems to have stalled, while Congress and the frenzied media speculate about whether the President is a Russian mole brought to power by Russian hacking. There is talk of a “silent coup,” and apparently distractions and obstructions to the promised Trump agenda on all fronts. Meanwhile, ObamaCare continues to hemorrhage red ink.

The Trump Administration has not withdrawn its appeal from the U.S. House of Representatives’ case against subsidies to insurers that were not lawfully appropriated. Instead, the Administration has asked the appeals court to delay ruling for another 90 days. The cost-sharing subsidies were paid for May, but nothing in the request commits payment past this month. The future of the subsidies has been in doubt since the May 2016 district judge’s ruling that the government did not have the authority to make the payments.

“The parties continue to discuss measures that would obviate the need for judicial determination of this appeal, including potential legislative action,” the Administration’s report said.

The delay could further destabilize insurance markets as insurers are developing rates and deciding whether to participate in 2018. Loss of the cost-sharing subsidies, they say, could lead them to increase premiums by 15 percent to 20 percent or more, on top of any increases they might seek for other reasons. https://www.nytimes.com/2017/05/22/us/politics/health-care-subsidies-trump.html

AHIP (America’s Health Insurance Plans), along with the U.S. Chamber of Commerce, the American Medical Association, the American Hospital Association, BlueCross BlueShield Association and others, wrote a letter to Senate leaders on Friday asking lawmakers to guarantee the subsidies will be funded through 2018. http://money.cnn.com/2017/05/22/news/economy/trump-subsidies-obamacare/

These subsidies are the item that might make ObamaCare explode. https://www.washingtonpost.com/news/wonk/wp/2017/04/11/this-is-how-obamacare-might-actually-explode/?utm_term=.424082b5d337

Senate Republicans are reportedly considering a two-step phase-out of ACA. Perhaps a bill will be ready in June. The Senate plans to write its own bill instead of using the House bill, the American Health Care Act (AHCA). https://www.usatoday.com/story/news/politics/2017/05/22/senate-republicans-consider-two-step-obamacare-replacement/102027786/

One big problem the Senate sees with AHCA is that it repeals ACA’s Medicaid expansion and replaces it with a flat tax credit that doesn’t provide enough assistance to the working poor, writes Avik Roy. https://www.forbes.com/sites/theapothecary/2017/05/04/if-the-senate-doesnt-fix-the-houses-obamacare-replacement-the-gop-will-pay-a-steep-price/#e81f9114a58f

Steve Forbes writes that Ryan’s “misbegotten healthcare tax credit” is a formula for political suicide, as it will “make health insurance unaffordable for millions of Americans who earn too much to qualify for Medicaid but are too young for Medicare.” He calls on Senate Republicans to save their party. https://www.forbes.com/sites/steveforbes/2017/05/08/will-senate-republicans-rescue-their-party-from-political-suicide/#215af25dd45c

The fate of AHCA’s tax cuts ($1 trillion over 10 years) is uncertain. AHCA repealed most ACA taxes, but the manager’s amendment delayed the Medicare payroll tax hike repeal for 6 years, to 2023. Senator Bill Cassidy (R-La.) has even suggested delaying repeal of even more ObamaCare tax hikes so that the government can spend more than the House AHCA on Medicaid and the refundable aspects of the individual credits, writes Ryan Ellis. https://www.forbes.com/sites/ryanellis/2017/05/10/senate-should-not-leave-taxpayers-behind-in-obamacare-repeal/#5c15fd474df3

With all the emphasis on coverage, Republicans are losing sight of the most important metric: price. http://www.americanthinker.com/blog/2017/04/the_real_metric_for_fixing_health_care.html

Also neglected in all the discussion are the grim fiscal realities—including the main problems of Medicare and Medicaid along with ObamaCare. https://fee.org/articles/americas-fiscal-outlook-in-6-sobering-charts/

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