This week’s ObamaCare news round-up curated by Jane M. Orient, M.D.
Republicans are posturing about the repeal of the Affordable Care Act (ACA or “ObamaCare”) through the budget reconciliation, but this is only a partial repeal, which leaves intact the regulations that make the insurance market insolvent, depress the job market, and result in sky-high premium increases. The plan may repeal only part of the funding mechanism. The bill proposed by Sen. Bill Cassidy (R-FL) would keep the Cadillac tax to help fund “Obamacare 2.0.” More of the replacement would be financed through a reserve fund set up to “recapture the budget savings from repealing the Obamacare subsidies,” writes Daniel Horowitz. https://www.conservativereview.com/commentary/2017/01/the-republican-plans-to-embrace-obamacare-2-0[In other words, the negative of a negative is a positive: not spending funds that you don’t actually have but have appropriated to spend somehow puts positive funds into your account. Or, the negative of a liability, e.g. a canceled debt, is not zero but rather a positive asset that can be spent. The money tree has been discovered!]
“Trump ran on tearing down onerous insurance regulations, purchasing insurance across state lines, and expanding HSAs. In other words, he ran on cutting prices, not on the elusive and counterproductive goal of universal coverage. Why are Republicans headed in the exact opposite direction, and why are conservatives missing in action?” Horowitz writes.
The RINO plans fail to deal with “the central problem of many with the ACA,” writes Brian Blase. That is “its requirement for comprehensive coverage.” The way to get better care for much less money is to replace this as the favored method to pay for medical care.
“Through Medicare, Medicaid, the ACA, and the tax exclusion for employer-sponsored insurance, the federal government is providing more than $1 trillion of subsidies for comprehensive health insurance each year. The subsidies tend to be delivered directly to insurance companies or hospitals. Outcomes would undoubtedly be far better if financial assistance was provided directly to consumers and market forces—producers attempting to satisfy consumer desires and consumers looking for the best deals—were allowed to flourish.” http://www.forbes.com/sites/theapothecary/2016/11/16/getting-better-health-care-for-much-less-money
Since Republicans still insist on accepting ObamaCare’s flawed assumptions, and the demand that a replacement cover at least as many people, the pretend-to-repeal strategy under threat of Obama’s veto has become “repeal and delay.” http://www.forbes.com/sites/theapothecary/2016/12/11/for-obamacare-repeal-delay-isnt-just-republicans-best-choice-its-their-only-choice/print/
If premiums are to be subsidized, Avik Roy suggests health status rather than income as the basis, along with ways to prevent people from gaming the system by buying coverage only when they think they will need it. http://www.forbes.com/sites/theapothecary/2016/11/12/donald-trump-is-right-you-can-repeal-obamacare-and-still-cover-everyone-with-pre-existing-conditions
Roy distinguishes his suggestion of risk adjustment from risk corridors, which do nothing to solve the problem of assuring that “the enrolled population will be sicker than the eligible population.” http://www.forbes.com/sites/theapothecary/2016/11/30/how-to-cover-everyone-with-pre-existing-conditions-some-clarifications
The proposed refundable tax credits in the Price plan, for those buying their own coverage in the individual market, are based on age only: $1,200 for individuals 18 to 35; $2,100 for 35-50; and $3,000 for those who are 50 and over. http://www.forbes.com/sites/merrillmatthews/2016/12/01/now-we-know-what-the-republican-obamacare-replacement-plan-will-look-like
If Republicans actually repeal ObamaCare, instead of keeping the tax revenue for their own purposes, it will be the biggest tax cut of the year. ObamaCare contains 20 new or higher taxes. http://www.forbes.com/sites/ryanellis/2016/11/29/obamacare-repeal-will-be-biggest-tax-cut-of-new-year/
But Avik Roy writes that “keeping” $700 billion of the $1.2 trillion ACA tax hikes “would be enough to get [Republicans] to the right result” for covering the uninsured. http://www.forbes.com/sites/theapothecary/2016/12/24/republicans-will-fail-to-replace-obamacare-unless-they-carefully-craft-their-repeal
Many Republicans are seemingly unwilling to admit that a replacement plan cannot work unless the pre-existing conditions provision ends. http://www.forbes.com/sites/merrillmatthews/2016/11/21/the-preexisting-condition-provision-must-end-for-a-republican-replacement-plan-to-work.
It is not possible to cover pre-existings without an individual mandate. The premium increases in ACA are the result of ObamaCare “hypocrisy” on this point, and the absence of a sufficiently tough mandate, explains Seth Chandler. http://www.forbes.com/sites/theapothecary/2016/12/21/the-individual-mandate-even-hypocrites-are-sometimes-right/
The reason the Republicans haven’t been able to agree on a replacement plan is the anticipated political fallout from taking away perceived benefits. http://www.forbes.com/sites/johngoodman/2016/12/20/why-the-republicans-dont-have-an-obamacare-replacement-plan
Yet the cost of real and potential taxpayer bailouts keeps rising. The risk-corridor program, for example, ran a $2.5 billion deficit for the 2014 plan year as far more insurers incurred losses than made profits. In 2015, the deficit increased to more than $5.8 billion—a 132% increase, writes Brian Blase. http://www.forbes.com/sites/theapothecary/2016/11/21/a-taxpayer-bailout-of-obamacare-insurers-just-got-a-lot-more-expensive
A new direction is needed, writes Blase—away from the government bias favoring comprehensive coverage. http://www.forbes.com/sites/theapothecary/2016/12/15/obamacares-failure-and-moving-health-care-policy-in-a-new-direction
Seen on Social Media:
— Westby Fisher, MD (@doctorwes) December 20, 2016
— Twila Brase (@twilabrase) December 23, 2016
— MedicalQuack (@MedicalQuack) December 26, 2016
Little-known illness, cannabinoid hyperemesis syndrome, tied to smoking weed on the rise https://t.co/JsU1zclObZ
— C. Michael Gibson MD (@CMichaelGibson) December 29, 2016
My comment as filed today with the NEJM Baron/Braddock article (in case it fails to see the light of day): pic.twitter.com/poQDpTQbkr
— Westby Fisher, MD (@doctorwes) January 1, 2017