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Can Republicans Make ObamaCare Worse?

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

If Republicans “replace” ObamaCare, they will own the resulting system. If Americans get worse or more expensive care, Republicans will surely be blamed.

Cost increases are already baked in. If claims and thus premiums are underestimated one year, the company has to try to “correct” premiums the next. Geisinger has filed for a 40% increase in 2017. http://www.nytimes.com/2016/06/10/us/health-insurance-affordable-care-act.html

The federal government is giving states $22 million in grants to “hold insurance companies accountable for unjustified hikes.” But rate reviews “may not be effective in 2017 because many insurance companies have proof this year that the marketplace is hurting their bottom line.” Proposed premium increases are “shockingly higher than expected.” Insurers in Connecticut are seeking an average increase of 26.8% for individual plans. http://thehill.com/policy/healthcare/283617-states-receive-22m-to-help-control-obamacare-premium-hikes

A number of ObamaCare insurers have said they are losing money on the plans because their risk pools are sicker than they had anticipated when they set prices for previous years. http://www.cnbc.com/2016/06/15/states-get-offer-of-federal-money-to-boost-insurer-compliance-with-obamacare.html

There is also growing dissatisfaction with ACA coverage. Despite the fact that a large majority of enrollees receive large subsidies, only 45% rated their insurance as “good” or “excellent” coverage in 2016, down from 55% in 2015. Of people who switched plans, often because a plan became unavailable, 37% thought they were getting a worse value, and only 27% thought it was a better value, writes Brian Blase (Forbes 6/5/16). http://www.forbes.com/sites/theapothecary/2016/06/09/survey-reveals-growing-discontent-among-obamacare-enrollees

Speaker Paul Ryan has introduced a 37-page “conversation starter” that includes ideas for Medicare and Medicaid reform as well as an ObamaCare “replacement.” http://www.forbes.com/sites/theapothecary/2016/06/22/a-detailed-look-at-house-republicans-first-official-plan-to-replace-obamacare-and-reform-entitlements/

Scott Gottlieb explains that it challenges the key tenet of ObamaCare, which aims to push all “providers” into risk-bearing entities, with key decisions being made by government regulators. Ryan offers a modern refashioning of consumer empowerment, turning principally on an expansion of health savings accounts. It accepts, however, the central premise of guaranteeing universal access to “coverage.” http://www.forbes.com/sites/scottgottlieb/2016/06/22/paul-ryans-healthcare-plan-re-challenges-a-central-tenet-of-obamacare

Michael Cannon of the Cato Institute says that the Ryan Plan is not all bad. But it might provide even worse coverage for the sick than ObamaCare. It would replace ACA with slightly modified versions of its worst provisions: guaranteed issue, community-rating price controls, and the millennial mandate. The Ryan tax credits, he says, are the equivalent of the individual mandate. “Pretending to repeal all of ObamaCare but then reinstating some of its provisions with a Republican imprimatur would make those provisions completely repeal-proof.” http://www.forbes.com/sites/michaelcannon/2016/06/23/house-republicans-health-plan-might-provide-even-worse-coverage-for-the-sick-than-obamacare

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