Most of the criticism of Obamacare by its right-of-center opponents has focused on its regulatory mandates, botched implementation and rising premiums for less-favored purchasers. Far less attention has been paid to how little the new health law accomplished in fulfilling its advocates’ promises to boost the growth of small business and new entrepreneurial start-up firms.
The Bureau of Commercereports that new business formation inched up slightly for a few years from its low point in 2010 – after four years of decline. But its 2013 figure of 406,000 new businesses remains far below the recent pre-recession peak number of 560,000 in 2006.
Similar measures of entrepreneurial activity by the Kauffman Foundation find modest evidence of recent upticks, but levels still below historical norms.
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President Barack Obama was in Milwaukee Thursday to congratulate the city for winning a federal health insurance sign up contest during the latest open enrollment period under the Affordable Care Act.
Gov. Scott Walker said greater enrollment is good, but the complaints he says he hears about the law are bad.
“What we hear routinely from small business owners and farmers across the state is that it’s anything but affordable,” Walker said. “They’ve actually seen their health care costs go on up dramatically even with the so-called Affordable Care Act.”
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This year my family joined millions of others whose health-insurance premium has become their biggest annual expense. More than our mortgage. More than our property taxes. More than our state income tax. More than our annual food or energy costs. With this year’s $194-a-month premium increase, I could roughly buy a Chevy Sonic or Ford Fiesta. Since 1999 our premiums are up 350%. Bad as this is, the story gets worse.
Each year our family is subject to paying health-insurance premiums and, if we see a doctor, deductibles and copays. Think of this total exposure as “health-care cost risk”—the sum of certain payments (premiums) plus the potential payments you could incur (copays and deductibles).
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As of the end of the third open enrollment under the Affordable Care Act, 12.7 million people had signed up for coverage in the health insurance marketplaces, up from 11.7 million last year and 8.0 million in 2014.
Actual enrollment will end up somewhat lower than this because some people will not pay their premiums or will have their coverage terminated due to inconsistencies on their applications, and there is typically additional attrition as the year progresses (e.g., as some enrollees get jobs with health benefits).
While enrollment is in line with the HHS target announced in advance of this year’s open enrollment, it is short of earlier projections by the Congressional Budget Office, which became an implicit yardstick for judging the law. In March 2015, CBO projected average monthly marketplace enrollment of 21 million in calendar year 2016, though recently lowered that forecast to 13 million.
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The Independent Payment Advisory Board, or IPAB, is one of the more notorious provisions of the Affordable Care Act because it is the perfect embodiment of belief in technocratic expertise. The IPAB’s 15 “expert” members would have great power and little accountability.
Since the law’s passage in 2010, opponents have successfully publicized the danger the IPAB poses to sensible Medicare policy and constitutional self-government, to the point that many in Congress now assume it will never go into effect. In June 2015, the House passed legislation to repeal the IPAB in its entirety.
And, yet, it is also clear that Congress’ attention is elsewhere. The slowdown in Medicare spending growth in recent years has made the IPAB less relevant – for now.
But IPAB’s demise is not a foregone conclusion, especially when Medicare spending growth accelerates again, as it almost inevitably will.