Spending on prescription drugs for health plans created under the Affordable Care Act increased last year at a rate more than three times that of other commercial plans and most government-run plans managed by Express Scripts Holding Co.
Express Scripts, the largest manager of prescription drug plans for U.S. employers, on Tuesday said year-over-year spending per person for individual insurance plans sold on the Obamacare exchanges where it manages the pharmacy benefit rose 14% in 2016, driven by higher drug prices and utilization.
Express Scripts said per-capita spending for other commercial plans it manages, mostly for employers, rose just 3.8% last year, despite an 11% increase in list prices for brand-name drugs.
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With the passage of the ACA, Congress promised Americans that they would be able to keep the plans and doctors they like while paying less for health insurance and healthcare overall. Seven years later, many Americans have fewer choices when it comes to health decisions and are paying more for care and insurance. The State Policy Network has compiled stories from around the country that highlight state and local challenges and represent the need for a state-based approach that unleashes innovation in health care based upon the needs of citizens.
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In the populist era of the early 20th century, the people’s rage was directed not at political elites or government, as it is today, but at huge private monopolies, the “trusts.” Teddy Roosevelt’s trustbusting campaign helped establish competition as America’s fundamental mechanism for inducing private businesses to serve the public. If today’s populists are equally serious about protecting ordinary people, they should declare a similar war against monopoly in health-care markets.
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The shaky case for the individual mandate is based on mistaken premises, faulty economic analysis, short-sighted politics, and flawed health policy. Opponents have found the mandate to be administratively challenging, politically unsustainable, economically unnecessary, beyond the proper role of government, and constitutionally questionable. Arguments in favor of the individual mandate usually present it as a necessary, though far less popular, means to more laudable ends.
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Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions. But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance.
The researchers estimate a patient with multiple sclerosis, for example, might file $61,000 in claims. ObamaCare’s rules let MS patients buy coverage for far less, forcing insurers to take a loss on every MS patient. That creates “an incentive to avoid enrolling people who are in worse health” by making policies “unattractive to people with expensive health conditions,” the Kaiser Family Foundation explains.
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Obamacare has already failed, and it failed because the government violated several basic economic and free-market principles, resulting in devastating outcomes for those seeking coverage, people already covered, and taxpayers.
Under Obamacare, our most vulnerable citizens in Pennsylvania are paying more for health insurance with fewer choices. According to the Kaiser Family Foundation, individual premiums increased by more than 50% in Philadelphia this year. Deductibles for a family plan now exceed $6,000, and the choices continue to shrink.
Pennsylvania’s health care delivery system should encourage participation in the health-insurance market rather than mandating it as Obamacare did, offer the option of using open network, lower-cost, catastrophic plans supported by health savings accounts, and place much greater emphasis on prevention and addressing the causes of poor health.
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President Donald Trump’s initial budget outline signals he won’t immediately press forward with major entitlement reforms, but House Speaker Paul Ryan pointed to Republican efforts to repeal and replace Obamacare as proof that the GOP is unified on addressing the issue.
“Two entitlements are being reformed with repealing and replacing Obamacare, right now,” the Wisconsin Republican told reporters Tuesday at a weekly Capitol Hill news conference. “We are well on our way to repealing Obamacare.”
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Congressional Republicans have been struggling for months to resolve one of the most vexing problems in their tortuous effort to replace the Affordable Care Act: What to do about the generous federal funding for states that broadened their Medicaid programs under the law, while not shortchanging the 19 states that balked at expansion?
Now, as the House begins to hone details of its legislative proposal, a possible compromise has emerged. It would temporarily keep federal dollars flowing to cover almost the entire cost of the roughly 11 million Americans who have gained Medicaid coverage but would block that enhanced funding for any new participants.
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On Friday, Politico released a leaked version of draft budget reconciliation legislation circulating among House staff—a version of House Republicans’ Obamacare “repeal-and-replace” bill. The discussion draft is time-stamped on the afternoon of Friday February 10—and according to my sources has been changed in the two weeks since then—but represents a glimpse into where House leadership was headed going into the President’s Day recess.
A detailed summary of the bill is below, along with possible conservative concerns where applicable. Where provisions in the discussion draft were also included in the reconciliation bill passed by Congress early in 2016 (H.R. 3762, text available here), differences between the two versions, if any, are noted. In general, however, whereas the prior reconciliation bill sunset Obamacare’s entitlements after a two-year transition period, the discussion draft would sunset them at the end of calendar year 2019—nearly three years from now.
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Anthem Inc. and other U.S. health insurers complained to the White House for more than a year that they were losing money on people who waited to sign up for Obamacare coverage until they were sick.
They pleaded with the Obama administration to stem their losses by tightening up on the enrollment rules. When their pleas went unmet, UnitedHealth Group Inc, Humana Inc, and Aetna Inc pulled out of most of the government subsidized health insurance market.
But now that the new Trump administration and Republican lawmakers control the future of healthcare, the industry is getting a new hearing.
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