The Congressional Budget Office is not politically biased. But its work is beset by challenges that run much deeper than that: They are structural, and require us to think about both the CBO and the larger congressional budget process in which it plays a part in terms of institutional reform. When legislation is built around eccentricities in the CBO model, as Obamacare was in some key respects, the CBO finds itself confronted with some very strange problems. One is the tendency of the CBO to model competition as having minimal effect on costs while modeling price controls to be efficient and effective. Competition is obviously much more difficult to model than mandates and price controls, but the agency’s experience with Medicare Advantage and the Medicare prescription-drug benefit suggests that it tends to significantly understate the effects of competition — which obviously has consequences for its scoring of reforms intended to increase the market orientation of the health-care system.
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Senate Republicans are struggling to agree on health reform, and the biggest divide concerns Medicaid. The problem is that too many seem to accept the liberal line that reform inevitably means kicking Americans off government coverage.
This narrative serves the liberal goal of scaring the public to preserve ObamaCare, but center-right and even liberal states have spent more than a decade improving a program originally meant for poor women and children and the disabled. Even as ObamaCare changed Medicaid and exploded enrollment, these reforms are working, and the House bill is designed to encourage other states to follow.
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Boosting enrollment is also important for stabilizing the individual insurance market. Currently, under the ACA, the markets are less stable than they could be, or should be, because there are too few younger and healthier enrollees. Automatic enrollment would boost enrollment into insurance among this group of potential customers, and thus help create a more balanced risk pool.
We believe that automatically enrolling Americans eligible for tax credits into no-premium health plans should be an important component of a renewed effort at health reform. Many of the uninsured who do not make plan selections on their own can be enrolled into plans that provide true insurance against significant or catastrophic health events.
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Hundreds of miles from the health care debate that will begin again this week in Congress, lobstermen here are out in force, bees are furiously pollinating the state’s famous blueberries and part-time workers are preparing for another summer tourist season.
As a result of their short-term spike in income, many of Maine’s working class will likely lose some or all of their health insurance subsidy, a feature of the federal health care law, which has been a complicated blessing for the citizens of Maine.
Senator Susan Collins, Republican of Maine, has spent a lot of time thinking about how to deal with these “subsidy cliffs,” even as her party’s leaders press for the wholesale repeal of the Affordable Care Act, President Barack Obama’s signature domestic achievement.
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Sen. Bill Cassidy got cheers on late-night television for calling for an Obamacare replacement plan that would pass what he calls “the Jimmy Kimmel test” — that is, cover children like the comedian’s son recently born with a congenital heart defect.
To hear him tell it, he’s the one in Congress fighting to keep President Donald Trump’s promises to his base. On the campaign trail, Cassidy argues that Trump consistently promised a health care plan that would reduce premiums, eliminate mandates, ensure continuous coverage and protect people with pre-existing conditions. Any GOP plan, he says, needs to meet that bar.
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President Trump’s recent 2018 budget proposal, which includes roughly $800 billion in cuts to Medicaid over the next decade, has led to howls of outrage from Democrats.
Medicaid’s defenders claim that it’s a bargain for patients and taxpayers alike. As Sen. Schumer put it, “Medicaid has always benefitted the poor. That’s a good thing.” A recent issue brief from the Kaiser Family Foundation, meanwhile, concludes, “Medicaid is cost-effective.”
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Republicans should be on the lookout. While the GOP tries to repeal and replace Obamacare, Democrats are sharpening their message on health care. In their race to the left, Democrats are increasingly calling for a full-fledged single-payer system. The momentum is shifting, and the stakes are getting higher for Republicans. As we all know, in politics, a bumper sticker beats an essay. With the “single-payer, universal health care” catchphrase, Democrats are beginning to use their simple “bumper stickers” more frequently.
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A new Lancet study adds to the growing mountain of evidence that market-oriented health care systems outperform the single-payer systems that have captivated the imagination of progressives for more than a century. Yet despite their claims of believing in evidence-based policy, far too many progressives persist in disparage efforts by Republicans to move the U.S. health system in a more market-oriented direction even while working feverishly on a misguided quest to put California on the path to single-payer health care.
The Lancet study focuses on the extent to which countries are able to avert “amenable mortality.” “Amenable mortality” refers to “unnecessary, untimely deaths,” i.e., deaths that hypothetically would not occur with timely and effective medical care. The idea is that it makes no sense to fault a country’s health system for deaths that never could have been averted even if the system was organized to be as efficient and effective as possible. Market-driven systems have shown to be superior at averting avoidable deaths.
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Senate Republicans may be all over the map on an Obamacare repeal plan, but on one fundamental point — reducing insurance premiums — they are in danger of overpromising and underdelivering.
The reality is they have only a few ways to reduce Americans’ premiums: Offer consumers bigger subsidies. Allow insurers to offer skimpier coverage. Or permit insurers to charge more — usually much more — to those with pre-existing illnesses and who are older and tend to rack up the biggest bills.
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Republican senators return on Monday from a 10-day recess with immediate decisions to make on their quest to overhaul the 2010 health care law.
While Senate leaders have largely avoided putting any artificial timelines on their endeavor, the GOP is under an extreme time crunch to produce and advance their own legislation to match the House bill that narrowly passed the chamber last month.
Some members, however, are now openly doubting whether Republicans can follow through on their seven-year effort to repeal and replace President Barack Obama’s signature domestic achievement.
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