Conservative Republicans, worried about growing voices within the party advising or accepting a slower pace for repealing the Affordable Care Act, are redoubling their push to speed the GOP’s long-desired goal.
President Donald Trump on Sunday became the latest top Republican to sound cautious notes about the party’s ability to rapidly repeal large swaths of the 2010 health law and enact its own vision. He told Fox News’s Bill O’Reilly that “maybe it’ll take until sometime into next year,” saying repeal and replacement was “statutorily” difficult to accomplish quickly.
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In his first post, Conover argued that drawing inferences from observational studies about whether covering the uninsured will save lives is a fool’s errand . Quasi-experimental studies hypothetically provide a better tool for figuring out whether insurance coverage reduces mortality risks. Unfortunately, the two studies we have available are very unreliable instruments for figuring this out.
That said, based on the two studies reviewed, Conover cannot rule out the possibility of “excess deaths” in the event some people lost coverage as a result of repeal-and-replace efforts. Ironically, because the lion’s share of coverage gains under Obamacare has been through Medicaid, the New York study arguably is the most appropriate one to use to determine the effects of repeal. However, it is less credible than the Massachusetts study in terms of how much confidence anyone should have in its results.
In short, beware of anyone who claims we will lose 1 life for every 435 newly uninsured. 1 life for every 830 people is more believable, but even that is exaggerated and is far more likely to apply to those gaining private coverage than those enrolling in Medicaid. Unfortunately, the current state of science does not provide a very solid basis for guessing how much this estimate is inflated.
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Obamacare proponents have been increasingly shameless in trotting out scare statistics to convince people that the GOP wants to “make America sick again:”
Two Harvard professors–who, not uncoincidently, are diehard single payer advocates–are lamenting that “repealing the Affordable Care Act will kill more than 43,000 people annually”
False claims about the adverse effects of repealing Obamacare on mortality that are grounded in observational studies result from:
- Grossly exaggerating the number of people who would actually lose coverage. This exaggeration of lost coverage occurs even in the worst-case scenario that Obamacare is not replaced.
- “Excess” mortality estimates related to lack of coverage that are both upward-biased and unreliable by nature due to the inability of researchers to account for unmeasured influences.
- Inappropriate extrapolation of results to populations (e.g., Medicaid) not included in the original study.
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As Republicans consider paring back the Affordable Care Act’s federal mandates, they face a difficult question: What does health insurance need to cover?
The 2010 health law created a new set of federal requirements for plans sold to individuals and small businesses, including a list of 10 benefits, among them prescription drugs, mental-health services and laboratory tests. It also mandated that plans cover preventive services such as vaccinations at no cost to enrollees.
The rules, along with other minimum standards set by the law, were meant to ensure that consumers had strong protections and weren’t surprised by unexpected gaps or limits in their coverage. But that also contributed to making individual insurance more expensive in many cases.
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Senate Democrats have pummeled Rep. Tom Price, President Trump’s pick to lead the Department of Health and Human Services, for supporting Medicaid block grants, but it’s a policy unlikely to win a place in Republicans’ Obamacare repeal-and-replace plan.
If Republicans succeed in making significant changes to Medicaid, they more likely would turn to a more moderate per-capita system embraced by a wider swath of Republicans. Like block grants, a per-capita system would limit federal contributions, but it would allow federal assistance to rise with enrollment growth.
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The Republican Study Committee is a group that includes some of the most conservative legislators in Congress. A few years ago, it asked Rep. Phil Roe (R-TN), who co-chairs the Republican Doctors Caucus, to come up with a plan to replace Obamacare.
“I was asked to put together a plan that increased access [and] lowered costs but didn’t increase entitlements, so my hands were a bit tied,” he says.
What he came up with was this: Repeal Obamacare entirely. Get rid of the current tax preference for employer-sponsored coverage too. Regardless of where people get their health insurance, the RSC plan would give all Americans a standard deduction for health insurance — $20,500 for families and $7,500 for individuals.
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Congressional Republicans are facing their first big decision on taxes under President Trump: Which ones to scrap in the repeal of ObamaCare.
Republicans have in the past sought to erase most of the big tax hikes in the healthcare law, and the chairmen of the tax-writing committees have expressed support for eliminating the taxes in a repeal bill.
“After spending seven years talking about the harm being caused by these taxes, it’s difficult to switch gears now and decide that they’re fine so long as they’re being used to pay for our healthcare bill,” Sen. Orrin Hatch (R-Utah), the chairman of the Senate Finance Committee, said Wednesday.
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President Donald Trump walked back his recent vow that Obamacare would be replaced in short order, telling F0x News’ Bill O’Reilly that the process is “complicated” and “maybe it’ll take till sometime into next year.”
“It statutorily takes a while to get,” Trump said in a wide-ranging interview that aired Sunday during the Super Bowl pre-game show. “We’re going to be putting it in fairly soon, I think that yes I would like to say by the end of the year at least the rudiments, but we should have something within the year and the following year.”
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No one’s interested in trying to save Obamacare’s centerpiece as it faces certain death.
Even as the healthcare industry heavily lobbies Republicans to keep the Affordable Care Act’s other main components, such as its subsidies and Medicaid expansion, doctors, hospitals and insurers are stepping away from the law’s individual mandate for people to buy insurance or pay a fine.
Not even Democrats are campaigning to keep the mandate, which was once viewed as the key to making Obamacare successful. The thought was that the mandate would prompt enough healthy young people to buy coverage to keep premiums stable. But nearly everyone agrees it didn’t work as well as intended. And repealing it is top of list for Republicans.
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Tom Price spent years railing against Obamacare. Now he’ll finally have sweeping power to do something about it.
The Georgia Republican congressman is on the verge of becoming the Trump administration’s top health care official, armed with broad authority to begin unwinding Obamacare by using as much executive power as possible, even as Congress struggles to find consensus on a plan to repeal and replace the health care law. First, he could ax Obamacare’s mandate ensuring coverage for contraception and give insurers more latitude to determine which health benefits they will — and won’t — pay for. Those changes will likely be paired with stricter monitoring of Obamacare enrollees, as the administration aims to win over jittery health plan executives with policies that prioritize insurance market predictability and profitability.
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