Last week’s seven-candidate debate hosted by the Fox Business Network once again found much to discuss in terms of national security issues, immigration law enforcement, even a little economic policy, and, of course, the latest round of character attacks and counter-attacks. Still missing in action: at least the first subcutaneous probe of where the respective candidates stand on health policy issues.
Based on recent performance, it’s questionable whether health policy has attracted sufficient interest among the media and Republican primary voters to command more than a few seconds on the debate stage. But it’s not for lack of potential lines of inquiry.
Here are some questions to the candidates from Tom Miller of the American Enterprise Institute that still await new rounds of oversimplified, evasive, or (one might hope) thoughtful answers.
In November, UnitedHealth abruptly reversed its previously sunny take on ObamaCare and said that the company would have to pull out of the government-run exchanges if market conditions didn’t improve.
UnitedHealth’s bombshell raised the specter, once thought safely in the grave, of the “adverse selection death spiral,” the phenomenon where sick people are more likely to buy insurance, which raises the average expenditure, which means higher premiums, which makes insurance a worse deal for the healthiest members of your insurance pool, which means they drop out, which means your pool is even sicker and average expenditure goes up even more … and there goes the insurance market.
While Democrats are quite eager to point out that ObamaCare has reduced the number of uninsured by 17.6 million, they have conveniently failed to point out that in 2014, American taxpayers effectively paid about $6,000 for each person who became newly covered due to ObamaCare.
Is it really worth reducing worker wages by $1,200 apiece just to cover 2.3 million young adults? And leaving aside all the chaos created by millions of cancelled policies, premium increases paid by tens of millions who received no taxpayer subsidies whatsoever to soften the blow and similar market dislocations, are ObamaCare defenders really prepared to claim that it is worth paying $6,000 apiece to reduce the ranks of the uninsured?
The percentage of people without health insurance held steady in 2015, according to the Gallup polling organization, which last week announced that the un-insurance rate remained “essentially unchanged” throughout 2015. That wasn’t good news for the administration, which had hoped the pollster would confirm that ObamaCare had significantly reduced the un-insurance rate in 2015. Doug Badger, Senior Fellow at the Galen Institute, digs deeper by comparing the Gallup poll with government surveys conducted by the Centers for Disease Control and the Census Bureau.
Recently, the Obama administration said 11.3 million Americans had signed up for 2016 health exchange plans by late December.
“That’s still significantly lower than what experts had initially expected at this point in time in exchange implementation,” said Caroline Pearson, senior vice president with health care consulting firm Avalere. “We had anticipated, based on the Congressional Budget Office estimates, that perhaps 21 million people might be enrolled in 2016.”
“Many middle income people continue to suggest that exchange plans just aren’t affordable for them,” Pearson told CNBC. “Even with the subsidies, they simply can’t make the monthly premiums work in addition to all of the out of pocket costs.”
UnitedHealth Group Inc., the largest U.S. health insurer, said its rates for ObamaCare plans in New York may be too low because the failure of a competing insurer last year might lead to shortfalls in payments designed to stabilize Obamacare markets.
In states like New York, health insurers participating in ObamaCare negotiate annually with regulators to set prices for coverage. UnitedHealth’s rates were set anticipating risk-sharing payments designed to stabilize the new insurance markets, William Golden, the company’s northeast region chief executive officer, said Wednesday. If the loss of a participant reduces the funds available to UnitedHealth, the company’s rates in New York’s ObamaCare market may be insufficient, he said.
For the first time, businesses that employ the equivalent of 50 to 99 full-time workers face a fine of $2,160 per worker if they don’t provide coverage. (An employer’s first 30 workers are excluded from the calculation.)
For an employer with the equivalent of 75 full-time workers, for example, the maximum penalty would be $97,200 for 2016.
A growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance, a trend that could challenge the stability of the Affordable Care Act (ACA).
The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. Their membership growth has been spurred by an ACA provision allowing participants in eligible ministries to avoid fines for not buying insurance.
Ministry officials estimate they have about 500,000 members nationwide, more than double the roughly 200,000 members before the law was enacted in 2010.
Obama administration officials said last month that about 2.5 million new customers had bought insurance through HealthCare.gov since open enrollment began on Nov. 1. The number of new enrollees is 29% higher than last year at this time, suggesting that the threat of a larger penalty may be motivating more people to get covered.
But plenty of healthy holdouts remain, and their resistance helps explain why insurers are worried about the financial viability of the exchanges over time. People who earn too much to qualify for federal subsidies that defray the cost of coverage may be most likely to opt out.
A group of health policy analysts have collaborated on a set of proposals for replacing the Affordable Care Act (ACA) and also reforming other major portions of health care delivery, such as the tax treatment of employer-sponsored health insurance, Medicaid, Medicare, and Health Savings Accounts. Because so much attention has been paid to the repeal of the ACA by those who have opposed it, we believe it is important to focus on a serious proposal that could both replace this law and provide additional measures of reform, especially to the health care entitlement programs.
We believe our reform agenda represents such a proposal. Furthermore, none of us regards the pre-ACA health care system as an acceptable alternative.