ObamaCare’s impact on health costs.

The seismic effects of the Affordable Care Act on insurance markets continue to be felt nearly eight years after its enactment. Premiums for individual coverage more than doubled between 2013 and 2017. Much of that increase resulted from Obamacare’s new regulations. Some regulations-such as essential health benefits and actuarial value requirements-had discrete effects on premiums. A cluster of regulations prohibiting medical underwriting, requiring the issuance of coverage, and banning pre-existing condition exclusions under any circumstances collectively had the largest effect on premiums. Additional provisions of the ACA, such as those that induced costly enrollees with other coverage options to migrate to the subsidized individual market, also drove up premiums. The Trump Administration has taken some steps to help mitigate these challenges, but legislative action is the most effective approach. The Graham-Cassidy proposal offers a starting point for policymakers seeking to address these issues, by providing a conceptual framework for empowering states to repair or ameliorate much of the market dislocation resulting from Obamacare.
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Amazon, Berkshire Hathaway and J.P. Morgan have announced a nonprofit initiative to address excessive spending on health care, starting with their own million or so employees. They can expect many suggestions. Here’s one: The three CEOs— Jeff Bezos, Warren Buffett and Jamie Dimon, whom I’ll call “BB&D”—could do a huge service by describing the depth and nature of the cost problem, something politicians have long failed to do.

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Gwen Hurd got the letter just before her shift at the outlet mall. Her health insurance company informed her that coverage for her family of three, purchased through the Affordable Care Act marketplace, would cost almost 60 percent more this year — $1,200 a month.

She and her husband, a contractor, found a less expensive plan, but at $928 a month, it meant giving up date nights and saving for their future. Worse, the new policy required them to spend more than $6,000 per person before it covered much of anything.

“It seems to me that people who earn nothing and contribute nothing get everything for free,” said Ms. Hurd, 30. “And the people who work hard and struggle for every penny barely end up surviving.”

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Georgia families face some of the biggest increases in health care premiums in the country this year. For many families, health care is rapidly becoming unaffordable – a necessity that is becoming a luxury. Candidates running for Governor and the Legislature would be wise to take note of other states’ successes in granting patients the right to shop for health care to lower health care costs.

Data show that the primary reason premiums are going up is the escalating costs of treatments and procedures. Consumers’ deductibles and copays are going up, too. In other words, patients are paying more but getting less. At a time when the internet is making more and more information available online – just think of Yelp or Angie’s List – consumers face real obstacles in knowing ahead of time how much a procedure will cost and how much they will have to pay from their own pockets.

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When Erica Jackson and her husband decided she would quit her job as a nurse and stay at home with their three kids, they knew they couldn’t afford insurance on the individual market. The family of five, who live in Wichita Falls, Texas, near the Oklahoma border, could already barely afford Jackson’s employer coverage, which cost $900 per month for a plan with a $12,000 deductible.

So Jackson reached out to her insurance broker for alternatives to exchange plans, and he suggested that she and her family would be a good fit for Medi-Share, a nonprofit insurance alternative based in Florida in which members share each other’s health care costs. There was a catch, though. The plan was run by a nonprofit religious ministry.

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Oregon voters recently upheld a myriad of new taxes that were passed as part of a major health-care law last summer. The state government is planning to use the estimated $320 million in revenue to cover hundreds of thousands of residents who have enrolled through the Affordable Care Act. The outcome of this vote has serious implications anyone enrolled in a health-care plan in Oregon.

The referendum was on sections of House Bill 2391, which imposes a 0.7 percent tax on small hospitals as well as a 1.5 percent on individual and family health-care premiums. These revenue raisers are intended to generate more tax dollars for the state. But they also allow Oregon to receive $630 million to $960 million in federal Medicaid matching funds.

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American workers have not seen their wages grow in tandem with the success of their employers.

Meanwhile, health spending has been growing faster than the broader economy. Health benefits consequently are getting more expensive for employers to offer, and companies are responding by making employees shoulder more of their own health care costs — either through higher premiums or higher out-of-pocket costs, like deductibles and copays.

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Health care dominated the news cycle in 2017. Yet, for all the legislative wrangling and rhetoric, little changed this past year.

It is my job to listen to health-care consumers. They entered 2017 worried about the cost of coverage. They find themselves at the start of this year in the same place they ended the last. People want to know: What happened to the “affordable” part of the Affordable Care Act?

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Republican leadership emerged from their Camp David policy retreat earlier this month announcing that significant healthcare reform is not on their 2018 agenda. That’s bad news for the one-quarter of Americans who put off or postpone getting the healthcare they need each year because of its costs, which have doubled since 2013.

To meaningfully address these skyrocketing healthcare costs, bold reforms are needed. Rather than simplistic assertions that blame doctors, legislators must tackle healthcare’s stultifying bureaucracy consisting of federal and state government agencies, big insurance companies, and, yes, the American Medical Association.

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The less-explored question involves why Obamacare’s overall combination of taxpayer subsidies, expanded insurance programs, health benefits requirements, AND coverage mandates had so much less of an effect than the law’s architects envisioned.

It turns out that many of the nominally uninsured still have other alternatives to health care than just through heavily-subsidized Medicaid and exchange-based insurance. You might call such uncompensated care either an option for “implicit insurance” or a hidden tax on acquiring more formal coverage.

Health policy researchers Amy Finkelstein, Neale Mahonem and Matthew Nolowidigdo unravel the puzzle in a recent National Bureau of Economic Research paper. They explain why there is less “demand” than expected for the increased “supply” of subsidized coverage for lower income individuals and more limited take up of subsidized coverage than once predicted.

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