In new research published by the Mercatus Center, I analyze the causes and impact of the much higher-than-expected enrollment and spending associated with the Affordable Care Act (ACA) Medicaid expansion. Though unpredicted by Washington experts, the results were predictable. The federal government’s 100% financing of state spending on expansion enrollees has led states to boost enrollment and create high payment rates. (See this 2-minute Mercatus video for additional information on this significant development.)
In states that have expanded, enrollment and per enrollee spending are nearly 50% higher than predicted. While interest groups within the states—particularly hospitals and insurers—benefit from the higher spending being charged to federal taxpayers, substantial evidence suggests much of this new spending is wasted or provides little value for its intended recipients.
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The Congressional Budget Office’s latest long-term forecast, released last month, is a bracing report. As President Obama’s term comes to end, CBO finds that the federal government is on track to run up historically large deficits over the coming three decades, pushing federal debt to 141% of GDP, up from 39% in 2008.
The president has mostly avoided talking about the federal budget during his time in office, but he did promise that the Affordable Care Act — ObamaCare — would help lower deficits in the short and long term. CBO backed him up on this claim in 2010, estimating that the deficit would be reduced by 0.5% to 1.0% of GDP over the medium term. But the agency’s new forecast shows why the law is more likely to make the deficit worse, not better.
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Another day, another healthcare co-op failure. In July alone, three co-ops, HealthyCt in Connecticut, Community Care of Oregon, and Land of Lincoln in Illinois announced they are closing up shop. They join 13 other failed co-ops out of the original 23 that were a centerpiece of the Affordable Care Act’s vision for the future of healthcare organization — an unrealistic vision based on wishful thinking and sabotaged by the ACA itself.
The ACA created Consumer Operated and Oriented Plans (co-ops) — private, state licensed, non-profit health insurance companies — to provide low-cost, consumer friendly coverage to individuals and small businesses. The theory was that since the co-ops didn’t have to show a profit, they could charge lower premiums, provide more services and be more responsive to their members. They would use collective purchasing power to lower administrative and information technology costs and keep members healthy through preventive care and evidence-based medicine.
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Humana recently announced that next year it is withdrawing from 88% of the counties where it sold Affordable Care Act (ACA) exchange plans this year. United Healthcare forecasts higher earnings in 2017, stemming in part from its decision to shut down most of its exchange business. Aetna has cancelled plans to expand its ACA market footprint and is instead reevaluating its current participation. At least four states, Alaska, Alabama, Oklahoma and Wyoming will likely have only one exchange insurer this coming year. Sixteen of the 23 co-ops initiated with ACA funding have collapsed. And researchers supportive of the ACA estimate that insurers are requesting average gross premium increases of 23% next year These data points suggest the ACA’s individual market changes are faring poorly thus far.
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CBO projects that the combined federal spending on Social Security, Medicare, Medicaid, and the ACA subsidies will grow from 11 percent of GDP in 2016 to 16.3 percent of GDP in 2046. This run-up in spending will increase annual federal budget deficits and push cumulative federal debt to 141 percent of GDP in 2046 — well past the point that most economists would consider dangerous for the economy. (Spain’s debt is 99 percent of GDP in 2016).
CBO’s base case scenario is also probably too optimistic. CBO’s projection assumes federal revenue will grow from 18.2 percent of GDP in 2016 to 19.4 percent in 2046 (the 50-year average of federal revenue, from 1966 to 2015, was 17.7 percent of GDP). But the projected growth in federal revenue derives from tax provisions that are sure to change in coming years. For instance, under the ACA, a new 3.8 percent tax was imposed on non-wage income for persons with incomes over $200,000 annually and on couples with incomes over $250,000 per year. These thresholds are not indexed, which means more and more taxpayers, and, eventually, the middle class, will pay this tax as their incomes grow naturally with inflation.
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Health spending in the U.S. grew to $3.2 trillion in 2015, fueled partly by the expansion of health insurance to millions of people under the Affordable Care Act, according to a new estimate published in the journal Health Affairs.
The study also looks forward, projecting that through the next decade, national health spending will climb at 5.8 percent per year, on average, to encompass a fifth of the economy by 2025.
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The Republican assertion that the administration is spending on health insurance subsidies without required congressional authority hasn’t gotten much news coverage. Many people dismiss it as yet another time-wasting attempt by Republicans to undermine the president’s signature domestic policy achievement.
But the central issue goes beyond health care to the fundamental division of federal power, particularly in a time of deep fissures between the legislative and executive branches.
Congress is supposed to approve every penny of federal spending. But the institution is in such partisan disarray that the appropriations process barely functions, giving rise to the temptation for presidents to assert greater power over the purse, marginalizing Congress.
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House Republicans on Wednesday released their healthcare spending bill for fiscal 2017, boosting funding to fight opioid abuse and the Zika virus while taking aim at ObamaCare and abortion.
Today, after years of hearings and speeches and debates, the Paul Ryan-led House of Representatives has done something it has not done before: it has released a comprehensive, 37-page proposal to reform nearly every federal health care program, including Medicare, Medicaid, and Obamacare. No proposal is perfect—and we’ll get to the Ryan plan’s imperfections—but, all in all, we would have a far better health care system with the Ryan plan than we do today.
The first thing to know about the Ryan-led plan — part of a group of proposals called “A Better Way” — is that it’s not a bill written in legislative language. Nor is it a plan that has been endorsed by every House Republican.
Instead, it’s a 37-page white paper which describes, in a fair amount of detail, a kind of “conversation starter” that House GOP leadership hopes to have with its rank-and-file members, and with the public, in order to consolidate support around a more market-based approach to health reform.
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House Speaker Paul Ryan’s policy plan for health care, as expected, leans heavily on market forces, more so than the current system created by Obamacare. The proposal contains a host of previously proposed Republican ideas on health care, many of which are designed to drive people to private insurance markets.
Importantly for conservatives, as part of a full repeal of the Affordable Care Act, the current law’s mandates for individuals and insurers would disappear under the GOP plan. It would overhaul Medicare by transitioning to a premium support system under which beneficiaries would receive a set amount to pay for coverage. The plan also would alter Medicaid by implementing either per capita caps or block grants, based on a state’s preference.
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