The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers

This week, the Tax Court gave Benjamin and Delores Gibson the bad news that they would have to pay back a premium credit of $4,628.80 that went to Benjamin Jr. The Gibsons filed their 2014 return claiming Junior as a dependent even though he had not been living with them for much of the year. There is an interesting practice question here. Dependency is a matter of fact, not an election, but when it comes to older kids not living at home, it can be treated as, in effect, an election. Preparers need to be alert to the health care credit implications of claiming a dependent and weigh that against other benefits.

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Middle-class Americans, who have been hardest hit by Obamacare, are desperate for Congress to do something — anything — to lower costs.

Today, health insurance can cost more than a mortgage. The average family of four will face a staggering $22,622 in health insurance and related medical costs this year ($14,300 for premiums with an $8,322 deductible). The average annual cost of a mortgage (principal and interest) is about $18,000 for a $309,000 house.
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Conspicuously absent from most commentary arguing that Kansas should expand Medicaid under the Affordable Care Act is any discussion about the program actually improving the health of recipients. Instead, we are left with terribly materialistic arguments about forgone federal money. Why is it that on the biggest policy questions facing Kansas, such as Medicaid or education, we hear lots about money spent and little about health outcomes or student achievement?
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Lower than expected enrollment, rising premiums, and declining issuer participation have led to an increased focus by state and federal policymakers on stabilizing the individual health insurance market. Legislative proposals aimed at addressing these concerns are currently being discussed. Assuming the package of proposals were approved by Congress and issuers were permitted and willing to refile rates for the 2018 plan year, a combination of these policies may lead to the reduction of individual market premiums—as compared to current law–by 13% to 17% for 2018, driven primarily by the reinsurance program as well as the continued Health Insurance Tax moratorium.

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Single-payer is back on the docket in California. Late last month, Assembly Speaker Anthony Rendon announcedthat he’d formed a special committee “to develop plans for achieving universal health care in California.”

Rendon has been under pressure from progressive activists all summer, ever since he shelved SB 562, a bill passed by the state Senate on June 1 that would put all the state’s residents into a new, state-run single-payer healthcare system. At the time, he deemed it “woefully incomplete.” SB 562 did not specify how, exactly, the state would pay for single-payer.

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Donald Trump’s gleeful deal with the Democrats—ratcheting up the debt ceiling, as well as the ire of the Republican establishment—puts John Cogan’s mind on 1972. Starting in February of that year, the Democratic presidential candidates engaged in a bidding war over Social Security to gain their party’s nomination. Sen. George McGovern kicked off the political auction with a call for a 20% increase in monthly payments. Sen. Edmund Muskie followed suit, as did Rep. Wilbur Mills, chairman of the Ways and Means Committee. Former Vice President Hubert Humphrey, never one to be outdone, offered a succulent 25%.

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eHealth, Inc. CEO Scott Flanders  endorsed the Department of Health and Human Service’s (HHS) decision to reduce and rethink the Affordable Care Act’s (ACA or Obamacare) navigator program, which spent over $62 million to enroll 81,000 people in Obamacare in 2017 ($768 per enrollment).

“Secretary Price has an obligation to the American people to use their money effectively and efficiently, and the navigator program failed on both fronts,” said Scott Flanders, CEO of eHealth, Inc. “The navigator program’s results are discouraging, but HHS’ decision to acknowledge that failure and try something else is a positive step for government.”

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Health and Human Services announced that the agency will alter the funding structure for ObamaCare “navigators.” These are the community outfits the Obama Administration paid to steer folks through the Affordable Care Act’s subsidies and penalties. Last year the Obama Administration handed out $62.5 million in grants for open enrollment for 2017, and the period arrives again in November.

One grantee took in $200,000 to enroll a grand total of one person. The top 10 most expensive navigators collected $2.77 million to sign up 314 people, and it would have been much cheaper to offer to pay all of their premiums for a year. All told, the navigators last year enrolled about 81,000 people, less than 1% of the total.

The Trump Administration will tie grants to performance.

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In an effort to promote medical breakthroughs, the 21st Century Cures Act tries to create an “information commons”: a government-regulated pool of data accessible to all health researchers, regardless of background, training or motive.

Although speeding research is a noble goal, there’s little evidence that patients are willing to sacrifice their privacy the way that the 21st Century Cures Act requires.

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While Republicans fret over how many taxpayer-funded patches they will have to stick on ObamaCare to keep it on life-support, Democrats are already moving on to their real goal: a government-run, single-payer healthcare system.

Moderate Republicans like Sen. Lamar Alexander (R-Tenn.) are hoping to find bipartisan support for legislation that will save the individual (i.e., non-group) health insurance market and keep the ObamaCare exchanges from collapsing.

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