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

Forget the Affordable Care Act: The future of our health care system will be shaped by a much bigger and broader fight — one that will likely culminate with a 2020 choice between private markets and an authentic government-run program in the form of a Bernie Sanders-style Medicare for All.

The bottom line: The cost of health care — both for individuals seeking coverage and the government seeking sustainability — promises to return as the biggest domestic issue once the Trump obsession burns off.

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Sandy Dowland has been to the emergency room 10 times in the past year and was hospitalized during four of those visits. She has had a toe amputated and suffers from uncontrolled diabetes, high blood pressure, major depression, obesity and back pain.

But her health is not high on the 41-year-old woman’s priority list.

“I have a lot going on,” said the unemployed mother of five who lives in a homeless shelter. She said it’s a struggle just to get herself and children through each day.

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The next great health care war is already starting. It’ll be about costs this time, not coverage, and Democrats are the ones firing the first shots — though neither party has a complete strategy just yet.

Why it matters: After a bruising, decade-long fight over the Affordable Care Act, plenty of candidates and lawmakers would love to keep their distance from the politics of health care. But the issue is so personal, and the system is so dysfunctional, that may be impossible.

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The downward spirals have begun. The combined Social Security trust funds—one for disability, one for retirement—as well as Medicare’s hospital-insurance trust fund, will begin eating into their reserves this year, according to reports released this week by the programs’ trustees. The trust funds for these safety-net programs are now projected to diminish until they are depleted. The Medicare hospital-insurance fund is projected to run dry in 2026. The bipartisan trustees have for several years been warning that Social Security and Medicare finances need fundamental repairs or people are going to get hurt.

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Remember Obamacare? The fight is far from over on the future of the Obama-era health insurance overhaul. Republicans are making a list-ditch effort this year to turn the program and the money over to the state. This isn’t full Obamacare repeal, but would make a world of sense because states would be free to experiment and find ways to reduce costs and provide better services.

Democrats are adopting a new political spin, which is that everything is fine with Obamacare. They claim that the only reason premium and deductible costs keep exploding is because President Trump repealed the individual mandate tax — which was nothing more than an unfair penalty on low-income families that can’t afford the high cost of the health law’s mandates. But if Mr. Trump is to blame, why were the costs skyrocketing two years before Mr. Trump even entered the Oval Office?

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Escalating premiums, higher plan deductibles, higher out-of-pocket maximums, and narrowing provider networks are all manifestations of the basic flaws in Obamacare’s public policy architecture. One effect is that Obamacare’s maximum out-of-pocket limits are higher than those for HSA-compatible plans. As a result, over half of all plan designs offered on Healthcare.gov in 2018 have out-of-pocket maximums that are too high for the plan to qualify as HSA-compatible. Congress needs to get back to work on repairing the damage done to the individual insurance market by Obamacare.
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The Obama administration said Tuesday that 11.7 million Americans now have private health insurance through federal and state marketplaces, with 86 percent of them receiving financial assistance from the federal government to help pay premiums.

About three-fourths of people with marketplace coverage — 8.8 million consumers — live in the 37 states served by HealthCare.gov, the website for the federal insurance exchange. The other 2.9 million people are in states that created and operate their own exchanges.

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States that have expanded Medicaid have seen strong gains in coverage and better access to care without having to sacrifice other social programs, new research has found.

But that may not last long.

An analysis by the Kaiser Family Foundation found the 33 states that expanded their Medicaid program to 133% of the poverty line saw a 7.4% decrease in the uninsured rate from 2013 to 2017 compared to a 2.7% drop to those that didn’t.

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First Charlie Gard and now Alfie Evans. These are babies who, though verbally silent, still gave clarion warnings to proponents of single-payer health care: The government — not my parents — is in charge of my life.

Charlie Gard was born in August 2015 with a rare genetic disorder that carried a poor long-term prognosis. In July 2017, little Charlie was just 23 months of age and on a ventilator. Over the objections of his parents, British doctors decided to withdraw life-sustaining care. According to British Courts, the National Health Service (NHS), the country’s single-payer system, is the ultimate medical decision maker — not the family. Ventilator support was withdrawn and Charlie died.

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Democrats are confidently running on Obamacare for the first time in a decade.

They’ve got a unified message blaming Republicans for “sabotaging” the health care law, leading to a cascade of sky-high insurance premiums that will come just before the November midterm elections. They’re rolling out ads featuring people helped by the law. And Tuesday, they’re starting a campaign to amplify each state’s premium increases — and tie those to GOP decisions.

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