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

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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Republican presidential nominee Donald Trump said that as president he would use Medicaid to cover poor people who can’t afford private health insurance, and make birth control available without a prescription.

The comments appeared to differ both with what some Republicans have proposed in the past, and — in the case of Medicaid — aspects of Trump’s own policy proposals on his website. Republicans generally opposed the expansion of Medicaid to higher income levels under Obamacare, for example.

Speaking on “The Dr. Oz Show,” Trump said Medicaid, the joint federal-state program for the poor, should be used to help provide health coverage for those who can’t afford to buy plans from private health insurers. The show was taped Wednesday and aired Thursday.

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Some of the nation’s largest companies are already taking steps to avoid ObamaCare’s “Cadillac tax,” according to a business survey released Wednesday.

About 12 percent of companies said they have taken steps to avoid being hit by the much-maligned tax on high-priced health insurance plans, which goes into effect in 2020.

Employers say they have either shifted more costs to workers, dropped their pricier options or picked plans with fewer providers, according to the annual employer benefits survey by the Kaiser Family Foundation and the Health Research & Educational Trust.

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A grace period in President Barack Obama’s health care law is allowing exchange customers to dodge the penalty while also helping them get more out of their medical coverage.

Insurers told the administration Monday in an annual meeting that making changes to the grace period is one way to make it easier for them to continue to participate in Obamacare’s exchanges. As is, the grace period leads to higher costs for health insurance policies, forcing some insurers to leave the exchanges due to massive financial losses.

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A top Obama administration health official indicated Wednesday that there are discussions underway about a settlement with insurance companies over Obamacare payments. This possibility has drawn alarm from Republican lawmakers, who warn that the administration is seeking to get around limitations set by Congress. Several insurers have sued the administration for funds they are owed under an Obamacare program called risk corridors, which is meant to protect insurers from heavy losses in the early years of the health law. A shortfall in funds has limited payouts. Congress enacted a provision preventing the administration from shifting funds into the program in 2014 but warn that judicial settlements now could be a way around that prohibition, for what they term to be a “bailout” of insurers.

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One of the more controversial parts of the Affordable Care Act is its expansion of Medicaid. A new study from the Mercatus Center at George Mason University reviews Medicaid’s longstand­ing problems, discusses the incentives states face as a result of the elevated federal reim­bursement rate for the ACA Medicaid expansion population, and analyzes the impact of the expansion. Overall, the expansion significantly adds to Medicaid’s unsustainable spending trajectory, likely fails to produce outcomes worth the corresponding cost, and creates a large federal government bias toward nondisabled, working-age adults at the expense of traditional Medicaid enrollees.

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The latest data from the Centers for Disease Control suggests that the number of uninsured has declined roughly 22 million since 2013, and 17.8 million since 2010 (darn you, financial crisis!). And today we got data from the Census Bureau, which suggests that the number of uninsured people has fallen from 13.3 percent to 9.1 percent since 2013, or by about 12.8 million. There are other surveys too. But we hardly need more numbers.

How can everyone get such different answers? Well, for one thing, methodologies differ.

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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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Eight of the states that will determine the Senate majority in November are likely to see significant reductions in the number of insurers participating in ObamaCare marketplaces.

The likely departures of insurers in Illinois, Wisconsin, Florida, Pennsylvania, Ohio, North Carolina, Arizona and Missouri are pushing the healthcare law toward the center of some of the most competitive Senate races in the country.

GOP strategists say Obama-Care’s troubles this year are morphing into a perfect storm for their candidates, providing a boost in a year when the party is defending 24 Senate seats.

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Just over 50 percent of Americans disapprove of the Affordable Care Act, according to a Gallup poll released Thursday.

Among people surveyed in the poll, 51 percent said they disapproved of the law, while 44 percent said they approved of it. It’s a slight increase in disapproval of the law since the spring, when a Gallup poll found 49 percent of people disapproved of the law and 47 percent of people approved of it. Overall, Gallup polls have found people have been more pessimistic than optimistic about the law for the past three years.