The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
“For the most part, the political debate over President Barack Obama’s health-care overhaul has become a duel between vague slogans: Republicans say they want to “replace” the Affordable Care Act but generally don’t say with what. Democrats say they want to “fix” it but usually don’t say how.
So Democratic Senators Mark Warner and Mark Begich deserve credit for advancing specific legislation to change the law. The main change they’re advocating, though, is unlikely to make people any happier with the law — and could cause new problems.”
“We now have the Medicaid and private-market health insurance enrollment data for the second quarter of 2014 needed to complete the picture of how Obamacare’s rollout affected coverage.
What we’ve learned is that the Obamacare gains in coverage were largely a result of the Medicaid expansion and that most of the gain in private coverage through the government exchanges was offset by a decline in employer-based coverage. In other words, it is likely that most of the people who got coverage through the exchanges were already insured.”
“During the long congressional debate over the Affordable Care Act (ACA) — i.e., Obamacare — one thing was certain: The Congressional Budget Office (CBO) would ultimately certify that the final legislation would lower future budget deficits.
It had to be that way. President Obama had made an unequivocal promise in a nationally televised address to Congress: He would not sign a bill that added “one dime” to projected federal deficits. The only way to make good on that promise was to have in hand a CBO cost estimate showing modest deficit reduction from the law’s provisions. CBO delivered what the president was looking for with its final cost estimate of the legislation in March 2010.”
“Australia’s federal government is about to raise almost $5 billion by privatizing its largest health insurer: Australia hopes to raise up to Aus$5.51 billion (US$4.82 billion) through the sale of the country’s largest health insurer in an initial public offering, Finance Minister Mathias Cormann said Monday. Cormann said the sale would remove the current conflict where the government is both the regulator of the private health insurance market and owner of the largest market participant. Medibank provides cover to 3.8 million people. The government has previously said Medibank is one of 34 competing funds in the private health insurance market in Australia and that a scoping study had found no evidence that premiums would rise as a result of the sale.”
“A great deal of analysis has been published on the causes of the health care spending slowdown system-wide — including in the pages of Health Affairs. Much attention in particular has focused on the remarkable slowdown in Medicare spending over the past few years, and rightfully so: Spending per beneficiary actually shrank (!) by one percent this year (or grew only one percent if one removes the effects of temporary policy changes).
Yet the disproportionate role played by prescription drug spending (or Part D) has seemingly escaped notice. Despite constituting barely more than 10 percent of Medicare spending, our analysis shows that Part D has accounted for over 60 percent of the slowdown in Medicare benefits since 2011 (beyond the sequestration contained in the 2011 Budget Control Act).”
“Gov. John Kasich of Ohio was the first potential 2016 candidate to get snared in the Obamacare/Medicaid media snafu. As one of several GOP governors who expanded Medicaid, he naturally defends that move, which in an Associated Press interview came out as a defense of Obamacare, to which the Medicaid extension was attached. Kasich clarified his view, but the liberal media, Democrats and potential 2016 opponents may think they have their gotcha quote.
Kasich, however, is correct that one can be for repealing Obamacare and still support states’ expansion of Medicaid. But other governors should be forewarned: You better be crystal clear about what you want to do.”
“Using data on household income and health insurance coverage maintained by the Census Bureau and McKinsey estimates on previously uninsured households enrolled through the Health Insurance Marketplace, the American Action Forum was able to construct state-level estimates of individual mandate payments. After accounting for exemptions, AAF estimates that 5.2 million people will be subject to the individual mandate penalty for being uninsured in 2014 and will pay a total of $5.8 billion in additional taxes. The AAF estimates include the exemptions for unauthorized immigrants, households that do not file income taxes, households that earn less than 138 percent of the federal poverty level, and households that cannot purchase a Bronze plan with 8 percent of household income, but do not attempt to project how many households may apply for one of the many hardship exemptions.”
“Ohio Gov. John Kasich, the Republican governor and possible 2016 contender, had a dust-up this week when the Associated Press reported pro-Obamacare comments he made. In reality, he subsequently said, he was only praising the Medicaid expansion — which he’s trying to argue is totally separate.
I’ve already written about why this is a dishonest distinction, but his office has decided to dig in further. In a statement released on Twitter on Tuesday, his press department attempted to trick conservatives by using several cynical strategies often employed by Republicans trying to explain their big government policies.”
“The vast majority of Americans gaining health coverage under Obamacare actually qualified for Medicaid because of loosened eligibility —and that’s what boosted enrollment among those previously uninsured, according to a new report from The Heritage Foundation.
The Obama administration has boasted that the Affordable Care Act, popularly known as Obamacare, would allow those previously uninsured to purchase quality, affordable health care.
“The inescapable conclusion is that, when it comes to covering the uninsured, Obamacare so far is an expansion of Medicaid,” Heritage Foundation health policy experts Edmund F. Haislmaier and Drew Gonshorowski write in a research paper scheduled for release today.”
“Much of the ACA’s tax effect resembles unemployment insurance: both encourage layoffs and discourage people from returning to work. The ACA’s overall impact on employment, however, will arguably be larger than that of any single piece of legislation since World War II.
•The ACA’s employment taxes create strong incentives to work less. The health subsidies’ structure will put millions in a position in which working part time (29 hours or fewer, as defined by the ACA) will yield more disposable income than working their normal full-time schedule.
•The reduction in weekly employment due to these ACA disincentives is estimated to be about 3 percent, or about 4 million fewer full-time-equivalent workers. This is the aggregate result of the law’s employment disincentives, and is nearly double the impact most recently estimated by the Congressional Budget Office.
•Nearly half of American workers will be affected by at least one of the ACA’s employment taxes—and this does not account for the indirect effect on others as the labor market adjusts.
•The ACA will push more women than men into part-time work. Because a greater percentage of women work just above 30 hours per week, it is women who will be more likely to drop to part-time work as defined by the ACA.”