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

A new study in the New England Journal of Medicine suggests that the assumption that the ACA would lead to lower Emergency Room use was wrong as Medicaid expansion in Oregon produced a spike in ER visits. A surge in ER use will likely produce adverse health consequences for many and may be contributing to skyrocketing Medicaid expansion spending, which was 49% higher per enrollee in 2015 than the government expected.

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Bob Kocher and Ezekiel Emanuel, who worked in the Obama White House on health care reform, argue that it’s “misleading” to raise concerns about the fact that individual market health insurance premiums have nearly doubled under Obamacare. “Premiums today,” they say, “are 20% lower than the Congressional Budget Office predicted when the ACA was passed.” Their argument is nonsensically out of touch, and it illustrates why the designers of the ACA got so many things wrong. The unaffordability of exchange-based insurance is the ACA’s most serious problem. As research from Avalere Health has shown, enrollment in ACA-based insurance is alarmingly low among those whose incomes exceed 200% of the federal poverty level.

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President Barack Obama delivered a robust defense of Obamacare on Thursday, but also acknowledged his signature domestic achievement needs fixes as premiums rise and insurers are fleeing the law.

Obama hailed the achievements of the federal health care law six years after passage, providing coverage to an additional 20 million Americans and reducing the uninsured rate to the lowest level ever recorded. And he sought to remind Americans that they likely benefit from the law’s consumer protections, even though just a small fraction of the country actually buys coverage from Obamacare’s insurance marketplaces.

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Less than half of the approximately 27 million uninsured people in the U.S. are eligible for federal financial assistance, an analysis released Tuesday by the Kaiser Family Foundation shows.

Roughly 11.7 million, or 43 percent of that population, are not taking advantage of some sort of federal assistance to get health insurance that they are eligible for, according to the analysis. That assistant may be in the form of a subsidy to purchase a policy on the Affordable Care Act exchange or a Medicaid plan a consumer is eligible for but not signed up for.

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President Obama and Hillary Clinton love to talk about the “20 million people” who’ve allegedly been added to the health insurance rolls under Obamacare. But in truth, a lower percentage of Americans have private health insurance now than in 2007, even though Obamacare is the law. This is according to the federal government’s own figures. According to the Centers for Disease Control and Prevention, 67% of those living in the United States had private health insurance in 2007. Now, as of 2015, only 66% have private health insurance.

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Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients.

The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans — including Blue Shield of California — that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say.

The Obama administration is considering changes to how these dollars are allocated in the state and federal exchanges, but critics say the proposed modifications don’t go far enough.

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Health care experts on both sides of the aisle projected the next Congress may tie reforms to Obamacare to other legislative efforts, speaking Tuesday at a National Coalition on Health Care forum. Conservatives on the panel suggested any negotiations would be tied to how willing both parties are to compromise. Douglas Holtz-Eakin, president of the American Action Forum, suggested GOP priorities such as tax reform or adjusting how the federal government addresses poverty could address health care in some way if the next administration and Senate are willing to acknowledge them and make trades. Joseph Antos, a health analyst at the American Enterprise Institute, agreed, saying adjustments would be possible based on how much the incoming administration is willing to negotiate with Congress.

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Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients. The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans—including Blue Shield of California—that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say.

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Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. “In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.”

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Nearly 30 million American adults remain uninsured. Despite the Affordable Care Act’s vast—and growing—cost to taxpayers, it has failed to place the U.S. on the road to near-universal health insurance coverage. To deliver coverage that is more affordable and attractive to middle-class Americans, structural reforms to the ACA are urgently needed. Until then, America’s middle class will suffer the ACA’s high costs without enjoying its benefits.

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