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

Insurers have announced that they are sharply raising prices or pulling out of the Obamacare markets entirely. Many consumers will have fewer choices of insurance plans, and many insurance plans will include fewer doctors and hospitals. Many of the most important problems can be understood if you think of an Obamacare marketplace as a particular kind of restaurant: an all-you-can-eat buffet. It can be a solid business, but it’s hard to get the pricing right. For example, you can be in deep trouble if your buffet suddenly becomes the favorite hangout of the high school football team.  Unless you make major adjustments, you will quickly lose money. That may be what has happened to some of the companies selling health insurance.

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ObamaCare is plainly unaffordable for many young Americans. We’re at the start of our careers—and the bottom of the income ladder—so paying so much for something we likely won’t use makes little sense. The IRS penalty of $695 or 2.5% of our income is often cheap by comparison. We may be young, but we can do the math.

Young Americans aren’t looking for “outreach” and “engagement” from President Obama. We’re looking for affordable health-insurance plans—and ObamaCare doesn’t offer them.

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A majority of physicians look negatively at their profession and are increasingly burdened by new reimbursement models, according to a new survey.

The Physicians Foundation, a not-for-profit organization that supports research on the impact of the Affordable Care Act on physician groups, surveyed 17,236 physicians across the U.S. (PDF) on a variety of issues related to their field.

The report highlighted low morale among a majority of physicians. Fifty-four percent of physicians rated their morale as somewhat negative or very negative and only 37% were positive about the future of their profession. This is a decrease, however, from 2012 when 68% of physicians described low morale when surveyed by the organization.

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President Obama has an opportunity to win a positive legacy in health care. Although his attempt at payment reform, Obamacare, has failed in public opinion, he is also encouraging important initiatives in medical innovation. The Cancer Moonshot and Precision Medicine Initiative represent investments in innovation that can bring big payoffs. However, they will not succeed fully unless the Food and Drug Administration allows patients access to new therapies. Legislation modernizing the FDA, the 21st Century Cures Act, is being fumbled inches away from the Congressional end zone. Presidential leadership is needed.

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The Affordable Care Act has expanded Medicaid and has added to its unsustainable spending trajectory, according to a report from the Mercatus Center.

“Before the Affordable Care Act, the federal government provided states with an open-ended reimbursement of at least half of each state’s Medicaid expenditures,” the report states. “Because of the federal reimbursement, both state Medicaid spending and federal spending (through the reimbursement) have increased significantly since the program’s inception.”

According to the report, experts did not account for how states would respond to the reimbursement rate and underestimated the number of enrollees and their related costs.

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Yahoo Finance’s Ethan Wolff-Mann, who may have the best name in journalism, writes it’s not true that ObamaCare has caused employers to reduce workers’ hours because the new Kaiser Family Foundation/Health Research Educational Trustsurvey found “a whopping 7% of employers with more than 50 employees actually gave part-timers full-time jobs since Obamacare was officially launched in 2013. Only 2% of employers cut full-timers to part-time.” Leaving aside the question of whether 7 percent is a whopping figure, the figures Wolff-Mann cites don’t necessarily support his claim.

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In the event of a victory by Donald Trump in November, political analysis will take on a forensic cast. How did establishment politics — first in the GOP primaries, then in a national electorate — come to die?

Privately, Democrats would regret their selection of one of the most joyless, least visionary presidential candidates in recent memory. Publicly, they would blame trends that incubated within the Republican coalition, particularly a nativism incited by conservative media and carried by a candidate — alternately cynical and frightening — who is unbound by truth, consistency or decency.

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New York has revolted against a critical component of the Affordable Care Act: RiskAdjustment.  If its revolt survives an almost certain legal challenge, a number of states are likely to double down on New York’s actions and remove one of the few remaining fingers holding Obamacare on to a cliff.

Acting under direction of its new Superintendant of Financial Services, Maria Vullo, New York has joined the chorus of those familiar with the program in contending that the federal Risk Adjustment program is backfiring. Critics say the program transfers too much money amongst insurers and is actually destabilizing the market.  New York is the first state, however, to put money behind the critique.

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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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