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

“No one can see a bubble. That’s what makes it a bubble.” That was Christian Bale’s character’s summation of a market bubble in last year’s hit movie “The Big Short,” which chronicled the few investors who saw the signs pointing to the mortgage market collapse. With terrorism, email scandals and race relations dominating the headlines, has a healthcare bubble been filling up quietly behind the scenes?

Since the 2010 passage of the Patient Protection and Affordable Care Act (ACA or ObamaCare), the health care industry has seen record growth and increased revenues. Why? Illness, especially chronic, sadly is a moneymaking business. Illness requires more office visits, more hospitalizations and inevitably more bills. ObamaCare halted insurance companies’ practice of rating premiums based on a customers illness history, or as more commonly known, preexisting conditions.

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Six years after ObamaCare was signed into law – and countless assurances later that the law is “working” – America’s major insurance companies are facing mounting losses and threatening to pull out of the exchanges, leaving customers facing higher costs and fewer options.

In the most recent example, Tennessee regulators are bowing to pressure to let insurers refile their 2017 rate requests, which could lead to steep hikes for customers. A state official acknowledged to The Tennessean they are “not alone” in letting companies seek bigger increases — as some insurers head for the exits.

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Americans should be more worried than ever about Medicaid, which provides health insurance for America’s most vulnerable. The cost of the $500 billion program is expected to rise to $890 billion by 2024, according to the Centers for Medicare and Medicaid Services. Yet more spending doesn’t necessarily mean better care for beneficiaries, 57% of whom are low-income minorities. The expansion of Medicaid is one of the most misguided parts of ObamaCare—shamefully expanding second-class health care for the poor.

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As college students and their parents finalize their enrollment and pay tuition and fees for fall, many face one fewer headache than in years past: no more worrying about whether they’ve waived the optional health-insurance coverage in time to avoid being charged for it.

In large part because of changes brought by the federal Affordable Care Act, a number of colleges have stopped providing student health insurance.

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Aetna announced in early August that it would not expand into additional Obamacare markets and that it might consider leaving existing markets. It’s just the latest example of the failures of this massive healthcare law.

In an editorial, Investor’s Business Daily declared: “Obamacare is failing exactly the way critics said it would.” The outlet explained that Aetna had already lost $200 million thanks to Obamacare, but had expected to break even in 2016. That didn’t happen, so the company will no longer expand into five additional states and is rethinking whether it will stay in the 15 states it already offers Obamacare plans.

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With Donald Trump’s presidential campaign faltering, Republican health policy experts are gaming out Plan B for working with a Hillary Clinton administration to achieve conservative healthcare goals.

Their focus is on a possible “grand bargain” that would give conservative states greater flexibility to design market-based approaches to make coverage more affordable and reduce spending in exchange for covering low-income workers in non-Medicaid expansion states. A key element, conservative experts say, would be for a Clinton administration to make it easier for states to obtain Section 1332 waivers under the Affordable Care Act. Those waivers allow states to replace the law’s insurance exchange structure with their own innovative models.

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“If Hillary Clinton were able to institute a public option, I anticipate it would accelerate insurers’ exit from Obamacare exchanges, making it unlikely that exchanges would ever become profitable, as Medicare Advantage and Medicaid managed-care are. While those programs have bipartisan political support, Republican politicians are fully committed to opposing Obamacare exchanges.

However, a public option administered by the same contractors (subsidiaries of health insurers) which process Medicare claims would be a good business opportunity for insurers. So they should be quite happy to allow Obamacare beneficiaries to shift from risk-bearing plans to a government plan.”

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Narrow networks have changed considerably under the Affordable Care Act, but the trajectory of regulation remains unclear.

Competition on the Obamacare marketplaces will decline next year. There will be significantly more places in the country where customers have no choice of health insurance because just one company signed up to sell coverage.

This is the conclusion that health policy experts have increasingly gravitated toward in recent months and weeks, as major insurance companies have announced hundreds of millions of dollars in financial losses on the Obamacare marketplaces.

“Under any likely scenario, there will be less insurer participation in the exchanges in 2017 than there was in 2016,” says Michael Adelberg, a senior director at FaegreBD Consulting who previously worked in the Obama administration helping to manage the marketplaces’ launch.

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CBO projects that the combined federal spending on Social Security, Medicare, Medicaid, and the ACA subsidies will grow from 11 percent of GDP in 2016 to 16.3 percent of GDP in 2046. This run-up in spending will increase annual federal budget deficits and push cumulative federal debt to 141 percent of GDP in 2046 — well past the point that most economists would consider dangerous for the economy. (Spain’s debt is 99 percent of GDP in 2016).

CBO’s base case scenario is also probably too optimistic. CBO’s projection assumes federal revenue will grow from 18.2 percent of GDP in 2016 to 19.4 percent in 2046 (the 50-year average of federal revenue, from 1966 to 2015, was 17.7 percent of GDP). But the projected growth in federal revenue derives from tax provisions that are sure to change in coming years. For instance, under the ACA, a new 3.8 percent tax was imposed on non-wage income for persons with incomes over $200,000 annually and on couples with incomes over $250,000 per year. These thresholds are not indexed, which means more and more taxpayers, and, eventually, the middle class, will pay this tax as their incomes grow naturally with inflation.

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