The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
On Wednesday, Tucker Carlson debated Massachusetts Institute of Technology Professor Jonathan Gruber, often considered one of the “architects” of ObamaCare, on the merits of the law and why Republicans want it repealed.
Carlson said that 20 percent of those on the insurance exchanges only have one coverage option, and listed a few criticisms that Americans have of the law.
“There’s been a lot of misinformation,” Gruber said, adding that some costs increases have been slower than before the law was passed.
“Americans just dont understand what this law has done for them,” he said.
Gruber said that the richest Americans and the youngest and healthiest may have indeed been hurt by the law, but the fact they often must pay more for healthcare has helped others who are less fortunate.
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President Obama recently warned that if Congress junks the Affordable Care Act, “133 million Americans with pre-existing conditions” will be in jeopardy. That’s a phony figure, for several reasons. The actual number is roughly 500,000.
For starters, half of Americans get their insurance through an employer, according to the Kaiser Family Foundation. Another 34% are on Medicaid or Medicare. For all these people, pre-existing conditions are no barrier to coverage.
Pre-existing conditions mattered before ObamaCare only in the individual market, but even there few were affected. Many of these people with pre-existing conditions managed to get health coverage through the high-risk pools run by 35 states. Those pools covered about 225,000 people in 2011, according to the Kaiser Family Foundation.
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“What about the 20 million people who got coverage?”
Republicans are naturally concerned. Liberals have weaponized this number to stop repeal of the ACA. But should 20 million people keep a bad law on the books? To answer this question, Congress must ask two different questions.
First, is the number real? In March 2016, the Department of Health and Human Services (HHS) estimated that 20 million uninsured adults gained coverage under the ACA: 17.7 million non-elderly adults (ages 18 to 64) since October 2013, and 2.3 million young adults (ages 19-25) between 2010 and 2013.
The estimates are based on data from the National Health Interview Survey and the Gallup-Healthways Well-Being Index. The estimates are “adjusted to account for changes in general economic conditions (via employment status), geographic location, demographics and other secular trends.” Thus, the 20 million is an estimate, not a rock-solid fact.
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Practically since Obamacare became law, Republicans in Congress have been promising to repeal it. The law has been consistently unpopular during that time as well.
The January edition of the Kaiser Health Tracking Poll shows that those who want to repeal Obamacare outnumber those opposed 48 percent to 47 percent. This is higher than in the November edition, which found that 43 percent wanted to repeal or scale back the law.
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The U.S. public has been split in their views on the Affordable Care Act since the law was enacted in 2010, but what about those Americans who actually buy their health insurance through the federal program’s marketplaces?
Although most Obamacare participants give high marks to their health coverage, a growing segment of ACA exchange users has expressed frustration with rising costs and what they see as a shortage of plan options. According to the Henry J. Kaiser Family Foundation, the share of Obamacare enrollees who are dissatisfied with their plans rose from 14 percent in 2014 to 29 percent in 2016.
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The latest Kaiser Health Tracking Poll finds that health care is among the top issues, with the economy and jobs and immigration, Americans want President-elect Donald Trump and the next Congress to address in 2017.
While the average estimate shows nearly 21 million people have benefitted from Obamacare, it’s important to note that some people currently enrolled in Medicaid could have enrolled in Exchange coverage with nearly full subsidization had their state not expanded Medicaid, and would likely be eligible for whatever new subsidy structure might replace the current system. Regarding those in the Individual Market, not all of these individuals are receiving subsidies and would therefore not be financially impacted by the repeal. Making reasonable assumptions and accounting for those who lost insurance because of the ACA, and setting aside any assistance that would be provided by ACA replacement policies, the number of people who, on net, are potentially at risk of being negatively impacted is likely closer to 13-14 million.
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My colleague Avik Roy has suggested that passing a full Obamacare replacement (as opposed to a partial replacement passed via reconciliation) might be possible even though it would require Democratic votes to obtain the 60-vote threshold in the Senate, and that a pre-condition to achieving that would require the Congressional Budget Office (CBO) score the replacement as covering at least as many people as the Obamacare does.
As if to give a warning shot across the Republican bow, the officially non-partisan CBO warned that it “would not count those people with limited health benefits as having coverage” when evaluating changes to the health care law, and that changes to the “essential health benefits” required under the ACA could result in people receiving tax credits to help pay for health insurance under a new law, but being counted as not having health insurance according to the CBO, if the coverage they have doesn’t meet the CBO’s requirements. At issue, basically, is “What is health insurance?”
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As Congress readies legislation to repeal and replace the Affordable Care Act (ACA), Congressional Budget Office (CBO) estimates will play an important and respected role as they did in the passage of the law in 2010. We now know that many of CBO’s projections of important aspects of the ACA have significantly differed from actual outcomes. In this piece, I highlight CBO’s key past errors in projecting effects of the ACA. They can largely be grouped into two categories. First, CBO projected that the exchanges would be stable by now with more than twice as many enrollees as they currently have, rather than suffering from severe adverse selection in most states as they now are. Second, CBO projected that the ACA Medicaid expansion would be much smaller and less expensive than it has turned out to be.
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Cost overruns are endemic to government health programs, and ObamaCare is turning out to be no different. Not only are its Medicaid expansion costs exploding, skyrocketing premiums are now pushing insurance subsidy costs through the roof.
A new study from the Center for Health and Economy finds that because of the double-digit premium increases across the country, federal spending on ObamaCare’s insurance subsidies will shoot up by nearly $10 billion next year
That’s because the amount of the subsidy is directly tied to the cost of insurance in any given market. The Obama administration treats this as a cardinal virtue of ObamaCare, because the subsidies largely shield eligible enrollees from premium rate shocks. In fact, the administration has argued that higher premiums are a good thing, because they make more people eligible for those subsidies.
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