The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
For Linda Dearman, the House vote last week to repeal the Affordable Care Act was a welcome relief.
Ms. Dearman, of Bartlett, Ill., voted for President Trump largely because of his contempt for the federal health law. She and her husband, a partner in an engineering firm, buy their own insurance, but late last year they dropped their $1,100-a-month policy and switched to a bare-bones plan that does not meet the law’s requirements. They are counting that the law will be repealed before they owe a penalty.
“Now it looks like it will be, and we’re thrilled about that,” Ms. Dearman, 54, said. “We are so glad to feel represented for a change.”
The voices of people like the Dearmans helped spawn a political movement after the passage of the health law seven years ago.
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Of the 498 rating regions in the United States, 146 had only one insurer selling nongroup coverage through its state marketplace in 2017; 125 had just two insurers. Markets with one insurer include the entire states of Alaska, Alabama, North Carolina, Oklahoma, most of Arizona, and rural areas of several states. Markets with only one or two marketplace insurers tend to be much less populated than areas with more competing insurers.
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Health care has become an ongoing source of pain for many small-business owners. It was the top issue owners wanted Trump to address in a survey of 700 owners and prospective buyers in late February by BizBuy Sell, a marketplace for small businesses.
Among respondents, 60 percent favored an ACA repeal. The major reason: spiraling health insurance premiums — often a result of insurance companies fleeing the marketplace.
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Two years ago, I was a 7-month-pregnant widow with one toddler who got a letter two weeks after my husband died informing me I’d lost my third or fourth health insurance plan since the ACA passed. If you’ll remember, the promise was that I could keep my plan if I liked it. I could not. While the ACA has helped millions of people, there are many of us—many with far fewer resources than I—who now have much more expensive, less effective, junkier, nearly unusable plans than we had back when our allegedly “junk” plans were outlawed. Again, we are not the only ACA story. But we are part of the story, we were sold a bill of goods, and we’re often overlooked.
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The Republican predicament is illustrated in the cultural response to a monologue by late-night host Jimmy Kimmel who, through tears, made an impassioned plea to President Donald Trump and the GOP not to decrease public funding for or access to health insurance.
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Given the damage wrought by Obamacare, it’s understandable that so many Americans want a comprehensive overhaul of our health sector. But single-payer is one of the few approaches to health policy with a worse track record than Obamacare. What proponents of government-run medicine ignore is that the policy has been an utter disaster everywhere it’s been tried—from Canada, to the UK, to America’s own experiment in single-payer care, the Veterans Health Administration. The only way to ensure that Americans have access to timely, affordable, high-quality care is by creating a competitive healthcare market—not a government healthcare monopoly.
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Although insurers have generally remained profitable overall since implementation of the Affordable Care Act, many companies participating in the individual market – where most of the major market reforms took place in 2014 – experienced substantial losses in this market in the early years of reform. The individual market is where just 7% of the U.S. population gets their insurance (and thus also represents a small share of most health insurers’ business), but the stability of the market and willingness of insurers to continue to participate is essential to the ACA’s success. Going into 2017, there were a number of high-profile exits and premium increases, raising concerns over the stability of the individual market. Although some local markets are likely fragile, the Congressional Budget Office expects the ACA individual market to remain stable across most part of the country.
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Nearly two-thirds of Republicans still want Congress to pursue health care reform, a new Morning Consult/POLITICO poll shows.
Among Republicans, 62 percent of registered voters want reform efforts to continue, versus just 30 percent who think lawmakers should stop. Among all voters, 51 percent said the GOP should move on to other efforts, while 37 percent said they want Congress to continue with health care reform.
There is no precise headcount of how many people have gained coverage because of the Affordable Care Act. And it is downright impossible to reliably estimate the number of people who might lose coverage if Congress repeals and replaces it. The “20 million” figure appears to have originated in a March 2016 report by the U.S. Department of Health and Human Services. That report declared that “the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million adults through early 2016.”
Estimates by the Heritage Foundation find that 14 million people (including children) gained public or private coverage in 2014 and 2015. Unlike government surveys, Heritage examined data from insurance company regulatory filings and from the government’s own headcount of Medicaid enrollment.
They found that 84% of the newly insured gained coverage through Medicaid and a related government program for low-income children.
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Republicans are talking about repeal-and-replace as “three pronged”—pass the current House bill, deregulation through Mr. Price’s executive action, and then measures that can later be attached to must-pass bills. Mr. Price’s letter is the beginning of prong two.
Republicans have an obligation to try to revitalize insurance markets, and not only because Americans depend on coverage. Repealing and replacing ObamaCare is also an opportunity to show that conservative ideas can work in health care. The reason the opposition is so furious is that liberals fear they might succeed.
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