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

The government says about 500,000 fewer Americans had no health insurance the first three months of this year, but that slight dip was not statistically significant from the same period in 2016.

Progress reducing the number of uninsured appears to have stalled in the last couple of years, and a separate private survey that measured through the first half of 2017 even registered an uptick.

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It looked just like a campaign launch, from the line winding around the Fellowship Chapel Church, to the tailgaters giving away hot dogs, to the 2,000 voters who eventually packed inside.

But when Sen. Bernie Sanders (I-Vt) and Rep. John Conyers Jr. (D-Mich.) arrived, there were no waving signs. They were there to kick off the push for universal health care, with legislation queued up for September, and no expectation that the Republican-controlled Congress would pass it.

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In Part 1, we learned that real per capita health spending saw a 25-fold increase the 8 decades starting in 1929 even as real per capita GDP grew only 5-fold during the same period.

In Part 2, we learned that annual excess growth in inflation-adjusted health spending above and beyond general economic growth has been a persistent phenomenon: from 1929 to 2015, the average rate of growth in real per capita health spending (4.1%) was slightly more than double the rate experienced in the rest of the economy (2%).

Today we will examine the consequences of this outsized growth in health spending: health spending–which includes both spending on health services (“health care”) as well as health insurance–absorbs an ever-growing fraction of the economy and government spending (in this post, my term “health spending” is equivalent to the official government term used by actuaries at the Centers for Medicare and Medicaid Services: National Health Expenditures or NHE: it includes both spending for medical care services/supplies/medications as well as health insurance and the attendant administrative costs borne by health care providers and health insurers; in short, it includes everything).

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A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015. Wisconsin Sen. Ron Johnson presents intriguing evidence that the Medicaid expansion under ObamaCare may be contributing to the rise in opioid abuse. According to a federal Health and Human Services analysis requested by the Senator, overdose deaths per million residents rose twice as fast in the 29 Medicaid expansion states—those that increased eligibility to 138% from 100% of the poverty line—than in the 21 non-expansion states between 2013 and 2015.

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Some strategists expect Democrats will consolidate around some form of single payer by 2020, though others won’t concede that as a given. The problem: most people don’t think a single payer system has a shot at becoming law anytime soon, and playing to the party’s base may ignore real concerns about affordability.
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The oracles at the Congressional Budget Office this week descended from Delphi to predict 20% premium increases if the Trump Administration ends illegal Obama Care subsidies for insurers, and Democrats are happy to agree. Yet a careful reading of the report reveals some surprising results that are far less ominous and for consumers mostly benign.

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The ACA has expanded funding for Medicaid services, but it has also to an even greater degree expanded the pool of people eligible. It used to be that Medicaid did a fair job of providing for the truly disabled and needy. Now it does a lousy job of serving more people. My wife and I have an adult child living at home and will for the rest of our lives. Please join me in supporting the repeal of the ACA and put Medicaid funding back in the pot for the truly needy and disabled in our society. Our daughter will thank you.

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Wait, I thought Obamacare was supposed to solve the problem of access to affordable health coverage—especially for older Americans!  Are Democrats now saying their signature legislation has made the problem worse?

Senator Debbie Stabenow (D-Mich.) has introduced the “Medicare at 55 Act” to allow Americans aged 55-64 to buy into the Medicare health insurance program. Seven other Democrats are original co-sponsors of the legislation.

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The ACA is dead, long live the ACA. At a time when it seems that all we hear about in healthcare revolves around the political folly of legislating healthcare, there has been little attention paid to the underlying crisis that threatens access, quality and cost; a workforce that is exhausted, depressed, and clinically, burnt out.

This problem has been lurking behind all the grandstanding of repeal and replace and has been evolving and increasing at an alarming rate. Burnout, in this case, is defined as a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), a feeling of cynicism (depersonalization), and a low sense of personal accomplishment.

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The individual market shrank by 15% between March 2016 and March 2017, including a 25% decline among unsubsidized policyholders.  The individual market is not “sound.”  Because of rising premiums, millions of people who are not receiving subsidies can no longer afford to buy individual policies, and millions more may forfeit their policies in the next round of rate hikes.

Relinquishing at least some regulatory authority to the states might produce more functional markets where insurers can offer consumers the coverage they want at a price they can afford.

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