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

More than six years of efforts by Republican and other right-of-center opponents to repeal, replace, or substantially reshape Obamacare have fallen short.

The strategic options ahead for Obamacare critics on the right are:

  • Rinse and repeat: more of the same
  • Gamble on a more ambitious long-shot strategy
  • Adapt tactically in the near term, to minimize future damage

House Republicans released their latest plan – “A Better Way” – to repeal and replace the Affordable Care Act last month. It blends all three of the strategies above, but its lite brew for reform remarkably manages to be both too cautious and too unrealistic all at once.
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The platform approved Monday at the Republican National Convention suggests that a future Republican administration could dismantle Obamacare using regulatory authority. A Republican president could not waive portions of the law, but he could act to stop controversial payments that are being made to insurers.

In its section on health care, the platform pledged of Obamacare: “a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal.” The waiver concept echoes language used by 2012 Republican nominee Mitt Romney, who pledged that “If I were president, on Day One I would issue an executive order paving the way for Obamacare waivers to all 50 states.”

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Only about one-third of health insurers came out ahead in their first year in the ObamaCare marketplace, according to a study by the Commonwealth Fund released Wednesday.

While insurers made nearly twice as much money from healthcare premiums in 2014, overall profits “diminished noticeably” because of higher payouts, according to the expansive new analysis on companies participating in the exchanges.

Overall, health insurers underestimated their total medical costs by about 5.7 percent in their first year.

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The Republican platform seems to have taken its cue from Speaker Paul Ryan’s A Better Way, at least when it comes to health policy. Not surprisingly, health care did not get top billing in the 66 page document. The economy, jobs, and taxes led off, with the Affordable Care Act, Medicare, and Medicaid relegated to later chapters.  Although there is not much text, those words are important.\

Significantly, the platform takes up Medicare and Medicaid in the chapter on government reform. The document points out that Medicare’s long-term debt is in the trillions, and does not shrink from recommending actions that could set the program on a fiscally sound path.  That requires change that will not be welcomed by everyone, so the platform pushes off that change for a decade in the hope of not alienating the senior vote.  Nonetheless, the Republican Party has now officially endorsed Ryan’s premium support plan that can promote competition and more efficient health care.

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A provision of the Affordable Care Act that allows insurers to charge smokers higher premiums may have discouraged smokers from signing up for insurance, undercutting a major goal of the law, according to a study published this month.

The surcharges, of up to 50 percent over nonsmokers’ premiums, also showed no sign of encouraging people to quit.

The Affordable Care Act eliminated insurers’ ability to charge higher premiums based on whether a person was sick. But it does allow them to vary premiums with age, geography, family size and smoking status.

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The Republican party’s 2016 platform, unveiled Monday, echoes many of the proposals included in the health care plan House Republicans laid out last month.

The platform calls for the full repeal of the Affordable Care Act and for state control of insurance markets. It backs selling insurance across state lines and states that insurance should be more portable so that consumers can move from job to job with the same policy.

“We must recover the traditional patient-physician relationship based on mutual trust, informed consent, and confidentiality,” the platform reads.

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Top insurer UnitedHealth Group said Tuesday its 2017 earnings will benefit as it mostly exits the ObamaCare exchanges, its worst-performing business line.

UnitedHealth reported second-quarter earnings of $1.96 per share, up 13% from a year earlier, handily beating analysts’ estimates of $1.89. Still, the company just slightly raised its full-year earnings outlook to $7.80-$7.95 a share from $7.75-$7.95, roughly in line with consensus estimates for $7.89.

The high end of its full-year 2016 earnings guidance held steady because worse-than-expected results in its ObamaCare individual market business called for a conservative outlook, management said in an earnings call.

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The Republican leading the House caucus’ campaign arm said the party’s presumptive nominee will work with the caucus to replace the Affordable Care Act if elected in November.

“House Republicans have put forward patient-centered health care that will be affordable for families,” Rep. Greg Walden (R-Ore.) said Monday in a speech at the Republican National Convention. “We’re offering a real alternative, and showing voters that Republicans are the party of new and good ideas, while Democrats are clearly the party of the failed status quo, especially on health care.”

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The Trump health plan reportedly would make 18 million people uninsured by 2017. But by entirely repealing Obamacare and all its attendant taxes and regulations, the plan also is expected to reduce net federal savings over 10 years of $583 billion and reduce premiums in the non-group market by at least 20%. Progressives surely would be aghast at this prospect and you can be certain that unless Trump modifies the plan’s key features, Hillary Clinton will make it an important campaign issue this fall. But what should the average American think about this trade-off? It all comes down to how much Americans should be forced to pay to prevent each year of being uninsured.

To figure this out, we need to know the total amount that Americans would save if Obamacare were repealed and the net increase in uninsured person-years that would result.

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Until now, health care hasn’t been a big part of Donald Trump’s campaign for the presidency.

But conventions are about more than the nominee, and Republicans are likely to have something to say about issues including Obamacare, abortion, and perhaps even medical research.

Here are the five biggest things to watch in health and medicine:

  • Will Pence take the pressure off on abortion issues?
  • Will Republicans hit Clinton on drug prices?
  • Who likes Paul Ryan’s Obamacare repeal plan?
  • Will Zika be discussed?
  • Will Trump say anything about medical research?

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