The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
Washington experts have been frequently wrong about the Affordable Care Act.
They projected far more enrollees in ACA exchanges than materialized. They also projected that the individual insurance market would stabilize in 2016 with robust competition. Instead, the country is grappling with enormous premium hikes and fewer choices.
A new government report reveals perhaps the largest mistake yet: Medicaid enrollees who gained coverage through the ACA cost almost 50 percent more, on average, than the government projected just one year ago.
ACA supporters often point to Medicaid expansion as the law’s greatest success since it reduced the overall uninsurance rate. We now know that result comes with a gigantic price tag.
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A government report finds that the cost of expanding Medicaid to millions more low-income people is increasing faster than expected, raising questions about a vital part of President Barack Obama’s health care law.
The law provided for the federal government to pay the entire cost of the Medicaid expansion from 2014 through the end of this year.
Obama has proposed an extra incentive for states that have not yet expanded Medicaid: three years of full federal financing no matter when they start. But the new cost estimates could complicate things.
In a recent report to Congress, the Centers for Medicare and Medicaid Services said the cost of expansion was $6,366 per person for 2015, about 49 percent higher than previously estimated.
The Affordable Care Act has overwhelmed large swaths of the economy, and the Administration is poised to upend yet another, by overriding Congress’ directives on how Medicare pays for the medicines that physicians prescribe under that program. Patients, healthcare providers and drug manufacturers all stand to suffer from the Administration’s disregard of a statutory mandate that controls over $20 billion in payments a year.
In the Medicare statute, Congress laid out a formula for Part-B drugs (those you get at a doctor’s office): Providers receive 106% of the average sales price—that is, the going rate plus a little to cover overhead costs. Enter the Centers for Medicare and Medicaid Innovation (CMMI), a bureaucracy within a bureaucracy, created to test “innovative payment and service delivery models.” CMMI recently proposed to “test” an approach to paying for Medicare Part-B drugs that will change reimbursements for three-quarters of the country.
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“Irony is wasted on the stupid.” This quote, attributed to Oscar Wilde, seems fitting in light of the Obama administration’s new campaign to block two blockbuster mergers between the health insurers Aetna and Humana and Anthem and Cigna. (It is also fighting hospital consolidation in many states.) The administration is rightly worried that this will lead to higher health care costs through reduced competition, yet it ignores the fact that its signature law, the Affordable Care Act, was specifically designed to foment such consolidation.
The central planners behind the Affordable Care Act – also known as Obamacare – were convinced that consolidation in health care would lead to decreased health care spending by eliminating duplication, standardizing treatment protocols and incentivizing better utilization. As three of Obamacare’s primary authors wrote in The Annals of Internal Medicine in 2010, the law was designed to “unleash forces that favor integration across the continuum of care.” No part of health care was supposed to be spared – doctors, hospitals, insurers, pharmaceutical companies and others were given regulatory and financial incentives to merge.
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Over the past year, a new wrinkle has emerged. Federally subsidized co-ops included in the ACA after the defeat of the government-payer “public option” began failing rapidly when Congress limited their potential subsidy to taxes collected through the ACA. Most of them have now closed after having lost access to nearly unlimited amounts of red ink in the HHS budget. Joining them are a growing number of private insurers, unhappy about the losses they continue to absorb in Obamacare exchanges.
In short, the individual markets keep marching closer and closer to collapse. Whether or not the imposition of a single-payer system on all Americans in a crisis was the secret plan all along for ACA advocates, the existential crisis for this market is nearly upon us. This is the time to spring socialized medicine in the US, right?
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Clinton tried hard to get health reform passed when she was first lady in the 1990s. Now that President Obama has done that, she would continue to implement his law if she wins in November. But she has shown a deep interest in more healthcare reform, proposing a number of policies aimed at making coverage more affordable.
Last fall, she released a plan to reduce prescription drug costs that included capping out-of-pocket drug expenses for consumers and requiring pharmaceutical companies to pay larger rebates to Medicare for low-income patients.
In a healthcare proposal on her campaign website, she also calls for requiring insurers to cover more doctors visits even before a patient pays the deductible and providing families with a tax credit to help pay for out-of-pocket health expenses.
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“Last week, I outlined eight possible futures for Obamacare. By curious coincidence, few of them looked like the paradise of lower premiums and better care that the law’s supporters had promised. In the best case scenarios, they looked more like what critics had warned about — “Medicaid for all,” or fiscal disaster, or a slow-motion implosion of much of the market for private insurance as premiums soared and healthy middle-class people dropped out.
What I did not explore was why we seem to have come to this pass — which is to say, why insurers seem suddenly so leery of the exchanges and why premiums are going up so much for Obamacare policies. No one really seems to know exactly why insurers are having so much trouble in the exchanges. . . .”
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Moving beyond “Obamacare,” political activists are looking to state ballot questions to refocus the nation’s long-running debate over government’s role in health care.
This fall, California voters will decide whether to lower some prescription drug prices, while Coloradans will vote on a state version of a “single-payer” government-run health system, similar to what Vermont Sen. Bernie Sanders proposed in his unsuccessful bid for the Democratic presidential nomination.
Sanders supports both the California and Colorado initiatives, said spokesman Michael Briggs.
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“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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