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

Clinton says she wants to “build on” Obamacare — the very law that has failed to provide affordable, quality healthcare to millions of Americans. She believes that more government — more mandates, more regulations, more subsidies — will do the trick.

And if her initial reform plan fails, she has her next move planned: a government take-over of the healthcare sector.

Obamacare requires all policies sold on the exchanges to cover numerous benefits, like maternity care or substance abuse treatment. But these extras aren’t free. To cover their cost, insurers have had to raise premiums.

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Former House Speaker Newt Gingrich remembers the day 23 years ago when Hillary Clinton, notebook in hand, came to see him and other senior Republicans to talk about “Hillarycare.”

It was early 1993. Clinton, on behalf of her husband, then-President Bill Clinton, was leading a healthcare reform drive that vaulted her onto the national stage.

Hillarycare would famously collapse after a fierce debate. In interviews with Reuters, some participants looked back on it as a crucible for the Democratic presidential front-runner that helped shape her approach to politics and governing.

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A proposed Medicare experiment encouraging doctors to use cheaper meds is either a necessary fix for America’s high drug prices — or the first step to President Donald Trump dismantling Obamacare.

It all depends whom you ask. And experts interviewed for POLITICO’s “Pulse Check” podcast showed the sides couldn’t be further apart.

The Obama administration’s Medicare experiment would test whether the program’s payment system encourages doctors to prescribe more expensive drugs, since they’re paid a set percentage of a drug’s price — therefore getting more for a higher-cost drug.

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Consumers are facing the prospect of significant premium increases for health insurance next year and faulty ACA provisions are at least partly to blame.

For example, people have figured out they can get a year’s worth of medical care while paying just nine months of premiums.  They also can wait to sign up for health insurance after they get sick and get the care they need. And young people are required to pay much more for health coverage than they expect to need in medical services so many just don’t enroll.

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The fate of the Obama administration’s significant investments in biomedical research will end up in the hands of either a candidate with a long, wonky track record on health and medicine — with mixed results — or the candidate whose views are an almost complete mystery.

Clinton “really knows what’s going on and is a policy wonk on medical research as well as health care,” said Mary Woolley, president of Research!America, a coalition of groups that promote medical research. Trump, however, has such an “in the moment” approach to medical research — almost never raising the issue unless someone asks him about it — that it will be impossible to know what he’d do until people ask him more questions, she said.

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About 1,000 health care economists from around the country descend on Philadelphia this week for the biennial conference of the American Society of Health Economists.

Think of it as Woodstock for health geeks who will, over several days, present nearly 550 papers covering insurance, hospital mergers and a host of other issues.

Of all those, Obamacare will be the jam that gets played over and over with 78 papers focused on some aspect of the law.

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Republican Obamacare replacement plans released so far would change the federal tax code to mitigate the cost of health insurance for individuals and families.

The Sessions-Cassidy legislation would provide a universal health insurance tax credit (UHITC) of $2,500 for individuals and $5,000 for married couples filing jointly, plus $1,500 per qualifying dependent.

A plan Price released in May 2015 would award tax credits for health insurance based on the ages of taxpayers and their dependents, ranging from $900 per year for individuals under age 18 to $3,000 for individuals aged 50 and older, according to the text of the Empowering Patients First Act of 2015.

Instead of a credit, the Republican Study Committee (RSC) has recommended a standard federal income tax deduction for health insurance of $7,500 per individual and $20,500 per family, as proposed in the American Health Care Reform Act of 2015 (AHCRA), sponsored by Rep. David Roe (R-TN) and 98 cosponsors.

All three plans also promote the use of health savings accounts and include provisions for giving states block grants to fund and reform their Medicaid programs according to their particular needs.

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The number of part-time workers in jobs for economic reasons shot up by 468,000, apart from the 458,000 that left the workforce altogether.  Slack work or business conditions accounted for 181,000 of these jobs, while another 77,000 could only find part-time work.

Analysts at Goldman Sachs have noticed this trend for some time, and put the blame on Obamacare.

“The evidence suggests that the [Affordable Care Act] has at least modestly elevated involuntary part-time employment,” Goldman Sachs economist Alec Philips wrote in a research note published on Wednesday. Obamacare had the greatest impact on industries that traditionally do not offer strong health insurance coverage, such as retail stores and the hospitality industry. Phillips noted that these have the highest levels of involuntary part-time workers, and believes that the ACA has forced “a few hundred thousand” to take cuts in hours or accept part-time work as a result.

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Last month, the Kaiser Family Foundation released the results of its 2016 survey of 671 people who purchased individual market plans compliant with the new mandates and rules established by the Affordable Care Act (ACA). As many insurers announce large premium hikes for next year and others announce they are withdrawing from the market, the survey reveals that enrollees are increasingly unhappy with their coverage. Given that these enrollees are one of the primary groups that the ACA is supposed to be helping, their declining satisfaction is particularly concerning and suggests a change of direction in federal policy is warranted.

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The Affordable Care Act’s employer mandate has at least modestly led to a rise in involuntary part-time employment, according to a Goldman Sachs study released Wednesday.

“We would estimate that a few hundred thousand workers might be working part-time involuntarily as a result of the Affordable Care Act,” said Alec Phillips, an economist at the investment bank, in a research note.

This is only a fraction of the 6.4 million workers employed part-time for economic reasons, he said, but would be a significant share of the “underemployment gap.”

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