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

Donald Trump’s health secretary was on fire during a March 5 address to the Federation of American Hospitals. Alex Azar, the former Eli Lilly executive now charged with overseeing everything from Medicare to the Centers for Disease Control & Prevention, outlined plans to achieve nothing less than the “value-based transformation” of American health care.

“Today’s healthcare system is simply not delivering outcomes commensurate with its cost,” he said. And Azar put his biggest finger on a commonly blamed problem: the fact that American health care is “paying for procedures and sickness” instead of “outcomes and wellness.”

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  • Healthcare edges out crime, guns and deficit as top problem
  • Healthcare or economy has typically been top worry since 2001
  • Worries about unemployment, economy continue to decline

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ObamaCare turns eight years old today. Some opponents had hoped to mark the occasion by giving supporters the birthday gift they’ve always wanted: a GOP-sponsored bailout of ObamaCare-participating private insurance companies. Fortunately, a dispute over subsidies for abortion providers killed what could have been the first of many GOP ObamaCare bailouts.

ObamaCare premiums have been skyrocketing. All indications are this will continue in 2019, with insurers announcing premium increases up to 32 percent or more just before this year’s mid-term elections. Some Republicans fear voters will punish them for the effects of a law every Republican opposed and most still want to repeal.

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On March 5, the Trump administration’s top health official told a conference of hospital executives to hurry up. Washington has spent more than a decade slowly nudging the medical industry away from treating health care as a volume commodity business, where more care is better, and toward incentives that reward improving patients’ health. In all that time, almost nothing has changed. “That transition needs to accelerate dramatically,” said Alex Azar, a former Eli Lilly and Co. executive who was confirmed as secretary of Health and Human Services in January.

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Democrats revolted against this week’s spending package because the deal includes the 1970s Hyde Amendment, which bans federal funds from subsidizing abortion. The left claims this is some new GOP initiative. But Hyde protections have long applied to: Medicaid, Medicare, the Children’s Health Insurance Program, the Indian Health Service, the Federal Employees Health Benefits Program, the military health-care program Tricare, among others, as Republicans have pointed out. Such guarantees are standard for appropriations bills.

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Big news on the health-care policy front: Democrats appear to be converging on an actual agenda if they win in 2020.

Senator Elizabeth Warren introduced new legislation on Wednesday that policy guru Charles Gaba calls “ACA 2.0.” The Huffington Post’s Daniel Marans has details here.

This is, as Gaba describes it, more than just patching up Obamacare to make up for the damage done by Congress, states and design flaws in the original bill. It’s an upgraded version of the Affordable Care Act. At the same time, it’s nowhere close to the various single-payer or “Medicare for all” proposals that liberals have been spending a lot of time talking about over the last two years.

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The Trump administration this month announced its own effort to update the Electronic Health Record systems, which disrupt the doctor-patient relationship. The government could do even more good by deregulating EHRs, establishing a free market for user-friendly products. Perhaps Amazon, through its partnership with JP Morgan Chase and Berkshire Hathaway , could eventually do for medicine what it’s done for retail.

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We said Republicans would pay dearly for failing to replace ObamaCare, and the bill is already coming due this week in a political extortion fight with health insurers. The GOP may pad the omnibus spending bill with enough cash to preserve the law through the 2020 election.

Congress is debating how to handle cost-sharing reductions, which are payments to insurers for defraying out-of-pocket costs or deductibles for low-income individuals. The Trump Administration stopped these payments last year. Congress had declined to appropriate the money, and a federal judge said the Obama Administration wrote the checks illegally.

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Promising to build on the Affordable Care Act, a coalition of influential interest groups announced a new legislative push Thursday for a patchwork of measures that aim to make healthcare in California cheaper and more accessible.

Advocates touted a slate of proposals, including expanding Medi-Cal access to adults without legal status and increasing subsidies to those buying insurance on the Covered California exchange, as priorities for this legislative session.

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The only consistent characteristic of the Affordable Care Act (ACA) is its ability to generate litigation. The gift that keeps on giving for Obamacare opponents seems to defy common law doctrines curbing the practices of champerty and maintenance (frivolous lawsuits).

Last month 20 state attorneys general and two governors launched the latest lawsuit in federal district court in Texas, arguing that the upcoming repeal of tax penalties for the ACA’s individual mandate, as of January 2019, means that the entire law has become unconstitutional (or at least a number of its related insurance regulation provisions).

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