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

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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More than two-thirds of state benchmark plans violate federal requirements to cover treatment for addiction disorders.

The National Center on Addiction and Substance Abuse surveyed addiction treatment benefits offered among 2017 Essential Health Benefits benchmark plans and found none offered a comprehensive array of addiction treatment benefits.

The report cites benchmark plans, which determine the minimum level of benefits available to those covered in state exchange plans, frequently “excluded or not explicitly covered benefits” related to residential treatment and the use of methadone as therapy.

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Donald Trump’s inconsistencies on health policy are baffling experts and deepening the doubts that conservatives have about his candidacy.

The presumptive Republican presidential nominee has put forward a healthcare plan on his campaign website that leaves out many of the bolder promises he has made during debates and speeches.

Trump has repeatedly promised to “take care of everybody,” but his health plan includes no major expansion of coverage; one analysis asserted the proposal would actually end coverage for 21 million people.

Similarly, he has vowed to keep protections for people with pre-existing conditions, but his plan includes no such provision.

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The Congressional Budget Office and the Joint Committee on Taxation estimate that the total net subsidy provided by the federal government for people under the age of 65 will amount to approximately $660 billion in 2016. The CBO and JCT project that this subsidy will rise annually at a rate of 5.4 percent. The forecasted net subsidy for the 2017-2026 period discussed in the report is $8.9 trillion.

Most of the costs of these subsidies can be attributed to Medicaid and to employer-sponsored health insurance coverage for those under age 65. The latter cost arises primarily because health insurance premiums paid by employers are exempt from federal income and payroll taxes. These employment-based coverage subsidies are expected to increase to $460 billion in a decade and will total around $3.6 trillion during the 2017-2026 period.

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The president and CEO of Blue Cross Blue Shield of North Carolina (BCBSNC) gives Obamacare a D+ for how it has performed in his state. In an interview with WRAL’s David Crabtree, BCBSNC CEO Brad Wilson conceded that he was a strict grader and that “on a good day” he might give the ACA a C+.

He acknowledged that the health law had provided coverage to 500,000 previously uninsured North Carolinians (“a very good thing”), but also warned that after two and a half years of operation, it was very clear that the financial underpinning of the Obamacare exchanges was not stable.

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