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

Paul Ryan has gotten his often fractious House Republicans to endorse an outline of a plan to replace Obamacare, although not yet an actual piece of legislation. While the outline contains many of the health policies conservatives sought even before Obamacare, those policies may have particular appeal against the backdrop of the health-care system Obamacare has created.

In the past Republicans have argued about how to reform tax policy on health care: Should employer-provided coverage remain untaxed, or should this tax break end? Should people without access to such coverage get a tax credit or a tax deduction? The House plan lets the tax break stay — avoiding the political disaster that a less compromising free-market plan would have courted — but trims it for the most expensive plans.

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House Republicans have estimates from the Congressional Budget Office on how their health care plan, released Wednesday, would affect the federal deficit. They’re just not releasing them.

The 37-page white paper doesn’t include cost and savings estimates, according to a senior GOP aide, because Republicans may want to break up the plan into smaller bills and some of the numbers depend on major decisions yet to be made.

Health analysts say there’s another reason for not offering estimates — it keeps Republicans from publicly making tough decisions about tradeoffs between cost savings and coverage. These decisions could open them up to harsh criticism from Democrats and would likely divide members of the GOP caucus itself.

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John McCain is running for reelection like it’s 2010.

The Arizona Republican has made his opposition to Obamacare — which dominated Senate races across the country six years ago — a central point of his campaign, by all accounts, the toughest reelection fight of his career.

He’s betting that shrinking coverage options and premium increases that could go as high as 65 percent if insurers get their way will resonate with Arizona voters, even as most of his Republican colleagues running this year have moved on to other issues.

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Is the new House Republican plan to replace Obamacare politically viable? Two factors weigh in the plan’s favor: First, after the administration sold Obamacare as a program for middle-class families who were anxious about losing their coverage if something went wrong, Democrats delivered a plan that made a lot of middle-class families worse off, and few of them better off. Second, the continuing problems in the insurance exchanges mean we remain at risk of seeing the number of uninsured start to march back upward, as unsubsidized consumers start to drop their high-priced, high-deductible, narrow-network insurance.

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Today, after years of hearings and speeches and debates, the Paul Ryan-led House of Representatives has done something it has not done before: it has released a comprehensive, 37-page proposal to reform nearly every federal health care program, including Medicare, Medicaid, and Obamacare. No proposal is perfect—and we’ll get to the Ryan plan’s imperfections—but, all in all, we would have a far better health care system with the Ryan plan than we do today.

The first thing to know about the Ryan-led plan — part of a group of proposals called “A Better Way” — is that it’s not a bill written in legislative language. Nor is it a plan that has been endorsed by every House Republican.

Instead, it’s a 37-page white paper which describes, in a fair amount of detail, a kind of “conversation starter” that House GOP leadership hopes to have with its rank-and-file members, and with the public, in order to consolidate support around a more market-based approach to health reform.

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A House Republican alternative to Obamacare is coming this week, and some reports suggest it will include a refundable tax credit to subsidize health insurance. This would present some tough political and policy choices about whether and how to pay for a new program of tax credits.

Changing the tax treatment of employer-provided health insurance could provide one of the largest potential sources of financing for a new refundable credit. It also would bring hefty trade-offs. On the political side, capping the deductibility of employer-based health plans to finance refundable credits that are considered government spending would not please some Republicans. Put another way: Repealing Obamacare’s tax increases to replace them with other revenue increases is unlikely to go over well with conservative voters.

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Democrats should push for universal health coverage ahead of the November election, several health care advocates urged the committee drafting the Democratic National Committee’s platform at a recent session focused on health policy.

Their liberal health care proposals echo a similar theme from an environment-themed session the same day, in which activists criticized DNC members for not pushing harder on climate change.

The hearing was part of a series of regional events held by the Democratic Platform Drafting Committee “designed to engage every voice in the party.”

Too many people are still uninsured six years after the passage of the Affordable Care Act, said many of the advocates who spoke before the committee in Phoenix on Friday. Still more are underinsured, they said, and people are struggling to pay for rising premiums and to afford prescription drugs.

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A federal judge recently ruled that the Obama administration violated the Constitution by spending $7 billion on subsidies for insurance companies without Congress’s permission. Worse still, the administration knew all along that it was flouting the law.

If the ruling is upheld, Americans will face higher premiums and fewer choices in the health insurance market. If it comes to that, they’ll have President Obama to thank.

At issue are the Affordable Care Act’s “cost-sharing reduction” subsidies. Obamacare’s “essential benefits” mandates require all exchange policies to cover a long list of services, from maternity care to substance abuse treatment to speech pathology counseling. In a normal market, insurers would charge patients higher premiums, deductibles, and copayments to cover the costs of these extensive benefits.

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Medicaid payments to hospitals and other providers play an important role in these providers’ finances, which can affect beneficiaries’ access to care. Medicaid hospital payments include base payments set by states or health plans and supplemental payments. Estimates of overall Medicaid payment to hospitals as a share of costs vary but range from 90% to 107%. While base Medicaid payments are typically below cost, the use of supplemental payments can increase payments above costs.  Changes related to expanded coverage under the Affordable Care Act as well as other changes related to Medicaid supplemental payments could have important implications for Medicaid payments to hospitals.  This brief provides an overview of Medicaid payments for hospitals and explores the implications of the ACA Medicaid expansion as well as payment policy changes on hospital finances.

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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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