The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
In a presidential campaign that has been much more about personality than policy, here’s some news: A lot of Americans really do care about health care.
Terrorism and the personal attributes of Donald Trump and Hillary Clinton top a list of 10 issues that registered voters consider “extremely important” in a recent poll, but not far behind are gun policy, the economy and, at No. 5, health care. The Kaiser Tracking Poll found 37 percent of voters checked off this issue.
And the Trump vs. Clinton race offers voters a stark choice, starting with their views on the Affordable Care Act, also known as Obamacare. Clinton wants to improve it and make it more affordable. Trump has vowed to kill it, starting on the day he takes office.
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Pence has always been a vocal opponent of the Affordable Care Act, even after the federal law passed in 2010 and was upheld by the Supreme Court.
But when faced with the choice of whether to expand Medicaid to cover Indiana residents who earn incomes that are 138 percent or below the federal poverty level — a key part of the ACA — Pence made a compromise. He debuted a conservative-friendly version of the expansion, one that requires Medicaid recipients to pay a monthly contribution, based on income, into a health savings account.
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The Obama administration went to court Thursday to block two major health insurance mergers, siding with consumer advocates and medical groups worried that the consolidation of large national health plans could lead to higher premiums.
The long-anticipated move by the Justice Department and attorneys general in California and 10 other states, will at least temporarily prevent Anthem Inc.’s $48-billion purchase of Cigna Corp., a combination that would create the nation’s largest health insurer.
And it will stop Aetna Inc.’s $34-billion bid to acquire Humana Inc., a merger that would have combined the nation’s third- and fifth-biggest health plans.
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The Journal of the American Medical Assn. recently published a very unusual article: a scientific study authored by a sitting president of the United States. That’s never happened before.
In a sense, it’s cool that President Obama cares enough about science to want to publish a paper in one of the world’s leading medical journals. But JAMA has set a bad precedent. The article, on healthcare reform in the United States, is problematic not only in its content but in the threat it poses to the integrity of scientific publishing.
It would be difficult, if not impossible, to find another paper in any scientific journal in which a politician was allowed to subjectively analyze his own policy and declare it a success. This is a textbook definition of conflict of interest.
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Politicians tend to be most enraged by the problems they cause, and the liberal fury against insurance mergers is a classic of the genre. ObamaCare was designed to create government-directed oligopolies, but now its authors claim to be alarmed by less competition.
Last week federal and 11 state antitrust regulators filed a double lawsuit to block the pending $54 billion insurance tie-up between Anthem and Cigna and the $37 billion acquisition of Humana by Aetna.
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Hillary Clinton led a health care reform effort in the 1990s, promoted medical research as a senator, and has been bashing price-hiking drug companies on the campaign trail and in TV ads.
So there’s every reason to expect her to make health care a major theme when she accepts the Democratic presidential nomination in Philadelphia on Thursday night. What she says about the future of medical research, public health, and the uninsured will give a valuable preview of what her priorities would be — and how far she’s willing to go to co-opt the ideas of her defeated rival, Bernie Sanders.
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The Department of Health and Human Services’ (HHS) annual report on Medicaid’s finances contains a stunning update: the average cost of the Affordable Care Act’s Medicaid expansion enrollees was nearly 50% higher in fiscal year (FY) 2015 than HHS had projected just one year prior. Specifically, HHS found that the ACA’s Medicaid expansion enrollees cost an average of $6,366 in FY 2015—49% higher than the $4,281 amount that the agency projected in last year’s report.
The government’s chief financial experts appear not to have anticipated how states would respond to the federal government’s 100% financing of the cost of people made eligible for Medicaid by the ACA. It appears that the enhanced federal funding for the ACA expansion population has led states to set outrageously high capitation rates—the amount government pays insurers—for the ACA Medicaid expansion population. The rates are much higher than the amounts for previously eligible Medicaid adult enrollees and suggest that states are inappropriately funneling federal taxpayer money to insurers, hospitals, and other health care interests through the ACA Medicaid expansion.
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More than six years of efforts by Republican and other right-of-center opponents to repeal, replace, or substantially reshape Obamacare have fallen short.
The strategic options ahead for Obamacare critics on the right are:
- Rinse and repeat: more of the same
- Gamble on a more ambitious long-shot strategy
- Adapt tactically in the near term, to minimize future damage
House Republicans released their latest plan – “A Better Way” – to repeal and replace the Affordable Care Act last month. It blends all three of the strategies above, but its lite brew for reform remarkably manages to be both too cautious and too unrealistic all at once.
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The platform approved Monday at the Republican National Convention suggests that a future Republican administration could dismantle Obamacare using regulatory authority. A Republican president could not waive portions of the law, but he could act to stop controversial payments that are being made to insurers.
In its section on health care, the platform pledged of Obamacare: “a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal.” The waiver concept echoes language used by 2012 Republican nominee Mitt Romney, who pledged that “If I were president, on Day One I would issue an executive order paving the way for Obamacare waivers to all 50 states.”
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Only about one-third of health insurers came out ahead in their first year in the ObamaCare marketplace, according to a study by the Commonwealth Fund released Wednesday.
While insurers made nearly twice as much money from healthcare premiums in 2014, overall profits “diminished noticeably” because of higher payouts, according to the expansive new analysis on companies participating in the exchanges.
Overall, health insurers underestimated their total medical costs by about 5.7 percent in their first year.
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