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

The desire for autonomy and work-life balance is driving more workers into freelance roles, but at the same time there are growing incentives for companies to employ workers via contracts rather than hire them full-time.

Chief among those incentives is the cost of providing (or not providing) health care to workers under the Affordable Care Act. Nearly three-quarters of companies said that they would contract with more freelancers this year because of Obamac\Care, according to a new survey by online work platform Field Nation and executive development firm Future Workplace.

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In the face of losses in the Affordable Care Act marketplace, Blue Cross and Blue Shield of Illinois is looking for new ways to cut spending.

Starting June 1, the Chicago-based health insurer will no longer accept credit cards as a form of payment for members who buy their own health insurance on or off the Illinois marketplace. The company began notifying customers of the change last month. Blue Cross will still accept other forms of payment, including debit cards.

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Among the most hotly debated of the issues Hillary Clinton and Bernie Sanders have taken on in the Democratic primary contest is how best to get to universal health insurance coverage. The former secretary of state favors incremental steps, and the senator calls for a single-payer system. That debate, and their focus on universal coverage as their goal, appears to have had a modest and perhaps surprising effect on attitudes toward the Affordable Care Act. The health-care law is an issue about which public attitudes seldom shift, yet the share of Democrats who want to expand the Affordable Care Act rose over the past year.

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Sound fiscal policy is essential for sound governance. History shows that powerful nations that engage in reckless spending and borrowing eventually fall into periods of decline. It would be disastrous if the United States were to drift into such a slide.

What’s needed are fundamental reforms that will change the direction of key programs in ways that will last for decades. This kind of project will take many years to achieve, and some very important policy changes are likely to require lengthy transition provisions to reassure voters who are accustomed to current arrangements. But the current welfare state wasn’t built in a day, and changing its orientation is going to require persistence and patience.

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House Ways and Means Committee Chairman Kevin Brady (R-Texas) said Friday that House Republicans would unveil their ObamaCare replacement plan sometime in the next 45 days.

“The task force is working on it,” Brady said at a Bloomberg Government event. “We’ll be laying that out here over the next month and a half.”

Republicans have said that they plan to have Speaker Paul Ryan’s (R-Wis.) policy task forces lay out their plans before the Republican National Convention in July.

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For years, voters in this swing state have rejected tax increases and efforts to expand government. But now they are flirting with a radical transformation: whether to abandon President Obama’s health care policy and instead create a new, taxpayer-financed public health system that guarantees coverage for everyone.

The estimated $38-billion-a-year proposal, which will go before Colorado voters in November, will test whether people have an appetite for a new system that goes further than the Affordable Care Act. That question is also in play in the Democratic presidential primaries.

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Key Findings:

  • Health care is one of the top four issues mentioned by voters when asked which issues they most want to hear candidates discuss in the campaign, but half as many cite health care as mention the economy and jobs.
  • When asked specifically what health care issues voters would most like to hear the presidential candidates discuss, the 2010 health care law (ACA) and health care costs top the list.
  • Overall ratings of the ACA lean negative this month, with 38 percent saying they have a favorable view and 49 percent saying they have an unfavorable view.
  • The percentage of Democrats who have an unfavorable opinion of the law increased 6 percentage points from last month. Of the Democrats who did not express a favorable opinion, 40 percent want to expand what the law does.

The public’s views of the Affordable Care Act, which were evenly divided following the Supreme Court’s ruling last summer upholding a key section of the law, are again more negative than positive. Currently, 44% approve of the 2010 health care law, compared with 54% who disapprove of the law.

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Another bombshell could soon drop on the Affordable Care Act insurance exchange market, and it might come at a highly vulnerable moment for ObamaCare.

Rosemary Collyer, U.S. District Judge for the District of Columbia, is expected to soon issue her ruling in U.S. House of Representatives v. Burwell, a case in which House Republicans claim the Obama administration is illegally funding the ACA’s cost-sharing subsidies without a congressional appropriation.

If, as some legal observers believe is possible or even likely, the George W. Bush-nominated Collyer decides against the administration, it would further rattle insurers who are facing multiple difficulties in the exchange business. UnitedHealth Group announced last week that it was pulling out of most exchanges because of its financial losses. Such a ruling would be a shock, even though it surely would be appealed, and the case could ultimately reach the Supreme Court.

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Even before President Obama leaves office, ObamaCare has begun unraveling.

The law was passed over the objections of a majority of Americans, it is still opposed by a majority of Americans — and their opposition has been vindicated. Last week, UnitedHealth Group announced that, after estimated losses of more than $1 billion for 2015 and 2016 under ObamaCare, the company was pulling out of most of its ill-fated exchanges. In fact, commercial insurers across the country are hemorrhaging money on ObamaCare at alarming rates.

The president promised these insurers taxpayer bailouts if they lost money, but Congress in its wisdom passed legislation barring the use of taxpayer dollars to prop up the insurers. Without the bailouts, commercial insurers are being forced to eat their losses — while more than half of the ObamaCare nonprofit insurance cooperatives created under the law failed.

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