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

Kentucky’s new Republican governor, Matt Bevin, has notified the Obama administration that he plans to dismantle the state’s ObamaCare marketplace. Bevin, who was sworn in last month, promised to scrap the marketplace, called Kynect, as part of his campaign, but he is now making it official. Bevin’s office said in a statement to WFPL News in Kentucky that having the state run the marketplace is a “redundancy.”

The health care law is gradually finding its niche as an entitlement for what the Census Bureau defines as the “working class”–lower middle-class families that earn too much to qualify for Medicaid, but instead fall into the sweet spot of ObamaCare’s subsidies. Increasingly, these Americans will find themselves forcibly moved into ObamaCare, even if they currently have coverage sponsored by their employers.

A key number to watch from this year’s enrollment season is the percentage of enrollees who receive cost-sharing subsidies. It’s a fair bet that this will be the only number that rises by a notable margin over last year even as the rest of the program stalls. In the end, Americans are rational economic actors. Not only when it comes to who avoids the ObamaCare scheme, but who gets drawn into its grips.

The flurry of budget deals struck by congressional Republicans with President Obama in the final months of 2015 will increase the federal debt by hundreds of billions of dollars in the coming decade. They also make it clear that the true state of U.S. fiscal policy is far worse than shown in official projections — which are based on policies that are not going to survive over the long run.

James C. Capretta of the Ethics and Public Policy Center explains how the budget deals will affect the implementation of ObamaCare and ultimately the U.S. economy.

A new National Bureau of Economic Research Working Paper shows that workers with employer-based coverage experienced a yearly reduction in wages of $1,200 because of the mandate to expand coverage to 26-year-old children. The researchers from Stanford and Harvard also found that the wage reduction was not concentrated among those with children on their policies, showing that all workers with employer coverage are paying a price for the ObamaCare mandate.

ObamaCare needs to be replaced with a plan that provides Americans with affordable coverage and reliable access to doctors. Fortunately, many Republicans — including the bulk of the GOP field running for president — agree on the core ideas behind a replacement plan.

Sally C. Pipes of the Pacific Research Institute lists some of those ideas, including replacing income-based subsidies on the individual market for refundable tax credits and reforming the Medicaid program.

Are New Yorkers looking at a health insurance tax to pay for the more than $200 million in unpaid doctor and hospital bills remaining after the collapse of the state’s consumer-run nonprofit insurance co-op? Or could that money come from the billions in bank settlements that have flowed to state coffers in recent years?

Those are among the questions that lawmakers and Gov. Andrew Cuomo will likely be debating in the upcoming legislative session. Also unclear is the future status of the approximately 215,000 New Yorkers who had low-cost health insurance policies through the short-lived Health Republic co-op.

According to the Department of Health and Human Services, half the uninsured who are eligible for subsidized coverage through the exchanges have refused to purchase it. As a result, those remaining in the insurance pool have tended to be sicker and older — and they’ve used more health services than insurers expected.

How much more? According to the consulting firm McKinsey & Co., insurers collectively swallowed $2.5 billion in unexpected medical expenses from exchange enrollees in 2014.

The health insurance industry will be watching and waiting to see if antitrust regulators approve several big insurance mergers, whether the Affordable Care Act’s exchange market grows more sustainable, and whether states adopt new regulations governing provider network adequacy.

Looming above all those issues is the possibility of the election of a Republican president who would seek to jettison the ACA framework and replace it with an entirely different healthcare financing framework.

Released on December 22, 2015, the third estimate of Gross Domestic Product (GDP) for the third quarter indicates growth in health services spending is maintaining a disproportionate share of still slow GDP growth.

Spending on health services grew faster (4.8%, annualized, in current dollars) than spending on non-health services (3.9%) The growth in health services spending ($24.8 billion, annualized) accounted for 17% of all GDP growth ($146.5 billion), just under one fifth of personal consumption expenditure ($130.6 billion) ), and 29% of all services spending ($84.7 billion).

The evidence continues to indicate Obamacare is not bending the cost curve.

 

 

A growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance, a trend that could challenge the stability of the Affordable Care Act (ACA).

The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. Their membership growth has been spurred by an ACA provision allowing participants in eligible ministries to avoid fines for not buying insurance.

Ministry officials estimate they have about 500,000 members nationwide, more than double the roughly 200,000 members before the law was enacted in 2010.