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

The chairman of the National Republican Senatorial Committee said a GOP alternative to the Affordable Care Act must be mindful of those who currently have coverage through the law.

“Clearly we don’t want to do any harm to people in the system now,” Sen. Roger Wicker (R-Miss.) said at a Wednesday news conference at the Republican National Committee. “We want to be mindful.”

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We are nearing the grand finale of our long and disheartening election opera, one we dare not ignore because the outcomes matter so much. While the election results will not be determined by public reactions to the Affordable Care Act, the ACA’s fate will be mightily determined by Tuesday’s outcomes. What have we learned about our collective health future over the past 18 months and what might this mean for our health system’s future?

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In July analyst Paul Westra of the brokerage firm Stifel Nicolaus warned of a looming “restaurant recession,” noting that it might be the first sign of a more widespread U.S. recession in 2017. He said this in a bearish report that downgraded 11 restaurant stocks.

The facts on the ground support his gloomy forecast. Restaurant traffic has declined 2.8% from the start of the year through September, according to the Restaurant Industry Snapshot, a survey of some 25,000 restaurants by research firm TDn2K. At this pace, the firm said, “2016 would be the weakest annual performance since 2009, when the industry was recovering from the recession.”

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Rising health care costs have become the hallmark of a partisan Obamacare law that was sold with promises to lower them. The Obama White House just announced that health care premiums will rise again this year for millions of Americans by an almost unbelievable 25% under Obamacare. And that’s just a national average. Many Pennsylvanians face hikes in their health premiums as high as 55%; Oklahomans up to 69%, and Arizonans as much as 116%.

Behind these numbers are the stories of families and individuals struggling just to make ends meet already.

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Having health insurance is vital for 21-year-old Mercedes Nimmer, who takes several expensive prescription drugs to manage multiple sclerosis. So Nimmer was thrilled to get health insurance last year through the Affordable Care Act’s marketplace and qualify for a federal subsidy to substantially lower her cost.

Yet, the government assistance still left her with a $33 monthly premium, a hefty amount for Nimmer, who makes $11,000 a year as a part-time supply clerk.

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President Barack Obama leaves the White House in 12 weeks, but the law that bears his name will polarize politics long after he’s gone.

Big price hikes to Affordable Care Act premiums announced this week mean that Obama’s proudest legislative achievement will fail to resolve the decades-old controversy surrounding the government’s role in managing the cost of and access to health care.
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A new poll conducted for POLITICO and the Harvard T.H. Chan School of Public Health finds that 54 percent of likely voters think Obamacare is working poorly. Ninety-four percent of self-identified Donald Trump voters hold that view, while 79 percent of Hillary Clinton supporters believe the law is working well.
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President Obama promised that the Affordable Care Act would increase competition and choice in insurance markets. In a 2009 speech to a joint session of Congress, for example, the president said, “Individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers.” This claim, along with many othersmade by ACA supporters, have proven to be wrong. In fact, Americans have far fewer choices for individual market coverage today than they had before the ACA took effect and there is a rapidly declining number of insurers now offering coverage in the ACA exchanges.

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Those on both the left and the right overestimated the effect Obamacare would have on the larger health care system. The footprint of Obamacare has been smaller than expected. It hasn’t shaken up the employer system all that much, and it hasn’t changed the underlying health system as champions and critics thought it would. It hasn’t reduced the uninsured as much as expected and (therefore) hasn’t cost as much as expected overall even though per capita costs are higher than projected. The exchanges have drawn far too few healthy people to be stable and the rules that govern them have had too little of an effect on the dynamics of our larger health economy to be fundamentally disruptive.

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The Trump campaign has doubled down on Health Savings Accounts, the health-insurance-as-401(k) product the Affordable Care Act was supposed to extinguish but which was specifically saved by President Obama in order to provide Americans with a health insurance option they could actually afford. The ACA specifically delegates the important job of defining what is and what isn’t health insurance to the Department of Health and Human Services. A President Trump could use that authority to greatly expand the role of HSAs in the exchanges and in entitlements, limited only by changes in budget such revision might entail.

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