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

The ObamaCare “risk adjustment” program was designed to support health plans with lots of sick, expensive customers by giving them money from plans with healthier customers. The goal is to help keep insurance markets stable by sharing the “risk” of sicker people and removing any incentive for plans to avoid individuals who need more medical care. Such stability is likely to encourage competition and keep overall prices lower for consumers, while its absence can undermine both and limit coverage choices—the basic principles of the law.

Yet the way the Obama administration has carried out this strategy shows another unexpected consequence of the 2010 health care law. Critics say the risk adjustment program is having a reverse Robin Hood effect—taking money from some plans that are small, innovative or fast-growing, while handing windfalls to some of the industry’s most entrenched players.

In his final State of the Union address, President Obama spent little time discussing health care programs. In sum, the president made one generic reference to Medicare, made no mention of Medicaid, and spent only about 30 seconds discussing his signature health care legislation—the Affordable Care Act—recapping its main purpose and making three claims about how it is performing.

The president claimed that the purpose of the ACA Is to ensure portability of coverage, that health care inflation has slowed, and that nearly 18 million people have gained coverage so far. He also claimed that businesses have created jobs every single month since the ACA became law. He failed to mention the nation’s greatest fiscal challenge: the unsustainability of entitlement programs.

This piece by Brian Blase aims to fill in some of the gaps.

Reconciliation shows repeal is possible. Now is the time to show that replacing ObamaCare is possible too. To do that, Congress should spend the next year building a framework for a patient-centered, market-based alternative that empowers individuals to control the dollars and decisions regarding their health care. Congress must use sound financing, stabilize and liberate the health care market, and make financing simpler, transparent and direct to individuals.

Among ObamaCare’s few popular features, even among Republicans, is the mandate to cover adult children through age 26 on the insurance plans of their parents. Although sold as a gratuity, somebody must ultimately pay. In a working paper, Gopi Shah Goda and Jay Bhattacharya of Stanford and Monica Farid of Harvard find “evidence that employees who were most affected by the mandate, namely employees at large firms, saw wage reductions of approximately $1,200 per year.”

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.