The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
The demise of Health Republic, the largest of the nonprofit cooperatives created under ObamaCare, left its more than 215,000 enrollees scrambling to find new insurance. But New York’s physicians and hospitals say the shutdown has left them, too, in a lurch. The Medical Society of the State of New York, a physician’s association, said of 800 doctors surveyed, 43% have claims unpaid by the insurer. Of these, 18% said they were owed $25,000 or more.
Tara O’Neill of the American Action Forum argues that the decision over how biosimilars should be reimbursed by the Centers for Medicare & Medicaid Services (CMS) should be determined by economic principles based on the value of the medication to patients and without putting patient safety and access to such products at risk. If the statutory text does not clearly provide for the favorable regulatory outcome of these factors, it should be amended.
Philip Dorsey, a retired lawyer and legal editor, recounts his experience with health insurance since the Affordable Care Act was enacted. Mr. Dorsey has been forced out of his plan each New Year’s Day since 2012.
“In the first year I got a glimpse of how reform reduced coverage for the many on the group health plans offered by large corporations to their employees. In the second year I saw how it had similar effects on the owners and employees in small businesses that obtain group plans through professional or trade associations. In the third year I would see how individuals who lost group insurance coverage were affected when forced into the individual market.”
The Affordable Care Act reordered the legal framework to let a president impose price restrictions unilaterally through the Independent Payment Advisory Board and the Center for Medicare and Medicaid Innovation. These executive-branch bodies were crafted to control what procedures doctors perform, but there is reason to believe they can also control drug prices.
The future of the Affordable Care Act could depend on the success of federal and state administrators in signing people up in the current open enrollment period—the last one before the 2016 election. Over 10 million people eligible for ACA coverage have yet to sign up. Retention of those already covered may be hindered by rising premiums, dissatisfaction with high deductibles or coinsurance in some plans, limited choices of providers offered by plans, or simple ignorance of the necessity to re-enroll.
A new survey by Gallup shows growing discontent with ObamaCare and the U.S. health care industry generally after years of relative satisfaction with the quality and cost of the health-care system. 53% of Americans rate health care quality in U.S. positively, 1 in 3 rate U.S. health care coverage positively, and fewer than 1 in 4 are satisfied with the cost of health care.
Avik Roy, who serves as GOP presidential candidate Marco Rubio’s health care advisor, suspects United may just be the first domino to fall. Other commercial insurers, such as Aetna, Anthem, and Cigna, have raised premiums by double digits and still say they can’t make the numbers work in their favor. Hence, they have withdrawn from counties where their losses were particularly acute.
UnitedHealth Group’s shock $425 million downgrade to its earnings forecast for 2015 was almost entirely driven by losses on the ObamaCare exchanges. UnitedHealth is the largest U.S. insurer by enrollment, and the company is warning it may withdraw from ObamaCare in 2017. The insurer has already suspended advertising for its ObamaCare coverage and stopped paying commissions to insurance brokers for signing people up.
James Capretta & Joseph Antos argue that one of the most consequential provisions of the Affordable Care Act is also one of its most obscure. The “productivity adjustment factor,” inserted by the ACA into the Medicare program, is a massive spending cut included to make room in the federal budget for the ACA’s expensive new health insurance subsidies. If Congress follows past practice, the ACA’s higher spending will be with us long after savings from the productivity adjustment factor have been reduced or eliminated altogether.
The annual rate of healthcare inflation is at a 6 decade low. At the end of the day, reasonable people will disagree about the exact proportion of credit ObamaCare deserves and neither side has (or will have) conclusive empirical evidence to prove their view beyond a shadow of a doubt. In reality, parsing out credit for the slowdown in health inflation is less relevant than the far more important question to average Americans (and policymakers): will this slowdown continue?