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

In her confrontation with Bernie Sanders, Hillary Clinton always promises to “build on the successes” of ObamaCare, so allow us to recommend a follow-up question: What would those be, precisely? The entitlement is becoming less stable and less entrenched, not more, as it gets older.

The latest jolt is the $475 million loss UnitedHealth Group booked on the insurance exchanges in 2015, which the largest U.S. mega-insurer by membership expects to rise this year to another $500 million.

In 2015, the U.S. federal government spent more on healthcare than on Social Security for the first time. The Affordable Care Act’s expansion of Medicaid and the growing availability of subsidies for exchange plans are driving much of the higher spending.

Enrollment in the ACA’s insurance exchanges will hover around 13 million in 2016, the Congressional Budget Office said in an expanded economic report Monday, down from its previous estimate of 21 million but still above HHS’ most optimistic projection.

Federal spending on major health care programs will jump by $104 billion, or 11.1%, this year, according to Congressional Budget Office estimates published on Monday.

Those figures include a $24 billion increase stemming from a shift in the timing of certain Medicare payments from 2017 into 2016. Today’s CBO figures are a detailed version of the broader estimates published last week.

The nonpartisan CBO projected in its 2016-2026 Budget and Economic Outlook that spending on federal health programs will make up 5.5% of the country’s gross domestic product this year, and reach 6.6% by the end of 2026.

The Congressional Budget Office (CBO) issued a new budget forecast last week. It should be a wake-up call to policymakers, and to the candidates running for president. It is also a clear indictment of fiscal policy during the Obama presidency.

The forecast shows annual federal budget deficits rising throughout the coming decade, pushing total federal debt to levels well above the historical norm. CBO projects the federal budget deficit will be $544 billion in 2016, or 2.9 percent of GDP. By 2026, the annual deficit will be nearly $1.4 trillion, or 4.9 percent of GDP. Over the period 2016 to 2025, CBO expects the federal government will need to borrow an additional $9.4 trillion, pushing total federal debt up to $23.8 trillion, or 86 percent of GDP.

The deficits projected in CBO’s forecast, and the level of debt they would cause, are almost unprecedented in the nation’s history.

The House GOP emerged from its retreat earlier this month united in its goal to come up with an alternative to Obamacare. But the deeper into health policy the members dig, the more difficult finding consensus will become.

Republicans have determined that they will select pieces of different GOP proposals rather than simply put forth one of the party’s old plans as its main health proposal. The older conservative health plans are unworkable in a post-ACA world.

Does the American public know that, buried deep in the website, the health insurance coverage available to a family gets worse as their income rises? Do people know that a family expecting to earn $51,000 in 2016 is not even allowed to buy the same coverage as a family that expects to earn $49,000?

John Podczerwinski explains what he encountered as he researched his family’s healthcare options for 2016. Under ObamaCare, when you earn more money, you receive worse health care.

Repealing the Affordable Care Act is not enough. The country has been drifting toward full federal control of health care for decades. What’s needed is a credible plan to reorient federal policy across the board toward markets and the preferences of consumers and patients, and away from one-size-fits-all bureaucratic micromanagement.

Lanhee Chen and James Capretta, along with 8 other colleagues, have developed such a plan. This plan would:

– Retain employer coverage for 155 million Americans
– Provide age-adjusted tax credits to individuals without employer-sponsored coverage
– Allow for continuous coverage protection
– Reform the Medicaid and Medicare programs
– Expand the use of Health Savings Accounts

UnitedHealth Group Inc. said its projected losses on the Affordable Care Act exchanges for 2016 deepened as enrollment grew despite the company’s efforts to reduce sign-ups.

The biggest U.S. health insurer said it is expecting losses of more than $500 million on its 2016 ACA plans, compared with previous projections that amounted to $400 million to $425 million in losses.

UnitedHealth had taken steps to pull back on its exchange business in anticipation of losses, including reducing marketing and slashing commissions to health-insurance agents.

Enrollment through the ObamaCare exchanges has been more sluggish than initially expected, with just about 12 million sign-ups likely this year. That’s better than the 10 million or so officials projected back in October, but far less than the 21 million the Congressional Budget Office estimated as the law was taking shape.

Part of the problem seems to be that people are finding ways to game the system by signing up outside of the limited annual enrollment period and then dropping insurance shortly after. The law has a number of exemptions that allow people to buy coverage at any time throughout the year, such as changing or losing a job, having a child, moving, and getting married.

The people who come in via those special enrollment exemptions, it turns out, are far more expensive to cover. In an earnings call last November, an executive with UnitedHealth, the nation’s largest insurer, said that people buying in outside of the standard enrollment period cost about 20% more.

Last week’s seven-candidate debate hosted by the Fox Business Network once again found much to discuss in terms of national security issues, immigration law enforcement, even a little economic policy, and, of course, the latest round of character attacks and counter-attacks. Still missing in action: at least the first subcutaneous probe of where the respective candidates stand on health policy issues.

Based on recent performance, it’s questionable whether health policy has attracted sufficient interest among the media and Republican primary voters to command more than a few seconds on the debate stage. But it’s not for lack of potential lines of inquiry.

Here are some questions to the candidates from Tom Miller of the American Enterprise Institute that still await new rounds of oversimplified, evasive, or (one might hope) thoughtful answers.