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

The Urban Institute’s Robert D. Reischauer and Brookings Senior Fellow Alice M. Rivlin highlight three main health care issues the candidates should focus on that are likely to dominate the election debate. Republicans must form consensus around a replacement plan for the Affordable Care Act and Democrats must develop ways to improve the law. Both must focus on how to control rising health spending and how to preserve Medicare for the growing elderly population.

One of the untold elements of the rapid decay underway in the ObamaCare exchanges is the massive shift toward the Medicaid managed care companies, and away from the traditional commercial insurers like UnitedHealth Group and Aetna. In short order, ObamaCare is evolving into a Medicaid marketplace. Not only in terms of the design and quality of the narrow-network plans that are being offered, but in the actual carriers that sell those policies.

UnitedHealth expects to lose $425 million on ObamaCare, including $275 million in 2016. The situation is so dire, the company took the unusual step of announcing between quarterly reports both the losses and that it may withdraw from Obamacare entirely after 2016. If United indeed pulls out, it would cause hundreds of thousands more Americans to lose their health plans.

This high incidence of failure teaches us two things. First, it should end the thinking that non-profits are somehow better than for-profits. The second lesson is for Republicans in Congress. While there are major problems with Obamacare that should be addressed, legislators shouldn’t throw away the baby with the bathwater.

For many consumers, switching health insurance plans has become an unwelcome ritual, akin to filing taxes, that is time-consuming and can entail searching for new doctors and hospitals each year. Gail Galen, 63, is preparing to leap to her third insurer in three years as she braces for another round of shopping on the federal insurance marketplace. “Every year I feel like I’m starting all over again, and I just dread it,” said Galen. “My stress level just shoots up.”

Starting in January, the Affordable Care Act will require businesses with 50 or more full-time-equivalent employees to offer workers health insurance or face penalties that can exceed $2,000 per employee. The health care law’s employer mandate, a provision that business groups fought against fiercely, is intended to make affordable health insurance available to more people by requiring employers to bear some of the cost of providing it. For some business owners on the edge of the cutoff, the mandate is forcing them to weigh very carefully the price of growing bigger.

The brief’s key findings:

  • The 2010 Affordable Care Act (ACA) included roughly 165 provisions to improve Medicare’s finances.
  • The Medicare Trustees Report, which reflects the ACA provisions, shows dramatically lower cost projections for Medicare in the future.
  • The Medicare actuaries also produce alternative projections assuming that the legislated restraints on growth in payments to health providers are not feasible.
  • A review of both sets of projections over the past six years shows that the gap between them is narrowing due to declines in the alternative cost projections.
  • However, a significant gap still remains, which underscores the inherent uncertainty involved in long-range projections.

Big news: UnitedHealth Group slashed its earnings outlook today, citing new problems related to Obamacare, and told investors it may exit the program’s exchanges. “In recent weeks, growth expectations for individual exchange participation have tempered industrywide, co-operatives have failed, and market data has signaled higher risks and more difficulties while our own claims experience has deteriorated,” Stephen J. Hemsley, chief executive officer of UnitedHealth Group, explained in a press release.

Beginning in December of 2016, restaurants with more than 20 locations will be required to provide calorie information on their menus as part of the multi-stage Obamacare rule roll-out. While big chain restaurants and their large-scale suppliers like Coca-Cola or Budweiser will be able to follow this rule relatively easily, this could effectively ban craft beer from these establishments as smaller breweries struggle to comply.

A recent National Bureau of Economic Research (NBER) study reveals that ObamaCare Marketplace plans are a bad deal, even for near-poor enrollees receiving large subsidies from the federal government. The study confirms that net premiums (after subsidies) were still several times what enrollees might have paid out-of-pocket for medical expenses had they remained uninsured.