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

Seemingly lost in the news of last week’s big tax-cut victory for the GOP was the repeal of the individual mandate — the Obamacare provision that required Americans to have health coverage or else pay a penalty. This is, to borrow a phrase from Vice President Joe Biden, a “big f***ing deal.” It is a big victory for conservatives, who disdained the mandate as government coerciveness. But from a broader perspective, the rise and fall of the mandate is yet another example of how Congress struggles to regulate the national economy.
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Congressional Republicans’ move to scrap the Affordable Care Act’s individual mandate is likely to drive up sales of cheap, short-term health plans that do not have Obamacare’s consumer protections or benefits, health insurance experts say — a development that could further destabilize the Obamacare exchanges.

The GOP’s final tax legislation, which is now awaiting President Donald Trump’s signature, eliminates in 2019 the ACA’s mandate requiring most people to have health insurance or pay a penalty. For 2018, the penalty is set at $695 or 2.5 percent of household income, whichever is greater.

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As President Donald Trump completes his first year in office, Americans are increasingly concerned about health care, and their faith that government can fix it has fallen.

A new poll by The Associated Press-NORC Center for Public Affairs Research finds that 48 percent named health care as a top problem for the government to focus on in the next year, up 17 points in the last two years.

The poll allows Americans to name up to five priorities and found a wide range of top concerns, including taxes, immigration and the environment. But aside from health care, no single issue was named by more than 31 percent.

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Washington continues to debate health policy as if the number of people covered by government insurance programs is the key measurement of success. This week brought more evidence that the ObamaCare experiment of signing up millions more people for subsidized coverage has not made Americans healthier.

“Life expectancy in the United States fell for the second year in a row in 2016,” NBC News reports this week. The network quotes the government’s National Center for Health Statistics:

“This was the first time life expectancy in the U.S. has declined two years in a row since declines in 1962 and 1963,” the NCHS, part of the Centers for Disease Control and Prevention, said in a statement.

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California’s “Medi-Cal” program is one of the worst offenders when it comes to controlling costs.  It’s getting worse not better.  In fact, Medi-Cal is such a big spender it begs the question what is driving out of control spending in the Golden State – waste, fraud, abuse, incompetence, or all of the above?  Every taxpayer in America should be asking these questions, as we are all footing the majority of the bill.

Over the past ten years, Medicaid spending in California has almost tripled, growing from $37 billion per year to a whopping $103 billion per year—including both state and federal funding. And things have only accelerated since the state expanded Medicaid to a new group of able-bodied adults.

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As part of the Affordable Care Act, the federal government adjusts reimbursements to health-care providers up or down based on the quality and cost-effectiveness of their services, as measured by a set of standards established by the Centers for Medicare and Medicaid Services (CMS). The standards use metrics such as how long emergency-room patients must wait to be seen and how long it takes heart-attack victims to get stents placed in their blocked arteries. The intention is to encourage savings and sound practices and enhance patient satisfaction.

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Shopping to update your coverage on the health insurance marketplace may be annoying — didn’t you just do this last year? But letting the exchange automatically renew your coverage instead could be a big mistake. If you don’t like the plan you’re auto-enrolled in this year you may be stuck with it in 2018, unlike previous years when people could generally switch.

It’s all in the timing. This year, the open enrollment period, which started Nov. 1, will end a week from today, on Dec. 15 in most states. On Dec. 16, if you haven’t picked a new plan, the marketplace will generally re-enroll you in the one you’re in this year or another one with similar coverage.

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Growth in U.S. health spending slowed considerably in 2016, rising by 4.3 percent, after two years of higher spending growth spurred by Obamacare and prescription drugs.

The slowdown in health spending growth was seen broadly across all major forms of private and public insurance, and in medical services, prescription drugs and other goods, according to an official analysis released Wednesday.

But because health spending grew faster, as it has for years, than overall gross domestic product, health spending’s share of the economy increased to 17.9 percent in 2016, up from 17.7 percent of the economy the year before.

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Mr. Summers offers various caveats along with his prediction of a mass-casualty legislative event. But he largely accepts the Congressional Budget Office’s guess that 13 million more people will choose not to enroll in government health plans if insurance is no longer required (Summers rounds the guess down to 10 million), and he basically credits his former colleague Kate Baicker’s research suggesting people are more likely to die if they are not enrolled in a health insurance plan.

Mr. Summers is not alone among ObamaCare defenders in wanting to persuade people that the number of people covered by government insurance is the true measure of health. But the vast expansion of such coverage engineered by his old boss doesn’t seem to have made Americans healthier.

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The House and Senate recently passed tax reform bills because they successfully made the case that reform is a “once-in-a-generation” opportunity that is long overdue. It’s a compelling argument. When the last tax reform bill passed in 1986 the Internet was in its infancy and cell phones were the size of a briefcase. The world has changed, the argument goes, but our tax code has not.

What’s curious, however, is that the largest deduction in the tax code – the exclusion from income tax of employer-sponsored insurance, which dates back to the 1940s – is untouched by the reform bills. This omission is an enormous missed opportunity for American consumers and both political parties.

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