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

On Donald Trump’s victory Republicans in Congress are primed for an ambitious agenda, and not a moment too soon. One immediate problem is ObamaCare’s expansion of Medicaid, which has seen enrollment at least twice as high as advertised.

Most of the insurance coverage gains from the law come from opening Medicaid eligibility beyond its original goal of helping the poor and disabled to include prime-age, able-bodied, childless adults. The Supreme Court made this expansion optional in 2012, and Governors claimed not joining would leave “free money” on the table because the feds would pick up 100% of the costs of new beneficiaries.

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The main objective of the Affordable Care Act (ACA) was to increase enrollment in health insurance among those who were previously uninsured. Official estimates from the Census Bureau have consistently overstated the number of people who are uninsured. A major factor in the overestimate is the undercount of people in Medicaid. Also, millions of Americans have been officially uninsured despite their eligibility for public insurance or employer coverage. With the passage of the ACA, fewer than 10 percent of the remaining uninsured do not have a realistic path to securing health insurance. The future of the ACA is now uncertain, but any future policy changes will likely need to provide a sure path to insurance coverage for all Americans as well.

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President Obama will be leaving office with the Affordable Care Act, his signature policy initiative, in deep peril.  An incoming Republican president and Congress, concerned with the cost of ACA exchange plans jumping by an average 25 percent next year and employee health care costs rising, have pledged to repeal the law.  For his part, the President sought to shift the blame for rising out-of-pocket cost from the ACA’s flaws to employers and insurers.  During a recent speech defending the law, he said the ACA has had no impact on the affordability of employer-provided health care benefits “except to make it a better value.”  As the President put it, “if your premium is going up, it’s not because of Obamacare.  It’s because of your employer or your insurer — even though sometimes they try to blame Obamacare for why the rates go up.  It’s not because of any policy of the Affordable Care Act that the rates are going up.”

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Fox Business host Maria Bartiromo got into a heated exchange with controversial Obamacare architect Jonathan Gruber on Tuesday as the two disagreed over skyrocketing health insurance premiums.

Gruber claimed Obamacare has actually “saved people money,” despite recent damaging headlines indicating President Barack Obama’s signature health care law will cause a 25 percent increase in key premiums. He also claimed the industry is just not “prepared” yet for the “new and innovative insurance market.”

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When the new Congress and President-elect Trump take office in January, Republicans will have a real chance to repeal President Obama’s Affordable Care Act. If they succeed, it will be the result of their carefully executed strategy to repeal the law and repeated congressional votes to do so. This approach was the subject of much derision from Democrats, but sticking to it has now put the Republicans in a position where they can reach their goal.

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President-elect Trump and the GOP-controlled Congress can repeal Obamacare pretty easily, but the biggest question is when and if there will be a transition while a replacement gets crafted.

Trump has promised to repeal Obamacare in its entirety and congressional Republicans are on board. However, when the repeal would take effect is largely in doubt, as some Republicans are wary of immediately ending coverage for millions of people without a replacement.

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Colorado voters rejected a ballot measure that would have created a first-in-the-nation single-payer health insurance system, a significant setback for progressive proponents of universal health care.

Tuesday’s defeat of Amendment 69 was decisive, as predicted. Polling ahead of Election Day showed that two-thirds of residents opposed the measure, which would have established a program called ColoradoCare to cover most people in the state.

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Democrats are already panicked that Donald Trump will repeal ObamaCare and throw millions of people off the subsidy rolls, while some conservatives seem panicked that the President-elect will renege on his campaign promises and millions of people won’t be thrown off the entitlement. Like most inflamed political questions after Mr. Trump’s victory, the health-care debate would benefit from some perspective.

“Either ObamaCare will be amended, or repealed and replaced,” Mr. Trump told the Journal last week, and on “60 Minutes” on Sunday he added that “we’re not going to have a two-year period where there’s nothing. It will be repealed and replaced.” Mr. Trump is being more subtle than his critics.

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Not all of Obamacare would be “shut right down” once the unified Republican government takes power next year, House Majority Leader Kevin McCarthy said Monday.

“You wouldn’t have everything shut right down. … You wouldn’t take everything away,” the California Republican told reporters on Capitol Hill. 

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Republicans could pass a budget reconciliation bill that gradually sunsets the law, preserving its subsidies and Medicaid expansion for a time while they agree on a replacement. They’ve already got a script for that approach, after passing a reconciliation bill last January which President Obama vetoed.

Or Congress could pass a replacement plan right away by coupling it with a repeal bill, although it’s questionable Republicans could find consensus in such a short timeframe.

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