The impact of ObamaCare on doctors and patients, companies inside and outside the health sector, and American workers and taxpayers
Six provisions of the Affordable Care Act (ACA) should come up for target practice next week on the Capitol Hill shooting range. Included in a budget reconciliation measure before the House of Representatives are such items as repeal of the individual mandate, employer mandate, Independent Payment Advisory Board, medical device tax, and auto-enrollment of workers in larger businesses. None of those clay pigeons are likely to suffer any permanent harm, given the certainty of a veto if the bill manages to get to President Obama’s desk. But the latest political contortions over one particular provision — the so-called Cadillac tax – are particularly rich in circular irony and evasion.
Health insurance enrollment data for 2014 shows that the number of Americans with health insurance increased by 9.25 million during the year. However, the vast majority of the increase was the result of 8.99 million individuals being added to the Medicaid rolls. While enrollment in private individual-market plans increased by almost 4.79 million, most of that gain was offset by a reduction of 4.53 million in the number of people with employment-based group coverage. Thus, the net increase in private health insurance in 2014 was just 260,000 people.
Obamacare was enacted more than five years ago, and is now in its second year of nearly full implementation, but, in political terms, it is still not a settled matter. Republicans remain nearly unanimous in their opposition to the law, which continues to inspire widespread unease among the larger electorate. Many of its most important provisions — for instance, the individual mandate, the Independent Payment Advisory Board, and the “Cadillac” tax — are so unpopular that even many Democrats would like to see them repealed.
For decades, federal health policy — through taxes, spending, and regulation — has encouraged people to get their health insurance through their employers, and has encouraged them to choose health plans that pay for routine care. These policy decisions have inflated prices and made insurance harder to obtain for people who don’t have access to employer coverage, and especially for those who have chronic ill health. Obamacare attempted to fix some of these problems, mainly by adding an additional layer of government interventions and attempting to centralize the health-care system.
Jeb Bush’s new health-care plan looks a lot like the plan Scott Walker embraced two months ago, which in turn looks a lot like the one Marco Rubio sketched in an op-ed article and the one touted by Senators Orrin Hatch and Richard Burr and Representative Fred Upton. That’s a good thing. It means that Republicans are finally reaching a consensus on what to do about health policy that draws on the best conservative thinking on the subject. Bush (for whose campaign my wife works) is helping to ratify that consensus.
Today in New Hampshire, former Florida Gov. Jeb Bush unveiled his plan to repeal and replace Obamacare. In many ways, the plan reflects the mainstream of Republican wonk thinking on health care, and expresses similarities to an earlier plan proposed by Wisconsin Gov. Scott Walker. Like Walker’s plan—but in a different way—Bush’s plan seems likely to increase the deficit.
It has been clear for some time that Republicans need just two things in order to repeal Obamacare—a winning alternative and political willpower. The jury is still out on how much of the latter the party possesses. But when it comes to uniting around a well-conceived alternative that can pave the way to full repeal, the news is increasingly good. Jeb Bush’s just-released Obamacare alternative is the latest example of this encouraging trend.
Tonight, the first Democratic debate of the election season will kick off. With two GOP debates in the rearview mirror, the first of the debates on the left should offer an opportunity to see how the candidates will distinguish themselves. In particular, one issue that’s been largely absent (at least from the GOP debates beyond “repeal and replace”) is health care. In this coming debate, and in the later GOP debates, the moderators ought to seek out the candidates’ positions on a slew of health care issues.
Joshua Smith, a Rockland County insurance broker, was deluged with questions from clients after regulators said they were shutting down Health Republic Insurance of New York, which was known for having some of the lowest rates in the state.
“It’s been a week of craziness,” said Mr. Smith, who owns Vanguard Benefit Solutions LLC, which enrolled about 75 small businesses in Health Republic’s plans. “Lots of emails, lots of calls, and everybody is nervous about what is going to happen.”
In apparent recognition of the distinct unpopularity of the Affordable Care Act’s Cadillac tax—an excise tax on high-value, employer-provided health benefits—more than 100 economists have signed a letter defending it. As the Washington Post headline about the letter read: “101 Economists Just Signed a Love Letter to the Obamacare Provision Everyone Else Hates.”