Articles on the implementation of ObamaCare.

What happens to Obamacare after its namesake leaves the White House? The Affordable Care Act (ACA) has faced fierce opposition from congressional Republicans and many GOP-led state governments, survived unexpected legal challenges, and overcome a disastrous rollout of healthcare.gov. Through it all, ACA supporters could count on President Barack Obama to defend the law. But come January 20, 2017, that will change. If Donald Trump becomes president and Republicans maintain congressional majorities, the GOP could seek to repeal major ACA provisions, though Trump’s health care agenda is uncertain.

 

If Donald Trump is elected president, one thing that is fairly certain is that we’d hear loud calls from some quarters for the incoming administration and Congress to move quickly in 2017 on a “clean” repeal of Obamacare. “Clean” means that the bill would go as far as possible to repeal the health care law without being encumbered politically by new provisions to replace it. Some conservatives will advise against embracing any new reform because of the political risk, but lawmakers should ignore this advice. If GOP leaders pass up the chance to pursue a market-based approach to health reform when given the chance, they will have no one to blame but themselves as U.S. health care slides inexorably toward full governmental control in coming years.

. . .

What are the prospects for action on the Affordable Care Act (ACA) during the next Congress and presidential administration? There is no easy answer to that question in this unusual election year, although one’s first reaction might be “not much.” As Larry Leavitt, MPP, noted in the JAMA Forum recently, the presidential platforms suggest fundamentally different, maybe even irreconcilable, approaches.

At the risk of being proven wrong, it also seems reasonable to assume that there will continue to be a political standoff in practice next year, with neither party able to push through its preferred solutions for health care.
. . .

Obamacare used the law’s vast authority to get control over the design and composition of health benefits. Clintoncare will try to use these same administrative riggings to get power over the pricing of these products and services. To rescue President Obama’s struggling health-care law, Hillary Clinton has proposed resurrecting the “public option.” This failed idea—a government-run health-care plan to compete with private insurers—can’t save Obamacare. But introducing it across the country would move the U.S. much closer to the single-payer system progressives have always longed for.

. . .

This week, the Georgia Chamber of Commerce released a new plan to impose more of Obamacare on their state. The Chamber acknowledged that their “guiding principle” in crafting the Medicaid expansion plan was simply to “take advantage of all federal dollars available.” As such, they’re lobbying for policymakers to expand Medicaid to a new welfare class of more than 700,000 able-bodied adults.

Although the “plan” has few details – so far it consists solely of two PowerPoint slides – one thing is certain: it will be a more costly way to expand Obamacare that combines some of the most expensive aspects of other expansion plans from around the country.

. . .

The House Ways and Means Committee on Thursday approved a GOP bill that responds to the failure of about two-thirds of the co-op insurers created under the Affordable Care Act.

The bill, which passed by a voice vote, would exempt people who lost insurance because the co-op through which they bought coverage folded mid-year from the Affordable Care Act’s individual mandate.

Roughly 750,000 families have had their coverage disrupted by the closure of 16 of the 23 co-ops created under the 2010 health care law, all citing financial problems, Committee Chairman Kevin Brady (R-Texas) said during the hearing. The bill would exempt consumers from the individual mandate for the remainder of that year, and they would be required to sign up for coverage during the next enrollment period.

. . .

The Health Republican Insurance of New Jersey announced Monday plans to shut down, hours after Sen. Ben Sasse introduced the CO-OP Consumer Protection Act.

The Garden State’s Obamacare co-op plans to close at the end of the year, making it the 17th of 23 to fail and cost Americans their health plans.

“Families in New Jersey have just been gut-punched and the last thing that Washington should do is force these CO-OP victims to pay Obamacare’s individual mandate. This started in Nebraska and Iowa and has been a catastrophe for countless Americans,” Sasse said in a press release.

. . .

Health insurance executives went to the White House on Monday and called for changes to ObamaCare that they say are necessary to keep the healthcare exchanges working.

The executives discussed a series of their long-running complaints about ObamaCare including tightening up the rules for extra sign-up periods, shortening grace periods for people who fail to pay their premiums and easing restrictions on setting premiums based on someone’s age.

Insurers say these changes would help shore up their finances. Several large insurers have in recent months announced they are pulling back from ObamaCare, citing financial losses.

. . .

 

The Chicago Tribune editorial board lays out a succinct explanation of why the Affordable Care Act is failing: The law hasn’t tamed U.S. medical costs, the penalties for going uncovered are low compared to skyrocketing premiums, the law has straitjacketed insurers into providing soup-to-nuts policies, and too many carriers simply can’t cover expenses, let alone turn a profit, in such a rigidly controlled system. Is Obamacare plunging in a so-called insurance death spiral? Is the market so unstable that plans are doomed to get more and more expensive, driving more Americans and more insurers out of the market until Obamacare thuds to the pavement?  The next president and Congress need to reckon with Obamacare’s failures or wait for the thud.

. . .

The Cuomo administration late Friday announced emergency regulations that would upend the federal government’s risk adjustment program, a move meant to protect some of the state’s smaller players and keep them from bolting the still nascent small-group market created by the Affordable Care Act.

The move comes the same day as the deadline for health insurance companies to contract with New York State of Health, the state-run exchange that sells insurance to individuals and small groups, and follows threats from several insurers that said they would not sell small group plans in 2017 if changes to the program were not made.

. . .