Articles on the implementation of ObamaCare.

As Republicans prepare to undo the Affordable Care Act, defenders of the law warn that repeal will leave millions of seriously ill people unable to buy health insurance. President Obama claims repeal will mean going back to discriminating against Americans with pre-existing conditions.

In truth, ObamaCare discriminates against healthy people who have to buy their coverage in the individual market. ObamaCare forces them to pay the same price as the chronically ill, whose medical costs are ten times as high, on average.

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The GOP isn’t killing Obamacare. The program is already dead.

Andy Slavitt will step down as the government official overseeing Obamacare on January 20. He should be charged with leaving the scene of an accident. Obamacare’s individual markets are a twisted wreckage. Insurers are fleeing them, consumers are shunning them, and Democrats are looking for someone to blame.

In addition to devolving regulatory authority to the states, federal policymakers should consider providing them with resources to reform markets and subsidize coverage. Instead of writing suffocating rules and enlisting the Internal Revenue Service to distribute subsidies and exact penalties, the federal government should set states free to innovate and hold them accountable for results.

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Oscar Insurance Corp., the Silicon Valley-backed health-care startup, continued to lose tens of millions of dollars in the third quarter as the company exits some markets and works to diversify away from of its Obamacare business.

The New York-based company sells health insurance to individuals in new markets set up by the Affordable Care Act. Its attempt to reinvent the insurance business has been marked by large losses — in the third quarter, closely held Oscar lost $45 million in New York, Texas and California, according to filings with regulators. That follows losses of $83 million in those states during the first six months of this year.

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Donald Trump hadn’t been president-elect for a week when he appeared to abandon his oft-repeated pledge to repeal Obamacare in its entirety. In interviews with the Wall Street Journal and 60 Minutes, Trump appeared to want to keep, or at least to be willing to accept, the Affordable Care Act’s centerpiece: it’s supposed prohibition on discrimination against health-insurance applicants with pre-existing conditions. Ramesh Ponnuru, my friend and a senior editor of these pages, says the downside of Trump’s triangulation is that retaining those provisions “makes it much, much harder to get rid of the individual mandate” — as if the mandate were the bigger problem. On the contrary, the pre-existing-conditions provisions are the centerpiece of Obamacare.

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In an ongoing backdoor attempt to pay off insurers burned by President Barack Obama’s signature legislation, the Affordable Care Act, the Obama administration is creating the framework needed to implement a “public option,” the precursor to a single-payer health-care system. Distracted by the presidential election and the news that ACA insurance premiums will increase by an average of 25 percent in 2017, many have failed to notice the administration’s plan to use a special U.S. Department of Justice fund, called the Judgment Fund, to funnel billions of dollars to insurers without congressional approval. If it successfully executes this plan, the Centers for Medicare and Medicaid Services will have circumvented Congress to secure a taxpayer bailout for insurers — directly contradicting Congress’s intentions as expressed by multiple spending bills, and possibly violating federal law.
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The presidential election outcome itself could create more problems for the ACA. The insurance plans sold on the law’s exchanges have already experienced substantial losses due to adverse selection, leading many insurance companies to pull back on their participation. The prospect of a Trump administration steering ACA implementation may be enough to convince some of the insurers still offering products on the exchanges in 2017 to rethink their plans. If more insurance companies head for the exits, the exchanges could become even less stable than they already are.

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The White House is urging people to sign up for coverage through ObamaCare, hours after the Republican electoral sweep that likely dooms the healthcare law’s future.

Spokesman Josh Earnest said Wednesday the Obama administration remains committed to its enrollment drive, which opened Nov. 1.

“There is no specific thing in mind that we’re going to do differently now,” Earnest said as he addressed reporters for the first time since President-elect Donald Trump declared victory.

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The Affordable Care Act transformed the medical system, expanding coverage to millions, injecting billions in tax revenue, changing insurance rules and launching ambitious experiments in quality and efficiency.

Less of that might disappear under President-elect Donald Trump’s pledge to “repeal and replace Obamacare” than many believe, say policy analysts. Republicans promising change might not quickly admit it, but in some respects Obamacare’s replacement may look something like the original.

“It gets into a questions of semantics,” said Mark Rouck, an insurance analyst for Fitch Ratings. “Are they really repealing the act if they replace it with new legislation that has some of the same characteristics?”

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For the past six years, Republicans — across Washington, and across the country — have virtually to a person run against Obamacare. Their campaign has helped them win numerous House and Senate seats, a majority of governorships, and now has given them unified control of Washington for the first time in 15 years. Like the dog that finally caught the proverbial car, Republicans will wake up Wednesday morning asking themselves — on Obamacare, as on many other issues — “What now?”

The answer might be less obvious than it first appears. Democrats used the decade and a half between the defeat of Hillary Clinton’s health plan in 1993–94 and the 2008 election to develop a consensus architecture about what their ideal health-care plan would look like. In the Democratic primaries that year, Senators Clinton and Obama disagreed strongly on the necessity of an individual mandate to purchase coverage — a difference they litigated very publicly, and at great length, during the primary campaign — but agreed on virtually everything else.

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While Obamacare is currently making headlines for (much) higher than predicted costs, the Centers for Medicare & Medicaid Services (CMS) want to create a national database of highly sensitive personal health information for the 30 million Americans with individual and small group coverage. Under Section 153.610 of a new Health and Human Services (HHS) rule for Obamacare, this proposal would require health plans to send CMS data on enrollees on an unprecedented scale, including:

  • Amount paid
  • Diagnoses received
  • Drugs prescribed
  • Procedures received
  • Health care providers seen
  • Out-of-pocket liabilities assumed
  • Individual demographics
  • Social Security Number

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