Articles on the implementation of ObamaCare.
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.
. . .
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.
. . .
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.
. . .
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.
. . .
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?”
. . .
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.
. . .
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
. . .
The health insurer Cigna is planning for a loss on the Obamacare market next year, its CEO said Thursday.
“We are going to expect to see some revenue growth but we are continuing to plan for a loss,” CEO David Cordani said on the company’s third quarter earnings call.
The insurer’s strategy to slowly expand into the new marketplace created by the Affordable Care Act has “proven to be more right than wrong,” he said, noting that was unfortunate.
. . .
This may seem like same-old, same-old at this point. After all, lots of health insurers are threatening to leave the exchanges. You could be forgiven for yawning at the news that yet another company might pull back.
But in fact, this is huge news, because Anthem runs the Blue Cross/Blue Shield organizations in 14 states. And though Anthem doesn’t appear to be the sole company offering exchange coverage in any of those states, the Blues are generally the backbone of the exchanges. Where others have quailed, the Blues have by and large stuck with Obamacare. If they pull out, then it’s likely that we’ll see more counties, and possibly entire states, with no Obamacare policies on offer.
. . .
The fourth open enrollment for health coverage under the Affordable Care Act opened Tuesday, a critical 90 days that the Obama administration hopes will boost participation and stabilize markets roiled by premium increases and insurer withdrawals.
HealthCare.gov and state equivalents began taking applications Tuesday morning from people signing up for individual health coverage and learning about their eligibility for subsidies. This year is especially critical because consumers so far have been sicker and older than expected, which has led to higher-than-anticipated costs.
. . .