“The Affordable Care Act is the worst piece of legislation ever passed into law in the United States. It was poorly conceived, poorly written, poorly enacted, and is being poorly implemented. The thing is a mess. However, it does open up some doors that were firmly locked before—things that most free-market economists have been espousing for years without success. We should not run away from those things just because they have President Obama’s name on it.
I am not talking about the things the idiot media think are popular—the slacker mandate, open enrollment, equal premiums for men and women, and free “preventative” services. These are all terrible ideas for reasons I won’t go into here (unless you insist).
I’m talking specifically about several more important elements of the law that were not well crafted in this particular bill, but can now be used as precedents for major improvements in American health care.”
“1.) AEI’s Joseph Antos and James Capretta present “A health reform framework: Breaking out of the Medicaid model.” Here’s a peek:
The Congressional Budget Office (CBO) projects that about one-third of the additional insurance coverage expected to occur because of the law will come from expansion of the existing, unreformed Medicaid program. The rest of the coverage expansion will come from enrolling millions of people into subsidized insurance offerings on the ACA exchanges — offerings that have strong similarities to Medicaid insurance. Unfortunately, ample evidence demonstrates that this kind of insurance model leaves the poor and lower-income households with inadequate access to health care….
2.) “Some still lack coverage under health law,” notes The Wall Street Journal:
Months after the sign-up deadline, thousands of Americans who purchased health insurance through the Affordable Care Act still don’t have coverage due to problems in enrollment systems. In states including California, Nevada and Massachusetts, which are running their own online insurance exchanges, some consumers picked a private health plan and paid their premiums only to learn recently that they aren’t insured.
3.) “Brace for the next round of Obamacare rate shock,” comments Philip Klein at The Washington Examiner:
As insurance companies begin to propose premiums for 2015, it’s time for Americans to brace themselves for the next round of rate shock in the wake of President Obama’s health care law. There are several ways in which Obamacare drives up the cost of health insurance. The primary way is that it requires insurance plans to offer a certain raft of benefits specified by the government and to cover everybody who applies, regardless of pre-existing conditions. It then limits the amount that insurers can charge older and sicker patients relative to younger and healthier patients, driving the costs up for the latter group.
4.) “Automatic Obamacare enrollment is anti-patient,” according to Diana Furchtgott-Roth:
With a new Avalere study showing that many Obamacare participants will face premium increases in the fall, the administration’s proposed rule that would automatically reenroll Americans in their existing federal health exchange plan is likely to leave many people paying higher premiums than necessary. Plus, Uncle Sam will be unable to verify correct amounts of health insurance premium subsidies. America is not yet ready for auto enrollment in Obamacare.
“Conservative criticism of the Affordable Care Act has created the impression that liberal, “big government” ideas are driving the health-care system. But plenty of ideas that conservatives like are taking hold in health care as well. To wit:
*The number of Medicare beneficiaries in private Medicare Advantage plans reached nearly 16 million this year, a record, and the Congressional Budget Office projects that it will hit 22 million by 2020. This partial privatization of Medicare is happening despite concerns that reductions in payments to private plans (what some call over-payments) would curtail enrollment.
*More than half of people on Medicaid are enrolled in managed-care plans, which are typically run by private insurers that contract with states on a capitated, or risk, basis. More than 30 million low-income Medicaid beneficiaries are in private plans. The number is growing as states move sicker and disabled populations covered by both Medicaid and Medicare to managed care and as many states expand their Medicaid programs under the ACA, putting newly covered beneficiaries into managed care.
About 50 million Americans covered by Medicare and Medicaid at some point in the year are in private insurance arrangements. Now, this is not the block grant of Medicaid or voucherization of Medicare that some conservatives ultimately seek–just as the ACA is not the single-payer system that some liberals want–but it’s a substantial privatization, and one that has occurred largely incrementally and under the radar.”
“While enrollment in private health insurance through online marketplaces may be closed until Nov. 15, Medicaid and the Children’s Health Insurance Program added almost a million new patients in May, according to the Centers for Medicare and Medicaid Services.
Between April and May 928,628 people signed up for Medicaid or CHIP across the 48 states that reported data, up from 805,038 who joined in April but down from the 1.4 million who joined in March. The May figures, released Friday, bring total enrollment to nearly 66 million.
Medicaid is jointly funded by states and the federal government to serve low-income children, parents, the elderly and disabled people. The program was expanded through the Affordable Care Act to childless adults earning up to about $15,856 for a single household, though states can choose whether to expand. Twenty-six states and the District of Columbia have done so. CHIP, which is also jointly funded, serves children in families with incomes that are too high to qualify for Medicaid.”
“A primary aim of the Patient Protection and Affordable Care Act (ACA) is to expand insurance coverage, especially among households with lower incomes. The Congressional Budget Office (CBO) projects that about one-third of the additional insurance coverage expected to occur because of the law will come from expansion of the existing, unreformed Medicaid program. The rest of the coverage expansion will come from enrolling millions of people into subsidized insurance offerings on the ACA exchanges — offerings that have strong similarities to Medicaid insurance.
Unfortunately, ample evidence demonstrates that this kind of insurance model leaves the poor and lower-income households with inadequate access to health care. The networks of physicians and hospitals willing to serve large numbers of Medicaid patients have been very constrained for many years, meaning access problems will only worsen when more people enroll and begin using the same overburdened networks of clinics and physician practices.
It does not have to be this way. It is possible to expand insurance coverage for the poor and lower-income households without reliance on the flawed Medicaid insurance model. Opponents of the ACA should embrace plans to replace the current law with reforms that would give the poor real choices among a variety of competing insurance offerings, including the same insurance plans that middle-class families enroll in today. Specifically, we propose a three-part plan that includes a flexible, uniform tax credit for all those who lack employer-based coverage; deregulation of Medicaid; and improved safety-net primary and preventive care.”
“Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health coverage.
The targeted states are Alaska, California, Kansas, Michigan, Missouri and Tennessee.
“CMS is asking several state Medicaid agencies to provide updated mitigation plans to address gaps that exist in their eligibility and enrollment systems to ensure timely processing of applications and access to coverage for eligible people,” said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. He said the agency will monitor states’ progress in solving the problems getting people enrolled in the state-federal insurance program for the poor.”
“Obamacare advocates in New York have had good reason to celebrate. In contrast to Oregon’s and other state-based exchanges, New York’s exchange rollout was a relatively smooth, successful affair. Indeed by the time open enrollment closed, nearly 1 million enrollees were notched— split between Medicaid (525,000) and private health insurance (370,000). Moreover, state officials estimate that some 80% of enrollees were previously uninsured.
Now for some cold water: New York still has a long way to go. While the state surpassed its first-year goal, total enrollment remains only around 30% of the total eligible population.
Moreover, New York State’s Medicaid program, already among the nation’s largest and most expensive, just grew by 10%. And 87% of the new Medicaid enrollees were eligible under New York’s generous, old rules. This means the state will be picking up 50% of the cost for much of this population—not the 10% headline rate for the newly eligible, childless adult population. When all is said and done New York’s Medicaid program will remain bloated and expensive , claiming 1 in 5 New Yorkers as beneficiaries and 28% of the state budget.
“One in five Americans now gets their health insurance through the Medicaid program, new data released by the Obama administration Wednesday show.
Enrollment in the program has grown quickly in states expanding the public insurance program as part of Obamacare. Those states had 15.3 percent more enrollees than they did before the Medicaid expansion. Non-expansion states’ Medicaid programs have grown by 3.3 percent over the same time period.”
“The federal health-care law was intended to create a uniform standard of health coverage across the U.S. But the law also is creating opportunities for states to pursue their own solutions.”
“While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed—with some stuck in limbo for as long as eight months, according to officials in 15 large states.”