“When Capitol Hill Republicans and other conservative health policy analysts focus on developing viable “replacement” alternatives to Obamacare, they usually start with changing how the tax code subsidizes purchases of health insurance coverage. The two main proposals would expand the benefits of the current tax exclusion for employer-sponsored insurance (ESI) premiums to other insurance purchasers – either through tax deductions or through tax credits – and then limit its maximum amount per insured person. But neither one by itself strikes the right balance between efficiency, equity, and sustainability.”
“Medicaid, originally considered an afterthought to Medicare, is today the largest health insurance provider in the United States. Under the Affordable Care Act, the Congressional Budget Office projects Medicaid enrollment to increase nearly 30 percent by 2024, and federal spending on the program to double over the next decade. For the states, Medicaid is already the largest single budget item, and its rapid growth threatens to further crowd out other spending priorities.
In this collection of essays, nine experts discuss the escalating costs and consequences of a program that provides second-class health care at first-class costs. The authors begin with an explanation of Medicaid’s complex federal-state funding structure. Next, they examine how the system’s conflicting incentives discourage both cost savings and efficient care.
The final chapters address the pros and cons of the most mainstream Medicaid reform proposals and offer alternative solutions. This book offers a timely assessment of how Medicaid works, its most problematic components, and how—or if—its current structure can be adequately reformed to provide quality care, at sustainable costs, for those in need.”
Provide refundable and advanceable premium credits and cost sharing subsidies to eligible individuals and families with incomes between 133-400% FPL to purchase insurance through the Exchanges.
Provide states that offer Medicaid coverage of and remove cost-sharing for preventive services recommended (rated A or B) by the U.S. Preventive Services Task Force and recommended immunizations with a one percentage point increase in the federal medical assistance percentage (FMAP) for these services.
Require disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies.
“Many franchisees of big chains hover around the threshold at which they will be required to start insuring workers or pay the penalty. With high turnover and a large percentage of part-time and seasonal workers, restaurant and retail operators must juggle several variables in figuring out whether they will cross the threshold.”
On Monday, e21 sponsored a discussion, moderated by National Journal’s Major Garrett, between Charles Blahous and Jared Bernstein. The topic was Blahous’ recent paper entitled “The Fiscal Consequences of the Affordable Care Act” (published by the Mercatus Center of George Mason University). The full event can be viewed here.
Not surprisingly, the back and forth between Blahous and Bernstein was spirited and covered mainly familiar ground. Blahous repeated the main arguments from his paper, which is that ObamaCare will add hundreds of billions of dollars to the federal deficit over the next decade, contrary to official estimates. Bernstein then picked up many of the criticisms of paper that have appeared in blog posts and opinion columns from defenders of ObamaCare.
Blahous’ argument rests on the fact that ObamaCare’s supposed cuts in Medicare spending aren’t, in reality, cuts at all. They merely substitute for spending restraint (or tax increases) that would be required under law and happen anyway whenever Congress is faced with impending trust fund insolvency.
Bernstein countered that the baseline against which ObamaCare was measured is the same baseline both sides have used for many years. Changing the rules of the game at this point would have been both odd in a procedural sense and also a thinly veiled attempt by political opponents to scuttle the legislation with arcane rules instead of substantive arguments.
What this debate really comes down to actually relatively straightforward. Does extending the life of the Medicare Hospital Insurance (HI) trust fund, with spending cuts and tax hikes, result in new Medicare spending, or not? Because if it does, that would mean ObamaCare spent the Medicare cuts twice — once on future Medicare benefits, and a second time on ObamaCare’s coverage expansion entitlements.
It should be obvious that extending the life of the HI trust fund does authorize more Medicare spending. Otherwise, why does Congress worry about trust funds becoming depleted at all? Because, if Medicare benefits were going to be paid in full regardless of the status of the trust fund, all of this worrying by Congress about trust fund exhaustion would be completely misplaced. The truth is that Congress worries for good reason: trust fund depletion would mean Medicare benefits could not be paid in full. The fact that official baselines do not reflect this reality of trust fund law (for reasons that are themselves also rational) does not mean it isn’t so.
“As we approach the second anniversary of ObamaCare, it’s worth re-examining some of the claims its proponents made about the impact of the law on health-care costs. Three of the law’s most-touted cost-control measures have already been shown to be unlikely to succeed.”
“For much of the last year, the White House had adopted a ‘strategy of silence’ on ObamaCare. That’s clearly over… But ObamaCare is back to center stage this month, and the more people learn about the law, the more unpopular it becomes. Here are just some of the recent revelations:”
“On February 10, on the same day that the administration announced it wanted to craft the so-called accommodation, it finalized the rule that had been previously issued with no change. That rule includes the infamous four-part test by which HHS bureaucrats will determine which houses of worship are pure enough to warrant a full exemption from the mandatory coverage of abortion-inducing drugs, sterilization procedures, and contraception. It is also the same rule that provides no exemption from the mandate for religious employers that provide services to the general public. So, as matters stand today, the Obama administration has implemented rules that even it concedes infringe on the traditional rights of religious employers.”