As small business owners learn what their 2018 health insurance costs will be, some are considering providing different types of coverage for their employees.
Companies are receiving notices of premium and coverage changes for 2018. The changes vary, depending on factors including the state where a company is located, how many employees it has and how comprehensive its insurance is. But many owners are seeing rate increases of double-digit percentages, finding dramatically reduced coverage, or both. Health insurance consultants expect more owners to rethink their strategies beyond 2018 and choose alternatives like paying for claims themselves or adding health services that can lower costs.
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Cyndee Weston can barely remember the last time she didn’t have to switch health plans during an Affordable Care Act sign-up season. By her count, she has been on five plans in five years.
Every fall, after she has spent months figuring out her insurance plan’s deductibles, doctor networks, list of covered drugs and other fine print, she receives notice that the policy will be canceled as of Dec. 31. Because her job doesn’t come with insurance, “it’s agonizing going through all the plans and trying to compare,” said Weston, 55, who has diabetes and a history of melanoma. “Every year it’s the same scenario: ‘We’re not going to renew your policy.’”
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Republicans have famously failed to pass health-care legislation this year. But future attempts at reforming Obamacare will have an advantage over previous ones. The most politically powerful argument against Republican health-care legislation has been that it would “take insurance away” from many millions of people. That argument was based on the CBO’s findings, and most of it was based on the end of the individual mandate.
If Republicans end the mandate in the tax bill, any estimates of the effects of future legislation on coverage will be about 13 million lower. The tax bill doesn’t just advance a major conservative objective on health policy. It prepares the ground for replacing other parts of Obamacare as well.
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Mr. Summers offers various caveats along with his prediction of a mass-casualty legislative event. But he largely accepts the Congressional Budget Office’s guess that 13 million more people will choose not to enroll in government health plans if insurance is no longer required (Summers rounds the guess down to 10 million), and he basically credits his former colleague Kate Baicker’s research suggesting people are more likely to die if they are not enrolled in a health insurance plan.
Mr. Summers is not alone among ObamaCare defenders in wanting to persuade people that the number of people covered by government insurance is the true measure of health. But the vast expansion of such coverage engineered by his old boss doesn’t seem to have made Americans healthier.
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The House and Senate recently passed tax reform bills because they successfully made the case that reform is a “once-in-a-generation” opportunity that is long overdue. It’s a compelling argument. When the last tax reform bill passed in 1986 the Internet was in its infancy and cell phones were the size of a briefcase. The world has changed, the argument goes, but our tax code has not.
What’s curious, however, is that the largest deduction in the tax code – the exclusion from income tax of employer-sponsored insurance, which dates back to the 1940s – is untouched by the reform bills. This omission is an enormous missed opportunity for American consumers and both political parties.
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Congressional repeal of Obamacare’s individual insurance mandate penalty is not tantamount to pressing the button on the doomsday machine.
Critics of the Senate tax bill say repeal of the mandate penalty to buy Obamacare coverage will result in a spike in premiums, an increase in the numbers of the uninsured, and a “collapse” of the health insurance markets. In other words, the individual mandate is the “glue” that holds Obamacare together.
The assumption: Millions of Americans will buy Obamacare coverage—regardless of whether they want it or like it—because the government forces them to do it, and penalizes them if they do not.
Do we have compelling evidence that this is, in fact, the case? No.
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At the 2017 Forbes Healthcare Summit, I interviewed Seema Verma, Administrator of the U.S. Centers for Medicare and Medicaid Services, about her policy agenda. CMS is one of the most important agencies in the federal government, administering programs spending over a trillion dollars a year, including Obamacare.
Our discussion was wide-ranging. Verma spoke about fellow Indianan Alex Azar, President Trump’s nominee for the post of Secretary of the Department of Health and Human Services. She discussed her view of what CMS can do on drug pricing. She talked about the opioid crisis, and how to modernize the Medicare and Medicaid programs and empower patients to take charge of their own health care.
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House Ways and Means Committee Chairman Kevin Brady (R-Texas) told reporters Tuesday that he expects most House Republicans will support repealing ObamaCare’s individual mandate in tax legislation, as GOP senators did.
“We’ll be asking our members where do they want us to be on that position. I suspect there will be strong support,” he said.
The House-passed tax bill did not include repeal of the individual mandate, while the Senate bill did. The two chambers now must reconcile their versions of tax-reform legislation in a bicameral conference.
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Maine made history earlier this month by becoming the first state to adopt Obamacare’s Medicaid expansion via ballot initiative. The vote could inspire progressive activists in other states to push for similar referenda.
Expanding Medicaid to cover childless, able-bodied adults would blow a hole in state budgets while yielding few, if any, public health gains. That’s because Medicaid provides such low-quality care that its beneficiaries often experience worse health outcomes than people with no health insurance.
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Since 2011, the U.S. Census Bureau has reported on a new, more comprehensive Supplemental Poverty Measure (SPM) that accounts for various safety net programs. The new measure takes into account the hundreds of billions of dollars provided to the needy—including food stamps and cash assistance programs—and makes adjustments for major expenses such as out-of-pocket medical spending, income, and taxes. According to the new measure, out-of-pocket health spending alone added 10.5 million people to the ranks of the poor in 2016 .
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